|
|
|
2010-01-01
Purpose A fast and robust algorithm was developed for automatic segmentation of the left ventricular endocardial boundary in echocardiographic images. The method was applied to calculate left ventricular volume and ejection fraction estimation. Methods A fast adaptive B-spline snake algorithm that resolves the computational concerns of conventional active contours and avoids computationally expensive optimizations was developed. A combination of external forces, adaptive node insertion, and multiresolution strategy was incorporated in the proposed algorithm. Boundary extraction with area and volume estimation in left ventricular echocardiographic images was implemented using the B-spline snake algorithm. The method was implemented in MATLAB and 50 medical images were used to evaluate the a...
AN ANALOG ECHOCARDIOGRAM FOR ESTIMATING VENTRICULAR STROKE VOLUME
A multiple range-gated echocardiographic signal processor has been developed for the purpose of converting the complex ultrasonic image of the left ventricular anterior and posterior wall boundaries to equivalent analog signals as a means of estimating stroke volume and computing...
Estimation of heart size - radiological methods versus two-dimensional echocardiography
1985-04-01
Radiologic heart volume measurement (HV) and twodimensional echocardiographic estimation of left ventricular volume and ejection fraction (EF) were carried out in 108 healthy subjects and 68 patients with hypertony, dilatative cardiomyopathy and hypertrophic-obstructive cardiomyopathy (HOCM). Healthy subjects show a close relationship between echocardiographic determined volume and absolute heart volume (HV), in patients with hypertony, dilatative cardiomyopathy and HOCM there is also a significant correlation. However, no correlation exists between EF and HV and HV/kg in patients with hypertony and HOCM, whereas patients with dilatative cardiomyopathy show a high significant inverse relationship. It is concluded that these results are caused by great differences in muscle mass. The clinical value of radiologic heart volume as a parameter of left ventricular systolic function seems to be low and depends on cause of the heart enlargement.
2009-01-01
Despite the potential ability of left ventricular (LV) shape analysis to provide independent information complementary to ventricular size and function, in clinical practice only ejection fraction (EF) is currently assessed while LV shape is not routinely quantified. Moreover, geometric assumptions in the computation of EF from multiple two-dimensional (2-D) cut-planes by disc summation or area-length methods, introduce inaccuracies in the estimates. Also, previous approaches for the quantification of LV shape were based on geometric modeling and, as a result, proved inaccurate. Our aims were (1) to develop and test a three-dimensional (3-D) technique for direct quantification of LV shape from real-time 3-D echocardiographic (RT3DE) images without the need for geometric modeling using a ne...
2009-01-01
Objectives The aim of our study was to investigate whether echocardiographic phase imaging (EPI) can predict response in patients who are considered for cardiac resynchronization therapy (CRT). Background CRT improves quality of life, exercise capacity, and outcome in patients with bundle-branch block and advanced heart failure. Previous studies used QRS duration to select patients for CRT; the accuracy of this parameter to predict functional recovery, however, is controversial. Methods We examined 42 patients with advanced heart failure (New York Heart Association [NYHA] functional class III to IV, QRS duration >130 ms, and ejection fraction <35%) before and 6 to 8 months after CRT. Left ventricular (LV) dyssynchrony was estimated by calculating the SD of time to peak veloci...
2010-01-01
Background: There are few data on echocardiographic indexes incorporating peak mitral inflow velocity (E), left atrial volume index (LAVi), and pulmonary artery pressure (PAP) for estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fraction (EF ≥ 50%). Methods: Patients underwent echocardiography 12 had 75% sensitivity and 78% specificity for LVEDP ≥ 20 mmHg (area under curve (AUC) = 0.79, P 30 (sensitivity = 72%, specificity = 80%, AUC = 0.84, P 57 (sensitivity = 73% and specificity = 81%, AUC = 0.82, P 90 cm/sec had 96% positive, predictive value for LVEDP ≥ 20 mmHg. (E + LAVi)/2 added incrementally to E/Ea when E/E...
2009-01-01
Abstract Serum cystatin C concentration is an alternative measure of kidney function that is less affected by age, sex or muscle mass, and is a more sensitive indicator of early renal dysfunction than creatinine-based estimations of glomerular filtration rate. Cardiovascular sequela increases progressively with the increase in left ventricular mass. Our goal was to evaluate the effect of olmesartan medoxomil on cystatin C levels and left ventricular hypertrophy (LVH) in patients with hypertension. Forty-four newly diagnosed hypertensive patients (27 women and 17 men) were recruited in the study. Olmesartan medoxomil (20mg/day) was started and the patients were followed up for 6 months. Baseline echocardiographic findings (i.e. left ventricular mass index), serum creatinine, urine albumin/c...
1996-12-01
Measurement of global left ventricular function is important in the follow-up of cardiac patients and is a good prognostic indicator in acute cardiac situations. We compared quantitative measurements of global left ventricular function made with radionuclide angiography (RNA) and contrast cardiac ventriculography (CVG) to visual semiquantitative estimates from two-dimensional echocardiographic images (2D-echo). Three hundred and thirty-nine consecutive patients who underwent RNA were assessed with 2D-echo within 3 months. In addition, 92 of these patients also underwent CVG (correlation of ejection fraction between CVG and RNA: r=0.82; P=}505; 1=35%-49%; 2=21%-34%; and 3={<=}20% ejection fraction) 0 (133/166; 80%) and 3 (18/30; 60%) but low concordance in classes 1 (27/82; 33%) and 2 (21/61; 34%). For accurate assessment of global left ventricular ejection fraction, visual semiquantitative judgement of a 2D echocardiographic image is limited in comparison to CVG or RNA, especially in patients with a slight or moderate reduction in left ventricular ejection fraction. (orig.). With 2 figs., 2 tabs.
2009-01-01
Background The purpose of this study was to clarify the clinical characteristics and prognostic implications of left atrial (LA) dilation evaluated echocardiographic volume in patients with normal LA dimension (LAD). Methods A total of 140 consecutive patients (81 men, mean age: 5718years) with normal LAD (
BackgroundEchocardiographic measurements of left ventricular (LV) myocardial displacement may produce different results depending on the choice of employed modality and subjective...Full Text Available
Evaluation of left ventricular diastolic function using color kinesis
2007-01-01
Purpose Color kinesis (CK) is a real-time echocardiographic technique based on acoustic quantification that yields regional and global information by tracking and color-encoding endocardial motion. The aim of this study was to determine the feasibility and usefulness of diastolic CK images with ICK software to objectively assess global and regional left ventricular (LV) diastolic function. Accordingly, diastolic properties obtained from CK images were compared with conventional Doppler echocardiographic indices. Methods We studied 56 subjects who underwent echocardiographic evaluation in our laboratory for assessment of cardiac structure and function. Criteria for inclusion included the presence of normal sinus rhythm and adequate two-dimensional echocardiographic imaging. Exclusion criter...
2010-01-01
Infants with hypoplastic left heart syndrome and intact or highly restrictive atrial septum require emergent therapy to relieve pulmonary congestion. Transcatheter stenting has become, in most large centers, the mainstay of therapy for relief of left atrial hypertension. Normally, this procedure is performed with the assistance of transesophageal echocardiographic guidance. However, the transesophageal approach is untenable in neonates of low birth weight, as the transducers can be traumatic and can cause ventilatory difficulty. We present two cases in which transthoracic echocardiographic guidance was used to guide atrial perforation and stenting in low birth-weight neonates with hypoplastic left heart syndrome with intact or highly restrictive atrial septum. Both procedures were straight...
The Incremental Prognostic Value of Echocardiography in Asymptomatic Stage A Heart Failure
2010-01-01
Objective This multicenter study consisted of echocardiographic examination of subjects with stage A heart failure (HF) with cardiovascular risk factors and normal electrocardiogram and clinical examination results to (a) define whether stage A subjects with risk factors are really free of functional or structural cardiac abnormalities and (b) assess the impact of the presence of risk factors and incremental value of echocardiographic parameters in the prediction of progression of HF or in the development of cardiovascular events. Methods A total of 1097 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. Left ventricular (LV) dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow ve...
2010-01-01
The objective of this study was to analyze the echocardiographic characteristics of juxtaposition of the atrial appendages and to determine its prevalence in children with congenital heart disease. From June 1998 to December 2008, 10,880 children underwent selective angiocardiography, magnetic resonance imaging (MRI), and echocardiography for evaluation of congenital heart disease. Juxtaposition of the atrial appendages was diagnosed based on the results of angiocardiography and MRI; the echocardiographic characteristics of this anomaly were analyzed retrospectively. There were 33 patients diagnosed with juxtaposition of the right atrial appendage (JRAA); no patient was diagnosed with juxtaposition of the left atrial appendage. The prevalence of JRAA in children with congenital heart disea...
2010-01-01
Background Echocardiographic measures of left ventricular (LV) mass and relative wall thickness and left atrial (LA) size predict future cardiovascular morbidity and mortality. The aim of this study was to compare young adults with low cardiovascular risk (body mass index, 18.5-24.9 kg/m2; blood pressure
Echocardiography has been useful in the evaluation of congestive and hypertrophic cardiomyopathies. We present echocardiographic findings in seven patients with infiltrative cardiomyopathy due to amyloid. Cardiac amyloidosis was documented at autopsy in two patients, and the diagnosis was suggested by clinical, echocardiographic, tissue, or hemodynamic findings in the other five. Hemodynamic findings in three patients mimicked constrictive pericarditis; and autopsy was performed on one of the three and showed a normal pericardium. Underlying disorders were multiple myeloma (five patients), ankylosing spondylitis (one patient), and an unknown disorder (one patient). The basic echocardiographic findings in infiltrative cardiomyopathy due to amyloid were (1) symmetrically increased left ventricular wall thickness (in the absence of hypertension or aortic valvular disease), (2) hypokinesia and decreased systolic thickening of the interventricular septum and left ventricular posterior wall, and (3) small to normal size of the left ventricular cavity. Two patients also had small pericardial effusions. Thus, in a patient with congestive heart failure, these echocardiographic findings should suggest infiltrative cardiomyopathy.
1996-06-01
The objective was to assess by echocardiography the occurrence and degree of late cardiac sequelae after treatment for Hodgkin`s disease by radiation and chemotherapy. Abnormal left sided valvar regurgitation was detected in one fourth of the patients, affecting the aortic valve in more than half of the cases. Females had increased risk of valvar regurgitation. Echocardiographic screening after high-dose mediastinal radiation is recommended. (Author).
2010-01-01
Intra- and interobserver variability in Doppler echocardiographic velocity measurements (DEVM) is a significant issue. Indeed, imprecisions of DEVM can lead to diagnostic errors, particularly in the quantification of the severity of heart valve dysfunctions. To reduce the variability and rapidity of DEVM, we have developed an automatic method of Doppler velocity wave contour detection, based on active contour models. To validate our new method, results obtained with this method were compared with those obtained manually by two experienced echocardiographers on Doppler echocardiographic images of left ventricular outflow tract and transvalvular flow velocity signals recorded in 30 patients with aortic or mitral stenosis, 20 with normal sinus rhythm and 10 with atrial fibrillation. We focuse...
2010-01-01
Background Corin is a serine protease that cleaves pro-atrial and pro-B-type natriuretic peptides into biologically active hormones. The relationship between soluble plasma corin levels, plasma natriuretic peptide levels, myocardial structure and performance, and long-term clinical outcomes in the setting of chronic systolic heart failure has not been described. Methods and Results In 126 patients with chronic systolic heart failure (left ventricular ejection fraction r = 0.30, P = .003) and interventricular septum width (r = 0.22, P = .013). However, plasma corin levels did not correlate with age, arterial pressures, estimated glomerular filtration rate, echocardiographic indices of systolic or diastolic function, or plasma natriuretic peptide levels. In Cox proportional hazards analysis,...
Velocity vector imaging to quantify left atrial function
2010-01-01
The aim of our study was to assess the feasibility of a new image analysis, velocity vector imaging (VVI), in the assessment of left atrial volumes (LAV) and left atrial ejection fraction (LAEF). We retrospectively analysed 100 transthoracic echocardiographic findings in 71 men, and 29 women (mean age 5719.8years). Two subgroups of patients were defined: (1) with left ventricular (LV) EF
Comparison of Echocardiographic Measurements Before and After Short and Long Duration Spaceflight
Previous echocardiography studies in astronauts before and after short duration (4 - 17 days) missions have demonstrated a decrease in resting left ventricular (LV) stroke volume (SV), but maintained ejection fraction (EF) ...
2010-01-01
Background: The aim of this study was to assess left ventricular (LV) myocardial regional function in overt hypothyroidism by use of tissue Doppler imaging and to compare the results to the hormonal profile and standard Doppler echocardiographic examination. Methods: Hypothyroidic (Group 1, n = 25) and euthyroidic patients (Group 2, n = 25) underwent transthorasic echocardiography, strain and strain rate imaging. Results: Standard echocardiography showed that patients with overt hypothyroidism had significantly longer isovolumic contraction time (IVCT) (P
Echocardiographic characteristics of the criss-cross heart
2010-01-01
Objective: To assess the ultrasonic characteristics of the criss-cross heart, and explore the value of echocardiography in the diagnosis of this rare congenital cardiac defect. Methods: We reviewed the echocardiographic findings in 4 patients having criss-crossed atrioventricular connections at our hospital, and compared the findings with observations at surgery in 3 of the patients. Results: In all 4 patients, there was usual atrial arrangement, right hand ventricular topology, and concordant atrioventricular connections. The inlet components of the ventricular mass, however, crossed such that the apical component of the morphologically right ventricle was situated anteriorly and superiorly, and extended to the left relative to the apex of the morphologically left ventricle. The ventricul...
Diastology 2010: clinical approach to diastolic heart failure
2010-01-01
The role of echocardiography in the evaluation of left ventricular diastolic function is increasingly important in both systolic and diastolic heart failure. In routine clinical practice, the diastolic dysfunction associated with diastolic heart failure can mainly be evaluated by Doppler echocardiography. In order to use echocardiographic techniques for this purpose, one should recognize the definition, terminology, epidemiology, and pathophysiology of diastolic dysfunction and diastolic heart failure. There are various echocardiographic parameters for this purpose, including transmitral flow velocity, pulmonary venous flow velocity, mitral annular velocity, flow propagation velocity, left atrial size, strain, strain rate, twist, and so on. However, no single Doppler echocardiographic inde...
Cardiovascular Manifestations in Fabry Disease: A Clinical and Echocardiographic Study
2007-01-01
This study reviews the clinical and echocardiographic findings in a cohort of Fabry patients (n=12) and compares echocardiographic findings to normal controls. Almost all patients had extracardiac manifestations. Five out of 12 patients had cardiovascular symptoms. Nine out of 12 patients had left ventricular hypertrophy (LVH) on the electrocardiogram (ECG) and one patient had short PR interval. Three patients had epicardial coronary disease. Four patients had `rat-tail' appearance on left ventriculogram. Six patients who had myocardial biopsy showed extensive vacuolation of the myocytes on light microscopy and concentric, myelinoid lamellar cytoplasmic inclusion bodies on electron microscopy. On echocardiography, LV mass was significantly increased in the Fabry group compared to normal co...
Echocardiographic Indexes for the Non-Invasive Evaluation of Pulmonary Hemodynamics
2010-01-01
Ultrasound imaging has continuously developed over recent years, leading to the development of several novel echocardiographic indexes. Among these, of particular interest are those that focus on pulmonary hemodynamics, because they not only improve both sensitivity and specificity in the echocardiographic evaluation of pulmonary pressures (systolic, mean, and diastolic), but can also be used to estimate other pulmonary hemodynamic parameters, such as pulmonary vascular resistance, pulmonary capillary wedge pressure, and pulmonary capacitance and impedance. Such parameters can provide important diagnostic and prognostic information in patients with heart failure, chronic obstructive pulmonary disease, and pulmonary arterial hypertension and in every patient with suspected pulmonary impairm...
Echocardiographic parameters in 14 healthy English Bull Terriers
2003-01-01
Objective To determine the range of various cardiac parameters using echocardiography in apparently normal, healthy English Bull Terriers. Design Fourteen English Bull Terriers were selected for study. Cardiac auscultation of the parents of these dogs was normal. Echocardiographic examination of one parent of each animal showed: no mitral or aortic valve abnormalities; no myocardial lesions; no two dimensional evidence of fixed or dynamic left ventricular outflow tract obstruction; and no systolic aortic or left ventricular outflow tract turbulence on colour flow Doppler examination. The 14 selected dogs did not have arrhythmias or murmurs, and on echocardiographic examination had similar findings to their parents. Systolic blood pressure was measured in all dogs and they had no clinical evidence of Bull Terrier polycystic kidney disease or Bull Terrier hereditary nephritis. Procedure All dogs were auscultated and subjected to a sequential global echocardiographic assessment of the heart, including two dimensional long and short axis, and colour flow Doppler interrogation of the mitral and aortic valves. Dimensional measurements, including those from the left atrium, aortic annulus and left ventricle, were taken from a right parasternal window, and derived values such as fractional shortening, stroke volume and left atrial to aortic annulus ratio were calculated. Peak systolic aortic velocity was measured from the left parasternal window using two dimensional-guided pulsed wave Doppler with angle correction. Systolic blood pressure was measured using a Doppler monitor. The absence of Bull Terrier polycystic kidney disease was determined using renal ultrasonography, and of Bull Terrier hereditary nephritis using urinary protein to creatinine ratio. Results These 14 dogs had greater left ventricular wall thickness and smaller aortic root diameters than those reported as normal for other breeds of comparable body size. Left atrial dimensions were also larger, however this may have been due to the maximising method of measurement. These apparently normal English Bull Terriers also had higher aortic velocities than those reported for other breeds, possibly due to a smaller aortic root diameter or other anatomic substrate of the left ventricular outflow tract, lower systemic vascular resistance, or breed-specific normal left ventricular hypertrophy. While these dogs were selected to be as close to normal as possible, the breed may have a particular anatomy that produces abnormal left ventricular echocardiographic parameters. Conclusion These echocardiographic parameters may be used to diagnose left ventricular outflow tract obstruction and left ventricular hypertrophy, and inaccurate diagnoses may result if breed-specific values are not used. Publisher: Blackwell Publishing for the Australian Veterinary Association Contributor: Mark Thornley Coverage: 2003-09-01T00:00:00Z
2009-01-01
Arterial hypertension is associated with an increased risk of atrial fibrillation (AF), and leads to a pronounced increase in morbidity and mortality. Left atrial volume (LAV) is an important prognostic marker in the older populations. The aim of our study was to identify the clinical and echocardiographic determinants of LAV in middle-aged (
Anomalous drainage of the right superior vena cava into the left atrium
1983-08-01
A 22 year old man with asymptomatic hypoxemia was found to have a large right to left shunt due to a rare congenital anomaly: total drainage of the right superior vena cava into the left atrium. The anomaly was first suspected after radionuclide angiocardiography was performed using technetium-99m macroaggregated albumin and was confirmed by cardiac catheterization. Contrast echocardiographic and surgical findings are discussed. Other reports on this anomaly are reviewed.
Left Atrial Function: Doppler and Strain
2010-01-01
The left atrium modulates left ventricular filling with its reservoir, conduit, and contractile functions. There is growing literature on the importance of a detailed assessment of left atrial function. This review article discusses the echocardiographic assessment of left atrial function by conventional parameters such as atrial size measurements, transmitral and pulmonary Doppler flow, mitral annular tissue velocities, as well as newer techniques such as regional strain and strain rate imaging by color tissue Doppler imaging and two-dimensional speckle tracking techniques. The clinical applications of these techniques in various conditions are discussed.
In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images
2009-01-01
Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong ...
Echocardiographic abnormalities in adolescent and adult Saudi patients with sickle cell disease
2007-01-01
Cardiovascular complications in sickle cell disease (SCD) have been well documented but cardiac involvement in Saudi patients with SCD is not known. We sought to identify cardiac abnormalities by electrocardiography in adolescent and adult Saudi patients with stable SCD. Sixty-five consecutive patients with SCD followed at King Khalid University Hospital, Riyadh, were prospectively studied from January 2005 to December 2005. All patients underwent echocardiographic examination to determine chamber dimensions, left ventricular function, valvular anomalies and pulmonary artery pressure. Data were compared to normal age and gender-matched controls. Hematological data were also collected from the patients and correlated with the echocardiographic results. Twenty-eight males and 37 females were evaluated. The mean age of the group was 24.5+-9.2 range (14-44) ...
2009-01-01
Objectives Various approaches to myocardial reconstruction have been developed for the treatment of congestive heart failure resulting from ischemic cardiomyopathy. Methods In this study we determined whether in situ application of polymers could reshape left ventricular geometry in a chronic rodent model of ischemic cardiomyopathy. Results We demonstrate that alginate and fibrin can augment left ventricular wall thickness, resulting in reconstruction of left ventricular geometry and improvement of cardiac function. Echocardiographic results at 5 weeks after injection of alginate demonstrated persistent improvement of left ventricular fractional shortening and prevention of a continued enlargement of left ventricular dimensions, whereas fibrin glue demonstrated no progression of left ventr...
BACKGROUND: Left ventricular (LV) reconstruction surgery leads to early improvement in LV function in ischemic cardiomyopathy (ICM) patients. This study was designed to evaluate the impact of mitral valve (MV) repair ...
2010-01-01
The percutaneous implantation of a left atrial appendage closure device offers an alternative to chronic oral anticoagulation in patients with nonvalvular atrial fibrillation and concomitant risk factors for stroke. Transesophageal echocardiography plays a key role in defining left atrial appendage anatomy and in guiding device implantation. The authors describe a case in which contrast-enhanced transesophageal echocardiography was critically important in spatially resolving the borders of the left atrial appendage, which ultimately led to successful device implantation with cessation of warfarin therapy.
