RESUMEN
AIM: The aim of this study was to assess the impact of long-term physical training on left ventricular longitudinal contraction by strain rate analysis and tissue tracking imaging. METHODS AND RESULTS: The study population comprised 17 male elite endurance and 15 male elite strength athletes and 12 male control subjects of similar age. Tissue Doppler imaging was recorded in the apical views and used for analysis of the longitudinal systolic myocardial velocity, annular diastolic velocities, strain rate and tissue tracking. Left ventricular mass index was significantly increased in both endurance athletes (209+/-40 g/m(2)) and strength athletes (138+/-38 g/m(2)) compared with normal subjects (96+/-20 g/m(2), P<0.001). Tissue tracking score index and mean strain rate of the 16 segments were significantly increased in strength athletes (7.9+/-1.1 mm and -1.4+/-0.3 s(-1), respectively) compared with endurance athletes (7.5+/-0.9 mm and -1.0+/-0.4 s(-1), P<0.01 for both) and normal subjects (7.4+/-1.0 mm and -1.0+/-0.3 s(-1), P<0.01 for both). CONCLUSION: Despite significant left ventricular hypertrophy and extensive training in elite athletes, we found normal longitudinal left ventricular systolic function, and in strength athletes performing isometric exercise even increased function.
Asunto(s)
Ecocardiografía Doppler , Educación y Entrenamiento Físico/métodos , Resistencia Física/fisiología , Función Ventricular Izquierda/fisiología , Adulto , Análisis de Varianza , Ciclismo/fisiología , Estudios de Casos y Controles , Humanos , Masculino , Reproducibilidad de los Resultados , Levantamiento de Peso/fisiologíaRESUMEN
OBJECTIVES: We used tissue velocity imaging (TVI) and three-dimensional echocardiography to evaluate the effect of acute biventricular pacing on left ventricular (LV) performance and volumes in patients with severe heart failure and bundle branch block. BACKGROUND: Biventricular pacing causes acute hemodynamic improvement in patients with severe heart failure, and QRS duration has been used as a predictor of improved resynchronization. Tissue velocity has the potential of demonstrating the degree of LV resynchronization and three-dimensional echocardiography enables accurate quantitation of LV volumes and function. METHODS: TVI and three-dimensional echocardiography were performed during sinus rhythm and biventricular pacing in 25 consecutive patients with severe heart failure. RESULTS: Biventricular pacing significantly improved the extent of contracting myocardium in synchrony by 15.4% and the duration of contraction synchrony by 17% (p < 0.05 for both). Furthermore, end-diastolic and end-systolic volumes decreased by 7 +/- 4.5% and 13 +/- 6% (p < 0.01) and ejection fraction increased by 22.8 +/- 9% (p < 0.01). Baseline duration of QRS and the preejection period as well as the extent of myocardium with asynchronous contraction measured by TVI predicted pacing efficacy. In multivariate analysis, only the extent of myocardium with asynchronous contraction at the LV base predicted biventricular pacing efficacy. CONCLUSION: Biventricular pacing improves LV systolic performance and reduces LV volumes during short-term treatment. TVI provides important pathophysiological information on the degree of LV resynchronization and may contribute to improved patient selection.
