Video for Armstrong, Zoghbi Stress Echo

Eight Video Files Accompanying Armstrong, Zoghbi Stress Echo paper

Files in this Data Supplement:

• View Video 1 - Parasternal long and short axis views recorded in a patient with a normal exercise echocardiogram. The parasternal long axis view is represented in the upper panels and the short axis in the lower panels. The left hand images were recorded at rest and the right images immediately following maximum treadmill exercise. Notice the normal symmetric contractility of the left ventricle at rest and the normal hyperdynamic nature of contraction immediately following exercise in this individual with no evidence of obstructive coronary artery disease.
• View Video 2A - Exercise echocardiogram recorded in a 56 year old female with exertional dyspnea. The format is the same as for video 1. Note that immediately following exercise the entire anterior septum has become akinetic which can be appreciated in both the parasternal long axis and Parasternal short axis views.
• View Video 2B - Represents the apical views from the same patient. Note the normal contraction at rest on the left and the akinesis of the distal septum and apex in the apical four-chamber view as well as the akinesis of the distal anterior wall in the apical two-chamber view. This patients was subsequently demonstrated to have a 90% proximal left anterior descending coronary lesion.
• View Video 3 - Parasternal images recorded in a patient with exertional chest pain after 8 minutes of treadmill exercise. At rest note the normal contraction of the segments in the parasternal long and short axis views. Immediately following exercise the anterior septum and anterior lateral walls become frankly akinetic and only the true inferior wall (see the short axis view) has retained contractility. This patient was subsequently demonstrated to have a 90% left main coronary obstruction.
• View Video 4A - Apical four-chamber (4A) and two-chamber (4B) views with intravenous contrast for left ventricular opacification recorded in a patient with a large anterior apical myocardial infarction and chronic left ventricular dysfunction. Note in the apical four-chamber view the large apical aneurysm and relatively preserved function in the basal half of the septum and lateral wall. At a dose of 5µg/kg/min there is augmentation of function of all segments, except the very apex, with a reduction in diastolic and systolic cavity areas. At 7.5µg/kg/min worsening of wall motion started to occur in the apical segments and basal lateral wall with progressive increase in the diastolic and systolic volumes. Wall motion in the basal septum appears relatively preserved. At the peak dose of dobutamine (20µg/kg/min), note the deterioration in function in basal and apical segments compared to that seen at the 5µg dose. This is a classic biphasic response implying extensive viable myocardium likely to have recovery of function following revascularization. The area that did not demonstrate any change or viability by dobutamine is the apical segment only. In the apical two-chamber view (Video 4B) a similar biphasic response is noted involving the inferior and anterior segments, sparing the apex. More obvious cavity dilation at peak dobutamine is noted when comparing the low dose dobutamine to peak dose.
• View Video 4B - Apical four-chamber (4A) and two-chamber (4B) views with intravenous contrast for left ventricular opacification recorded in a patient with a large anterior apical myocardial infarction and chronic left ventricular dysfunction. Note in the apical four-chamber view the large apical aneurysm and relatively preserved function in the basal half of the septum and lateral wall. At a dose of 5µg/kg/min there is augmentation of function of all segments, except the very apex, with a reduction in diastolic and systolic cavity areas. At 7.5µg/kg/min worsening of wall motion started to occur in the apical segments and basal lateral wall with progressive increase in the diastolic and systolic volumes. Wall motion in the basal septum appears relatively preserved. At the peak dose of dobutamine (20µg/kg/min), note the deterioration in function in basal and apical segments compared to that seen at the 5µg dose. This is a classic biphasic response implying extensive viable myocardium likely to have recovery of function following revascularization. The area that did not demonstrate any change or viability by dobutamine is the apical segment only. In the apical two-chamber view (Video 4B) a similar biphasic response is noted involving the inferior and anterior segments, sparing the apex. More obvious cavity dilation at peak dobutamine is noted when comparing the low dose dobutamine to peak dose.
• View Video 5A - Baseline (Video 5A) and dipyridimole (Video 5B) contrast echocardiograms performed for evaluation of myocardial perfusion. In 5A, note the relatively preserved ventricular geometry, the mild hypokinesis of the apical septum and preserved perfusion. 5B was recorded during dipyridamole infusion and reveals a substantial degree of reduction in myocardial perfusion at the apex, seen in association with apical dilation and wall motion abnormality.
• View Video 5B - Baseline (Video 5A) and dipyridimole (Video 5B) contrast echocardiograms performed for evaluation of myocardial perfusion. In 5A, note the relatively preserved ventricular geometry, the mild hypokinesis of the apical septum and preserved perfusion. 5B was recorded during dipyridamole infusion and reveals a substantial degree of reduction in myocardial perfusion at the apex, seen in association with apical dilation and wall motion abnormality.