1983-02-01
Tallium-201 myocardial scintigram (Tl scan) and technetium 99m-labeled RBC blood pool scintigram (Tc scan) were performed in 66 patients with various heart disease (including hypertrophic and congestive cardiomyopathy, congenital, rheumatic and ischemic heart disease). The thickness of interventricular septum (IVS) and left ventricular posterior wall (PW), and transverse left ventricular dimension (LVD) of RI scintigram measured by visual inspection were compared with those by echocardiogram (UCG) and biventriculogram (BVG). Although favorable correlation were obtained both between Tc scan and UCG estimates and between Tl scan and UCG estimates, the relationship of the former was higher than that of the latter (IVS ; Tc vs UCG, r = 0.75 (p<0.001), Tl vs UCG, r = 0.58 (p<0.001). LVD ; Tc vs UCG, r = 0.75 (p<0.001), Tl vs UCG, r = 0.70 (p<0.001). The IVS determined by Tl scan was much thicker then those by UCG, BVG and Tc scan. This might be due to difficulty to decide the IVS border clearly by Tl scan. There was no correlationship between PW thickness determined by Tl scan and that by UCG. So, we concluded that the determinations of IVS and LVD by Tc scan were more reliable than those by Tl scan.
2010-01-01
Background Echocardiographic measurements of left ventricular (LV) mass, left atrial (LA) volume, and LV end-systolic volume (ESV) predict heart failure (HF) hospitalization and mortality. Indexing measurements by body size is thought to establish limits of normality among individuals varying in body habitus. The American Society of Echocardiography recommends dividing measurements by body surface area (BSA), but others have advocated alternative indexing methods. Methods Echocardiographic measurements were collected in 1024 ambulatory adults with coronary artery disease. LV mass, LA volume, and LV ESV were calculated using truncated ellipse method and biplane method of disk formulae. Comparison between raw measurements and measurements divided by indexing parameters was made by hazard rat...
Left ventricular strain and strain rate: characterization of the effect of load in human subjects
2010-01-01
Aims Left ventricular (LV) strain and strain rate have been proposed as novel indices of systolic function; however, there are limited data about the effect of acute changes on these parameters. Methods and results Simultaneous Millar micromanometer LV pressure and echocardiographic assessment were performed on 18 patients. Loading was altered sequentially by the administration of glyceryl trinitrate (GTN) and saline fluid loading. Echocardiographic speckle tracking imaging was used to quantify the peak systolic strain (S) and peak systolic strain rate (SR S) and dp/dt max was recorded from the micromanometer data. GTN administration decreased preload (LV end diastolic pressure [LVEDP]: 15.7 vs. 8.4 mmHg, P
Left Ventricular Function in Gestational Hypertension: Serial Echocardiographic Study
2010-01-01
BackgroundGestational hypertension (GH) is associated with hemodynamic changes, and alterations of systolic and diastolic left ventricular (LV) function. However, the magnitude and pattern of changes of different parameters of LV function and contractility in this patient population have not been fully clarified.MethodsThirty-five pregnant women with GH underwent three echocardiographic examinations, in second and third trimester of pregnancy, and 1 month after delivery. Twelve normotensive pregnant women served as gestational age-matched controls. Hemodynamic parameters and standard indexes of LV systolic and diastolic function were analyzed. Additionally, we have measured peak systolic velocity of mitral annulus (S′), end-systolic elastance (Ees), and early transmitral to early len...
2010-01-01
Background: Left ventricular (LV) diastolic function and right atrial (RA) size are not routinely included in preoperative echocardiographic examination in patients undergoing cardiac surgery with concomitant ablation for atrial fibrillation (AF). Objective: To investigate the role of echocardiographic variables including LV diastolic function and RA area in long-term rhythm outcome prediction, in patients with documented AF undergoing intraoperative ablation concomitant to coronary artery bypass grafting (CABG). Methods: Thirty-five consecutive patients, scheduled for CABG, and with a history of paroxysmal or permanent AF for 8.5 +- 11.3 years (mean +- SD) (median 5.8 years), were included in this prospective study. Echocardiography was performed prior to and 2.3 +- 0.4 years after the su...
2010-01-01
BackgroundThe risk stratification of patients with left ventricular (LV) dysfunction can be performed using echocardiographic parameters such as the ejection fraction (EF). Recently, new technologies based on deformation measurements have been shown to identify early myocardial dysfunction before EF decrease. Consequently, tools such as two-dimensional strain have been incorporated into echocardiographic systems, allowing for fast, reliable, and reproducible calculation of longitudinal components of LV systolic deformation. The hypothesis in this study was that as a more sensitive marker of LV dysfunction, longitudinal strain would allow for the risk stratification of patients with heart failure. MethodsThis multicenter study included 147 patients with heart failure with LV EFs Clinical ev...
2010-01-01
Background In this study, the functionality of echocardiographic particle imaging velocimetry (E-PIV) was compared with that of digital particle imaging velocimetry (D-PIV) in an in vitro model. In addition, its capability was assessed in the clinical in vivo setting to obtain the ventricular flow pattern in normal subjects, in patients with dilated cardiomyopathy, and in patients with mechanical and bioprosthetic mitral valves. Methods A silicon sac simulating the human left ventricle in combination with prosthetic heart valves, controlled by a pulsed-flow duplicator, was used as the in vitro model. Particle-seeded flow images were acquired (1) using a high-speed camera from the mid plane of the sac, illuminated by a laser sheet for D-PIV, and (2) using a Siemens Sequoia system at a frame...
2007-01-01
The objective of this study was to analyze echocardiographic characteristics of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and to explore the diagnostic value of transthoracic echocardiography. The echocardiagraphic characteristics of 8 patients hospitalized with ALCAPA from 2000 to 2005 were analyzed retrospectively, including the results of real time three-dimensional echocardiography in one case, and compared with angiographic results. Eight cases included 6 older type patients and 2 infant type patients. Echocardiography showed abnormal vessel inserting into pulmonary artery (PA), continuous shunt into PA and intercoronary collateral signals within the ventricular septum in all cases and bifurcate structure of the abnormal vessel with retrograde fil...
2010-01-01
Background The American Society of Echocardiography recommends calculating left atrial (LA) biplane volume because of its greater accuracy and prognostic value over LA diameter. However, biplane methods are not always feasible. The aim of this study was to assess the correlation between the echocardiographic LA biplane and single-plane volumes and their agreement in the classification of LA size when American Society of Echocardiography cutoffs are applied. Methods Two-dimensional echocardiography was performed on the participants of the population-based Cardiovascular Abnormalities and Brain Lesions study. LA volume was calculated by the biplane area-length and single-plane modified Simpson's methods and validated against three-dimensional echocardiography. Results The study sample consis...
Cardiac Structural and Functional Changes in Competitive Amateur Cyclists
2010-01-01
Purpose: To assess cardiac structural and functional changes induced by competitive amateur cycling. Methods: Fifty-one young competitive amateur male cyclists and 47 age- and gender-matched control subjects underwent complex transthoracic echocardiographic examination focused on the detailed assessment of cardiac size and function, especially of the left ventricle (LV). Subsequently, spiroergometry was performed in all study participants and its results were compared to echocardiographic data. Results: Higher left ventricular mass indexes due to the greater LV wall thickness and LV end-diastolic diameter were found in amateur cyclists as compared to control subjects. There were no differences with regard to the LV systolic function parameters. However, significantly better indices of LV d...
2010-01-01
Background The aim of this study was to develop a mathematical model using two-dimensional echocardiographic parameters to estimate right ventricular end-diastolic volume (RVEDVi) in adults with repaired tetralogy of Fallot. Methods Linear regression equations were used to examine the relationship between two-dimensional echocardiographic and cardiac magnetic resonance (CMR) imaging measures of RVEDVi. Imaging studies in 101 adults were used to create and validate the model. The ability of the model to detect changes in CMR RVEDVi was tested in 57 adults with serial studies. Results The optimal model to quantitate CMR RVEDVi included two-dimensional echocardiographic right ventricular end-diastolic area measured in the apical four-chamber view, indexed to body surface area (AreaDi) (CMR RV...
2010-01-01
This paper focuses on motion tracking in echocardiographic ultrasound images. The difficulty of this task is related to the fact that echographic image formation induces decorrelation between the underlying motion of tissue and the observed speckle motion. Since Meunier's seminal work, this phenomenon has been investigated in many simulation studies as part of speckle tracking or optical flow-based motion estimation techniques. Most of these studies modeled image formation using a linear convolution approach, where the system point-spread function (PSF) was spatially invariant and the probe geometry was linear. While these assumptions are valid over a small spatial area, they constitute an oversimplification when a complete image is considered. Indeed, echocardiographic acquisition geometr...
Left-sided migration of Sideris button atrial septal occluder device
2010-01-01
We report the case of a left-sided migrated `Sideris button' atrial septal defect occlusion device 6 years post-implantation with a residual secundum atrial septal defect and left atrial mass. The aims of this case report are to highlight an uncommonly seen atrial septal occlusion device, the importance of a complete echocardiographic examination of the path traversed by the device to assess for local trauma to structures, and the additional anatomical information gained and diagnostic use of intraoperative 3D transoesophageal echocardiography.
2010-01-01
The left and right ventricular function of the heart are influenced by the complex structure of the ventricular septum. The cyclic variation of ultrasonic backscatter over the cardiac cycle is known to be sensitive to both structural and functional characteristics of the myocardium. The objective of this study was to investigate differences in the measured magnitude and normalized delay of cyclic variation between the left and right sides of the ventricular septum in normal adult subjects (N = 31). The measured mean magnitudes of cyclic variation were found to be 4.9 +- 0.4 dB and 2.4 +- 0.3 dB (mean +- SE; p
2010-01-01
The origins of diastole lie in the preceding systole. Echocardiographic evaluation for diastolic function in hypertension incorporates evaluation for morphologic changes such as left ventricular hypertrophy and functional changes, especially abnormalities in left ventricular relaxation and compliance. Investigational tools such as studies of cardiac mechanics are proving useful in elucidating the various stages of the adaptation of the heart to pressure load and for understanding the transition from asymptomatic diastolic dysfunction to heart failure with preserved left ventricular ejection fraction. The effects of treatment on cardiac morphology and function continue to generate controversy with regard to whether there is evidence for unique cardiac benefits of certain antihypertensive th...
2009-01-01
Congenital coronary fistula is consisted of a communication between a coronary artery and a cardiac chamber or pulmonary vessel. Congenital left coronary arteryleft ventricle fistula is uncommon. A 41-year-old female patient admitted to our institution for evaluation of heart murmur etiology. A loud continuous murmur heard at the apex area was detected at auscultation. Echocardiography showed a large fistula draining into the left ventricle apex. Coronary angiography revealed fistula from left circumflex coronary artery to left ventricular cavity. Since the patient was asymptomatic and no concomitant cardiac pathology was detected, we advised endocarditis prophylaxis and medical follow-up.
Exercise and left ventricular function in chronic mitral valve insufficiency
2002-01-01
The projects of this thesis examine the complex interaction between isotonic exercise, functional capacity, exercise-induced myocardial ischaemia, severity of regurgitation and left ventricular function in patients with significant chronic mitral regurgitation. The concept of left ventricular contractile reserve, i.e. the ability of the left ventricle to increase its contractility and decrease its end systolic volume with isotonic exercise, is explored. In patients with chronic isolated mitral regurgitation without coronary disease, isotonic exercise was associated with a slight decrease in left ventricular end diastolic volume but a marked decrease in end systolic volume, resulting in a significant increase in the stroke volume and ejection fraction. Early after uncomplicated mitral valve repair surgery, there was a significant decrease in the left ventricular ejection fraction with a proportion of the patients developing left ventricular dysfunction despite a normal pre-operative ejection fraction. When different pre-operative echocardiographic indices of left ventricular function were evaluated for their ability to predict left ventricular function after mitral valve repair, the exercise indices were found to be superior to resting indices. Left ventricular end systolic volume immediately after exercise was found to be the best predictor. The optimal cut-off was at 25 ml/m2, which had a sensitivity and specificity of 83% in predicting early post-operative left ventricular dysfunction. Exercise indices appeared to be superior to resting indices in identifying patients with persistent left ventricular dysfunction <1 year after mitral valve repair. The concept of contractile reserve was further examined by estimating the left ventricular stroke work from simplified pressure-volume loops, which were constructed from non-invasively obtained parameters with geometric assumptions. Left ventricular stroke work immediately after exercise, but not at rest, was found to be significantly lower in patients with latent left ventricular dysfunction. Patients without latent ventricular dysfunction had similar increases in stroke work with exercise compared with healthy normal subjects. The ability of the left ventricle to increase its stroke work with exercise, a measure of the contractile reserve, was correlated with the left ventricular ejection fraction after mitral valve repair. A numerical model was constructed using the clinical data as input parameters. The results from the numerical model were similar to that obtained from the clinical study, testifying that the observation made in the clinical study was valid and independent of the geometric assumptions made in constructing the simplified pressure-volume loops. Left ventricular pressure-volume loops under different loading conditions were plotted from simultaneously measured left ventricular pressure and volume to measure the left ventricular end systolic elastance (Ees) and preload recruitable stroke work relationship (MSW). Despite normal or near normal haemodynamics at rest, a significant proportion of the study patients were found to have impaired left ventricular contractility, as measured by Ees, consistent with a state of latent left ventricular dysfunction. Exercise indices of left ventricular function were better correlated with Ees and MSW than resting indices. There were highly significant inverse relationships between end systolic volume index immediately after exercise and Ees and MSW. Moreover, there was a significant powered relationship between MSW and exercise left ventricular ejection fraction. There was no such relationship between Ees or MSW and any of the resting echocardiographic indices of left ventricular function. Furthermore, the optimal diagnostic cut-off level of end systolic volume index after exercise at 25 ml/m2 accurately identified those with impaired left ventricular contractility as defined by an Ees of > 2 mmHg/ml. In patients with chronic organic mitral regurgitation with ejection fraction of < 50%, objectively measured functional capacity, VO2max, was correlated with exercise cardiac output, patient age and gender but not to the severity of the mitral regurgitation or the resting left ventricular function. The VO2max of these patients were significantly lower than that of age and gender-matched healthy controls despite these patients' relative lack of subjective symptoms. There were significant individual variations in the response of the severity of the mitral regurgitation to isotonic exercise. Patients whose regurgitant stroke volume increased had a lower exercise cardiac output than those whose regurgitant stroke volume decreased. Such variability was also seen with the response of the left ventricular function to exercise. Patients whose left ventricular end systolic volume increased with exercise, i.e. patients with a limited contractile reserve, had a lower exercise cardiac output and lower VO2max than those whose end systolic volume decreased with exercise. The determinants of exercise capacity were then examined in patients with functional mitral regurgitation and left ventricular dysfunction. VO2max of these patients was correlated with exercise cardiac output and exercise left ventricular ejection fraction, a situation similar to that seen in patients with organic mitral regurgitation and normal left ventricular function. Furthermore, indices of left ventricular systolic function at rest and pulsed wave Doppler indices of diastolic function showed no significant correlations with VO2max. The determinants of VO2max remained unchanged in these patients after four weeks of supervised exercise training. The four weeks of exercise training resulted in a significant decrease in left ventricular end systolic volume, a trend towards an increase in left ventricular ejection fraction and some restoration of the contractile reserve. The total exercise time almost doubled. However, this dramatic improvement in total exercise time was accompanied only by non-significant increases in VO2max and left ventricular ejection fraction. Therefore, the benefits of exercise training in these patients may involve more than just central mechanisms. Exercise induced myocardial ischaemia may also contribute to a limited left ventricular contractile reserve in patients with mitral regurgitation. Electrocardiographic changes at rest are commonly seen in patients with mitral regurgitation due to mitral valve prolapse. These resting electrocardiographic changes make exercise electrocardiography uninterpretable for exercise-induced ischaemia. Exercise electrocardiographic changes are also commonly encountered in these patients despite the absence of coronary artery disease and a normal resting electrocardiogram, making exercise electrocardiography unreliable as a non-invasive screening test for coronary artery disease. In these patients, exercise echocardiography was slightly more sensitive but significantly more specific in diagnosing significant coronary artery disease. The overall accuracy and the positive predictive value were significantly higher for exercise echocardiography than for exercise electrocardiography. The "cost-effectiveness" of different diagnostic strategies for coronary artery disease in patients with mitral valve prolapse was examined based on the results of the clinical study. Strategies involving exercise electrocardiography as part of the screening test were costly and were associated with a high false negative rate. Strategies involving exercise echocardiography were more accurate and less costly but the initial costs of exercise echocardiography for all patients meant that the overall costs were still considerable. Assessing the pre-test probability of coronary artery disease in these patients and using exercise echocardiography as the initial test for patients with at least a moderate pre-test probability of coronary artery disease seemed to result in the best compromise between cost and effectiveness. The studies of this thesis have shown that a limited cardiac contractile reserve is a sign of latent ventricular dysfunction in patients with chronic mitral regurgitation. The presence of a limited contractile reserve can be used to predict left ventricular dysfunction after mitral valve repair. The concept of a limited contractile reserve is further supported by the finding of a limited increase in left ventricular stroke work with exercise from a theoretical as well as a numerical model of left ventricular pressure-volume loops. Exercise echocardiographic indices show better correlations to invasively measured Ees and MSW than resting indices. VO2max in these patients is determined more by their ability to increase their forward cardiac output with exercise and not by the regurgitant volumes. Exercise training in patients with left ventricular dysfunction and functional mitral regurgitation results in some restoration of contractile reserve. Exercise echocardiography is also a reliable and cost-effective test in the non-invasive screening for coronary artery disease in these patients. Based on the results of the studies in the thesis, one can incorporate exercise echocardiography as one of the important assessment tools in the management of patients with significant mitral regurgitation as it allows measurement of left ventricular volumes and assessment of contractile reserve. Further studies are needed to examine whether a policy of monitoring of contractile reserve in these patients to guide therapy and surgical referral will result in a better preservation of long term left ventricular function, an improvement in functional capacity and patient outcome. Publisher: Awarded by:University of New South Wales. South Western Sydney Clinical School Language: EN Rights: Copyright Dominic Y. C. Leung; http://unsworks.unsw.edu.au/copyright
The significance of a combined echocardiographic study of patients who survived myocardial infarction for evaluation of ventricular hemodynamic disturbances was shown. According to the ultrasonic B-scanning data the left ventricular end-diastolic and endsystolic volumes in such patients were increased, and ejection fraction values, delta S and VCF were markedly decreased. The most pronounced left ventricular pump and contractility dysfunctions occurred in transmural and anterior myocardial infarctions. During M-mode echocardiography in patients with posterior wall hypokinesia, the prolongation of isovolumic relaxation and contraction followed by the shortening of rapid filling was observed. A significance correlation between the prolongation of isovolumic relaxation and polygraphic T interval was found. The thinning of the left ventricular hypokinetic posterior wall was observed during the ejection period, and that of hypokinetic ventricular septum was seen within the cardiac cycle. The signs of more marked left ventricular dilatation with its decreased contractility were found in patients with systolic murmur recorded soon after myocardial infarction development. Such a murmur phonocardiographically recorded was a sign of mitral valve insufficiency.
BackgroundHeart failure with preserved left ventricular ejection fraction and abnormal diastolic function is commonly observed after recovery from an acute myocardial infarction....Full Text Available
BackgroundB-type natriuretic peptide (BNP) is increased in post-cardiac surgery patients, however the mechanisms underlying BNP release are still unclear. In the current study, we...Full Text Available
2009-01-01
We presented an unique case of apical hypertrophic cardiomyopathy concomitant with subaortic obstruction, apical sequestration, and valvular aortic stenosis. The echocardiographic findings were conflicting and characterized by quadruple pressure gradients within the left ventricle, which were compatible with the findings of 64-slice computed tomography imaging and cardiac catheterization.
Myocardial damage after spider bite (Latrodectus tredecimguttatus) in a 16-year-old patient.
The case of a 16-year-old patient with L. tredecimguttatus poisoning complicated by myocardial damage is reported. Symptoms (typical chest pain), electrocardiographic (ST-T changes in precordial leads) and echocardiographic (akinesia of interventricular septum with depressed left ventricular function) features and laboratory findings (increased myocardial enzymes) are described.
Echocardiography and perfusion scintigraphy in the diagnosis of pulmonary arteriovenous fistula
The echocardiographic and perfusion scintigraphic evaluation of an adolescent boy with a pulmonary arteriovenous fistula is reported. Contrast echocardiography following the rapid intravenous injection of indocyanine green dye was utilized to document extracardiac right-to-left shunting. Perfusion lung scintigraphy demonstrated the presence of a single large pulmonary arteriovenous fistula. Contrast echocardiography and perfusion scintigraphy are minimally invasive, safe and easily performed techniques for the rapid diagnosis of pulmonary arteriovenous fistula.
Echocardiography and perfusion scintigraphy in the diagnosis of pulmonary arteriovenous fistula
1978-05-01
The echocardiographic and perfusion scintigraphic evaluation of an adolescent boy with a pulmonary arteriovenous fistula is reported. Contrast echocardiography following the rapid intravenous injection of indocyanine green dye was utilized to document extracardiac right-to-left shunting. Perfusion lung scintigraphy demonstrated the presence of a single large pulmonary arteriovenous fistula. Contrast echocardiography and perfusion scintigraphy are minimally invasive, safe and easily performed techniques for the rapid diagnosis of pulmonary arteriovenous fistula.
Echocardiographic evaluation of left ventricular function during coronary artery angioplasty.