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Bloqueo de Rama/terapia , Gasto Cardíaco Bajo/terapia , Estimulación Cardíaca Artificial , Ecocardiografía Doppler en Color , Insuficiencia Cardíaca/terapia , Disfunción Ventricular Izquierda/terapia , Bloqueo de Rama/diagnóstico por imagen , Bloqueo de Rama/fisiopatología , Gasto Cardíaco Bajo/diagnóstico por imagen , Estimulación Cardíaca Artificial/métodos , Ecocardiografía Tridimensional , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis MultivarianteRESUMEN
BACKGROUND: Vascular remodeling is the major cause of restenosis after coronary balloon angioplasty but the pathophysiology of this process is not known. OBJECTIVE: To examine the time courses of vascular remodeling, formation of neointima and adventitial changes after coronary angioplasty. DESIGN: An experimental study on pigs using coronary angiography, intravascular ultrasound (IVUS), and histology. METHODS: Deep vessel-wall injury was induced by conventional balloon angioplasty in the circumflex and right coronary arteries, and by retraction of a chain-encircled balloon in the left anterior descending artery. Angiography in all three arteries and IVUS measurements in circumflex and left anterior descending arteries were performed before and after angioplasty, and at follow-up on days 0, 1, 4, 7, 14, 28, and 56 (n = 5 in each group). Serial IVUS measurements were used to determine vascular remodeling. Formation of neointima and neoadventitia was measured by histomorphometry. RESULTS: Angiographically evident loss of lumen and ultrasonographically detectable constrictive remodeling occurred between day 7 and day 28. IVUS measurements showed that late loss of lumen (days 28 and 56) was correlated to vascular remodeling but not to the increase in wall area (neointima plus media). Histomorphometry revealed that neointima was present from day 7 and that amount of neointima increased up to day 28. Area of adventitia increased during the first 4 days and remained unchanged thereafter. Adventitial neovascularization by vasa vasorum was observed from day 4 onward. CONCLUSIONS: Formation of neoadventitia precedes late loss of lumen, constrictive remodeling, and formation of neointima. The time course of vascular remodeling coincides with growth of neointima rather than with changes in the adventitia.
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Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria/terapia , Vasos Coronarios/fisiología , Endotelio Vascular/fisiología , Animales , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Modelos Animales de Enfermedad , Porcinos , Factores de Tiempo , Túnica Íntima/fisiología , UltrasonografíaRESUMEN
We hypothesized that tissue harmonic imaging (THI) in comparison with fundamental imaging (FI) would improve endocardial border detection, and therefore in combination with 3-dimensional echocardiography (3D echo), it would be a precise method for left ventricular (LV) volume measurement. Ten healthy subjects and 18 consecutive patients with dilated hearts underwent estimation of LV volumes by magnetic resonance imaging (MRI) and transthoracic 3D echo with THI and FI. In patients, the agreement between MRI and 3D echo was closer with THI in comparison with FI for assessment of LV volumes. Thus the mean +/- 2 SD of differences between MRI and 3D echo with THI versus FI, respectively, was -6.4 +/- 40.0 mL versus -17.4 +/- 57.6 mL (P <.01) for the end-diastolic volume (EDV), and 0.0 +/- 26.6 mL versus -8.1 +/- 35.6 mL (P <.01) for the end-systolic volume (ESV). In patients, THI in comparison with FI approximately halved observer variation on EDV and ESV. In healthy subjects, only ESV showed significantly reduced observer variation by THI. In conclusion, because THI demonstrated a clinically relevant reduction in observer variation and a closer agreement to the MRI technique in patients with dilated hearts, it should replace FI in LV volume measurements.
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Cardiomiopatía Dilatada/fisiopatología , Ecocardiografía Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Disfunción Ventricular Izquierda/fisiopatología , Adulto , Cardiomiopatía Dilatada/diagnóstico , Cardiomiopatía Dilatada/diagnóstico por imagen , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
OBJECTIVES: The purpose of this study was to investigate the relationship between arterial and coronary sinus endothelin (ET) concentrations and coronary vasomotor responses during rapid atrial pacing in patients with chest pain and normal coronary arteriograms (CPNA). BACKGROUND: Plasma ET concentrations are significantly higher in CPNA patients than in healthy control subjects. METHODS: We investigated 19 carefully characterized CPNA patients (14 women; mean age 53 +/- 9 years) of whom 10 had positive electrocardiographic responses to exercise. The percentage fall in coronary vascular resistance (%d.CVR) after 10 min of rapid atrial pacing was determined using a thermodilution pacing catheter. Plasma ET concentrations were measured by radioimmunoassay on simultaneously drawn arterial and coronary sinus samples. RESULTS: No significant differences in ET concentrations were observed between men and women, but a strong statistical trend suggested that %d.CVR was lower in women than men (27[23 to 31]% vs. 34[29 to 45]%--median[interquartile range]; p = 0.07). Simple regression analysis including only the women (n = 14) suggested a significant relationship between baseline arterial ET concentrations and %d.CVR (R2 = 0.34; p = 0.06). Furthermore, stepwise multivariate regression analysis of the group as a whole indicated that both gender (p = 0.03) and baseline arterial ET concentration (p = 0.02) were independently predictive of %d.CVR (R2 = 0.44; overall p = 0.02); this relationship predicts that women with high ET levels would have the lowest %d.CVR during pacing. CONCLUSIONS: These data support the hypothesis that elevated ET activity may be associated with reduced coronary flow responses during rapid atrial pacing in CPNA patients.
