RESUMEN
Up to 20% of individuals with primary hypothyroidism treated with L-thyroxine still suffer from severe symptoms. These are supposedly brain derived and involve both cognitive and emotional domains. Previously, no consistent relationship has been found between thyroid hormones (TH) or TSH levels in blood and quality of life (QoL). Recently, we reported an association between cerebrospinal fluid (CSF)/serum free-thyroxine (f-T4) ratio and QoL, in juvenile hypothyroid patients. Here, we investigated if CSF/serum f-T4 ratio and QoL estimates correlate also during L-thyroxine treatment. Moreover, the CSF biomarker neurogranin (Ng) was used as a biomarker for synaptic function and integrity in clinical research. Ng is partially controlled by TH and therefore we investigated the relationship between QoL parameters and Ng levels. Patients diagnosed with primary hypothyroidism were investigated using vital parameters, serum and CSF analyses of TH, TSH, Ng and QoL questionnaires. Similar procedures were performed after 6 months of treatment. The most marked associations with QoL were found for CSF/serum f-T4 ratio, which was strongly related to several QoL parameters such as the mental subscore of SF-36 (r = 0.83, p < .0005). Ng, which did not differ from that in our healthy controls, was lower in some patients during treatment and higher in others. However, the change in Ng during treatment was significantly correlated with QoL parameters including the mental subscore of SF-36 (r = -0.86, p < .0001). In addition, the CSF/serum f-T4 ratio correlated with the change in Ng (r = -0.75, p = .001). Our results suggest that the ratio between CSF and serum f-T4 is an important biomarker for QoL during treatment of patients with primary hypothyroidism, so far in research, but in the future maybe also in clinical settings. Moreover, this ratio also correlates with the changes in Ng levels during L-thyroxine treatment, further supporting the impact of the TH balance between serum and CSF on QoL.
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Hipotiroidismo , Tiroxina , Humanos , Tiroxina/uso terapéutico , Calidad de Vida , Triyodotironina , Tirotropina , Hormonas Tiroideas , Hipotiroidismo/tratamiento farmacológico , BiomarcadoresRESUMEN
BACKGROUND & OBJECTIVE: Patients with mild hypothyroidism often are depressed and have impaired quality of life despite serum free-T4 and T3 within reference values. Therefore, we investigated whether their symptoms were dependent on the concentrations of free -T4 and T3 in the circulation and cerebrospinal fluid (CSF). METHODS: Twenty-five newly diagnosed, untreated hypothyroid subjects and as many age- and sex-matched healthy controls were investigated. Blood and CSF sampling was performed in the morning after an overnight fast. Quality of life (QoL) was assessed by a Likert scale. In the hypothyroid subjects, the MADRS rating scale was also used to evaluate symptoms of depression. Furthermore, the results obtained by the questionnaires were related to serum and CSF levels of free- T4 and T3 as well as the ratios between them in CSF and in serum. RESULTS: Self-reported health was considerably lower in hypothyroid subjects. MADRS was considerably higher than the normal range for healthy individuals. Low CSF/serum free-T4 ratio was correlated with an increased depressed state according to MADRS (p < 0.01), and in addition, CSF/serum free-T4 ratio correlated positively with the self-reported general health Likert scale (p < 0.05). Concentrations of TSH, or free-T3 in serum or CSF, were not associated with an increased depressed state or self-reported general health. CONCLUSIONS: Low CSF/serum ratio of free-T4 was correlated with impaired general health and mood, in contrast to serum measurements not showing any correlations. These findings might partly explain why some patients with hypothyroidism suffer from mental symptoms, despite adequate serum levels of free-T4. However, the findings need to be confirmed in further and larger studies.