Balloon occlusion of a stenotic coronary artery during percutaneous coronary artery angioplasty provides a unique opportunity to study the effect of acute myocardial ischemia on left ventricular (LV) function. Simultaneous M-mode and 2-dimensional (2-D) echocardiograms and a 6-lead electrocardiogram were recorded during 20 episodes of coronary artery occlusion and release in 12 patients. No patient had previous myocardial infarction and all had normal LV function by angiography. All patients had isolated single coronary artery disease, with left anterior descending stenosis in 8 and right coronary stenosis in 4. In 18 of 20 episodes (90%), M-mode echocardiography during balloon occlusion revealed a significant (p less than 0.001) decrease in LV systolic, diastolic and percent systolic wall thickness; systolic excursion; systolic and diastolic endocardial velocities; and fractional shortening. These changes were observed in the area of the ventricular septum in patients with left anterior descending occlusion and posteroinferior wall in those with right coronary artery occlusion. Two-dimensional echocardiography revealed varying degrees of hypokinesia, akinesia and dyskinesia during balloon occlusion in 18 instances. The echocardiographic changes were observed within 15 to 20 seconds of balloon occlusion and resolved 10 to 20 seconds after balloon deflation. All patients who had echocardiographic changes during balloon occlusion also had concomitant electrocardiographic (ECG) ST-segment elevation, whereas 2 patients with normal LV function had no ECG changes. Both of these patients had profuse collateral blood supply to the stenotic coronary artery. The echocardiographic and ECG abnormalities increased proportionately to the length of balloon occlusion. This study confirms previous animal and recent human studies of transient LV dysfunction during coronary occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
2010-01-01
Congenital diverticulum and aneurysm are rare cardiac abnormalities. Given their very low incidence especially in adult patients and the few cases reported, the diagnosis might be ignored when the cardiac malformation is seen for the first time. This article presents two adult cases of congenital diverticulum and aneurysm, which were first detected by echocardiography. The relevant literature is reviewed. (Echocardiography 2010;27:344-347)
Evaluation of left atrial thrombi with computed tomography
1981-03-01
Left atrial thrombi were evaluated by computed tomography in 42 patients with valvular diseases. In eight of them, left atrial thrombi were delineated by computed tomography. Five of these eight had history of systemic thrombosis, and in four left atrial thrombi were confirmed by cardiac surgery or autopsy and the location and size of thrombi were well compatible with those detected by computed tomography. Thrombi were not detected angiographically in two and echocardiographically in three. The minimum size of thrombus detected by computed tomography was 3.5 g and the largest was 40 g in weight. Computed tomography is essentially non-invasive and appears to be one of the best methods to detect left atrial thrombi.
Etiologic significance of enlargement of the left atrial appendage in adults
1982-01-01
Fifty-one patients were divided into two groups: 20 patients with proven rheumatic mitral valve disease (RMVD) and 31 patients with left atrial enlargement (LAE) of a nonrheumatic etiology. The latter group included patients with ischemic papillary muscle dysfunction, mitral valve prolapse, and congestive cardiomyopathy. Radiographic studies showed that enlargement of the left atrial appendage (LAAE) was present in 18 of 20 rheumatics but in only one of 31 nonrheumatics. There was no direct relationship between enlargement of the LAA and radiographic or echocardiographic left atrial size, degree of pulmonary venous hypertension (PVH), or presence of atrial fibrillation. It is postulated that rheumatic influammation of the LAA allows it to dilate out of proportion to the body of the left atrium. In the adult patient with radiographic findings of PVH, LAAE is a valuable and specific radiographic sign of rheumatic mitral valve disease.
2005-01-01
An echocardiography was performed on 23 healthy warmblood horses and on 12 warmblood horses with cardiac diseases at rest and after treadmill or lungeing exercise. The B-mode technique was used, and the left ventricular wall motion was analyzed visually. The left ventricle was divided into 6 equally sized myocardial segments, 3 of them in the region of the interventricular septum, and the other 3 in the region of the left ventricular rear wall ("6-segment model"). The kinetic of each segment was determined using a kinetic score system. A normokinetic wall motion was defined with a kinetic index of 1. To the authors knowledge, the current study is the first to present a visual qualitative method for assessment of the healthy equine heart with regard to the myocardial left ventricular wall m...
Echocardiographic spectrum of hypertrophic cardiomyopathy.
1975-12-01
Full Text Available.Echocardiographic patterns in 15 patients with hypertrophic cardiomyopathy were compared with those in 30 healthy persons. Correlations with angiocardiographic data indicated that most of the anatomical abnormalities in hypertrophic cardiomyopathy can be assessed reliably by echocardiography. These include abnormal mitral valve motion, a reduction of the anteroposterior dimension of the left ventricular outflow tract and of the left and right ventricular cavities, increased thickness of the interventricular septum and the posterior left ventricular wall. Comparision of the haemodynamic and echocardiographic data showed that some degree of abnormal mitral valve motion during systole may occur in the absence of left ventricular outflow tract obstruction. On the other hand, it need not always be present with left ventricular outflow tract obstruction. Other, hitherto unrecognized, abnormalities in hypertrophic cardiomyopathy detected by this technique were: (1) Aortic valve regurgitation in three out of nine patients with evidence of left ventricular cutflow tract obstruction at cardiac catheterization. (2) Left ventricular inflow tract obstruction at the mitral valve level associated with gross septal hypertrophy (five cases). (3) Abnormal forward displacement of the posterior mitral valve leaflet and of the chordae tendineae during systole in 10 patients, in seven of whom there was confirmatory angiocardiographic evidence. Seven patients with miscellaneous cardiac disorders are described in whom asymmetric septal hypertrophy was revealed by echocardiography. In one of these patients coexisting hypertrophic cardiomyopathy was excluded histologically; thus asymmetrical septal hypertrophy is not confined to patients with hypertrophic cardiomyopathy.Images
Diagnosis of intracardiac space occupying lesion by computed tomography
1982-01-01
We carried out CT photographing by the method of non-gated by the fourth generation computed tomographic scanner, using contrast medium positively for 25 patients including 1 patient of cardiac tumor and 24 patients of mitral valvular disease. And we studied the utility of CT examination in the diagnosis of intracardiac space occupying lesion comparing with operative findings and echocardiographic evaluation. In a case of right ventricular tumor, the region, the extensity and the properties of the tumor were evaluated with accuracy and usefulness for emergency cardiac surgery. In mitral valvular disease, 8 cases showed left atrial thrombi when operated upon. By CT examination before the operation, we could deny left atrial myxoma in the case of giant thrombus. Left atrial appendage mural thrombus of 15 mm in diameter and thrombi filling left atrial appendage, whose detections are thought to be difficult in the echocardiographic examination, were clearly delineated by CT examination. In the diagnosis of intracardiac space occupying lesion, therefore, CT examination is concluded to have more application value clinically than echocardiography.
2010-01-01
Background Twenty-three patients (median age 23 months) who underwent Fallot's tetralogy repair were investigated prospectively to detect a possible association between histopathologic myocardial remodeling and echocardiographic findings of systolic or diastolic ventricular dysfunction. Methods Intraoperatively resected infundibular bands and subendocardial biopsy samples from the right ventricle (RV) and left ventricle were obtained for histopathologic evaluation. Tissue Doppler echocardiographic interrogation of the ventricles was performed before surgery and in the postoperative period. Results Histopathologic data revealed hypertrophy of the RV cardiomyocytes and increased interstitial collagen in both ventricles. Mean values of RV isovolumic acceleration decreased significantly at the...
Gender Differences in Cardiac Dysfunction and Remodeling due to Volume Overload
2010-01-01
Background This study examined the sex differences for hemodynamic and echocardiographic changes in hypertrophied and failing hearts induced by arteriovenous (AV) shunt. Methods and Results Echocardiographic and hemodynamic alterations were determined in male and female rats at 4 and 16 weeks after AV shunt. Ovariectomized females treated with estrogen for 16 weeks post-AV shunt were also used. Both genders developed cardiac hypertrophy at 4 and 16 weeks post-AV shunt; however, the increase in cardiac muscle mass was greater in females than males at 16 weeks. At 4 weeks post-AV shunt, increases in ventricular dimensions and left ventricular end-diastolic pressure (LVEDP) as well as a decrease in fractional shortening occurred in males only. Unlike the females, the rates of pressure develop...
Ethanol infusion in the vein of Marshall: Adjunctive effects during ablation of atrial fibrillation
2009-01-01
Background The vein of Marshall (VOM) is a left atrial (LA) vein that contains autonomic innervation and triggers of AF. Its location coincides with areas usually ablated during pulmonary vein (PV) antral isolation (PVAI). Objective This study sought to delineate the safety and ablative effects of ethanol infusion in the VOM during catheter ablation of atrial fibrillation (AF). Methods Patients undergoing PVAI (n = 14) gave consent for adjunctive VOM ethanol infusion. In 10 of 14 patients, the VOM was cannulated with an angioplasty wire and balloon. Echocardiographic contrast was injected in the VOM under echocardiographic monitoring. Two infusions of 100% ethanol (1 ml each) were delivered via the angioplasty balloon in the VOM. LA bipolar voltage maps were created before and after ethano...
Echocardiographic Assessment of Conjoined Twins with Congenital Heart Disease in Shanghai
2009-01-01
Background: The aim of this study is to improve the diagnosis of congenital heart disease in conjoined twins using echocardiography. Methods: Six sets of conjoined twins at Shanghai Children's Medical Center and Xin-Hua Hospital from 1980 to 2006 were assessed retrospectively. Cardiac anomalies of varying degrees of severity were first evaluated using 2D echocardiography. Tissue Doppler imaging (TDI) was then performed if fused ventricles were suspected. Peak systolic velocities, peak systolic strain rates, and peak systolic strains at the fused myocardium were quantitatively measured using strain rate imaging (SRI). If the M-mode echocardiographic image was poor or difficult to measure, the myocardial performance index (MPI) of the left ventricle was calculated. Results: Intracardiac anom...
2001-01-01
We examined the potentialities of Magnetic resonance imaging (MRI) in the evaluation of the main cardiomyopathies: hypertrophic, dilated, restrictive and arrhythmogenic right ventricular. The hypertrophic cardiomyopathy is generally adequately investigated by echocardiography, that well defines the myocardial thickening and the obstruction of the left ventricular output. However, by echocardiography we still have difficulties in the evaluation of the apex of the left ventricle and the right ventricle involvement. MRI provides a complete evaluation of the heart with a clear evidence also of the echocardiographic dark zones by means of a clear evidence of the apex of the right ventricle. The dilated form is also well investigated by MRI that provides a clear evaluation of the volumes, mass and ejection fraction by means of the 3D analysis including conditions of the ...
A unique case of superoinferior ventricles, left atrial isomerism, concordant atrioventricular connection, and discordant ventriculoarterial connection is described. The associated anomalies were azygous vein continuation, large subpulmonary and apical ventricular septal defects, and left ventricular outflow tract obstruction (pulmonary stenosis). The diagnosis was mostly made by fetal echocardiography and the superoinferior location of the ventricles was confirmed by postnatal echocardiography. Fetal and postnatal echocardiography facilitated the precise morphologic diagnosis and segmental analysis of this defect.
A quantitative technique that aligns the diastolic and systolic silhouettes was used to assess left ventricular function (wall thickening and endocardial wall motion) from two-dimensional echocardiographic studies for every 2/sup 0/ of arc of the left ventricular circumference in canines. Thirty-two dogs were studied before and at specific intervals up to 14 days after either temporary or permanent occlusion of the left anterior descending coronary artery. Decreased systolic wall thickening and frank systolic thinning were observed in the ischemic/infarcted region 90 min and 6 hr after occlusion; endocardial motion showed the abnormally contracting segment less clearly. Partial recovery was seen in both groups of animals but to a greater degree in those with temporary occlusion. The technique was useful for assessing sequential changes in wall motion.
1984-09-01
A quantitative technique that aligns the diastolic and systolic silhouettes was used to assess left ventricular function (wall thickening and endocardial wall motion) from two-dimensional echocardiographic studies for every 2/sup 0/ of arc of the left ventricular circumference in canines. Thirty-two dogs were studied before and at specific intervals up to 14 days after either temporary or permanent occlusion of the left anterior descending coronary artery. Decreased systolic wall thickening and frank systolic thinning were observed in the ischemic/infarcted region 90 min and 6 hr after occlusion; endocardial motion showed the abnormally contracting segment less clearly. Partial recovery was seen in both groups of animals but to a greater degree in those with temporary occlusion. The technique was useful for assessing sequential changes in wall motion.
1984-01-01
A quantitative technique that aligns the diastolic and systolic silhouettes was used to assess left ventricular function (wall thickening and endocardial wall motion) from two-dimensional echocardiographic studies for every 20 of arc of the left ventricular circumference in canines. Thirty-two dogs were studied before and at specific intervals up to 14 days after either temporary or permanent occlusion of the left anterior descending coronary artery. Decreased systolic wall thickening and frank systolic thinning were observed in the ischemic/infarcted region 90 min and 6 hr after occlusion. Endocardial motion showed the abnormally contracting segment less clearly. Partial recovery was seen in both groups of animals but to a greater degree in those with temporary occlusion. The technique was useful for assessing sequential changes in wall motion
2009-01-01
Background: Impaired left ventricular (LV) function is shown by strain rate (SR) imaging in patients with diabetes mellitus (DM). Left atrium (LA) function in patients with DM, however, has not been assessed by this method and the effect of hypertension (HT) on LV and LA functions in diabetic patients has not been fully studied. The aim of this study was to quantitatively assess LA function in diabetic patients with and without HT in combination with LV function. Methods: Conventional echocardiographic and SR imaging studies were performed in 55 subjects with normal systolic LV function (LV ejection fraction of 55% or more) and no evidence of coronary artery disease: 17 with DM (DM group), 22 who have both DM and HT (DM+HT group), and 16 age-matched controls. SR imaging was performed from ...
2002-01-01
Progressive ventricular dilatation is an important prognostic factor in patients with acute myocardial infarction. We evaluated clinical, angiographic, echocardiographic and thallium-201 single-photon emission tomography (SPET) imaging variables predictive of the change in left ventricular volume during a 7-month follow-up period after primary angioplasty in patients with acute myocardial infarction. Thirty-six patients with first acute myocardial infarction treated with primary angioplasty within 12 h of onset underwent 201Tl SPET imaging (5.8+-2.1 days after angioplasty). Changes in left ventricular volume were assessed over the 7-month period. The left ventricle dilated significantly after angioplasty (Prevealed that the number of segments with 201Tl uptake
2010-01-01
Obstructive sleep apnea (OSA) is associated with cardiovascular mortality and morbidity. It may predispose patients to left ventricular hypertrophy and heart failure. The aim of this study was to determine the left ventricular mass (LVM) and myocardial performance index (MPI) reflecting left ventricular global function in uncomplicated OSA patients. Sixty-four subjects without hypertension, diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment. According to the apnea hypopnea index (AHI), subjects were divided into three groups: group 1, control subjects with nonapneic snorers (AHI
2009-01-01
Aims/hypothesis Weight excess and insulin resistance mediate the link between obesity and left ventricular dysfunction. We investigated the effect and mechanisms of lifestyle modification on left ventricular function changes in obese patients. Methods Reduction of body weight and insulin resistance was sought using a behavioural intervention programme including dietary restrictions and exercise training in 261 patients (age 4513years) with BMI 30kg/m2, no history of cardiac disease and a normal stress echocardiogram. Each patient underwent echocardiographic measurement of myocardial deformation and velocity at baseline and at 6month follow-up. Results Improvements in left ventricular systolic and diastolic function were demonstrated only in patients with significant reduct...
Clinical investigation of 31 patients with idiopathic hypertrophic subaortal stenosis (IHSS) and idiopathic hypertrophic nonobstructive cardiomyopathy (IHNCMP) comprised electro- and phonocardiography, roentgenologic examination and echocardiography. The disease was latent in 3 patients, and ischemic heart disease or rheumatic heart lesion had been diagnosed prior to echocardiography in 26. Asymmetrical hypertrophy and hypokinesia of the upper third of the ventricular septum, narrowed left-ventricular cavity and septum-wise systolic movement of the anterior mitral cusp were findings common to all IHSS patients. The ventricular septum/left-ventricular posterior wall thickness ratio was elevated (1.42 +/- 0.06). In IHNCMP patients, this ratio was within normal range. The results of an acute pharmacologic test with 10 mg intravenous obsidan given to 10 IHSS patients suggested that the obstruction of left-ventricular outflow pathway was somewhat reduced. Prolonged (2 months to 3 years) obsidan treatment was given to 25 patients and was associated with positive effect in terms of improved subjective manifestations of the disease. However, echocardiographic patterns only showed moderate improvement in 9 of the 13 patients who had completed 1-3 years' treatment course.
Prognostic value of thallium-201 perfusion defects in idiopathic dilated cardiomyopathy
1991-01-15
To assess the prognostic significance of thallium-201 perfusion defects in patients with idiopathic dilated cardiomyopathy (IDC), 43 patients underwent thallium scintigraphy in addition to clinical, echocardiographic, angiographic and hemodynamic evaluation. Eleven patients had no significant thallium perfusion abnormality, 19 had multiple small defects and 13 had a large defect. During 3.2 +/- 2.2 years, 14 patients had disease-related mortality. The patients who died had a higher incidence of ventricular tachycardia (71 vs 31%; p less than 0.02), increased cardiothoracic ratio (60 +/- 6 vs 54 +/- 6; p = 0.005), decreased fractional shortening (11 +/- 6 vs 15 +/- 5; p less than 0.05), increased pulmonary wedge pressure (15 +/- 7 vs 10 +/- 6 mm Hg; p = 0.05), increased left ventricular end-diastolic pressure (21 +/- 8 vs 14 +/- 6 mm Hg; p = 0.02) and abnormal thallium perfusion defects (13 of 14 vs 16 of 26; p less than 0.05) compared with survivors. Age, gender, left ventricular end-systolic and end-diastolic dimensions, cardiac index and ejection fraction were not statistically different in the survivors versus the patients who died. Kaplan-Meier survival estimates at 1, 3 and 5 years were 100% in patients without significant perfusion abnormality; 89, 77 and 64%, respectively, in patients with multiple small defects; and 84, 76 and 30%, respectively, in patients with a large defect (p less than 0.025 by log rank test).
Measurement of normal left atrial function with gated radionuclide angiography
1981-09-01
A method is described for measuring relative left atrial volume changes with gated radionuclide angiography, using an approximate computer-generated functional image to locate the atrial region of interest. M mode echocardiographic measurements of left atrial and left ventricular distances from the chest wall allowed calculation of a correction factor for the differential attenuation of atrial and ventricular photons. Background-corrected left atrial time-activity curves obtained from normal subjects exhibited excellent temporal resolution and were used to identify and quantitate the reservoir and contractile phases of left atrial volume change. In 20 normal subjects, the mean (+/- standard deviation) value for left atrial fractional emptying was 0.39 +/- 0.07. Expressed as fractions of the left ventricular stroke volume, mean values of the specific phases of atrial volume change were (1) reservoir volume 0.25 +/- 0.09, (2) contractile volume 0.29 +/- 0.10, and (3) conduit volume 0.46 +/- 0.12.
Measurement of normal left atrial function with gated radionuclide angiography
1981-09-01
A method for measuring relative left atrial volume changes with gated radionuclide angiography is described. The method uses an approximate computer-generated functional image to locate the atrial region of interest. M mode echocardiographic measurements of left atrial and left ventricular distances from the chest were used to calculate a correction factor for the differential attenuation of atrial and ventricular photons. Background-corrected left atrial time-activity curves were obtained from normal subjects. They exhibited excellent temporal resolution and were used to identify and quantitate the reservoir and contractile phases of left atrial volume changes. In 20 normal subjects, the mean value for left atrial fractional emptying was 0.39 + or - 0.07. Expressed as fractions of the left ventricular stroke volume, mean values of the specific phases of atrial volume change were: (1) reservoir volume 0.25 + or - 0.09 (2) contractile volume 0.29 + or - 0.10 and (3) conduit volume 0.46 + or - 0.12.
[Cardiac amyloidosis. Invasive and noninvasive diagnosis]
Aim of this study is the analysis of clinical, morphologic and haemodynamic features of cardiac amyloidosis. Cardiac amyloidosis was demonstrated histologically in 7 of our patients: in 6 by endomyocardial biopsy during cardiac catheterization, in one at autopsy. The clinical picture was characterized in every patient by signs and symptoms of congestive heart failure. The electrocardiogram showed several non specific signs: low voltage of the QRS complexes, both in peripheral (4/7) and precordial leads (7/7 cases); marked leftward and upward deviation of the QRS axis (6/7 cases); first degree A-V block (5/7); abnormal Q waves (7/7). M-mode and two-dimensional echocardiography invariably demonstrated a typical pattern: a non dilated left ventricle with thickened and hyper-refractile walls, and usually a slight-moderate diffuse hypokinesia. Other common features were a thickening of right ventricular walls, interatrial septum, and atrioventricular and semilunar valves. Computerized analysis of the M-mode tracings disclosed a marked impairment of the indexes of both systolic and diastolic ventricular function in all patients. By correlating electrocardiographic and echocardiographic data, we found in every case a striking disproportion between the low QRS voltage and the high muscle cross-sectional area (an echocardiographic index of left ventricular mass): this pattern appears to be highly suggestive of infiltrative heart disease. Cardiac catheterization (performed in 6 cases) showed an increase of left ventricular (6/6) and right ventricular (5/6) end-diastolic pressure, with a dip plateau pattern in some cases (4/6 of the left, 2/6 in the right ventricle). The cardiac index was decreased in 3/6 cases. Left ventricular angiography confirmed the echocardiographic data of normal volumes and a slight-moderate decrease of the ejection fraction. We conclude that cardiac amyloidosis usually mimics a restrictive cardiomyopathy (severe congestive heart failure with increased ventricular filling pressures, in the absence of severe systolic ventricular dysfunction). This disease can be suspected clinically by the correlation of the clinical, electrocardiographic and echocardiographic data. The final diagnosis requires an endomyocardial biopsy.