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Circulación Coronaria , Endotelinas/sangre , Angina Microvascular/sangre , Resistencia Vascular , Estimulación Cardíaca Artificial , Angiografía Coronaria , Vasos Coronarios , Electrocardiografía , Femenino , Arteria Femoral , Humanos , Lactatos/sangre , Masculino , Angina Microvascular/fisiopatología , Persona de Mediana Edad , TermodiluciónRESUMEN
This study investigated the epidemiology and prognostic significance of mitral valve prolapse, detected by ultrasonography, in 153 cavalier King Charles spaniels which were screened consecutively during a period of one year. Seventy-five of the dogs, which had either no murmur or a grade I murmur on screening, were reexamined three years later. The screening revealed that 82 per cent of the dogs aged one to three years and 97 per cent of the dogs over three years had various degrees of mitral valve prolapse. The presence and severity of the condition were independent of gender but correlated positively with age and negatively with bodyweight. The degree of mitral valve prolapse at screening correlated with the regurgitation status (murmur intensity and size of the regurgitant jets) at re-examination and with the percentage increase in the left ventricular end diastolic diameter over the three-year period. The presence of a grade I murmur was not a useful prognostic indicator.
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Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/epidemiología , Insuficiencia de la Válvula Mitral/veterinaria , Prolapso de la Válvula Mitral/veterinaria , Animales , Dinamarca/epidemiología , Perros , Ecocardiografía/veterinaria , Femenino , Modelos Logísticos , Estudios Longitudinales , Masculino , Tamizaje Masivo/veterinaria , Insuficiencia de la Válvula Mitral/etiología , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/epidemiología , Valor Predictivo de las Pruebas , PronósticoRESUMEN
Thrombus organization has been suggested to play a major role in late neointimal formation after coronary angioplasty. We sought to describe the time sequence of lesion formation after angioplasty in porcine coronary arteries and to quantify the relation between early thrombosis and late neointimal formation. Deep vessel wall injury was induced by conventional balloon angioplasty in the circumflex (CX) and right coronary (RCA) arteries and by retraction of a chain-encircled balloon in the left anterior descendent artery (LAD). Lesions were assessed by histomorphometry at days 0, 1, 4, 7, 14, 28, and 56 after angioplasty. A response-to-injury index (lesion area/injury length) was determined for each artery. Angioplasty led to rupture/removal of media. Thrombus was present at the exposed adventitia at days 0, 1, and 4. From day 7, neointima was observed on the luminal side of the arterial wall. All thrombus had disappeared at day 28, at which only neointima was observed. Histomorphometry revealed that lesion formation after angioplasty was a gradually increasing process from day 0 to day 28 with no further growth from day 28 to day 56. Maximal thrombus size (day 4, RCA: 0.07+/-0.04 mm, CX: 0.23+/-0.16 mm, LAD: 0.15+/-0.11 mm) was significantly smaller than late neointimal formation (day 28, RCA: 0.68+/-0.18 mm, CX: 0.63+/-0.23 mm, LAD: 0.71+/-0.18 mm) in all three arteries (p < .03). Lesion formation after angioplasty is a gradually increasing process for 4 weeks. Maximal thrombus size is about four times smaller than late neointimal formation. Thus, thrombus organization plays no major role in late neointimal formation.