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AIMS: Atrioventricular junction ablation (AVJA) is a highly effective treatment in patients with therapy refractory atrial fibrillation (AF) but renders the patient pacemaker dependent. We aimed to analyse the long-term incidence of hospitalization for heart failure (HF) and all-cause mortality in patients who underwent AVJA because of AF and to determine predictors for HF and mortality. METHODS AND RESULTS: We retrospectively enrolled 162 consecutive patients, mean age 67 ± 9 years, 48% women, who underwent AVJA because of symptomatic AF refractory to pharmacological treatment (n = 117) or unsuccessful repeated pulmonary vein isolation (n = 45). Hospitalization for HF occurred in 32 (20%) patients and 35 (22%) patients died, representing a cumulative incidence for hospitalization for HF and mortality over the first 2 years after AVJA of 9.1 and 5.2%, respectively. Hospitalization for HF occurred to the same extent in patients who failed pharmacological treatment as in patients with repeated pulmonary vein isolation (PVI), although the mortality was slightly higher in the former group. QRS prolongation ≥120 ms and left atrial diameter were independent predictors of hospitalization for HF, while hypertension and previous HF were independent predictors of death. CONCLUSION: The long-term hospitalization rate for HF and all-cause mortality was low, which implies that long-term ventricular pacing was not harmful in this patient population, including patients with unsuccessful repeated PVI.
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Fibrilación Atrial/mortalidad , Fibrilación Atrial/terapia , Estimulación Cardíaca Artificial/mortalidad , Ablación por Catéter/mortalidad , Insuficiencia Cardíaca/mortalidad , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Distribución por Edad , Anciano , Nodo Atrioventricular/cirugía , Terapia Combinada/mortalidad , Comorbilidad , Femenino , Insuficiencia Cardíaca/prevención & control , Humanos , Incidencia , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Tasa de Supervivencia , Suecia/epidemiologíaRESUMEN
OBJECTIVES: To assess the effects of intraoperative left atrial epicardial cryoablation on rhythm and atrial and ventricular function. DESIGN: Thirty five patients with coronary artery disease and documented atrial fibrillation underwent coronary artery bypass surgery and concomitant cryoablation. An age and gender matched control group of 35 patients with atrial fibrillation underwent bypass surgery alone. Echocardiography was performed 9 ? 32 days before and 22 ? 6 months after surgery. RESULTS: The proportion of patients in sinus rhythm at follow-up was 63% and 34% (p = 0.04) in the cryoablation and control groups, respectively. In patients with sinus rhythm both before surgery and at follow-up, the left atrial area increased (p = 0.002) and the mitral annular excursion during atrial contraction decreased (p = 0.01) after cryoablation. The mitral flow velocity during atrial systole decreased after cryoablation (p = 0.002). The LV diameter increased (p = 0.03) and the left ventricular ejection fraction (LVEF) decreased (p = 0.03) in cryoablated but not in control patients. Continued deterioration was seen in patients with atrial fibrillation both pre- and postoperatively. CONCLUSIONS: At long-term follow-up, a significantly higher proportion of patients was in sinus rhythm in the cryoablation than in the control group. The atrial and ventricular function had decreased at follow-up two years after surgery. This decrease was small and occurred within or close to the reference values in patients with sinus rhythm at follow-up, while patients remaining in atrial fibrillation showed a significant continued deterioration. Some subgroups were small, and the findings, although statistically significant, should be interpreted with caution.
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Función del Atrio Izquierdo , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Criocirugía , Pericardio/cirugía , Función Ventricular Izquierda , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/mortalidad , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Aleteo Atrial/etiología , Aleteo Atrial/fisiopatología , Estudios de Casos y Controles , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/fisiopatología , Criocirugía/efectos adversos , Criocirugía/mortalidad , Ecocardiografía Doppler , Electrocardiografía , Femenino , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pericardio/fisiopatología , Valor Predictivo de las Pruebas , Recurrencia , Medición de Riesgo , Factores de Riesgo , Suecia , Factores de Tiempo , Resultado del TratamientoRESUMEN
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 surgical procedure. RESULTS: Both LA and RA areas, LV diastolic function, paroxysmal AF, and sinus rhythm (SR) preoperatively were associated with SR at long-term follow-up. In the multivariate analysis, RA area (P = 0.004), and decreased LV diastolic function preoperatively, measured as the maximal LV long-axis relaxation velocity (P = 0.02), predicted SR at follow-up. CONCLUSIONS: RA size and LV diastolic function may be important variables in prediction of long-term rhythm outcome after intraoperative ablation for AF.