2000-01-01
The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress {sup 99m}Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest {sup 123}I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and {sup 123}I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by {sup 123}I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in {sup 123}I-BMIPP). Eighteen normotensive patients with apical defect by {sup 123}I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by {sup 123}I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by {sup 123}I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and {sup 123}I-BMIPP imaging are useful for the identification of these patients. (author)
1984-03-01
Patients with left ventricular thrombi not caused by recent myocardial infarction were prospectively studied by indium-111 platelet imaging and two-dimensional echocardiography to determine the reproducibility of these techniques and the short-term effects of sulfinpyrazone (200 mg four times daily), aspirin (325 mg three times daily) plus dipyridamole (75 mg three times daily), and full-dose warfarin. At baseline, all patients underwent indium-111 platelet imaging and echocardiography, and the results were positive for thrombus. In six patients on no antithrombotic drug therapy, repeat platelet scans and echocardiographic studies at 6.0 +/- 3.3 weeks remained positive and were unchanged. In seven patients studied on sulfinpyrazone, three platelet scans became negative, two became equivocal, and two were unchanged; the presence and size of thrombus was constant by echocardiography in all seven patients. Of the six patients studied on aspirin plus dipyridamole, one platelet scan became negative, those of three became equivocal, and two were unchanged; all echocardiographic findings remained positive, but one patient had decreased thrombus size. Among four warfarin-treated patients, three had resolution of platelet deposition and one was unchanged; by echocardiography, thrombus resolved in one patient, was decreased in size in one, and was unchanged in two. We conclude that, in the absence of antithrombotic drug therapy, platelet imaging and echocardiographic findings are stable in patients with left ventricular thrombi not caused by recent myocardial infarction. Sulfinpyrazone, aspirin plus dipyridamole, and warfarin all interrupt platelet deposition in some patients with chronic left ventricular thrombi.
2003-01-01
Reliability of left ventricular geometry assessed by echocardiography (Echo) using an assumed left ventricular mass (LVM) and one-dimensional eccentricity (relative wall thickness: RWT), remains questionable. This study evaluated the feasibility of three-dimensional left ventricular geometric analysis using magnetic resonance imaging (MRI). Echocardiography and MRI were performed on 55 patients with hypertension. LVM was calculated using 0.8 (American Society of Echocardiography-cube LVM)+0.6 g for Echo and the slice summation method for MRI. Eccentricity was determined by RWT (septal wall thickness+posterior wall thickness/left ventricular inner diameter) for Echo and LVM/1.05/left ventricular end-diastolic volume (LVEDV) ratio [MRI-mass volume/cavity (M/C) ratio] for MRI. Left ventricular geometry was classified into four patterns according to ...
In order to study left ventricular function in idiopathic hypertrophic subaortic stenosis (IHSS), left ventricular echograms were analyzed by computer and compared with results in normal subjects. Systolic function was consistently normal or above normal even in the presence of severe diastolic abnormalities. Wide variation in diastolic function in IHSS allowed separation of patients into three groups on the basis of the left ventricular peak filling rate. Because of the severe septal hypertrophy and hypokinesia, peak left ventricular filling rate is predominantly determined by the rate of free wall thinning. Patients in group 1 had rapid left ventricular filling rates, those in group 2 had normal filling rates, and those in group 3 had slow filling rates. With reduction in left ventricular peak filling rate caused by impaired free wall thinning, there was progressive increase in 1) duration of the rapid filling phase, 2) delay of mitral valve opening, 3) asynchrony between septum and posterior wall, 4) incidence of angina, and 5) incidence of atrial fibrillation.
2009-01-01
Right ventricular (RV) apical pacing induces dyssynchrony by a left bundle branch block type electrical activation sequence in the heart and may impair left ventricular (LV) function. Whether these functional changes are accompanied by changes in myocardial perfusion, oxidative metabolism and efficiency, and the relation with the induction of LV dyssynchrony are unknown. Our study was designed to investigate the acute effects of RV pacing on these parameters. Ten patients with normal LV ejection fraction and VVI/DDD pacemaker were studied during AAI pacing/sinus rhythm without RV pacing (pacing-OFF) and with RV pacing (pacing-ON) at the same heart rate. Dynamic [15O]water and [11C]acetate positron emission tomography was used to measure perfusion and oxidative metabolism (kmono) of the LV. An echocardiographic examination was ...
The effect of low-carbohydrate diet on left ventricular diastolic function in obese children
2010-01-01
Abstract Background: This study was conducted to evaluate left ventricle (LV) functions using conventional and tissue Doppler imaging in childhood obesity and to identify the effects of diet on LV diastolic functions. Methods: Conventional and tissue Doppler echocardiographic measurements were compared in 34 obese children and 24 age- and gender-matched lean controls. Fasting plasma glucose, insulin and homeostatic model assessment of insulin resistance levels were also obtained. Thirty-one of the obese children were subjected to a low-carbohydrate diet and their follow-up measurements were obtained after 6 months. Results: Left atrial diameter, LV mass and LV mass index were higher in obese children than in lean controls. Lateral mitral myocardial early diastolic (Em) and peak Em/myocardi...
Full Text Available.Left ventricular false tendons are thin, fibromuscular structures which traverse the left ventricular cavity. They are thought to be intracavitary radiations of the bundle of His. Usually these tendons span between the interventricular septum and the lateral wall or a papillary muscle. They have been known to be a source of innocent and musical murmurs.In this case report a peculiar left ventricular false tendon is shown—one extending between the two papillary muscles, giving the appearance of a musical note. During ventricular diastole the tendon is pulled taut between the two heads of the papillary muscles and during ventricular systole the tendon relaxes. The echocardiographic characteristics and possible long term implications are discussed.
2010-01-01
Background: Left ventricular diastolic dysfunction (LVDD) was reported as a significant predictor of mortality, mainly in patients with heart failure. However, prospective data are scarce in the hospitalized elderly population. Methods: We studied the association of severe LVDD, defined by conventional echocardiographic parameters, with cardiovascular and all-cause mortality in a population of 331 hospitalized elderly patients with a history of cardiovascular disease (mean age +/- SD, 87 +/- 7 years). After a mean follow-up of 378 days, 110 deaths occurred. Results: Compared with left ventricular systolic dysfunction (LVSD), subjects with severe diastolic dysfunction had a similar prevalence (12% vs 10%) and similar cardiovascular and all-cause mortality (18% vs 19%, 49% vs 50%). Both card...
Left Atrial Volume Provides Independent Prognostic Value in Patients With Chagas Cardiomyopathy
2009-01-01
Background Heart failure is a severe clinical manifestation of Chagas disease. Left atrial volume (LAV), a marker of chronically elevated left ventricular (LV) filling pressure, is a predictor of prognosis in patients with heart failure and may be important in the assessment of risk in patients with Chagas disease. The aim of this study was to identify echocardiographic parameters of diastolic function predictors of survival in patients with Chagas cardiomyopathy. Methods A total of 192 patients with Chagas cardiomyopathy (mean age, 48.5 ± 12.1 years; 37% women) were prospectively enrolled. The end points were death and cardiac transplantation. Results Over a mean follow-up period of 33.8 months, LAV normalized for body surface area emerged as an independent predictor of survival (h...
2010-01-01
Objective: Ketamine may be followed by a general increase in haemodynamics and oxygen consumption, which may be of concern in patients with ischaemic heart disease. The purpose of this study was to evaluate the effect of ketamine on left ventricular (LV) systolic and diastolic function by different modalities of echocardiography and tissue Doppler imaging in patients with ischaemic heart disease. Methods and Results: Prospective observational study of 11 patients acting as own control based on echocardiographic imaging before and after bolus ketamine 0.5 mg/kg. Simpson's 2 D-volumetric method was used to quantify left ventricular volume and ejection fraction. General global LV deformation was assessed by Speckle tracking ultrasound, systolic LV longitudinal displacement was assessed by Tis...
Impact of HIV Infection on Diastolic Function and Left Ventricular Mass
2010-01-01
Full Text Available.BackgroundHIV patients have increased risk for cardiovascular disease, but the underlying mechanisms remain unknown. The purpose of this study was to determine the prevalence of echocardiographic abnormalities among asymptomatic HIV-infected individuals compared to HIV-uninfected individuals.Methods/ResultsWe performed echocardiography in 196 HIV-infected adults and 52 controls. Left ventricular ejection fraction (LVEF), left ventricular mass indexed to the body surface area (LVMI), and diastolic function were assessed according to American Society of Echocardiography standards. LVMI was higher in HIV-infected patients (77.2g/m
2010-01-01
Functional assessment of continuous-flow left ventricular assist devices (LVADs) is usually performed with the patient at rest. This study compared echocardiographic indices of contraction and filling pressure with invasive measures in 12 ambulatory LVAD patients undergoing symptom-limited bicycle exercise. Exercise induced an increase in cardiac output, systolic pulmonary artery pressure, and diastolic pulmonary artery pressure. Although no changes in left ventricular dimensions or fractional shortening were seen on echocardiography, systolic mitral annular motion (S′) increased significantly (in parallel with cardiac output) and diastolic E/e′ ratio decreased (correlating inversely with diastolic pulmonary artery pressure). These findings emphasize the potential role of exe...
2008-01-01
Aims Conventional echocardiographic (ECHO) parameters of left ventricular (LV) and right ventricular (RV) systolic and diastolic function have been shown to be load-dependent; however, the impact of preload reduction on tissue Doppler (TD) parameters of LV and RV function is incompletely understood. The aim of this study was to examine the effect of acute preload reduction by haemodialysis (HD) on conventional (ECHO) and TD imaging (TDI) indices of systolic and diastolic function of the left and right ventricles. Methods and results Seventeen chronically uremic patients (age 31 +- 10 years), without overt heart disease underwent conventional 2D and Doppler ECHO together with measurement of longitudinal mitral and tricuspid annular motion velocities. Fluid volume removed by HD was 2706 +- 1...
2010-01-01
Background The left atrial volume (LAV) is an important indicator of the severity of certain diseases, and measuring LAV through the cardiac cycle may enable the evaluation of various left atrium (LA) functional parameters. The results of two-dimensional (2D) echocardiographic LAV measurement methods vary, and no technique is accepted as being optimal. Objective This study compared the accuracy of end-systolic and end-diastolic LAV measurements by 2D echocardiography with those obtained by magnetic resonance imaging (MRI). Methods Fifty consecutive patients who underwent both echocardiography and MRI due to clinical reasons with nonselective cardiac disease were studied. LAVs by 2D echocardiography were obtained with the prolate ellipsoid (PE), biplane area-length (AL), and modified Simpso...
2010-01-01
In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition to conventional treatment is able to augment LV and left atrial (LA) reverse remodeling in patients with AS undergoing AVR, we studied 114 patients scheduled for AVR. Patients were randomized to treatment with candesartan 32 mg 1 time/day or conventional therapy immediately after AVR. Patients were followed with echocardiographic evaluations 3, 6, and 12 months after surgery. Primary end point was change in LV mass index. At baseline and during follow-up no differences in systolic, diastolic, and pulse p...
Assessment of Cardiac Twist in Dilated Cardiomyopathy Using Velocity Vector Imaging
2010-01-01
Objectives: Velocity vector imaging (VVI) is a novel echocardiography technique to assess myocardial motion in two dimensions. In this study, we used VVI to assess left ventricular twist (LVtwist) in dilated cardiomyopathy (DCM) patients. Methods: Twenty DCM patients and 31 normal subjects were evaluated. Echocardiographic images of the long and short axis were processed by VVI software to measure peak rotation angle (ProtA), peak rotation rate (ProtR) in systole. In addition, peak untwisting velocity (Pun-twV) and untwisting rate (unTwR) were measured in diastole. LVtwist was defined as the net difference between the apical and basal angle of rotation, left ventricular torsion (LVtor) was calculated as LVtwist divided by left ventricular diastolic longitudinal length. Results: The pattern...
2008-01-01
Background The aim of this study was to determine the feasibility and accuracy of a new real-time 3-dimensional (RT3D) matrix-array transesophageal echocardiographic probe for the determination of left atrial appendage (LAA) geometry. Methods Sixty-six consecutive patients (mean age, 53 ± 17 years) referred for 2-dimensional (2D) transesophageal echocardiography (TEE) underwent additional RT3D TEE. The feasibility of RT3D TEE for LAA geometry was studied in the first 37 patients, and 2D and RT3D transesophageal echocardiographic quantification of the LAA were compared in the subsequent 29 patients. The LAA orifice diameter and depth were measured using biplane 2D TEE, and LAA orifice area was calculated as an ellipse. LAA orifice area and depth were measured in 3D and correlated to ...
2004-01-01
The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%. Type IV: n=12, 39%) to moderate (type I, n=1, 3%. Type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 ...
To underline the role of echocardiography in the detection of cardiac involvement in patients with amyloidosis, physical examination, echocardiography and electrocardiography were performed in 30 patients with AA amyloidosis (amyloid protein A, associated with chronic inflammatory disease, usually without cardiomyopathy) and 24 patients with AL amyloidosis (the immunoglobulin light chain derived type, often associated with cardiomyopathy). All patients had histological confirmation of amyloidosis by rectal or subcutaneous abdominal fat biopsy. The combination of increased thickness of the left ventricular posterior wall and interventricular septum with a low voltage electrocardiographic pattern is highly specific for cardiac amyloidosis and was found in 3/30 (10%) of the AA patients and in 13/24 (54%) of the AL patients. The echocardiographic abnormalities were strongly related to the degree of clinical heart disease, showing mildly or moderately increased wall thickness in the early asymptomatic phase or severe thickening and hypokinesia of the left ventricular posterior wall and interventricular septum in clinically apparent cardiac dysfunction. Echocardiography appears to be a sensitive test for the detection of cardiac involvement in amyloidosis, in symptomatic as well as asymptomatic patients.
Doppler echocardiograph evaluation of pulmonary hypertension in patients undergoing hemodialysis
2006-01-01
Abstract Pulmonary hypertension (PH) has been reported in hemodialysis (HD) patients, but data regarding its incidence and mechanisms are scarce. The aims of this study was to evaluate the prevalence of unexplained PH in long-term HD patients, and to examine some possible etiologic factors for its occurrence. The prevalence of PH was estimated by Doppler echocardiography in a cohort of 86 stable patients on HD via arteriovenous access for more than 12 months. All the patients underwent full clinical evaluation, chest radiography, and a standard 12-lead echocardiograph. Laboratory investigation included a mean of 12 months (serum calcium, phosphorus, parathormone (PTH), alkaline phosphatase, lipids, and hemoglobin). Pulmonary hypertension was defined as pulmonary artery systolic pressure
sup 99m Tc-labelled anti NCA-95 antibodies in prosthetic heart valve endocarditis
1991-08-01
A 54-y old women with earlier replacement of the mitral and aortic valves and clinical signs of localized endocarditis was studied with {sup 99m}Tc-labelled anti NCA-95 antibody. Whereas echocardiographic findings were negative, increased radionuclide uptake was observed left parasternal over the mitral valve as a sign of prosthetic valve endocarditis. This result could be confirmed by a similar study with leukocytes labelled in vitro with {sup 111}In-oxine. (orig.).
2010-01-01
Acute papillary muscle rupture results in severe mitral regurgitation and hemodynamic instability, and it carries a poor prognosis with a high mortality rate. We present a case of an 86-year-old woman affected by mitral regurgitation due to an acute posterior papillary muscle rupture. The patient underwent a mitral valve repair with annuloplasty and artificial chordae implantation. The neochorda was sutured to the posterior mitral leaflet and fixed through the left ventricle wall on the epicardium. The neochorda length was determined on the beating heart under echocardiographic view.
Echocardiographic abnormalities following cardiac radiation
Five years or more after receiving cardiac radiation, 41 patients with Hodgkin's disease and seminoma in remission were subjected to echocardiography. The abnormalities detected included pericardial thickening in 70%, thickening of the aortic and/or mitral valves in 28%, right ventricular dilatation or hypokinesis in 39%, and left ventricular dysfunction in 39%. In the 23 patients treated by an upper mantle technique with shielding, the incidence of right ventricular abnormalities and valvular thickening was significantly lower than in patients treated with modified techniques. Although no symptoms were attributable to the observed abnormalities, longer follow-up time may reveal important functional implications.
2005-12-15
Purpose: Patients (pts.) with atrial fibrillation (AF) and atrial thrombi are known to have an increased risk for cerebral embolism. However, little is known about the clinical course of atrial thrombi and the incidence of cerebral embolism in those patients during anticoagulation therapy. The high sensitivity of MR imaging (MRI) including diffusion-weighted imaging (DWI) suggests that this technique could provide an improved estimate of cerebral embolism associated with the presence of left atrial thrombi. The aims of this prospective study were to evaluate (1) the prevalence of clinically silent and apparent cerebral embolism in pts. with newly diagnosed AF and atrial thrombi using MRI/DWI, (2) the long-term fate of atrial thrombi under continued anticoagulation therapy and (3) the incidence of cerebral embolism during a follow-up period of 12 months with continuous anticoagulation therapy. Materials and methods: The study group consisted of 32 pts. with (1) newly diagnosed AF and evidence of left atrial (LA) thrombi detected by TEE and (2) a new start of anticoagulation therapy [International Normalized Ratio (INR) 2.0-3.0]. 19 pts. with (1) newly diagnosed AF and no evidence of atrial thrombi and (2) an equivalent anticoagulation regimen served as the control group. In both groups (a) MRI/DWI studies of the brain (weeks 0, 4, 8, 12, 20, 28, 36, 44, and 52), (b) transesophageal echocardiographic studies (TEE) for assessment of LA-Thrombi (weeks 0 and 52) and (c) clinical neurological assessments (weeks 0, 20 and 52) were performed. Results: In the study group (AF and LA-Thrombi) 11 out of 32 pts. (34%) displayed signs of acute (n=8) or chronic (n=3) cerebral embolism in the initial MRI studies. In 4 out of 32 pts.(13%), MRI/DWI depicted new or additional cerebral emboli (n=12) during the follow-up period despite continuous anticoagulation therapy. 2 (n=2/4; 50%) of these patients had clinically apparent neurological deficits. In the control group 1 out of 19 pts. (5%) showed evidence of chronic cerebral embolism as assessed by MRI/DWI at the beginning of the study (week 0). No embolic cerebral lesions were detected during the 12-month follow-up. Within 12 months only 63% (n=20/32) of LA thrombi in the study group resolved completely under anticoagulation. (orig.)
1984-06-01
We collected 98 cases of single atrial septal defect. Analytical study of the pulmonary vasculature and the shape of the heart allowed us to differentiate 71 cases of pulmonary hypervascularity with increased cardiothoracic index and an appearance of right ventricular dilatation. The left inferior segment was usually straight, but sometimes convex, with a great curvature including the middle left segment. Apart from these 71 typical cases, there were 18 cases of incomplete patterns, 7 cases of atypical patterns with a convex left inferior segment with a small curvature and two normal cases (normal shape of the heart and normal vasculature). - Echocardiography was performed in 35 cases. It was valuable in 34 cases and established the diagnosis each time the X-ray picture was uncertain. Increase of the ratio of the telediastolic diameter of the right to left ventricle is almost constant and the septal motion is paradoxical in 79% of all cases. - Post-operative change was characterized from the radiological point of view by rapid return to normal of the pulmonary vascularity, followed by decrease of the cardiothoracic index, while the modifications of the shape of the left middle and inferior segment regress slowly and incompletely. As for echocardiography there is constant decrease of the ratio of the telediastolic diameter of the right of left ventricle, while the septal motion returns to normal in 79% of all cases.
1983-01-01
We reported a case of hypereosinophilic syndrome with an apical thrombus obstructing left ventricular cavity near the apex and apical hypertrophy of the left ventricle de monstrated by echocardiography and computed tomography. Abnormal laboratory findings included a white blood cell count of 22,800/mm3 with 64 per cent of eosinophils, high serum IgE level, and eosinophilic abscess formation in the lymph node specimen. The electrocardiogram showed left precordial high voltage and giant negative T waves in leads Vsub(4--5). Two-dimensional echocardiograms revealed an abnormal mass obstructing the left ventricular cavity. Computed tomography demonstrated marked apical hypertrophy of the left ventricle and a filling defect of 24 x 31 mm, which attached to the interventricular septum. Because of the lack of its movement on echoardiograms and significant ...
Case of anemia with left atrial myxoma suspected as late effect of an atomic bomb
1980-12-01
A 43 years old housewife with a history of exposure to an atomic bomb at 8 years old, recently developed anemia and palpitation. The laboratory data showed accelerated ESR, anemia (Hb 10.0 g/dl), and hyper ..gamma..-globulinemia. Despite the suspicion of late effect of atomic radiation, further examinations confirmed the diagnosis of left atrial myxoma. The echocardiographic studies revealed the decrease of diastolic descent rate, and multiple echos reflected from the tumor within the mitral orifice during diastole. Cardiac catheterization demonstrated remarkably high value of PCWP (V-wave 38 mmHg) and space filling defect moving from left atrium to left ventricle by cineangiography. Phonecardiographic studies were similar to mitral stenosis. After left atrial myxoma was removed, her symptoms and laboratory data including all noninvasive findings were improved. Therefore we suspected that her symptoms was related with left atrial myxoma rather than the late effect of atomic bomb exposure. We have discussed its significance and usefulness of noninvasive diagnostic approaches as well as whole body computed tomography in heart tumor.
AIM: To study echocardiographic parameters associated with embolic complications in patients with cardioembolic and other pathogenetic subtypes of ischemic stroke. MATERIAL AND METHODS: 330 patients with ischemic stroke (IS) were examined. Transthoracal echocardiography was made in all the patients, transesophageal echocardiography was performed in 53 (16.1%) patients. The patients were divided into two groups: 104 (31.5%) patients who survived cardiocerebral embolism (group 1), 226 (68.5%) patients with other pathogenetic subtypes of stroke (group 2). RESULTS: Cardiac pathology was detected in 220 of 330 (66.7%) examinees with ischemic heart disease in 50.0% and 51.3% patients of group 1 and 2, respectively; infectious-inflammatory diseases--in 27.9 and 4.4%, respectively (p < 0.0001), other diseases (mitral prolapse, aneurysm and interatrial defect, idiopathic arhythmia) in 25.0 and 5.3% patients, respectively (p < 0.0001). Left atrial myxoma was diagnosed in 1.9% patients of group 1. CONCLUSION: Echocardiographic changes associated with a risk of embolic complications were visualized in all pathogenetic subtypes of ischemic stroke. In cardioembolic stroke echocardiography detected most frequently prolapse with myxomatous degeneration of the cusps and mitral vegetations, mitral failure, calcinosis of the mitral ring, local hypokinesia of the left ventricle, dilation and thrombosis of the left atrium. Rare changes, indicating cerebral embolism, include replaced aortic and mitral valves, mitral stenosis, cardiac tumor, aneurysm and defect of the interatrial septum.