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Angioplastia Coronaria con Balón/efectos adversos , Trombosis Coronaria/patología , Vasos Coronarios/patología , Túnica Íntima/patología , Animales , Trombosis Coronaria/etiología , Vasos Coronarios/lesiones , Modelos Animales de Enfermedad , Rotura , Porcinos , Túnica Íntima/lesiones , Tiempo de Coagulación de la Sangre TotalRESUMEN
In cases of completed middle cerebral artery territory stroke, prognosis is very poor and the clinical course is characterised by a rapid decline in consciousness and signs of herniation 2-4 days after the onset of symptoms due to a space-occupying mass. Failure of conservative therapy is the rule, and herniation is the usual cause of death, occurring in almost 80 per cent of cases. Recently published results have suggested that hemicraniectomy may improve survival in patients with massive hemisphericstroke, decreasing mortality to less than 35 per cent. The article presents what is probably the first case to be reported in Sweden, where hemicraniectomy was performed on a 45-year-old woman with right hemispheric completed middle cerebral artery infarction.
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Infarto Cerebral/cirugía , Trastornos Cerebrovasculares/cirugía , Craneotomía/métodos , Descompresión Quirúrgica/métodos , Infarto Cerebral/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
UNLABELLED: Left ventricular hypertrophy and diastolic heart dysfunction have been reported in essential hypertension and in patients with chronic renal failure, treated with haemodialysis, but a close association with blood pressure (BP) level has not been uniformly documented. Thus, other factors could be involved in the pathogenesis of cardiac dysfunction. The aims of the present echocardiographic study were to investigate cardiac morphology and function in patients with chronic glomerulonephritis with mildly to moderately impaired renal function, and to study the relation between echocardiographic findings and glomerular filtration rate (GFR), BP and age. Twenty patients with chronic glomerulonephritis and 14 healthy controls, of the same age- and sex-distribution, were examined by 2D-, M-mode and pulsed-wave Doppler echocardiography. In patients, GFR was determined as plasma clearance of Cr-EDTA. The patients had significantly thicker left ventricular (LV) posterior walls in end diastole (8.7 vs 8.1 mm, p < 0.05), and a higher LV mass index (106.5 vs 93.8 g/m2, p < 0.05). Systolic functional indices, i.e. LV fractional shortening and LV ejection fraction, were statistically significantly lower in patients than in controls (p < 0.05). LV diastolic function in patients was characterized by a statistically significantly lower early peak flow velocity (E-Vmax) (0.66 compared with 0.8 m/s) and early to late peak flow velocity ratio (E/A ratio) (1.07 vs 1.41), as well as E/A ratio of time velocity indices (VTI-E/A) (1.45 vs 1.99) (p < 0.05). The right ventricular filling indices showed a tendency towards a lower E-Vmax in patients (0.55 compared with 0.62 m/s, p = 0.1). In patients, statistically significant negative correlations were found between age and mitral E/A ratio (r = -0.76, p < 0.0001), as well as LV VTI-E/A(r = -0.81, p < 0.0001). The same trend was seen for the tricuspid E/A ratio. No statistically significant correlations were found in patients between mitral or tricuspid E/A ratio and GFR, BP, LV mass or heart rate. IN CONCLUSION: in a group of patients with chronic glomerulonephritis and mildly to moderately impaired renal function, it was found by means of echocardiography that there was a higher LV mass index and decreased systolic function, when compared with healthy controls. In addition, the patients had diastolic dysfunction of primarily the left ventricle. The echocardiographic findings were not correlated to BP level or renal function. This suggests that factors other than GFR or BP per se might be involved in the pathogenesis of cardiac dysfunction, at an early stage.