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Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Ecocardiografía/métodos , Atrios Cardíacos/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/cirugía , Anciano , Fibrilación Atrial/complicaciones , Femenino , Humanos , Masculino , Tamaño de los Órganos , Pronóstico , Volumen Sistólico , Resultado del Tratamiento , Disfunción Ventricular Izquierda/etiologíaRESUMEN
OBJECTIVE: We investigated the feasibility and reproducibility of transesophageal (TE) recordings of displacements and velocities of 4 sites of the mitral annulus in anesthetized patients. Correlations to transthoracic measures and influence of the respiratory cycle were also investigated. METHODS: A total of 24 patients without heart disease were included. Another 10 patients were enrolled for the reproducibility study. Systolic and diastolic velocities and amplitude of motion were extracted from color-coded Doppler tissue recordings. RESULTS: The reproducibility was not acceptable for the anterior site or for late diastolic velocities. Transthoracic values were higher than TE values. A somewhat higher displacement during inspiration in spontaneous respiration and during expiration in positive pressure ventilation was seen. CONCLUSIONS: The anterior site should be omitted when TE recordings of the mitral annulus are used. TE values are about 15% lower than transthoracic values. There is no need to take the respiratory cycle into account.
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Ecocardiografía Transesofágica/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiología , Función Ventricular Izquierda/fisiología , Función Ventricular , Anestesia , Estudios de Factibilidad , Femenino , Humanos , Masculino , Movimiento/fisiología , Contracción Miocárdica/fisiología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Disfunción Ventricular IzquierdaRESUMEN
BACKGROUND: We aimed to establish a completely noninvasive technique to assess coronary artery atherosclerosis in living mice using proximal to middle left coronary artery (LCA) velocity ratio as assessed with color Doppler echocardiography (CDE). METHODS AND RESULTS: Three groups of apolipoprotein E/low-density lipoprotein receptor double-knockout (apoE/LDLr dko) mice 10, 40, and 80 weeks of age and 3 additional age-matched groups of C57BL/6 mice were examined under anesthesia. Coronary flow velocity in proximal (Vprox) and middle part (Vmid) of LCA was measured using CDE. A 40-MHz ultrasound biomicroscope (UBM) was used to visualize lumen and outer vessel diameter in the proximal LCA. Flow velocity in the proximal LCA increased significantly with age and remained constant in the middle part in the apoE/LDLr dko mice, whereas velocities at both the sites remained unchanged in C57 mice. CDE-assessed flow velocity ratio (Vprox/Vmid) increased significantly with age in apoE/LDLr dko mice (P=0.0055) and correlated significantly to percentage wall thickness, as assessed by UBM (P=0.0044; r=0.65) and histology (P=0.0002; r=0.78). Wall thickness increased with age in the apoE/LDLr dko mice as measured with UBM (P=0.0093; r=0.49), which was also confirmed with histology (P<0.0001; r=0.73). CONCLUSIONS: CDE and UBM are useful noninvasive tools to quantify mouse coronary artery atherosclerosis in vivo.
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Enfermedad de la Arteria Coronaria/diagnóstico , Circulación Coronaria , Ecocardiografía Doppler en Color , Animales , Apolipoproteínas E/deficiencia , Apolipoproteínas E/fisiología , Velocidad del Flujo Sanguíneo , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/etiología , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/patología , Lípidos/sangre , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Microscopía Acústica , Receptores de LDL/deficiencia , Receptores de LDL/fisiología , Resistencia VascularRESUMEN
BACKGROUND: In most echocardiographic studies concerning mitral annulus motion (MAM) in the assessment of left ventricular (LV) systolic function, comparisons have been performed between MAM, which represents a distance, and ejection fraction (EF), which represents a ratio between volumes. However, in theory, it is probably more suitable to compare the long-axis fractional shortening (FS(L)) (the ratio between the change in length [ie, MAM] and the end-diastolic length of the left ventricle) with EF. OBJECTIVES: To compare EF with MAM and EF with FS(L) in the assessment of LV systolic function. METHODS: Thirty healthy subjects were investigated using echo-cardiography, and the linear correlations between EF and MAM, and EF and FS(L) were calculated. RESULTS: The linear correlation (r) was found to be higher between EF and FS(L) (r=0.65; P<0.001) than between EF and MAM (r=0.49; P<0.01). CONCLUSIONS: The higher correlation between EF and FS(L) than between EF and MAM suggests that FS(L), which includes a correction for ventricular length, may be a more suitable index of LV systolic function than MAM per se.