Usefulness of radionuclide angiocardiography in predicting stenotic mitral orifice area
1986-12-01
Fifteen patients with pure mitral stenosis (MS) underwent high-temporal-resolution radionuclide angiocardiography for calculation of the ratio of peak left ventricular (LV) filling rate divided by mean LV filling rate (filling ratio). Whereas LV filling normally occurs in 3 phases, in MS it is more uniform. Thus, in 13 patients the filling ratio was below the normal range of 2.21 to 2.88 (p less than 0.001). In 11 patients in atrial fibrillation, filling ratio divided by mean cardiac cycle length and by LV ejection fraction provided good correlation (r = 0.85) with modified Gorlin formula derived mitral area and excellent correlation with echocardiographic mitral area (r = 0.95). Significant MS can be detected using radionuclide angiocardiography to calculate filling ratio. In the absence of the confounding influence of atrial systole calculation of 0.14 (filling ratio divided by cardiac cycle length divided by LV ejection fraction) + 0.40 cm2 enables accurate prediction of mitral area (+/- 4%). Our data support the contention that the modified Gorlin formula, based on steady-state hemodynamics, provides less certain estimates of mitral area for patients with MS and atrial fibrillation, in whom echocardiography and radionuclide angiocardiography may be more accurate.
2007-01-01
An integral component in the development of a control strategy for implantable rotary blood pumps is the task of reliably detecting the occurrence of left ventricular collapse due to overpumping of the native heart. Using the noninvasive pump feedback signal of impeller speed, an approach to distinguish between overpumping (or ventricular collapse) and the normal pumping state has been developed. Noninvasive pump signals from 10 human pump recipients were collected, and the pumping state was categorized as either normal or suction, based on expert opinion aided by transesophageal echocardiographic images. A number of indices derived from the pump speed waveform were incorporated into a classification and regression tree model, which acted as the pumping state classifier. When validating the model on 12,990 segments of unseen data, this methodology yielded a peak sensitivity/specificity for detecting suction of 99.11%/98.76%. After performing a 10-fold cross-validation on all of the available data, a minimum estimated error of 0.53% was achieved. The results presented suggest that techniques for pumping state detection, previously investigated in preliminary in vivo studies, are applicable and sufficient for use in the clinical environment. (C)2007Amercian Society of Artificial Internal Organs Publisher: American Society for Artificial Internal Organs Coverage: 2007-01-01T00:00:00Z
Echocardiograms obtained from 50 patients after valvular heart surgery (in 33 cases within 2 months of the procedure) were examined to study patterns of interventricular septal motion and left ventricular dimensional changes. Preoperative echograms were available in 28 cases. Before and after mitral commissurotomy septal motion and left ventricular diameters as well as the percent systolic shortening of the echocardiographic transverse axis were within normal limits. Before operation, aortic and mitral regurgitation were associated with increases in end-diastolic and end-systolic diameters, septal motion and percent systolic shortening of the left ventricular diameter. Septal dyssynergy, defined as paradoxical motion or marked hypokinesia, was seen within 2 months of operation in 91 percent of patients after aortic valve replacement and in 42 percent after mitral valve replacement. Of subjects studied more than 2 months postoperatively, none with mitral valve replacement and only 33 percent with aortic valve replacement manifested septal dyssynergy. After valve replacement for aortic or mitral regurgitation there were significant decreases in end-diastolic diameter, septal excursion and total and percent left ventricular systolic shortening. Two subjects not having valve replacement also demonstrated paradoxical septal motion postoperatively. The cause of septal dyssynergy after valvular surgery was not apparent although the use of cardiopulmonary bypass was an esential condition. We conclude that echocardiography can be utilized to follow up changes in left ventricular wall motion and dimensions after surgery for valvular heart disease, and that it may be of value in assessing the early and late postoperative results.
2010-01-01
The CHADS2 score (congestive heart failure, hypertension, age >75 years, diabetes, and previous stroke/transient ischemic attack) is used for embolic risk stratification in patients with atrial fibrillation (AF). Although systemic inflammation is a known predictor of left atrial thrombus formation in patients with nonrheumatic AF, the relation between the CHADS2 score and systemic inflammation is unknown. A total of 165 patients with nonrheumatic AF were enrolled and analyzed. According to the CHADS2 score, the study patients were grouped into low- (score 0 to 1), intermediate- (score 2 to 3), or high- (score 4 to 6) risk categories. The plasma C-reactive protein levels, transesophageal echocardiographic findings, and cardiovascular events (death, stroke, and heart failure) were com...
2008-01-01
There are different protocols of reconstruction in myocardial gated imaging that produce different values of left ventricular ejection fraction (EF). We attempted to determine how the parameters of reconstruction affect the calculated EF. The results were statistically compared with the values obtained from angiography and echocardiography. In this retrospective study, the data from 23 patients were used. All the patients had the angiographic and the echocardiographic data within 2 weeks before the test. Imaging was performed using a single-head gamma camera using technetium-99 methoxyisobutylisonitrile. The image data were reconstructed using 50 different combinations of the ramp, Hanning, Butterworth, Wiener, and Metz filters. The ordered subset expectation maximization (OSEM) technique was also examined using 12 combinations of iteration and subset. The ...
2010-01-01
Background: Cardiac fibrosis is common and associated with poor prognosis in patients with heart failure. We investigated the effect of cardiac fibrosis on the left ventricular (LV) diastolic function, functional capacity, LV remodeling, and biochemical parameters in patients with nonischemic dilated cardiomyopathy (NIDC). In addition, we investigated the biochemical and echocardiographic predictors of cardiac fibrosis in this group. Methods and Results: Forty patients with NIDC were enrolled. Cardiac fibrosis was evaluated according to the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Nineteen patients had cardiac fibrosis (Group I) and 21 patients did not have cardiac fibrosis (Group II). LV systolic and diastolic parameters were assessed with...
2010-01-01
Objective: To evaluate the accuracy of a semiautomatic quantification of left ventricular (LV) volumes and ejection fraction (EF) using two-dimensional (2D) feature tracking imaging (FTI). Methods: Thirty-four consecutive subjects (11 patients with dilated cardiomyopathy, 13 with hypertrophic cardiomyopathy, and 10 subjects with no cardiac disease) underwent, on the same day, trans-thoracic echocardiography (TTE) examination, FTI, and cardiac magnetic resonance imaging (MRI), as gold standard, in order to quantify LV volumes and EF. The echocardiographic quantification of LV volumes and EF was determined from four- and two-chamber views using both standard TTE Biplane Simpson's method and a semiautomatic border detection based on FTI. Furthermore, the time for data analysis for each method...
2010-01-01
BackgroundNonischemic dilated cardiomyopathy (NICM) is associated with diffuse global hypokinesia on echocardiography. However, NICM also may be associated with segmental wall-motion abnormalities (SWMAs) even in the presence of global hypokinesia, probably secondary to patchy myocardial scars. ObjectiveBecause myocardial scars serve as substrate for reentry, the purpose of this study was to determine whether SWMA is a predictor of ventricular arrhythmic events in NICM. MethodsEchocardiographic parameters and appropriate implantable cardioverter-defibrillator (ICD) therapy for arrhythmic events (shock or antitachycardia pacing) were studied in NICM patients with an ICD. Two-dimensional echocardiography of the left ventricle was recorded in a 16-segment model. SWMA was defined by the presen...
Sarcoidosis: a pattern of clinical and morphological presentation.
The diagnosis of cardiac sarcoidosis, particularly when there is no overt systemic involvement, is frequently delayed because of its varied manifestations. Focal left ventricular wall motion abnormalities were recognised in five patients with sarcoidosis. Three patients showed abnormal regional wall motion in the basal portion of the ventricular septum and free wall with sparing of the apex. The angiographic appearances supported the echocardiographic findings which were atypical of ischaemic heart disease. The remaining two patients both had diffuse left ventricular hypokinesia, with a focal abnormality that was most pronounced in the anteroapical region; this pattern is often seen with coronary disease. The recognition by echocardiography or angiography of focal abnormalities of wall motion affecting the basal portion of the ventricular septum should suggest the possibility of myocardial sarcoidosis even in the absence of recognised systemic manifestations.
Plasma atrial natriuretic peptide concentration in warmblood horses with heart valve regurgitations
2007-01-01
ObjectivesThis study measured plasma atrial natriuretic peptide (ANP) concentration in horses with heart valve regurgitations (HVR) with and without atrial and ventricular dilatation.BackgroundIn humans and small animals, plasma ANP concentration is increased in heart disease and correlates with the severity of clinical signs and heart enlargement.Animals, materials and methodsTen healthy horses (control) and 36 horses with HVR were evaluated by auscultation, electrocardiography, echocardiography, and determination of plasma ANP.ResultsControl horses demonstrated mean plasma ANP concentration of 21+-5.4pg/mL. Of the 36 horses with HVR, 17 horses possessed normal echocardiographic heart size (group 1), 10 horses had a left atrial dilatation (group 2) and 9 horses had both left atrial and ve...
Percutaneous Retrieval of a Right Atrioventricular Embolus
1998-01-01
Percutaneous retrieval of a 12-cm-long serpiginous clot lodged in the right atrium and ventricle is reported. Following bilateral common femoral vein puncture, a Bird's Nest cava filter was first positioned ready to deploy immediately below the renal veins via the right femoral vein. From the left femoral vein, a Cook intravascular retrieval basket was advanced to the right atrium. Under transthoracic echocardiographic visualization, the basket was used to engage, trap, and gently withdraw the clot in a single long strand below the prepositioned inferior vena cava filter. The filter was immediately deployed, leaving the clot trapped inferior to the renal veins, in the cava and left iliac vein. The patient remained well and asymptomatic at discharge
1983-05-01
This review evaluates noninvasive techniques for assessing cardiovascular performance in acute and chronic respiratory failure. Radiographic, radionuclide, and echocardiographic methods for determining ventricular volumes, right (RV) and left ventricular (LV) ejection fractions, and pulmonary artery pressure (PAP) are emphasized. These methods include plain chest radiography, radionuclide angiocardiography, thallium-201 myocardial imaging, and M mode and 2-dimensional echocardiography, which have recently been applied in patients to detect pulmonary artery hypertension (PAH), right ventricular enlargement, and occult ventricular performance abnormalities at rest or exercise. Moreover, radionuclide angiocardiography has proven useful in combination with hemodynamic measurements, for evaluating the short-and long-term cardiovascular effects of therapeutic agents, such as oxygen, digitalis, theophylline, beta-adrenergic agents, and vasodilators.
Mitral Valve Annular Bacterial Vegetative Mass Masquerading as a Left Atrial Myxoma
2010-01-01
A 49-year-old male with chronic kidney disease and history of renal transplantation in 2006 on chronic immunosuppressant therapy presented with a 1-week history of chills and generalized myalgia. He had a temperature of 101degreeF. One set of blood cultures grew methicillin-sensitive Staphylococcus aureus. Transesophageal echo (TEE) revealed a mobile mass that was 2 cm in length attached by a thin stalk to the base of the anterior leaflet of the mitral valve. The surgical diagnosis was a left atrial myxoma. The echocardiographic as well as the surgical findings were consistent with an atrial myxoma. However, the histopathology of the specimen showed no evidence of myxoma as the characteristic stellate mesenchymal cells were absent. Instead the milieu of inflammatory cells, fibrin and multi...
Left ventricular mass in hypertensive patients with mild-to-moderate reduction of renal function
2010-01-01
ABSTRACT: Aim: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular (CV) morbidity and mortality. The aim of the present study was to evaluate the relationship between LV mass and mild-to-moderate renal dysfunction in a group of non-diabetic hypertensives, free of CV diseases, participating in the Renal Dysfunction in Hypertension (REDHY) study. Methods: Patients with diabetes, a body mass index (BMI) of more than 35 kg/m2, secondary hypertension, CV diseases and a glomerular filtration rate (GFR) of less than 30 mL/min per 1.73 m2 were excluded. The final sample included 455 patients, who underwent echocardiographic examination and ambulatory blood pressure monitoring. Results: There was a significant trend for a stepwise increase in LV mass, indexed by both bo...
2009-01-01
The aim of this study was to assess the left ventricular diastolic function using conventional echocardiography and tissue Doppler imaging in children with familial Mediterranean fever. This study included 29 (13 males and 16 females) patients and 30 healthy subjects as controls. Body mass index was calculated and arterial blood pressure was monitored. After an overnight fast, venous blood samples were taken and serum amyloid A protein, C-reactive protein, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol levels were measured. A complete 2-dimensional, M-mode, pulse wave Doppler, and pulse wave tissue Doppler echocardiographic examination was performed. There...
Left Ventricular Torsion Parameters are Affected by Acute Changes in Load:CME
2010-01-01
Background: Quantification of left ventricular torsion may provide new indices of systolic and diastolic function. We sought to characterize the effect of acute manipulation of load on cardiac torsion, plecotropy in human subjects. Methods: Simultaneous Millar LV pressure, micromanometry, and echocardiograms were performed on 18 patients (10 male, mean age 66 years) with normal systolic function. Loading was altered sequentially by the administration of glyceryl trinitrate (GTN) and saline fluid loading. Echocardiographic speckle tracking imaging was used to quantify LV torsion and event timing was recorded relative to mitral valve opening (MVO). Results: GTN administration decreased preload (LV end diastolic pressure: 15.7 vs 8.4 mmHg, P
Left Ventricular Thickness Is Increased in Nonhypertensive Turner's Syndrome
2009-01-01
Background: Turner's syndrome (TS), the most frequent congenital anomaly in newborn girls, is associated with various cardiovascular abnormalities, predominantly bicuspid aortic valves and aortic coarctation. The causes of the left ventricular hypertrophy (LVH) and ECG findings associated with TS are unknown. We used echocardiography to assess cardiac structure and function in normotensive patients with TS. Method: Thirty-one patients with TS and 30 healthy women were enrolled in this comparative study. Twelve-lead ECG, 24-hour-ambulatory ECG recording, and echocardiography were performed. Results: With 24-hour-ambulatory ECG recording, the mean heart rate (HR) of TS women was higher than non-TS women. With echocardiographic examination, the interventricular septum diastolic thickness, lef...
Left Ventricular Noncompaction in Children
2009-01-01
ABSTRACT Objective. Left ventricular noncompaction (LVNC) is an uncommon type of cardiomyopathy in children. We sought to determine the clinical presentations and outcomes of children diagnosed to have LVNC. Design. The case records of children diagnosed to have LVNC between 1999 and 2007 were reviewed. The diagnosis was based on echocardiographic finding of a thick noncompacted myocardium layer characterized by a trabecular meshwork with deep endomyocardial spaces. Results. Ten patients (seven males) were diagnosed to have LVNC at a median age of 2 years (range, 7 days to 12 years). Seven patients had isolated LVNC while three had associated structural congenital heart diseases. The right ventricle was also involved in two patients. Clinical presentations included congestive heart failure...
2008-01-01
Background: Left atrial volume (LAV) is an independent echocardiographic predictor of cardiovascular events in the general population. We evaluated predictors of LAV in patients with advanced chronic kidney disease (CKD). Hypothesis: Increasing LAV identifies increased cardiovascular risk in patients with CKD. Methods: Transthoracic echocardiography was performed in CKD patients undergoing cardiovascular evaluation prior to listing for renal transplantation. LAV was measured using the biplane area-length formula and indexed for body surface area. Carotid intima-media thickness was assessed by B-mode ultrasound. Lipoproteins were measured by nuclear magnetic resonance spectroscopy. Values are presented as mean (standard deviation). Relationships with LAV were evaluated using univariate and ...
2010-01-01
The objective of this study was to assess the relation between strain pattern on electrocardiogram (ECG-strain) and echocardiographic indices of left ventricular (LV) structure and function in children with LV hypertrophy (LVH). ECG-strain is a marker of LVH and is associated with adverse cardiovascular prognosis in adults. The significance of ECG-strain and its relation to LV structure and function has not been studied in children. We retrospectively analyzed electrocardiograms (ECGs) and echocardiograms of 101 children enrolled in this study. Subjects were divided into three groups: group I (n=21) comprised children with LVH confirmed by echocardiography (LVHecho) with ECG-strain pattern; group II (n=54) comprised children with LVHecho without ECG-strain pattern; and group III (n...
2010-01-01
The analysis of left ventricular (LV) mechanics provides novel insights into the effects of cardiac resynchronization therapy (CRT) on LV performance. Currently, advances in speckle-tracking echocardiographic analysis have permitted the characterization of subendocardial and subepicardial LV twist. The aim of this study was to investigate the role of the acute changes in subendocardial and subepicardial LV twist for the prediction of midterm beneficial effects of CRT. A total of 84 patients with heart failure scheduled for CRT were recruited. All patients underwent echocardiography before and <48 hours after CRT implantation and at 6-month follow-up. The assessment of LV volumes, ejection fractions, and mechanical dyssynchrony (systolic dyssynchrony index) was performed with real-ti...
2010-01-01
Background Knowledge on the effects of volatile anaesthetics on left ventricular (LV) diastolic function in humans in vivo is limited. We tested the hypothesis that sevoflurane, desflurane, and isoflurane do not impair LV diastolic function in young healthy humans. Methods Sixty otherwise healthy subjects (aged 18-48 yr) undergoing minor procedures under general anaesthesia were studied. After randomization for the anaesthetic, transthoracic echocardiographic examinations were performed at baseline and under anaesthesia with 1 minimum alveolar concentration (MAC) of the volatile anaesthetics during spontaneous breathing and intermittent positive pressure ventilation (IPPV). Peak early (Eprime) and late (Aprime) diastolic velocities of the mitral annulus were studied as the main echocardiog...
Computer systems analysis of spaceflight induced changes in left ventricular mass
2007-01-01
Circulatory adaptations resulting in postflight orthostasis have frequently been observed in response to space travel. It has been postulated that a decrement in left ventricular mass (LVM) found after microgravity exposure may be the central component in this cardiovascular deconditioning. However, a physiologic mechanism responsible for these changes in the myocardium has not been determined. In this study, we examined the sequential alterations in echocardiographic measured LVM from preflight to landing day and 3 days into the postflight recovery period. In a previous study in returning astronauts we found a comparative 9.1% reduction in postflight LVM that returned to preflight values by the third day of recovery. This data was further evaluated in a systems analysis approach using a w...
Complex cyanotic congenital heart disease correctable with an intra-atrial baffle.
The clinical, angiocardiographic, and surgical findings in a cyanotic child with dextrocardia, L-loop, laterally inverted but otherwise normally related great arteries, and situs ambiguus are described and compared with other similar cases. Electrocardiographic, echocardiographic, and angiographic data are reviewed, and the segmental approach to diagnosis is stressed. Both systemic and pulmonary veins returned to the right-sided atrium. Blood then passed either through the mitral valve to the morphologically left ventricle and to the aorta or through an atrial septal defect to a small left-sided atrium, right ventricle, and pulmonary artery. Total correction was undertaken with an intra-atrial baffle to direct pulmonary venous return to the morphologically right ventricle and systemic venous return to the right ventricle. The subpulmonic stenosis was alleviated with an outflow patch.
2010-01-01
Left atrial (LA) volume is an important prognostic factor in cardiovascular disease. Multidetector computed tomography (MDCT) is an emerging cardiac imaging modality; however, its accuracy in measuring the LA volume has not been well studied. The aim of our study was to determine the accuracy of MDCT in quantifying the LA volume. A total of 48 patients underwent MDCT and 2-dimensional (2D) echocardiography (2DE) on the same day. The area–length and Simpson's methods were used to obtain the 2D echocardiographic LA volume. The LA volume assessment by MDCT was obtained using the modified Simpson's method. Four artificial phantoms were created, and their true volume was assessed by an independent observer using both imaging modalities. The correlation between the LA volume by MDCT and 2...
Assessment of Left Ventricular Systolic Asynchrony in Patients with Clinical Hypothyroidism
2010-01-01
Background: Hypothyroidism has a large number of adverse effects on the cardiovascular system such as impaired cardiac contractility. Left ventricular (LV) asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. Objective: To assess systolic asynchrony in patients with overt hypothyroidism. Methods: Asynchrony was evaluated in 31 patients with overt hypothyroidism and 26 controls. Clinical hypothyroidism was defined as serum thyroid-stimulating hormone (TSH) more than 4.2 mIU/mL with reduced free T4 less than 1.10 ng/dL. All the patients and controls were subjected to an echocardiographic study including tissue synchronization imaging (TSI). The time to regional peak systolic velocity (Ts) in LV via the six-basal-six-mid-segmental model was mea...
Angiographic and Hemodynamic Follow-Up of Patients After Partial Left Ventriculectomy
2005-01-01
Abstract Angiographic, Doppler-echocardiographic and hemodynamic studies early (+6 days) and late (+180 days) after partial left ventriculectomy (PLV) on 24 patients revealed that PLV decreased end-systolic volume (or dimension) more than the end-diastolic volume (or dimension), improving stroke volumes (or contractile excursion), and doubling ejection fraction (or fractional shortening). Results of PLV appeared to depend on a balance between improved systolic contractility and reduced diastolic performance. All these survivors had improved diastolic relaxation, suggesting myocardial viability is a prerequisite for PLV to be successful. (J Card Surg 2005;20:S35-S38)
Analysis of the Left Atrial Appendage by Three-Dimensional Transesophageal Echocardiography
2010-01-01
This study was designed to determine the ability and reliability of 3-dimensional (3D) transesophageal echocardiography (TEE) to assess the geometry and size of the left atrial appendage (LAA). Three-dimensional TEE may allow more accurate assessment of, and provide additional information on, LAA morphology compared to 2-dimensional TEE. Validation studies for LAA morphology data derived from 3D TEE were performed using 10 isolated porcine LAA specimens. Of 107 enrolled patients, 55 patients were in sinus rhythm (normal sinus rhythm), in whom 3D transesophageal echocardiographic images were obtained from full-volume mode imaging, and in 52 patients with atrial fibrillation, zoom-mode imaging was used. LAA orifice area, depth, and volume and the number of LAA lobes were assessed on reconstr...