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Glomerulonefritis/fisiopatología , Corazón/fisiopatología , Riñón/fisiopatología , Adulto , Anciano , Envejecimiento/fisiología , Presión Sanguínea/fisiología , Estudios de Casos y Controles , Enfermedad Crónica , Diástole , Ecocardiografía , Femenino , Tasa de Filtración Glomerular/fisiología , Glomerulonefritis/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Función Ventricular Izquierda/fisiología , Función Ventricular Derecha/fisiologíaRESUMEN
Acute pulmonary hypertension has a high mortality at the onset. Patients surviving the first phase will usually recanalize the pulmonary arteries through intrinsic thrombolytic mechanisms and medical treatment. However, in some cases there is insufficient resolution of the emboli with subsequent thrombotic and fibrotic reorganization, leading to a worsening of the pulmonary obstruction. In the open pulmonary arteries the disease may lead to hypertrophy of the media and intimal proliferation, thus leading to a further increase in the pulmonary vascular resistance. This again leads to hypertrophy of the right ventricle and ultimately to right-sided heart failure. Untreated, chronic thromboembolic pulmonary hypertension has a five-year mortality approaching 100%, but extensive pulmonary thrombendarterectomy using extracorporeal circulation and deep hypothermia has been shown to lower the pulmonary vascular resistance and thereby improve the prognosis significantly. Operative treatment can now be offered in Denmark, and the purpose of this review is to draw attention to the disease, its symptoms, diagnosis and the surgical treatment.
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Hipertensión Pulmonar/complicaciones , Embolia Pulmonar/complicaciones , Enfermedad Aguda , Enfermedad Crónica , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/mortalidad , Hipertensión Pulmonar/terapia , Pronóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidad , Embolia Pulmonar/terapiaRESUMEN
Chronic thromboembolic pulmonary hypertension has a five year survival rate of less than 10% in patients with a systolic pulmonary artery pressure of 50 mmHg with no convincing effect of medical treatment. The operative mortality from pulmonary thrombendarterectomy in specialised centres has been reduced to 9%, suggesting this treatment as being an option. The results from thrombendarterectomy of two Danish patients are reported. The first patient, a 34 year-old woman was operated at the centre in San Diego with the assistance of a Danish thoracic surgeon. The second, a 60 year-old man was operated at our institution by this surgeon. Following removal of sufficient amount of embolic masses and intimal tissue, the patients were discharged from hospital with a substantial improvement in their clinical status and near normalisation of pulmonary artery pressure, which remained at the latest follow-up (3 to 22 months).
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Endarterectomía/métodos , Hipertensión Pulmonar/cirugía , Embolia Pulmonar/cirugía , Adulto , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/diagnóstico , Masculino , Persona de Mediana Edad , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnósticoRESUMEN
This study included 249 consecutive patients with suspected significant aortic valve stenosis. Using contemporary ultrasound equipment we reassessed the value of out-patient Doppler-derived maximum pressure gradients for the prediction of peak-to-peak pressure gradients measured later at heart catheterization. It was possible to record the pressure gradient in 97% of the patients by Doppler examination and in 86% at heart catheterization. There was a fair, statistically significant correlation between Doppler and invasive gradients (n = 201, r = 0.80, p < 0.05, SEE = 21 mm Hg), independent of coexistent aortic regurgitation, atrial fibrillation, left ventricular function, number of days between the examinations and other variables analysed. A Doppler gradient > 80 mm Hg was 98% (90-100%) predictive of critical aortic stenosis (gradient > 50 mm Hg as determined by heart catheterization). Similarly, a Doppler gradient of < or = 30 mm Hg was 98% (87-100%) predictive of non-critical stenosis. In the remaining patients (53% of the population) the Doppler gradient did not contribute decisively to clinical management.
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Estenosis de la Válvula Aórtica/fisiopatología , Ecocardiografía Doppler , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Cateterismo Cardíaco , Ecocardiografía Doppler/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión , Análisis de Regresión , Estadísticas no ParamétricasRESUMEN
Over a five-year period (1990-1994), 72 consecutive patients were referred to transoesophageal echocardiography (TEE) on suspicion of thoracic aortic dissection. TEE was performed as the only or last investigation in 42 patients (58%). In 44 patients one or more other investigations were carried out before final clinical decision making: aortography (n = 30), X-ray computer tomography (CT, n = 18), and magnetic resonance imaging (MRI, n = 12). The final diagnosis was based on the combination of clinical information, the available examination results, and findings at surgery or autopsy; 31 of the patients were diagnosed as having aortic dissection. One patient with aortic dissection died during TEE while none of the other patients suffered major complications. The sensitivity (demonstration of dissection including correct classification in type A or B) was 81%, 80%, 45%, and 83% for TEE, aortography. CT, and MRI, respectively. The specificities were 88%, 93%, 71%, and 100%, respectively. Dissection of the thoracic aorta is a life-threatening condition demanding prompt and accurate diagnosis. None of the four techniques employed in the present study is ideal. Although TEE is adequate for immediate bedside examination our results show that more time-consuming and resource demanding investigations are sometimes required. Proper training and improved equipment may, however, increase the usefulness of TEE in patients with suspected aortic dissection.
