A national registry was begun in 1981 to collect data from 32 centers on patients diagnosed by uniform criteria as having primary pulmonary hypertension. Entered into the registry were 187 patients with a mean age (+/- SD) of 36 +/- 15 years (range, 1 to 81), and a female-to-male ratio of 1.7:1 overall. The mean interval from onset of symptoms to diagnosis was 2 years. The most frequent presenting symptoms included dyspnea (60%), fatigue (19%), and syncope (or near syncope) (13%). Raynaud phenomenon was present in 10% (95% of whom were female) and a positive antinuclear antibody test, in 29% (69% female). Pulmonary function studies showed mild restriction (forced vital capacity [FVC], 82% of predicted) with a reduced diffusing capacity for carbon monoxide (DLCO), and hypoxemia with hypocapnia. The mean (+/- SD) right atrial pressure was 9.7 +/- 6 mm Hg; mean pulmonary artery pressure, 60 +/- 18 mm Hg; cardiac index, 2.3 +/- 0.9 L/min X m2; and pulmonary vascular resistance index, 26 +/- 14 mm Hg/L/min X m2 for the group. Although no deaths or sustained morbid events occurred during the diagnostic evaluation of the patients, the typically long interval from initial symptoms to diagnosis emphasizes the need to develop strategies to make the diagnosis earlier.

Primary pulmonary hypertension: a national prospective study

Importance of imaging method over imaging modality in noninvasive determination of left ventricular volumes and ejection fraction: Assessment by two- and three-dimensional echocardiography and magnetic resonance imaging

https://docs.lib.purdue.edu/cgi/viewcontent.cgi?article=2204&context=cstech

Arbitrary topology shape reconstruction from planar cross sections

Background Reliable, serial, noninvasive quantitative estimation of left ventricular ejection fraction is essential for selecting and timing therapeutic interventions in patients with heart disease. Equilibrium radionuclide angiography is widely used for this purpose but has well-recognized limitations. Advantages of echocardiography over equilibrium radionuclide angiography include assessment of wall motion, valvular pathology, and cardiac hemodynamics, in addition to portability, lack of radiation exposure, and substantially lower cost. However, conventional echocardiographic techniques are limited by geometric assumptions, image positioning errors, and use of subjective visual methods. To overcome these limitations, a three-dimensional echocardiographic method was developed. This study compares ejection fraction by three-dimensional echocardiography, quantitative two-dimensional echocardiography, and subjective two-dimensional echocardiographic visual estimation with that by equilibrium radionuclide an...

Assessment of Cardiac Function by Three-dimensional Echocardiography Compared With Conventional Noninvasive Methods

Ratio measures, such as the ventricle-brain ratio (VBR) based on computed tomography or magnetic resonance imaging, are widely used in psychiatric research in studies of brain function and morphology. While imaging techniques have advanced considerably, the form of the index of a structure's size has remained the same—a proportion based on an estimate of the structure's size divided by a like estimate of the whole brain size. We demonstrate that ratio and similar indices can suffer greatly in reliability when compared with simple volume measures. This loss of reliability is related to the relation of a structure's size and whole brain size. We review various methods for measuring the size of structures and discuss their strengths and limitations in terms of reliability and validity. In many instances, other methods of “correcting” for brain size (e.g., regression or covariance) may yield measurements that are more appropriate than ratios.

Problems with ratio and proportion measures of imaged cerebral structures.

A volume algorithm is established which uses the data generated by computed tomography (CT) or ultrasound scans. The algorithm is based on a polyhedral reconstruction of an object of interest. Phantom studies indicate that the algorithm calculated volume is accurate within 3 percent. In a controlled clinical experiment on a laboratory animal, the algorithm calculated volume showed a maximum error of about 5 percent. In less controllable applications to human clinical data, volume calculations showed variations ranging up to 16 percent.

An Algorithm for Volume Estimation Based on Polyhedral Approxi mation

Diagnosis of Pericardial Effusion by Computed Tomography

Unexplained Severe Pulmonary Hypertension in the Older Age Group

Correlations of the His to ventricular (H-V) conduction time were made with the surface electrocardiogram during normal intraventricular conduction, unifascicular block (right bundle branch block), bifascicular block (left bundle branch block) and trifascicular block (right and left bundle branch block) in a patient with rate-dependent left bundle branch block who had transient right bundle branch block during recording of the His bundle electrogram. The results provide a functional confirmation of the theory that a prolonged H-V time is a manifestation of trifascicular disease.

Transient unifascicular, bifascicular and trifascicular block: Electrophysiologic correlations in a patient with rate-dependent left bundle branch block and transient right bundle branch block

We assessed the diagnostic utility of computed tomography (CT) in the detection of pericardial effusion by using a dog model in which the amount and type of pericardial fluid were controlled and by obtaining CT scans on patients with suspected pericardial effusion prior to pericardiocentesis. The experimental studies showed that CT was capable of detecting pericardial effusion composed of serous fluid or saline in amounts as small as 50 ml. However, the hemopericardium was radiographically isodense with the heart and difficult to detect by CT unless the epicardial fat pad was identified or intravenous contrast enhancement of the heart was used. CT clearly demonstrated the presence of pericardial effusion in all six patients studied prior to successful pericardiocentesis or pericardiectomy. We conclude that CT is a sensitive noninvasive method which can be used for the diagnosis of pericardial effusion.

Bert Y.S. Wong

Papers

An Algorithm for Volume Estimation Based on Polyhedral Approxi mation

Diagnosis of Pericardial Effusion by Computed Tomography

Unexplained Severe Pulmonary Hypertension in the Older Age Group

Transient unifascicular, bifascicular and trifascicular block: Electrophysiologic correlations in a patient with rate-dependent left bundle branch block and transient right bundle branch block

Diagnosis of pericardial effusion by computed tomography