2004-01-01
The usefulness of coronary flow reserve measurement in the left circumflex coronary artery by transthoracic Doppler echocardiography to detect myocardial ischemia was compared with exercise thallium-201 single photon emission computed tomography (SPECT). Transthoracic Doppler echocardiography was performed in 110 patients with suspected coronary artery disease. Color Doppler signals of the left circumflex coronary artery flow in the apical four-chamber view were identified, and the velocities at rest and during hyperemia recorded for calculation of coronary flow reserve by the pulsed Doppler method. All patients underwent SPECT within 1 week of the transthoracic Doppler echocardiographic study. Coronary flow reserve in the left circumflex coronary artery was measured in 79 (72%) of 110 patients. SPECT revealed reversible perfusion defect in the left ...
2009-01-01
Methods. We aimed to clarify arteriosclerotic risk and to document possible relationships between cardiovascular risk factors and echocardiographic parameters in paediatric peritoneal dialysis (PD) patients. M-mode/Doppler/tissue Doppler echocardiographic studies and lipid/lipoproteins, homocysteine, high-sensitivity C-reactive protein (HS-CRP) levels and carotid intima-media thickness (CIMT) were determined in 59 patients (age: 14.2 +- 4.5 years) and in 36 healthy subjects. Results. Structural and functional cardiac abnormalities were observed in patients on maintenance dialysis. Increased left ventricular mass index (LVMI, P = 0.000), relative wall thickness (P = 0.000), myocardial performance index (MPI, P = 0.000) were documented in the patients. Lipoprotein (a) (P = 0.000), homocystei...
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective endocarditis of the aortic valve eventually resulting in coronary artery compression, stroke or rupture into the left atrium, aorta or pericardial space. A prompt diagnosis by either transthoracic or transesophageal echocardiography is mandatory to address the patient to cardiac surgery. We report the clinical case of a 25-year-old white man who was admitted to the emergency department for dyspnoea and fever. Echocardiographic examination showed a bicuspid aortic valve with a huge sessile vegetation and a pseudaneurysm of the mitral-aortic intervalvular fibrosa. In addition to conventional two-dimensional examination, three-dimensional echocardiography provided additional information of this complication, precisely delineating the lesions and addressing the cardiac surgeon in choosing the most appropriate operating strategy. Patient underwent then aortic root replacement and the pseudoaneurysm was closed by means of a bovine pericardial patch.
2007-01-01
Obesity is a worldwide phenomenon of epidemic proportions. It has been estimated that there are more than 300 million obese humans worldwide and greater than 2 million adult Australians who are clinically obese. Epidemiology studies have linked obesity to heart failure. Overweight and obesity are potent predictors of subsequent clinical heart failure in Framingham Heart Study. Previous studies reported abnormal left ventricular (LV) diastolic function without consistent association with systolic dysfunction. There is limited information on the right ventricular changes. There are various limitations in the previous studies. Some of the earlier findings may reflect the role of co-morbidities that contribute to LV dysfunction (e.g. hypertension, diabetes, coronary artery disease and obstructive sleep apnoea). Furthermore, most of the previous studies used conventional echo techniques based on Doppler flow and blood pool information which were less sensitive than current measures and more load-dependent (e.g. mitral inflow velocities, IVRT and EF). Comprehensive echo- Doppler assessment is absent from most studies. Using conventional echocardiographic techniques, clinical heart disease is only detected when gross structural changes or (less reliably) when poorly defined changes in LV filling have occurred, and patients are already at increased cardiovascular risk. Overall, early stages of obese heart disease are not well characterized, largely due to associated comorbidities related to obesity such as coronary artery disease, sleep apnoea and hypertension. The pathophysiology of obesity cardiomyopathy likely involves structural but subclinical changes. The overall hypothesis of the studies undertaken in this thesis was that sensitive new echocardiographic techniques can make a major contribution to the understanding of myocardial dysfunction at an early stage in the development of obese heart disease. Further, this thesis hypothesizes that these new technologies will facilitate the evaluation of novel diagnostic strategies, and allows selection of at risk populations for intervention and quantification of the response to treatments in patients with obese heart disease or early myocardial changes. The thesis initially reviews the clinical aspects and pathophysiology of obese heart disease, emphasizing the independent role of excess weight, which may be a target for intervention. This is followed by a discussion of the current state of the art in echocardiographic assessment myocardial function, and potential new approaches which might allow more sensitive tissue characterization. The third chapter describes the metabolic testing, biochemical, vascular assessment and the other methodologies used in this thesis, with particular attention to the quantitative assessment of vascular function and structure. In chapter 4, new quantitative measures of LV long-axis systolic function (tissue Doppler, strain imaging and ultrasound backscatter), and conventional echocardiography, were assessed in 109 patients across a range of BMI with normal ejection fraction and free of cardiac symptoms, and compared with 33 matched controls. Obese and overweight patients had increased LV mass, reduced LV systolic tissue velocity, strain and backscatter parameters indicating systolic dysfunction, and reduced early diastolic myocardial velocity in a dose dependent manner across BMI groups. The severely obese subgroup has the most marked abnormalities in all parameters. These results indicate that excess weight is associated with diastolic dysfunction in particular, which may represent the earliest abnormality in obese heart disease. In addition, new quantitative echocardiographic techniques appear to be useful for evaluating subtle abnormalities of myocardial function in obese heart disease. In Chapter 5, we used these new techniques to assess the relationship of the number of features of the metabolic syndrome to early myocardial dysfunction and cardiorespiratory fitness in patients with metabolic syndrome. We studied 393 patients without cardiac symptoms, and screened to exclude significant coronary artery disease.. Myocardial systolic (myocardial systolic velocity, strain rate) and diastolic measures (myocardial early diastolic velocity) were highest in controls and became progressively lower in proportion to the number of metabolic syndrome components. The MS contributed to the reduced systolic and diastolic function in those with normal LV mass index. LV measures of strain rate and myocardial diastolic velocity (em) were independent predictors of exercise capacity. It was therefore concluded that reduced myocardial function is an independent predictor of exercise capacity in patients with metabolic syndrome and those who additionally have subclinical myocardial abnormalities and reduced cardiorespiratory fitness should be considered a potential target for primary intervention. Chapter 6, we evaluated LV torsion and rotational velocities by the novel method of speckle tracking echocardiography (STE). STE was proposed as a sensitive marker of LV function. We sought to evaluate the LV rotational motion and untwisting in obese subjects in comparison with tissue Doppler imaging (TDI). We demonstrated otherwise healthy obese subjects to have reduced global LV torsion as well as reduced regional rotation at the base and diastolic rotational velocities at both the base and the apex. Reduced LV torsion and rotational velocities were present even in those whose longitudinal function was preserved, indicating that the former abnormalities occur prior to any impaired systolic longitudinal function and the higher sensitivity of STE in detection of early myocardial disease. These results showed that the new ultrasound technologies enabled more objective assessment of left ventricular function. In Chapter 6, we therefore sought whether similar information could be obtained from myocardial velocities and strain indices of the right ventricle in obese subjects. We also sought to identify the determinants of RV dysfunction in overweight and obese subjects. Quantitative echocardiographic techniques similar to those used in earlier chapters were applied to 93 ambulatory overweight and obese subjects. RV tissue velocities and strain indices were reduced in obese patients irrespective of the presence and severity of sleep apnoea independent of age, gender, and blood pressure. These changes were shown to be associated with fasting insulin, adiponectin levels and reduced exercise capacity. In parallel with effects of obesity on the myocardium, obesity has effects on the vasculature. In order to understand the roles of the Metabolic Syndrome (MS) on the vasculature, in chapter 7, we examined whether MS clustering had similar additive impact on vascular structure and function beyond the atherosclerotic risk factors clustering. Components of MS synergistically impact vascular changes in patients with MS, although the clustering of atherosclerotic risk factors remains a better risk prediction for subclinical arterial changes. Next, we sought the relative prevalence of vascular and myocardial sequelae of obesity and MS. In chapter 8, we further examined the prevalence and associations of coronary artery disease (CAD), subclinical LV dysfunction (LVD), LV hypertrophy (LVH) and early vascular changes in 521 asymptomatic obese and diabetic populations in our community. The risk of CAD and vascular changes were disproportionably associated with DM as compared with MS. Both LV hypertrophy and LV dysfunction were prevalent in both diabetes and obesity. Finally, in chapter 9, the quantitative echo techniques which were validated as sensitive markers of myocardial dysfunction in chapter 4 were applied, together with vascular imaging, in an interventional study of the effect of weight reduction on early myocardial and vascular changes. Following lifestyle interventions of exercise with dieting, obese patients with successful weight reduction demonstrated increases in myocardial diastolic function, reduced myocardial tissue density and improved brachial arterial reactivity. This Increase in myocardial function was in turn related to improved exercise capacity. The results demonstrate that modest weight reduction through lifestyle intervention can modify myocardial function in metabolic heart disease and may provide a specific primary prevention strategy against risk of heart failure development. Coverage: 2007-06-05T00:00:00Z
Obesity is a worldwide phenomenon of epidemic proportions. It has been estimated that there are more than 300 million obese humans worldwide and greater than 2 million adult Australians who are clinically obese. Epidemiology studies have linked obesity to heart failure. Overweight and obesity are potent predictors of subsequent clinical heart failure in Framingham Heart Study. Previous studies reported abnormal left ventricular (LV) diastolic function without consistent association with systolic dysfunction. There is limited information on the right ventricular changes. There are various limitations in the previous studies. Some of the earlier findings may reflect the role of co-morbidities that contribute to LV dysfunction (e.g. hypertension, diabetes, coronary artery disease and obstructive sleep apnoea). Furthermore, most of the previous studies used conventional echo techniques based on Doppler flow and blood pool information which were less sensitive than current measures and more load-dependent (e.g. mitral inflow velocities, IVRT and EF). Comprehensive echo- Doppler assessment is absent from most studies. Using conventional echocardiographic techniques, clinical heart disease is only detected when gross structural changes or (less reliably) when poorly defined changes in LV filling have occurred, and patients are already at increased cardiovascular risk. Overall, early stages of obese heart disease are not well characterized, largely due to associated comorbidities related to obesity such as coronary artery disease, sleep apnoea and hypertension. The pathophysiology of obesity cardiomyopathy likely involves structural but subclinical changes. The overall hypothesis of the studies undertaken in this thesis was that sensitive new echocardiographic techniques can make a major contribution to the understanding of myocardial dysfunction at an early stage in the development of obese heart disease. Further, this thesis hypothesizes that these new technologies will facilitate the evaluation of novel diagnostic strategies, and allows selection of at risk populations for intervention and quantification of the response to treatments in patients with obese heart disease or early myocardial changes. The thesis initially reviews the clinical aspects and pathophysiology of obese heart disease, emphasizing the independent role of excess weight, which may be a target for intervention. This is followed by a discussion of the current state of the art in echocardiographic assessment myocardial function, and potential new approaches which might allow more sensitive tissue characterization. The third chapter describes the metabolic testing, biochemical, vascular assessment and the other methodologies used in this thesis, with particular attention to the quantitative assessment of vascular function and structure. In chapter 4, new quantitative measures of LV long-axis systolic function (tissue Doppler, strain imaging and ultrasound backscatter), and conventional echocardiography, were assessed in 109 patients across a range of BMI with normal ejection fraction and free of cardiac symptoms, and compared with 33 matched controls. Obese and overweight patients had increased LV mass, reduced LV systolic tissue velocity, strain and backscatter parameters indicating systolic dysfunction, and reduced early diastolic myocardial velocity in a dose dependent manner across BMI groups. The severely obese subgroup has the most marked abnormalities in all parameters. These results indicate that excess weight is associated with diastolic dysfunction in particular, which may represent the earliest abnormality in obese heart disease. In addition, new quantitative echocardiographic techniques appear to be useful for evaluating subtle abnormalities of myocardial function in obese heart disease. In Chapter 5, we used these new techniques to assess the relationship of the number of features of the metabolic syndrome to early myocardial dysfunction and cardiorespiratory fitness in patients with metabolic syndrome. We studied 393 patients without cardiac symptoms, and screened to exclude significant coronary artery disease.. Myocardial systolic (myocardial systolic velocity, strain rate) and diastolic measures (myocardial early diastolic velocity) were highest in controls and became progressively lower in proportion to the number of metabolic syndrome components. The MS contributed to the reduced systolic and diastolic function in those with normal LV mass index. LV measures of strain rate and myocardial diastolic velocity (em) were independent predictors of exercise capacity. It was therefore concluded that reduced myocardial function is an independent predictor of exercise capacity in patients with metabolic syndrome and those who additionally have subclinical myocardial abnormalities and reduced cardiorespiratory fitness should be considered a potential target for primary intervention. Chapter 6, we evaluated LV torsion and rotational velocities by the novel method of speckle tracking echocardiography (STE). STE was proposed as a sensitive marker of LV function. We sought to evaluate the LV rotational motion and untwisting in obese subjects in comparison with tissue Doppler imaging (TDI). We demonstrated otherwise healthy obese subjects to have reduced global LV torsion as well as reduced regional rotation at the base and diastolic rotational velocities at both the base and the apex. Reduced LV torsion and rotational velocities were present even in those whose longitudinal function was preserved, indicating that the former abnormalities occur prior to any impaired systolic longitudinal function and the higher sensitivity of STE in detection of early myocardial disease. These results showed that the new ultrasound technologies enabled more objective assessment of left ventricular function. In Chapter 6, we therefore sought whether similar information could be obtained from myocardial velocities and strain indices of the right ventricle in obese subjects. We also sought to identify the determinants of RV dysfunction in overweight and obese subjects. Quantitative echocardiographic techniques similar to those used in earlier chapters were applied to 93 ambulatory overweight and obese subjects. RV tissue velocities and strain indices were reduced in obese patients irrespective of the presence and severity of sleep apnoea independent of age, gender, and blood pressure. These changes were shown to be associated with fasting insulin, adiponectin levels and reduced exercise capacity. In parallel with effects of obesity on the myocardium, obesity has effects on the vasculature. In order to understand the roles of the Metabolic Syndrome (MS) on the vasculature, in chapter 7, we examined whether MS clustering had similar additive impact on vascular structure and function beyond the atherosclerotic risk factors clustering. Components of MS synergistically impact vascular changes in patients with MS, although the clustering of atherosclerotic risk factors remains a better risk prediction for subclinical arterial changes. Next, we sought the relative prevalence of vascular and myocardial sequelae of obesity and MS. In chapter 8, we further examined the prevalence and associations of coronary artery disease (CAD), subclinical LV dysfunction (LVD), LV hypertrophy (LVH) and early vascular changes in 521 asymptomatic obese and diabetic populations in our community. The risk of CAD and vascular changes were disproportionably associated with DM as compared with MS. Both LV hypertrophy and LV dysfunction were prevalent in both diabetes and obesity. Finally, in chapter 9, the quantitative echo techniques which were validated as sensitive markers of myocardial dysfunction in chapter 4 were applied, together with vascular imaging, in an interventional study of the effect of weight reduction on early myocardial and vascular changes. Following lifestyle interventions of exercise with dieting, obese patients with successful weight reduction demonstrated increases in myocardial diastolic function, reduced myocardial tissue density and improved brachial arterial reactivity. This Increase in myocardial function was in turn related to improved exercise capacity. The results demonstrate that modest weight reduction through lifestyle intervention can modify myocardial function in metabolic heart disease and may provide a specific primary prevention strategy against risk of heart failure development.
2008-01-01
BackgroundSeptal myectomy in young patients with obstructive hypertrophic cardiomyopathy (HCM) can be performed with low mortality, and leads to excellent improvement in symptoms. Left atrial (LA) enlargement has been associated with exercise intolerance, severity of mitral regurgitation (MR), and left ventricular (LV) outflow tract (LVOT) obstruction in adults with HCM.MethodsYoung patients (1-22 years of age) who had a septal myectomy for obstructive HCM between 2002 and 2005 were identified. Retrospective analyses of premyectomy and postmyectomy echocardiograms were performed.ResultsIn this cohort of 32 patients (25 male), the average maximal LV wall thickness was 25 ± 9 mm and LVOT maximal instantaneous gradient was 106 ± 44 mm Hg. MR was present in all patients with a me...
Evaluation of left ventricular function by invasive and noninvasive methods
1982-06-01
Noninvasive methods in cardiology have progressed very rapidly in recent years. Cardiac catheterization and angiocardiography are the standard methods for evaluating of cardiac performance, however, they need expensive apparatus and are time-consuming, arduous procedures which do not permit to repeat frequently, and sometimes risky. In this article, the indices of pump and muscle function of the heart obtained by invasive methods were compared to those indices obtained by noninvasive methods, and correlation between two groups and usefulness and limitation were discussed. Systolic time intervals are convenient and repeatable measures of left ventricular performance in clinical cardiology. There are significant correlations of PEP/LVET with stroke volume, ejection fraction and mean circumferential shortening velocity. Although some limitations are present in application of this method to certain diseases, these measures are useful in the evaluation of left ventricular performance. Echocardiography has made an era of the noninvasive cardiology. Left ventricular volume, ejection fraction, mean circumferential shortening velocity and PSP/ESVI are accurately calculated by echocardiographic measurement. Nuclear cardiology is also accurate noninvasive method in evaluation of cardiac performance. With this tremendous growth in this field, it will make next era of noninvasive cardiology.
2009-03-01
Full Text Available.Objectives. This longitudinal study investigated survival, risk factors and causes of death in the multicentre ItinérAIR-Sclérodermie cohort of patients with SSc without severe pulmonary fibrosis or severe left heart disease at baseline.Methods. At 3-year follow-up, vital status was obtained from investigators or French national death records. Causes of death were classified as SSc-related or otherwise. Data were censored at 37 months, time of death or loss to follow-up, whichever was earlier. Survival was estimated using the Kaplan–Meier method. Multivariate survival analyses were conducted using the Cox model.Results. In total, 546 patients were followed for a median duration of 37 months, representing 1547 patient-years. At baseline, the majority of patients were female, with lcSSc, mean age 54.9 ± 13.0 years and mean duration of SSc of 8.8 ± 8.1 years. In total, 47 patients died, giving a 3-year survival of 91.1% and cumulative mortality of 3.04 deaths per 100 patient-years; 17 deaths (32.2%) resulted from pulmonary arterial hypertension (PAH) and eight (17.1%) from cancer. Of the 47 patients with PAH at baseline, 20 died during follow-up, giving a 3-year survival of 56.3%. In a multivariate analysis, PAH [hazard ratio (HR) 7.246], age at first symptom (HR 1.052), duration of SSc (HR 1.047 per year) and Rodnan skin score (per one point) (HR 1.045) were associated with increased mortality.Conclusion. This 3-year study observed survival and mortality estimates that were comparable with previous reports. PAH increased the HR for mortality in patients with SSc, justifying yearly echocardiographic screening.
1981-09-01
Echocardiographic and computed tomographic findings of a case of intrapericardial tumor are reported, and two other cases of mediastinal tumor are presented in a discussion of the differential diagnosis of intrapericardial from mediastinal tumors. Case report: A 7-year-old male complained of cough and dyspnea. Cardiomegaly had been pointed out at a mass X-ray examination about a month prior to the admission. Two-dimensional echocardiography revealed a massive anterior pericardial effusion and a fist-sized tumor with cystic structure. The tumor pushed the heart backward at the level of the aortic root. Non-gated computed tomography of the chest disclosed the size and location of the tumor, but failed to clarify the internal structure. The patient underwent successful removal of a tumor, 12 x 10 x 8 cm in size and 350 g in weight, originating from the left atrial wall. Histologically, the tumor was a fibrosarcomatous mesothelioma. Usually, an intrapericardial tumor is easily suspected by echocardiography by the presence of pericardial effusion, although there have been a few reports of intrapericardial tumors without pericardial effusion. Echocardiographic diagnosis of the intrapericardial tumor is difficult in such cases. Identification of the pericardium is necessary to diagnose whether a tumor is intra- or extrapericardial. This identification, however, is not always easy by echocardiography when the ultrasonic beams become tangent to the pericardium. The pericardium between the tumor and the heart could not be identified by echocardiography in our two cases of mediastinal tumor. Computed tomography is helpful in diagnosing the size and location of a mediastinal tumor.
OBJECTIVES: This study investigated whether echocardiographic Fourier phase and amplitude imaging can be used to evaluate ischemia-related regional wall asynergy. BACKGROUND: Because myocardial ischemia delays the onset and peak of endocardial inward motion and reduces its magnitude, Fourier phase and amplitude analysis of two-dimensional echocardiograms may be used to evaluate regional wall motion abnormalities objectively by analyzing temporal sequence and magnitude of endocardial motion. METHODS: Digital cine loops of left ventricular long- and short-axis views were obtained in six anesthetized dogs at baseline and 1 to 30 min after coronary microembolization and were mathematically transformed using a first-harmonic Fourier algorithm to obtain phase angles and amplitudes of endocardial segments. Mean phase angles and amplitudes were compared with visual wall motion analysis based on a scoring system and quantitative analysis based on segmental fractional area shortening derived from planimetry. RESULTS: Microembolization delayed segmental phase angles by 47 +/- 44 degrees in mild to moderate hypokinesia (fractional shortening [mean +/- SD] 41 +/- 13%) and by 77 +/- 63 degrees in severe hypokinesia (fractional shortening 13 +/- 5%) and reduced segmental amplitudes from 80 +/- 36 gray level intensity at baseline to 53 +/- 34 in segments developing mild to moderate hypokinesia, and from 93 +/- 36 to 35 +/- 28 gray level intensity in segments developing severe hypokinesia. Shifts in segmental phase angles correlated better with dynamic shifts in segmental fractional area shortening than did changes in wall motion score (r = -0.65 vs. r = 0.52, p < 0.001). CONCLUSIONS: Echocardiographic Fourier phase imaging can be used to evaluate ischemia-related regional wall asynergy, displaying contraction sequence and magnitude in a simple, objective format.