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Disección Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica , Adolescente , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Clinical studies have shown that Cavalier King Charles Spaniels (CKCS) have a high prevalence of mitral valvular insufficiency (MVI). Echocardiography has the potential to disclose early valvular changes, and the present prospective study was designed to investigate the occurrence of mitral valve prolapse (MVP) in young CKCS without heart murmurs, and to correlate the degree of MVP with the clinical status of the dogs by including CKCS with MVI as well. The study was based on blinded evaluations of echocardiographic recordings of mitral valves from 34 CKCS and 30 control dogs. Thirteen (87%) of 15 three-year-old CKCS without heart murmurs had MVP (2 total and 11 partial), as compared with 1 (7%) of 15 three-year-old normal Beagle dogs (P < 0.0001), and none of 15 three-year-old normal Medium Size Poodles (P < 0.0001). Of 19 CKCS with MVI, MVP was found in 84% of the entire group and in 100% of dogs with pulmonary congestion or edema. The occurrence of total MVP tended to be higher in the group with MVI (47%, 9/19), when compared with the younger CKCS without heart murmurs (13%, 2/15, P = 0.06). MVP was positively associated with excessive heart rate variability (P = 0.003). The radius of curvature of the anterior mitral valve leaflet in systole was significantly reduced in dogs with MVP when compared with those without (P < 0.0001). In conclusion, this study shows that CKCS at an early age have a high occurrence of MVP. This suggests: 1) A genetic predisposition of CKCS to MVP; and 2) That MVP is a pathogenetic factor in the development of mitral valvular insufficiency. Follow up studies may add further support to these proposals, and clarify whether echocardiography may be an aid in selecting CKCS for future breeding.
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Enfermedades de los Perros/diagnóstico por imagen , Prolapso de la Válvula Mitral/veterinaria , Animales , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/patología , Perros , Ecocardiografía/veterinaria , Femenino , Masculino , Insuficiencia de la Válvula Mitral/epidemiología , Insuficiencia de la Válvula Mitral/veterinaria , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/epidemiología , Prolapso de la Válvula Mitral/patología , Prevalencia , Estudios ProspectivosRESUMEN
The appearance of perivalvular cavities (PCs) in patients with infectious endocarditis (IE) was studied by transesophageal echocardiography (TEE) color Doppler examinations to determine whether the color Doppler TEE presentation was in keeping with the current concept of PCs representing abscesses. Two heart centers participated in the study. Videotape recordings of TEE examinations in patients with IE were analyzed retrospectively for 18 months in both centers, and one center included patients prospectively for an additional 18 months. A total of 118 patients with a diagnosis of IE based on TEE and clinical and laboratory findings were seen during the study period. TEE showed PCs in 34 patients. In 3 patients who died, no autopsy was performed; the PCs were proved at autopsy or surgery in the remaining 31 patients, who constituted the study population. All PCs were echo free at TEE. Apart from one technically inadequate examination, all PCs contained color Doppler signals indicating intracavitary blood flow; the PCs communicated through a narrow channel with high-pressure regions (the left ventricle or the ascending aorta). At surgery or autopsy, only 2 of the 31 patients had pus accumulations besides the blood-filled PCs. At TEE the pus accumulations presented as echo-rich, shaggy tissue thickening. It is concluded that well-delineated, echo-free PCs with intracavitary color Doppler signals at TEE appear to be pseudoaneurysms, and therefore the term abscess should not be used in these cases. Although further studies are needed, our findings suggest that PCs more likely occur by infectious tissue weakening and subsequent dissection rather than as a result of primary abscess formation with secondary rupture.(ABSTRACT TRUNCATED AT 250 WORDS)
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Absceso/diagnóstico por imagen , Aneurisma Falso/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Absceso/patología , Absceso/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Falso/patología , Aneurisma Falso/cirugía , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Diagnóstico Diferencial , Ecocardiografía Transesofágica/instrumentación , Ecocardiografía Transesofágica/métodos , Endocarditis Bacteriana/patología , Endocarditis Bacteriana/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/patología , Válvula Mitral/cirugía , Estudios Retrospectivos , Infecciones Estafilocócicas/patología , Infecciones Estafilocócicas/cirugía , Infecciones Estreptocócicas/patología , Infecciones Estreptocócicas/cirugíaRESUMEN
Intracoronary ultrasound is a new technique, by means of which it is possible for the first time to visualise coronary artery wall structures in vivo. Compared to conventional coronary angiography the advances of this new modality appear to be: 1) Improved diagnosis of minimal and non-obstructive atherosclerosis; 2) Characterisation of plaque morphology, thereby being an aid in decision on interventional procedures (PTCA, atherectomy, stent placement); 3) Better delineation of coronary artery lumen area, which improves the accuracy of stenosis graduation both before and after interventional procedures. The examination can be performed in up to 95% of cases. The procedure appears to be safe with a reported complication rate of myocardial infarction and bypass surgery of 0.16% in 1837 cases; transient coronary artery spasms occurred in about 3%. Complications are predominantly associated with interventional procedures. Although intracoronary ultrasound has mainly been used for research purposes, results of ongoing trials assessing its clinical utility, as well as technological improvement providing more consistent image quality, suggest that the procedure will evolve into an important adjunct to coronary angiography.
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Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Angiografía Coronaria , HumanosRESUMEN
A clinical study has been performed to investigate the influence of different administration procedures on the degree of contrast enhancement of the left ventricle. The administration variables assessed included Albunex injection rate, arm position, flushing rate and flushing fluid. Twenty-four healthy male volunteers were included. Compared to an injection rate of 1 ml/sec an injection rate of Albunex of 2 ml/sec caused an earlier appearance of contrast in the right ventricle (1 heart beat), whereas transpulmonary passage was not influenced. Horizontal arm position caused a delay in time to peak intensity of 2 to 3 heart beats in both systole and diastole as compared to elevated arm position. Injection rate of 1 ml/sec compared to 2 ml/sec caused a higher peak intensity and mean area under the curve and a longer mean time to peak intensity and transit time. Differences varied from 6 to 230 grey level units out of mean values of 2500. All the observed differences were small and thus probably of no clinical importance. The present study indicates that improvements in the pressure stability characteristics of the albumin microspheres in Albunex have been achieved. This implies that a simple administration procedure can be used. It is recommended that the contrast agent, after resuspension, is injected through a three-way stop cock cannula, followed by 10 ml of saline for flushing. The cannulas or syringes used should be no smaller than 20 G. The injection rate should be 1-2 ml/sec, depending on the diameter of the cannula. By using this procedure, a reliable transpulmonary passage and left ventricular opacification may be obtained.
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Albúminas/administración & dosificación , Medios de Contraste/administración & dosificación , Ventrículos Cardíacos/diagnóstico por imagen , Microesferas , Adulto , Albúminas/farmacocinética , Análisis de Varianza , Medios de Contraste/farmacocinética , Esquema de Medicación , Ecocardiografía , Ventrículos Cardíacos/metabolismo , Humanos , Inyecciones Intravenosas , Masculino , Función Ventricular IzquierdaRESUMEN
The aim of the study was to establish the prevalence of cardiovascular malformations in females with Turner's syndrome and analyse possible associations with the various karyotypes. One hundred and seventy nine of 393 females who had Turner's syndrome diagnosed in Denmark were examined. Complete chromosome analysis was available in all cases. Clinical examination, electrocardiography, and echocardiography including Doppler were performed. The distribution of the various karyotypes was 45,X, 58%; mosaic monosomy X, 35%; and structural abnormalities of the X chromosome, 7%. In 46 (26%) of the females a total of 69 cardiovascular malformations were found; aortic valve abnormality (18%) and aortic coarctation (10%) being the most common. There was a significant difference in the prevalence of cardiovascular malformations between 45,X and mosaic monosomy X (38% v 11%), primarily due to a significant difference in the prevalence of aortic valve abnormalities and aortic coarctation. Pulmonary valve abnormalities were seen only in females with mosaic monosomy X but the prevalence was low (3%). No patient with structural abnormalities of the X chromosome had cardiovascular malformations.