The Effects of beta-adrenergic antagonists in patients with heart failure
1997-01-01
Background Congestive heart failure is a common clinical syndrome, the incidence and prevalence of which appear to be increasing. Mortality and morbidity remain high despite major advances in the understanding of the pathophysiology and management of heart failure over recent years. Consequently there is a need for further therapies which can improve the outlook for patients with heart failure. The beta-blockers have traditionally been contraindicated in patients with heart failure. However, there is a strong rationale for using these agents in addition to the ACE inhibitors. The aims of this thesis were several fold. Firstly, to determine the magnitude of the problem which heart failure represents in New Zealand. Secondly, to determine the effects of beta-blockers, on LV size and function, symptoms, and exercise tolerance in patients with heart failure due to ischaemic heart disease. Finally, to conduct a systematic overview to determine the effects of beta-blockers on total mortality in patients with heart failure. Methods Data were obtained from the New Zealand Health Information Service regarding hospitalisations and deaths due to heart failure in New Zealand. A randomised, placebo-controlled trial of the effects of carvedilol, a vasodilator beta-blocker, was carried out in 20 hospitals in Australia and New Zealand. In this study patients with heart failure due to ischaemic heart disease were randomised to either carvedilol or placebo in addition to their usual treatment. An echocardiographic substudy was carried out in 10 of the 20 centres. The aims of this substudy were to determine the effects of carvedilol on left ventricular size and function, using quantitative 2D-echocardiography. Finally, the effects of beta-blockers on total mortality was examined in a systematic overview. Results The data regarding heart failure in New Zealand showed that each year there were an average of 8000 hospital admissions each year of 5000 patients with heart failure. In addition, there were at least 850 deaths each year directly related to heart failure. The cost associated with the hospital admissions was estimated at NZ$50 million per year, or 1% of the total health budget in New Zealand. The ANZ carvedilol study demonstrated firstly, that carvedilol is well tolerated in patients with heart failure due to ischaemic heart disease. Left ventricular ejection fraction improved compared with placebo treated patients and left ventricular size was reduced when assessed by M-mode echocardiography. Despite these improvements in left ventricular function, symptoms and exercise tolerance were unchanged. However, there was a reduction in a combined end-point of death or hospital readmission in the carvedilol group compared with placebo. The 2D-echocardigraphy substudy demonstrated that carvedilol reduced both end-diastolic and end-systolic volumes and prevented the progressive LV dilatation which occurred in the placebo group. These changes occurred with the improvement in LV ejection fraction which had previously been reported. In addition to these favourable effects on LV size and function, left ventricular regional wall motion was improved. The overview of 24 randomised trials involving 3141 patients showed that beta-blocker therapy reduced total mortality by 31% compared with control. Conclusions Firstly, the NZ data has confirmed that heart failure remains a major public health problem in New Zealand. The ANZ Carvedilol Trial has shown the carvedilol is safe and well tolerated in patients with heart failure due to ischaemic heart disease. Carvedilol improved left ventricular ejection fraction, reduced left ventricular volumes and improved left ventricular regional wall motion. In addition, carvedilol reduced death or hospital readmission but had little effect on symptoms or exercise tolerance. The results from the meta-analysis have shown that beta-blocker therapy reduced total mortality by approximately one-third. Such data support the use of beta-blockers in addition to ACE inhibitors in the treatment of patients with heart failure. However, further randomised, controlled trials are required to reliably determine the effects of beta-blockers in different patient subgroups, such as the elderly and those with more severe heart failure, as well as the effects on total mortality before such therapy can be recommended for widespread use in all patients with heart failure.Whole document restricted, but available by request, use the feedback form to request access. Publisher: ResearchSpace@Auckland Language: en Rights: Whole document restricted but available by request. Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.; http://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm; Copyright: The author
Coexistent transient pulmonary edema and pericardial effusion
1988-09-01
Eight (23%) of 35 children with acute pericardial effusions due to infection or juvenile rheumatoid arthritis (JRA) had associated transient pulmonary edema demonstrated on plain chest radiographs. The presence or absence of radiographic pulmonary edema correlated well with clinical and hemodynamic parameters in patients with JRA but not in those with infectious pericarditis. There was no definite relationship between radiographic edema and amount of pericardial fluid as estimated echocardiographically or removed at pericardiocentesis. Rapidity of pericardial fluid accumulation could not be assessed in this study. Children of young age with underlying JRA were the most likely subjects to have radiographic pulmonary edema in conjunction with an acute pericardial effusion.
Coexistent transient pulmonary edema and pericardial effusion
1988-01-01
Eight (23%) of 35 children with acute pericardial effusions due to infection or juvenile rheumatoid arthritis (JRA) had associated transient pulmonary edema demonstrated on plain chest radiographs. The presence or absence of radiographic pulmonary edema correlated well with clinical and hemodynamic parameters in patients with JRA but not in those with infectious pericarditis. There was no definite relationship between radiographic edema and amount of pericardial fluid as estimated echocardiographically or removed at pericardiocentesis. Rapidity of pericardial fluid accumulation could not be assessed in this study. Children of young age with underlying JRA were the most likely subjects to have radiographic pulmonary edema in conjunction with an acute pericardial effusion. (orig.)
2010-01-01
Abstract Although J2N-k strain of cardiomyopathic hamsters is an excellent model of dilated cardiomyopathy, the presence and mechanisms of apoptosis in the hearts of these genetically modified animals have not been investigated. This study examined the hypothesis that cardiac dysfunction and apoptosis in the cardiomyopathic hamsters were associated with tumour necrosis factor-alpha (TNF-a)-mediated signalling pathway involving the activation of some pro-apoptotic proteins and/or deactivation of some antiapoptotic proteins. Echocardiographic assessment of 31-week-old hamsters indicated an increase in the internal dimension of the left ventricle as well as decreases in the ejection fraction, fractional shortening and cardiac output without any evidence of cardiac hypertrophy. Increased level...
2009-01-01
Objective: Based on the adverse relationship between left ventricular (LV) remodeling and clinical outcome in ischemic cardiomyopathy, surgical ventricular restoration (SVR) is proposed as a valuable adjunct procedure. This study reports on the short-term clinical and hemodynamical performance of SVR. Methods: Using end-systolic LV volume as indication for SVR, 78 patients with ischemic cardiomyopathy are divided in two groups: group 1 comprised 55 patients treated by coronary revascularization and mitral annuloplasty, group 2 comprised 23 patients undergoing additional SVR. Hemodynamic investigation included echocardiographic assessment of systolic and diastolic function. Clinical follow-up focused on survival and functional status with exercise performance. Results: Both surgical approac...
We present an unusual case of cardiomyopathy in a two month old male infant with a grade-I systolic murmur. Echocardiographic examination disclosed left ventricular (LV), dysplasia with saw-tooth like inwards myocardial projections extending from the lateral walls towards the LV cavity. There was mild LV systolic dysfunction with apical hypokinesia. Cardiovascular magnetic resonance demonstrated in detail these cross bridging muscular projections originating from the inferior interventricular septum and lateral LV wall, along with areas of hypokinesis at the LV septum and apex in a noncoronary distribution, without any late gadolinium enhancement. We have termed this condition saw-tooth cardiomyopathy because of the very characteristic appearance.
Full Text Available.We present an unusual case of cardiomyopathy in a two month old male infant with a grade-I systolic murmur. Echocardiographic examination disclosed left ventricular (LV), dysplasia with saw-tooth like inwards myocardial projections extending from the lateral walls towards the LV cavity. There was mild LV systolic dysfunction with apical hypokinesia. Cardiovascular magnetic resonance demonstrated in detail these cross bridging muscular projections originating from the inferior interventricular septum and lateral LV wall, along with areas of hypokinesis at the LV septum and apex in a noncoronary distribution, without any late gadolinium enhancement. We have termed this condition saw-tooth cardiomyopathy because of the very characteristic appearance.
1986-02-01
Equilibrium radionuclide angiocardiography (ERNA) was performed at rest in 30 patients with chronic respiratory failure (CRF) in order to evaluate right ventricular performance and wall motion. The usual indices of left ventricular performance were also recorded and correlated with right ventricular parameters. Only CRF patients without clinical, electrocardiographic or echocardiographic criteria suggestive of congenital, valvular, hypertensive or ischemic heart disease were studied. A RV dyskinesis was detected in 5 of the 30 patients, occuring however only in stage II-III CRF, as if a longstanding RV pressure overload were necessary for a RV dyskinesis to develop. No significant differences were found between patients with and without RV dyskinesis for all the functional ERNA parameters (i.e. LVEF, RVEF, PER, PFR). On the other hand, a significant correlation between the stage of the CRF and RVEF was observed.
2000-01-01
It is likely that a close association exists between findings obtained by two methods: dobutamine stress echocardiography and 123I-MIBG scintigraphy. Both of these methods are associated with beta-adrenergic receptor mechanisms. This study was conducted to demonstrate the relation between myocardial response to dobutamine stress and sympathetic nerve release of norepinephrine in the failing heart. In 12 patents with heart failure due to idiopathic dilated cardiomyopathy, the myocardial effects of dobutamine stress were evaluated by low-dose dobutamine stress echocardiography. And sympathetic nerve function was evaluated by scintigraphic imaging with iodine-123[123I]meta-iodobenzylguanidine (MIBG), an analogue of norepinephrine. Echocardiography provided quantitative assessment of wall motion and left ...
2008-01-01
Background Recently, a novel real-time 3-dimensional (3D) matrix-array transesophageal echocardiographic (3D-MTEE) probe was found to be highly effective in the evaluation of native mitral valves (MVs) and other intracardiac structures, including the interatrial septum and left atrial appendage. However, the ability to visualize prosthetic valves using this transducer has not been evaluated. Moreover, the diagnostic accuracy of this new technology has never been validated against surgical findings. This study was designed to (1) assess the quality of 3D-MTEE images of prosthetic valves and (2) determine the potential value of 3D-MTEE imaging in the preoperative assessment of valvular pathology by comparing images with surgical findings. Methods Eighty-seven patients undergoing clinically i...
Radiological and clinical features of the single ventricle
1983-03-01
The case a twenty year old patient is reported, whose chest X-ray demonstrated cardiomegaly with a prominent pulmonary segment. The echocardiographical examination indicated a single ventricle with septal rudiments; heart catherization confirmed the diagnosis of a single ventricle of the right ventricular type with a well-sized left ventricular outlet chamber and the banding of the pulmonary artery. In addition the case of a 17 year old patient is reported, whose chest X-ray demonstrated dextrocardia. Clinical manifestations (cyanosis, elevated hemoglobin, clubbing, 3rd heart sound) as well as one- and two-dimensional echocardiography with echocontrast media confirmed the diagnosis of corrected transposition of the great arteries, pulmonary stenosis and incompetence, single ventricle and dextrocardia, a diagnosis made already 12 years ago by heart catherization.
Predictors of early readmission or death in elderly patients with heart failure
2010-01-01
Background: Contemporary heart failure (HF) patients are elderly and have a high rate of early rehospitalization or death, resulting in a high burden for both the patients and the health care system. Prior studies were focused on younger and less well-characterized patients. We aimed to identify predictors of early hospital readmission and death in elderly patients with HF. Methods: Patients with chronic HF taking part in the TIME-CHF study (n = 614, age 77 +/- 8 years, 41% female, left ventricular ejection fraction 35% +/- 13%) were evaluated with respect to predictors of hospital readmission or death 30 and 90 days after inclusion. Demographic, clinical, laboratory, echocardiographic, and social variables were obtained at baseline and included in a multivariable logistic regression analy...
Novel epicardial off-pump device for mitral regurgitation: acute evaluation
2010-01-01
Objective: This study evaluates the ability of a novel epicardial annuloplasty device Mitral Touch (MAQUET Cardiovascular LLC, San Jose, CA, USA) to reduce functional mitral regurgitation (MR) in a rapid ventricular pacing-induced dilated cardiomyopathy model in dogs. Methods: A median sternotomy was performed in 13 dogs after MR induction by rapid ventricular pacing (230 beats/min for an average of 35.6+/-12.8 days). Two-dimensional epicardial echocardiographic and haemodynamic measurements were performed to evaluate the baseline MR grade, the septal-lateral (S-L) dimension of the mitral annulus, mitral valve (MV) geometry and left ventricular function. The Mitral Touch was implanted by sliding the anterior arm onto the floor of the transverse sinus and positioning the posterior arm just ...
2010-01-01
Background The mechanism of sudden death in hypertrophic cardiomyopathy (HCM) is ventricular tachyarrhythmia emanating from myocyte disarray, fibrosis, and inhomogeneity in intramyocardial activation. Tissue synchronization imaging (TSI) allows the measurement of regional delay, while two-dimensional strain can be used to identify myocardial fibrosis. The aim of this study was to assess the relationship between new ultrasonically derived parameters and nonsustained ventricular tachycardia (NSVT) in patients with HCM. Methods Ninety-three patients with HCM (mean age, 36 +- 16 years) and 30 patients with hypertension with secondary left ventricular (LV) hypertrophy (mean age, 42 +- 10 years; 65% men) were studied. All underwent standard echocardiographic, TSI, and two-dimensional strain exam...
2010-01-01
Background: Doppler derived strain analysis has been shown to be angle dependent. Speckle tracking analysis using 2D echocardiographic images is thought to provide angle independent parameters of regional and global myocardial function. This study sought to evaluate whether myocardial circumferential strain and rotation derived from automatic frame-by-frame tracking of natural acoustic markers is dependent on angulation of the transducer. Methods: In 48 healthy volunteers (mean age 36 +- 3 years, 20 male) parasternal short-axis views at apical level were obtained as follows: at the standard parasternal position (5th intercostal space) with a most possible circular short-axis image of the left ventricle (angulation 1), at an angulation of the transducer by 20degree from this standard positi...
2010-01-01
Aims To evaluate the impact of high altitude on cardiac morphology and function in patients with coronary artery disease (CAD) and healthy controls. Methods and results Eight patients with a history of acute myocardial infarction [53 +- 8 years, left ventricular (LV) ejection fraction 54 +- 6%] and a low risk score were compared with seven healthy controls (41 +- 16 years) during the Dutch Heart Expedition 2007 at the Aconcagua (6960 m) in Argentina. An exercise test and echocardiography were performed at sea level and at base camp (4200 m). In the apical four-chamber view, right ventricular (RV) diameter, tricuspid annular plane systolic excursion (TAPSE), early transmitral inflow peak velocity (E), atrial transmitral inflow peak velocity (A), and peak tissue velocity during early diastol...
2006-01-01
Mitral regurgitation (MR) is common in patients with congestive heart failure (CHF) and has adverse effects on prognosis. In view of the altered hemodynamics in CHF, we examined the accuracy of auscultation for its detection in CHF with reduced systolic function. We examined 370 patients on stable heart failure therapy enrolled in our CHF clinic, if they had a physical examination by one of the two senior cardiologists and an echocardiogram within 2 weeks after the physical examination. The MR murmur was graded 0 to 6 on physical examination. MR was graded 0 to 4 on echocardiography using standard echocardiographic criteria. The left ventricular (LV) ejection fraction was 21 ± 12% and age was 65 ± 15 years. By echocardiography MR was present in 345 patients (94%), being 1�...
2009-01-01
The aim of this study was to determine whether there are differences in echocardiographic findings or in the level of a biochemical marker (ie, N-terminal probrain natriuretic peptide [NT-proBNP]) between controls and type-2 diabetic patients with or without ischemic heart disease. Echocardiography was used to assess left ventricular function and morphology. In addition, the plasma NT-proBNP concentration was measured. The prevalence of diastolic dysfunction was greater in diabetics without ischemic heart disease than in controls (88% vs 74%, respectively; P490 fmol/mL had a sensitivity of 84% and a specificity of 75% for detecting ischemic heart disease in diabetics.
2010-01-01
Background: The distribution of left ventricular ejection fraction (LVEF) - a key factor in coronary artery disease (CAD) patient management and prognostication - is poorly documented. Objective: To determine LVEF and heart rate (HR) values, and describe the management of stable CAD patients in France. Methods: The INDYCE survey was a prospective, multicentre registry of consecutive stable CAD outpatients attending a cardiology consultation. The survey focused on LVEF values measured using the echocardiographic Simpson biplane method. Drug therapy, resting HR, blood pressure and symptoms were also recorded. Results: Overall, 3119 patients (68.4+/-11.0years; 80% men) were enrolled. LVEF was 56.1+/-11.8% on average, and was poor (
2010-01-01
Abstract Left ventricular (LV) diastolic function is important because the enhanced systolic function that underpins high levels of cardio-respiratory fitness has to be matched by changes in LV filling, and LV diastolic dysfunction plays a key early role in the development and progression of a myriad of cardiovascular diseases. This review serves to detail knowledge in relation to: (1) the definition of diastole and the mechanical processes that occur during the diastolic period, (2) the quantitative assessment of diastolic function, predominantly focusing on non-invasive echocardiographic imaging modes such as tissue Doppler imaging and deformation analysis, (3) the impact of acute aerobic exercise on diastolic function, from the augmentation of function necessary to meet the demand for a...
Detection of mechanical ventricular asynchrony by high temporal resolution cine MRI
2008-01-01
The purpose was to assess the feasibility of high temporal resolution cine MRI (HTRC-MRI) to detect and to quantify mechanical ventricular asynchrony in patients with left bundle branch block (LBBB). Inter- and intraventricular delays were quantified by HTRC-MRI in 32 patients with (n=17) and without (n=15) LBBB. In patients with LBBB, delays by HTRC-MRI were correlated with echocardiographic parameters using pulsed wave Doppler echocardiography (PW-Echo) and tissue Doppler imaging (TDI-Echo). The interventricular delay by HTRC-MRI was 110+-50 ms in patients with and -1+-18 ms in patients without LBBB (P+-86 ms in patients with compared to 40+-49 ms in patients without LBBB (P
Comparison of two visual angiographic perfusion grades in acute myocardial infarction
2009-01-01
Introduction. Prognosis after opening the obstructed coronary artery in acute myocardial infarction (AMI) is influenced by several factors. In routine clinical practice, revascularization is considered to be successful when the restoration of epicardial blood-flow is complete. However, the patent epicardial artery does not always provide functional recovery in the myocardium. There are two visual angiographic grades to assess myocardial perfusion: myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMP). The aim of our study was to compare these two parameters, how they correlate with short-term indicators of myocardial damage. Patients and methods. The two visual grades were assessed along with enzymatic infarct size as creatine kinase release (CK), echocardiographic left ve...
2010-01-01
Objective Congenital bicuspid aortic valves frequently cause aortic stenosis or regurgitation. Improved understanding of valve and root biomechanics is needed to achieve advancements in surgical repair techniques. By using imaging-derived data, finite element models were developed to quantify aortic valve and root biomechanical alterations associated with bicuspid geometry. Methods A dynamic 3-dimensional finite element model of the aortic root with a bicuspid aortic valve (type 1 right/left) was developed. The models geometry was based on measurements from 2-dimensional magnetic resonance images acquired in 8 normotensive and otherwise healthy subjects with echocardiographically normal function of their bicuspid aortic valves. Numeric results were compared with those obtained from our pre...
Acute Ischemic Stroke in a Patient with a Native Valvular Strand
2010-01-01
Abstract Valvular strands are known to be a potential source of cardioembolism but the natural history of native valvular strands has not yet been fully outlined. We report a case of ischemic stroke in a patient with a native valvular strand of the aortic valve and the patient's clinical course. A previously healthy 21-year-old man suffered acute cerebral infarction in the right posterior cerebral artery territory. On echocardiography, there was a strand-like, oscillating mass on the left coronary cusp of the aortic valve. The patient received 100 mg aspirin daily and the valvular strand was not found on subsequent transthoracic echocardiography performed 10 days after the first examination. Serial echocardiographic examinations have been performed since the stroke and failed to find any a...
1995-09-01
Chronic {beta}-blocker therapy improves hemodynamics and cardiac function in patients with idiopathic dilated cardiomyopathy. However, the change in myocardial uptake of I-123 metaiodobenzylguanidine ({sup 123}I-MIBG) before and after treatment has not been determined. Myocardial imaging with {sup 123}I-MIBG was performed before and 2 or 3 months after {beta}-blocker (bisoprolol) therapy in 11 patients with dilated cardiomyopathy. The following parameters were compared before and after the treatment : (1) New York Heart Association functional class, (2) X-ray cardiothoracic ratio, (3) heart rate and blood pressure, (4) echocardiographic data (left ventricular end-diastolic and end-systolic diameters, and left ventricular ejection fraction), (5) plasma concentrations of epinephrine, norepinephrine and human atrial natriuretic peptide (HANP), and (6) exercise tolerance time by treadmill. The heart-to-mediastinum ratio of {sup 123}I-MIBG activities obtained 3 hours after intravenous injection (late H/M) and washout rate improved significantly after {beta}-blocker therapy. Cardiothoracic ratio, heart rate, echocardiographic parameters, HANP and exercise tolerance also improved significantly. Late H/M had no significant relationship with any of the clinical parameters, but washout rate was significantly related to left ventricular ejection fraction. These findings suggest that washout rate may be useful to assess the effect of short-term {beta}-blocker therapy in dilated cardiomyopathy patients. (author).
2007-01-01
Introduction Transthoracic echocardiography (TTE) is gaining acceptance as a powerful diagnostic tool in critical illness. It can assess left ventricular (LV) volumes, as well as indices of ventricular filling pressure (including the ratio of mitral E velocity/mitral annular velocity [E/E']). TTE evidence of raised filling pressure is associated with mortality following myocardial infarction but its prognostic value in critical illness is undefined. The aim of this study was to evaluate the prognostic significance of echo-cardiographic LV volumes and filling pressure in the critically ill. Methods A consecutive group of 94 patients (66 males, mean ± SD age 61 ± 15 years) who had standard TTE supplemented by measurement of E/E' in a tertiary referral ICU were enrolled. TTE was performed 5 ± 6 days after ICU admission. Severity of critical illness was assessed using APACHE III. Cox proportional hazards regression analysis was based on 28-day mortality from the date of echo with survivors censored on hospital discharge. Results The mean APACHE III score was 72 ± 25. Hospital mortality was 33% (n = 31). Table 1 summarises correlates of 28-day mortality. The independent predictors of mortality were APACHE III risk of hospital death (HR 1.3 (1.1–1.5), P = 0.003), and increased LV end systolic volume (HR 2.1 (1.2–3.7), P = 0.007). Indices of ventricular filling pressure (E/E', left atrial area/volume) were not predictors of mortality. Conclusion In this cohort of critically ill patients, increased echocardiographic LV end systolic volume, but not filling pressure, is a highly significant predictor of mortality that adds incremental value to APACHE III prediction. Publisher: BioMed Central Coverage: 2007-01-01T00:00:00Z
Transient left ventricular dysfunction in Churg Strauss syndrome: a case report.