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Cardiopatías Congénitas/complicaciones , Síndrome de Turner/complicaciones , Síndrome de Turner/genética , Adolescente , Adulto , Coartación Aórtica/genética , Válvula Aórtica/anomalías , Insuficiencia de la Válvula Aórtica/genética , Estenosis de la Válvula Aórtica/genética , Niño , Preescolar , Dinamarca/epidemiología , Femenino , Cardiopatías Congénitas/epidemiología , Humanos , Lactante , Cariotipificación , Persona de Mediana Edad , Monosomía , Prevalencia , Cromosoma XRESUMEN
OBJECTIVE: Since GH substitution therapy is now available for adult GH deficient patients, information on the cardiovascular effects of GH substitution has assumed major clinical interest. We have therefore assessed cardiovascular effects of short and long-term growth hormone substitution therapy in these patients. PATIENTS AND MEASUREMENTS: Doppler echocardiography was performed in 21 GH deficient patients after 4 months placebo and 4 months GH therapy, in a double blind cross-over study. In an open design study, 13 patients were reinvestigated following 16 months and 9 patients following 38 months of GH therapy. Twenty-one age and sex-matched normal control subjects were also investigated. RESULTS: Heart rate was increased in placebo treated patients as compared to controls. After 4 months of GH treatment, heart rate showed a further increase (10%, P < 0.01) and seemed to remain elevated after 16 months of GH therapy. Systolic and diastolic blood pressures were significantly lower in placebo treated patients than in controls, and did not change significantly after GH treatment. The left ventricular diastolic diameter was reduced in patients as compared to controls, but increased after 4 months GH therapy (P > 0.05) and seemed to increase further during prolonged GH treatment. Cardiac index was at the same level in controls and in placebo-treated patients, but increased by 20% following GH therapy and remained elevated after 16 and 38 months (P < 0.05) of GH substitution. CONCLUSION: Following GH substitution in GH deficient adult patients, left ventricular diastolic dimensions increased and seemed to normalize, while heart rate and cardiac output were found to be increased to supranormal levels.
Asunto(s)
Hormona del Crecimiento/efectos adversos , Hormona del Crecimiento/deficiencia , Frecuencia Cardíaca/efectos de los fármacos , Adulto , Gasto Cardíaco/efectos de los fármacos , Volumen Cardíaco/efectos de los fármacos , Estudios Cruzados , Diástole , Método Doble Ciego , Ecocardiografía Doppler , Femenino , Humanos , Masculino , Factores de TiempoRESUMEN
Using echocardiography (ECHO) as the reference method, the aim of this study was to determine the sensitivity, specificity, and predictive value of the electrocardiogram (ECG) in detection of left ventricular hypertrophy (LVH) in patients with aortic stenosis. Forty-one patients, 18 men and 23 women aged 25-80 years (mean 49 years) with uncomplicated aortic stenosis were studied. ECG-LVH was estimated by standard fixed voltage criteria. ECHO-LVH was defined according to left ventricular mass (LV mass) calculated by the Penn method. In the total material, the correlation between ECG-LVH and ECHO-mass was poor (r = 0.56, p < 0.05). The sensitivity and specificity of the ECG was respectively 50% and 100%. The positive predictive value of the ECG in detection of LVH was high (100%). We conclude that the sensitivity of the ECG in detection of LV hypertrophy is unsatisfactorily low. Accordingly, it is recommended that echocardiography be performed in all patients suspected of aortic stenosis.