A 42 year old woman was admitted to our hospital for investigation of eosinophilia. There were no findings from the physical examination of the lungs and heart. The echocardiography showed a segmental hypokinesia of the interventricular septum and the apex causing left ventricular dysfunction with an ejection fraction 45% and mild pericardial effusion. Cardiac magnetic resonance was performed, for detection of lesions associated with the underline disease, using electrocardiogram-triggered T2-weighted and T1-weighted multislice spin-echo images (before and after an intravenous bolus of gadolinium).The analysis of T2-weighted images revealed increased signal on the mid part of interventricular septum, suggesting myocardial oedema. In the delayed-enhanced images, areas of late phase gadolinium enhancement (indicative of fibrosis) were identified in the mid part of interventricular septum. Methylprednisolone therapy was started. The patient had follow-up echocardiographic examination every month and on sixth month improvement of left ventricular dysfunction was shown with an ejection fraction 55%.In conclusion our case is a typical Churg Strauss Syndrome with characteristic myocardial involvement which improved after corticosteroid treatment. The cardiac magnetic resonance has significant role for early and accurate detection and differentiation of myocardial damage even in preserved cardiac wall motion and cavity size.
Quality of life, dyspnea and ventricular function in patients with hypertension
2010-01-01
palhares l.c., gallani m.-c.b.j., gemignani t., matos-souza j.r., ubaid-girioli s., moreno h. jr, franchini k.g., nadruz w. jr &rodrigues r.c.m. (2010) Quality of life, dyspnea and ventricular function in patients with hypertension. Journal of Advanced Nursing 66(10), 2287-2296. Abstract Aim. This paper is a report of an investigation of the relationship between health-related quality of life and left ventricular function among patients with hypertension who did not fulfil the criteria for heart failure. Background. Heart failure is a common consequence of hypertension, with Doppler echocardiography being the gold-standard tool to evaluate left ventricular function, mainly hypertension-induced left ventricular damage. Echocardiographic data indicating poorer ventricular function have been ...
2008-01-01
The aim of this study was to determine whether the extent of late gadolinium enhancement (LGE) is associated with left ventricular (LV) function in patients with hypertrophic cardiomyopathy (HCM). Forty-seven patients with HCM (35 males, mean age 53+-14, 14 with LV outflow tract obstruction) underwent cardiovascular magnetic resonance imaging and comprehensive echocardiographic examination. The extent of LGE was expressed as LGE volume and LGE percentage of LV volume. LGE was present in 40 (85.1%) of 47 patients. The mean LGE volume was 36.5+-36 cm3, and the mean percentage of LV volume was 16.4+-17%. Following adjustment for age, mitral regurgitation and LV mass index, LGE volume and percentage positively correlated with the left atrial volume index (r=0.388, p=0.009 and r=0.425, p=0.004, respectively). However, ...
2010-01-01
Background Percutaneous transvenous mitral commissurotomy (PTMC) is an effective treatment for mitral stenosis, but transseptal puncture carries a certain risk of complications. Our previous report has shown the effectiveness of phase-array intracardiac echocardiography (ICE)-guided transseptal puncture in patients with dilated left atrium undergoing PTMC. However, there are few reports comparing the new-generation mechanical versus phase-array ICE-guided transseptal puncture in PTMC. Methods Between March 2007 and March 2008, 6 consecutive patients with symptomatic mitral stenosis with dilated left atrium (range, 4.1-6.1 cm) underwent transseptal puncture by mechanical ICE guidance in PTMC by the same experienced operator. The procedural, echocardiographic and clinical results were retros...
The effects of coronary artery surgery on left ventricular performance were assessed serially by echocardiography and treadmill exercise testing in 54 patients. Patients were assessed one day before operation and again before patients left hospital (mean 10 days after operation) and one month and six months after operation. At the predischarge assessment, 41 (77%) patients showed new abnormalities of left ventricular segmental wall movement, chiefly anteroseptal hypokinesia with hyperkinesia of the posterolateral segment. Although there were no significant changes in anteroseptal wall thickening after operation, there was a significant increase in posterior wall thickening at all postoperative assessments. The frequency of this abnormality decreased progressively after operation; it persisted in 19 (35%) patients at six months. Left ventricular fractional shortening decreased after operation and at one month was significantly less than before operation. There were no significant changes in left ventricular diastolic diameter during the study. Haemodynamic function during exercise, the duration of exercise, and features of reversible myocardial ischaemia all improved progressively and significantly after coronary artery surgery. Abnormalities in left ventricular segmental wall movement and thickening commonly develop early after coronary artery surgery but tend to resolve by six months and do not seem to impair left ventricular contractility at rest or exercise performance and haemodynamic function. Recognition of these echocardiographic changes may be clinically important in the assessment of patients after cardiac surgery.
Applications of magnetic resonance imaging in the assessment of left ventricular dysfunction
2002-07-01
This thesis has described the use of Magnetic Resonance Imaging (MRI) in the investigation of left ventricular dimensions and systolic function. This has been performed in conditions of left ventricular dysfunction, in congestive cardiac failure and following anterior myocardial infarction. The reproducibility of measurements of left ventricular dimensions using MRI has been presented. Such measurements were shown to be reproducible between different MRI studies of normal volunteers and patients with congestive heart failure. Furthermore, measurements from different MRI studies obtained from two commercially different systems were reproducible for the same subject groups. Ventricular dimensions and systolic function was evaluated in adult normal volunteers of different ages. Although left ventricular volumes and mass remained unchanged, detailed studies of the systolic images revealed significant differences between the two age groups. Differences in left ventricular cavity volumes and mass between patients with congestive heart failure and age-matched normal volunteers were also investigated. Left ventricular volumes and myocardial mass were assessed in a group of patients following anterior myocardial infarction. End-systolic volume was significantly increased compared to age-matched volunteers, but no changes in end-diastolic volume or myocardial mass was observed. Serial re-evaluation of these patients revealed no other changes over the subsequent six months. All these patients were treated with optimal medical therapy (thrombolysis, aspirin, beta-blockade and angiotensin converting enzyme inhibition). Thus, the use of this therapy may attenuate the process of left ventricular remodelling. Regional wall thickness was measured in the post-infarct patients. Wall thickening was significantly reduced both in the infarcted regions and in myocardium remote to the infarction. In contrast to previous echocardiographic studies, no 'hypercontractility' was observed at any stage over the study period. Furthermore, neither infarcted or remote myocardium demonstrated full recovery back to normal. (author)
OBJECTIVE: Long-term survivors of asymptomatic children treated with anthracycline may have cardiac toxicity without clinical findings. The subclinical cardiac toxicity could be evaluated by dobutamine stress echocardiography (DSE) with exploring effective and safe doses of dobutamine. METHODS: Twenty asymptomatic survivors (mean age: 19.2+/-4.0 years) treated with cumulative dose of 282.1+/-125.9 mg/m2 of anthracycline were compared with 18 age-matched healthy volunteers. Total time completed this treatment was 10.2+/-2.2 years. This was a cross-sectional case-controlled study and patient and control groups were evaluated at the time of routine appointments. Echocardiographic studies were performed before and after each dobutamine infusion of 5, 10, 15, 20 microg/kg/min. Statistical analysis: Mann-Whitney U test was used to evaluate the difference between the groups. ANOVA for repeated measurements test was used to compare each measurement of control and patients groups and Bonferroni posthoc test was used for correction. RESULTS: Hemodynamic changes are observed at the dobutamine doses of 15 microg/kg/min in the patient group. Before dobutamine infusion in the patient group only isovolumic relaxation and contraction times values were prolonged comparing to the control group. After the infusion of dobutamine ejection fraction, shortening fraction, left ventricular posterior wall thickening (%LVPWt), end-systolic wall stress (ESS), interventricular septum systolic thickening, left ventricular end-systolic and end-diastolic diameters, mitral acceleration (AT) and deceleration times values were deteriorated in the patient group compared to the control group (p=0.05 for all). The highest differences between the groups were observed in the %LVPWt, ESS and AT values at the end of test. CONCLUSION: The DSE is an effective and safe method to demonstrate the late anthracycline cardiotoxicity. Echocardiographic evaluation should be made at rest and dobutamine dose of 20 microg/kg/min. In the early diagnosis of late cardiac toxicity; assessment of %LVPWt, AT and ESS values in addition to standard echocardiographic examination could be the guidance for early diagnosis of late cardiac toxicity.
Cardiac function in patients with prior myocarditis
1980-07-01
Gated cardiac blood-pool imaging under rest and exercise was used to assess left-ventricular functional reserve in six asymptomatic patients with prior myocarditis and six age matched control subjects. Coronary artery disease was excluded in three of the six patients by coronary arteriography. In the remaining three, coronary artery disease was thought unlikely on the basis of history and the presence, during exercise, of a normal ECG and normal Tl-201 myocardial image. Conventional indices of resting left-ventricular function - including cardiothoracic ratio, echocardiographic left-ventricular diameter, and percentage change in minor diameter - were normal in those with prior myocarditis. The mean resting left-ventricular ejection fraction was also normal by gated blood-pool imaging, and not significantly different from that for control patients: 0.58 +- 0.05 and 0.65 +- 0.02, respectively. Three patients with prior myocarditis had resting left-ventricular ejection fractions of less than 0.50. On exercise, the patients with prior myocarditis decreased their mean left-ventricular ejection fraction by an average of 8% compared with an increase of 15% in the control group (p < 0.01). This study suggests that asymptomatic patients with prior myocarditis have left-ventricular dysfunction that may not be clinically apparent, and suggests the need for further long-term follow-up.
[Cardiologic aspects of Friedreich type heredoataxia]
The authors performed ambulatory electro-vectorcardiography polycardiography and echocardiography in 18 patients with typical Friedreich's disease, and 6 patients with atypical forms of hereditary spino-cerebellar ataxia classified on e basis of the degree of neurological involvement, without clinical signs of cardiocirculatory failure. The ECG and VCG recording commonly showed appearances suggestive of myocardial "necrosis" and were of little value in the differential diagnosis between typical and atypical forms of Friedreich's ataxia. This limitation also applied to the kinetocardiogramme which was sometimes pathological confirming the echocardiographic diagnosis of symmetric LV hypertrophy and of septal hypokinesia despite normal ECG and VCG. The systolic time intervals and echocardiographic parameters of the interventricular septum were more helpful in the differential diagnosis. Hypertrophic cardiomyopathy, usually symmetric, was observed in about 70 p. 100 of typical and only rarely in atypical forms of Friedreich's disease. The symmetric or asymmetric hypertrophy was associated with reduced left ventricular performance in less than 20 p. 100 of typical Friedreich's disease, systolic anterior motion of the mitral valve and other signs of dynamic left ventricular outflow tract obstruction were not observed in any of these patients. The correlations between the degree of neurological disability and the cardiac abnormalities, were, in general, disappointing compared with other reported series. The cardiac investigation of patients with Friedreich's disease remains valuable from the point of view of recent pathological hypotheses of a metabolic abnormality with eventual therapeutic implications.
2007-01-01
Objective The outcome of patients with chronic kidney disease (CKD) is influenced by overt left ventricular (LV) abnormalities. We sought the predictive value and treatment response of subclinical LV dysfunction in CKD. Method Resting and dobutamine stress echocardiography we're used to identify LV enlargement, dysfunction, or ischemia in 176 patients with CKD. In 129 patients who had normal dobutamine stress echocardiography, myocardial tissue characterization was Performed using tissue Doppler imaging and integrated backscatter. Clinical, biochemical, and echocardiographic parameters were recorded at baseline, and patients were followed up for cardiac events and all-cause mortality over 2.4 years. Follow-up echocardiographic and tissue characterization parameters were performed in 80 patients. Results Previous cardiac history (HR 5.2, P =.002) and serum phosphate (HR 6.2, P =.001) were independent clinical predictors of events (model chi(2) = 20.9). Diastolic tissue velocity (HR 0.8, P =.05) was an independent predictor of outcome, and its addition to clinical assessment added incremental prognostic information (model chi(2) = 24.8, P <.001). Patients who underwent transplantation (n = 45) showed reduction of wall thickness (P <.001) and LV volumes (P <.001) and increases in diastolic tissue velocity (P =.007) and strain (P =.001), whereas these measurements worsened in those who remained on dialysis. Conclusion In patients with CKD, subclinical LV dysfunction is associated with adverse outcome. Subclinical disease can be improved by transplantation but progresses in patients who continue on dialysis. Publisher: Mosby Inc. Contributor: Mark, D.; Califf, R. Coverage: 2007-01-01T00:00:00Z
Full Text Available.BackgroundThiazolidinediones, used for the treatment of patients with type 2 diabetes mellitus (DM2), are associated with an increased incidence of heart failure. We sought to investigate the effects of pioglitazone on novel echocardiographic indices of left ventricular (LV) diastolic function in DM2 patients with LV diastolic dysfunction (LVDD).MethodsEighty-eight asymptomatic DM2 patients on metformin and/or sulfonylureas, aged 64.5 ± 7.7 years, without known cardiovascular disease, with normal LV systolic function and evidence of LVDD were randomly assigned to pioglitazone 30 mg/day (n = 42) or an increase in dose of other oral agents (n = 39) for 6 months. All patients underwent transthoracic conventional and Tissue Doppler Imaging echocardiography at baseline and follow-up. The primary end-point was change in early diastolic velocity of the mitral annulus (E').ResultsImprovement of glycaemic control was similar in the 2 groups. A significant difference (p < 0.05) between the 2 groups was found in the treatment-induced changes in fasting insulin, the insulin resistance index HOMA, HDL cholesterol, triglycerides, diastolic blood pressure (all in favor of pioglitazone) and in body weight (increase with pioglitazone). No significant changes were observed in any echocardiographic parameter in either group and did not differ between groups (p = NS for all). E' increased non-significantly and to a similar extent in both groups (p = NS).ConclusionsIn asymptomatic DM2 patients with LVDD, the addition of pioglitazone to oral conventional treatment for 6 months does not induce any adverse or favorable changes in LV diastolic or systolic function despite improvements in glycaemic control, insulin sensitivity, lipid profile, and blood pressure.
Ultrasonic evidence of acute interstitial lung edema after SCUBA diving is resolved within 23h
2010-01-01
Recently, an increase in extravascular lung water (EVLW) accumulation with diminished left ventricular contractility within 60min after SCUBA diving was reported. We have observed previously that diving was associated with reduced diffusing lung capacity for carbon monoxide (DLCO) and arterial oxygen pressure for up to 60-80min postdive. Here we investigated whether increased EVLW persists 2-3h after successive deep dives in a group of seven male divers. The echocardiographic indices of pulmonary water accumulation (ultrasound lung comets (ULC)) and left ventricular function, respiratory functional measurements and arterial oxygen saturation (SaO2) were assessed 2-3h post diving, while venous gas bubbles (VGB) and the blood levels of NT-proBNP and proANP were analyzed 40min after surfacing...
2010-01-01
The aim of our study was to assess longitudinal (L), circumferential (C) and radial (R) strain (S) of the left ventricle (LV) in patients with acute myocarditis and preserved LV wall motion. Of the 26 male patients that were enrolled, 13 patients (26+-8 years) suffered from acute myocarditis and 13 (25+-2 years) were healthy participants (controls). Both patients and controls underwent cardiac magnetic resonance (CMR) and 2-dimensional S imaging (2D-S) echocardiography on the same day. Myocardial strains (RS, LS and CS) were quantified by 2D-S. In patients with myocarditis, a delayed enhancement (DE) CMR study was performed to identify damaged myocardial segments. In the myocarditis group there was a significant LS reduction compared with controls (-25+-7 vs -20+-7, P
Left atrial volume predicts mortality in low-risk dialysis population on long-term low-salt diet
2010-01-01
Background: Echocardiography provides insight to the management of end-stage renal disease (ESRD) and might be valuable in assessing the prognosis. We evaluated the predictive value of echocardiography along with clinical findings in a low-risk hemodialysis (HD) population who had been treated with strict salt restriction strategy for blood pressure control. Methods: Study population consisted of a cohort of 555 ESRD patients from 8 HD centers where the same strict volume control strategy applied for blood pressure control. Clinical findings and echocardiography were examined as predictors of mortality for a mean follow-up period of 3 years (29.6 +/- 11.6 months). Results: During the follow-up, 89 patients (16%) died. Left atrium (LA) volume index was the only independent echocardiographic...
2009-01-01
Cardiomyocyte apoptosis has been implicated in the pathogenesis of heart failure (HF). This study was performed in patients with left ventricular (LV) volume overload at different stages in the development of HF to correlate apoptotic gene expression with LV echocardiographic phenotype. LV biopsies were procured from 24 cardiac surgical patients selected from 4 distinct clinical groups (n = 6) in the progression from preserved LV function to HF. Group I consisted of control patients with normal LV function (e.g., with atrial myxoma), group II had aortic regurgitation with LV hypertrophy and preserved systolic function (ejection fraction >50%), group III had aortic regurgitation with LV dysfunction (ejection fraction 30% to 40%), and group IV had end-stage HF (ejection fraction �...
2010-01-01
It is known that primary angioplasty is more effective than thrombolytic therapy for the treatment of ST-segment elevation acute myocardial infarction. The aim of the present study is to compare the effects of the two strategies on the left ventricular functions using the Tei index (a combined myocardial performance index). Of 81 patients (11 female, mean age 52.7 11.9 years, and 70 male, mean age 54.8 11.5 years) matching the selection criteria, 41 patients were treated by primary percutaneous transluminal coronary angioplasty and stenting (group A, 41 patients) and 40 patients were treated by thrombolytic agents (streptokinase) (group B, 40 patients). All patients underwent a complete two-dimensional transthoracic echocardiographic and Doppler study in the left lateral decubitus po...
2010-01-01
b-Thalassemia major (b-TM), patients, asymptomatic and with preserved left ventricular ejection fraction (LVEF) were studied echocardiographically. Group A (26 patients), on deferiprone (L1) and deferoxamine (DFO) combination therapy (L1: 80 +- 27 mg/kg/day, DFO: 160 +- 87 mg/kg/week) and group B (35 patients) on DFO monotherapy (240 +- 40 mg/kg/week) for the last 2 years were compared. Another group, C (14 patients), switched to L1 (74 +- 15 mg/kg/day) plus DFO (158 +- 48 mg/kg/week) for 20-30 months, was prospectively studied for 2 years. In group A, MRI T2 values were increased and improved in group C during follow-up. The LVEF was better in group A than in group B, while such an improvement was also detected in the group C follow-up study. The Tissue Doppler study Eprime velocity and E...
Echocardiographic findings, lipids and lipoprotein(a) in patients with systemic lupus erythematosus.
Cardiac involvement, evaluated by echo-doppler-cardiography, occurred in 41 of 50 (82%) patients with systemic lupus erythematosus (SLE). Valvular pathology with aortic cusp sclerosis was the most prevalent finding irrespective of age. This finding, suggestive of atherosclerotic heart disease, was supported by increased levels of cholesterol and triglycerides in these patients. There was no significant increase in Lp(a) in the whole patient group, but Lp(a) was raised in patients with proteinuria. Forty percent of the SLE patients had pericarditis. Twelve patients with hypertension and/or mitral regurgitation had increased dimensions of left ventricle, left atrium or interventricular septum while 15 of 50 patients had isolated increase of these parameters. Localized hypokinesia was found in nine patients. Reduced cardiac index was found in five patients with SLE. There was no association between valvular disease, increased pulmonary artery pressure, and anticardiolipin antibodies.
Cardiovascular effects of metrizamide in infants
1983-09-01
A prospective study was performed in 30 children under 3 years of age to compare the cardiovascular effects of a nonionic contrast material of low osmolality, metrizamide, with those of a conventional ionic contrast material, meglumine sodium diatrizoate. Left ventricular end-diastolic pressure, left ventricular peak systolic pressure, heart rate, echocardiographically obtained end-diastolic and end-systolic dimension, and blood chemistries were obtained before and after angiography. Neither contrast material changed serum sodium, potassium, or creatinine levels. However, serum osmolality rose significantly following injection of diatrizoate, but not metrizamide. Both end-diastolic and end-systolic dimensions increased after diatrizoate injection. However, end-diastolic dimension was unchanged and end-systolic dimension fell after metrizamide infusion. It is concluded that although the effects on intracardiac pressures are similar for both contrast materials, metrizamide may be advantageous in the critically ill infant because it causes a smaller increase in osmolality, fewer changes in cardiac dimensions, and a reduced heart rate challenge.
2009-01-01
Background Left atrial (LA) volume, is related to cardiovascular morbidity. LA enlargement is usually assessed using trans-thoracic echocardiography (TTE). The association of modern multislice computed tomography (MSCT) imaging and new 3D reconstruction software, allows direct cardiac chamber volume measurement without geometrical assumptions. This study was designed to evaluate the maximal (LAmax) and minimal (LAmin) LA volumes during the cardiac cycle using MSCT and TTE approaches. Methods We screened 26 consecutive patients referred for coronary imaging using a 64-MSCT scanner and a TTE within 12h. Contiguous multiphase images were generated from axial MSCT data and semi-automated 3D segmentation technique was applied to generate LA volumes. Using TTE, LA volumes and LA ejection fract...
Website Policies and Important Links Comments
 |
 |
 |
WorldWideScience.org is maintained by the
U.S. Department of Energy's
Office of Scientific and Technical Information as the Operating Agent
for the WorldWideScience Alliance.