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Short-term exercise training has been shown to improve cardiovascular function, whereas long-term effects of a physically active lifestyle, on coronary artery function in particular, are still not well studied. We explored possible relationships between physical exercise capacity and coronary and peripheral vascular function in healthy young adults. Twenty-nine healthy young male and female volunteers participated in the study. They underwent 1) basic clinical and echocardiographic characterization, 2) coronary flow velocity reserve (CFVR) measurement of the left anterior descending coronary artery (LAD), 3) common carotid artery (CCA) intima-media thickness (IMT) measurement, 4) assessment of CCA stiffness index (SI), 5) forearm flow-mediated vasodilation (FMD), and 6) submaximal exercise test. The calculated weight-adjusted maximal oxygen uptake capacity (Vo(2 max)(c)) was positively correlated to LAD CFVR and inversely correlated to IMT and SI. Also, subjects with high compared with moderate exercise capacity had higher FMD. In addition, subjects with LAD CFVR in the upper median had greater ratios between endothelium-dependent and -independent vasodilation in the forearm and lower SI in CCA. High exercise capacity due to a physically active lifestyle is associated with high coronary and peripheral artery function, indicating an early protective role of physical exercise for cardiovascular health.
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Circulación Coronaria/fisiología , Ejercicio Físico/fisiología , Antebrazo/irrigación sanguínea , Flujo Sanguíneo Regional/fisiología , Adulto , Arteria Carótida Común/fisiología , Ecocardiografía Doppler , Endotelio Vascular/fisiología , Femenino , Humanos , Estilo de Vida , Masculino , Vasodilatación/fisiologíaRESUMEN
Coronary artery flow velocity during a short period of apnoea was investigated by transthoracic Doppler recording in 10 healthy men, aged 24-52. During breath holding for 29 +/- 6 s the oxygen saturation in the finger, measured by pulse oxymetry, decreased from 97.5 +/- 0.8 to 90.0 +/- 3.2% (P < 0.001). The maximal coronary blood flow velocity in the left anterior descending artery increased by 62% from 0.26 +/- 0.09 to 0.42 +/- 0.10 m s(-1) and the mean diastolic flow velocity by 47% from 0.19 +/- 0.04 to 0.28 +/- 0.08 m s(-1) (P < 0.001). In most subjects the increase of velocity started already after a few seconds of apnoea. Besides theoretical implications the results show that it is very important to be aware of the higher velocity during apnoea in order to avoid misinterpretation when using breath holding during magnetic resonance imaging or Doppler recording of coronary flow.
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Apnea/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Vasos Coronarios/diagnóstico por imagen , Ecocardiografía Doppler de Pulso , Adulto , Humanos , Masculino , Persona de Mediana Edad , OximetríaRESUMEN
AIMS: During recent years the maximal longitudinal contraction velocity (MLCV), measured by either pulsed tissue Doppler or M-mode, has been suggested as an index of left ventricular (LV) systolic function. The aims of the present study were to compare MLCV with ejection fraction (EF) in consecutive patients with known or suspected heart failure and to compare measures from recordings by pulsed tissue Doppler with recordings by M-mode. METHODS AND RESULTS: Sixty-four consecutive patients with suspected or known heart failure, referred to echocardiography, were included. Twelve of these patients had decreased LV systolic function defined as EF < 50% calculated by the biplane Simpson's rule, while a significantly (P > 0.05) higher proportion of 23 had decreased function defined as decreased MLCV recorded by pulsed tissue Doppler. Measures from M-mode recordings were significantly lower (P < 0.001) than the corresponding measures from tissue Doppler recordings. CONCLUSIONS: The study shows that higher values of MLCV are obtained by pulsed tissue Doppler than by M-mode. Reference values can therefore not be used interchangeably. The results also suggest that MLCV is a more sensitive index of LV systolic function than EF.
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Ecocardiografía Doppler de Pulso , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Contracción Miocárdica , Disfunción Ventricular Izquierda , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Ecocardiografía , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Volumen Sistólico , Sístole , Función Ventricular IzquierdaRESUMEN
OBJECTIVE: In vivo mouse coronary artery circulation is still largely unknown. We demonstrate here in vivo coronary flow velocity profiles in anesthesized mice using a novel high-resolution ultrasound technique. METHODS: Seven 10-week-old C57/Bl6 mice were used for ultrasonographic examination under anesthesia. An Acuson Sequoia 512 echocardiograph with a Microson 15L8 transducer was used. Left coronary artery (LCA) anatomy was mapped in situ. RESULTS: The proximal, mid LCA and its anterior (A-LCA) and lateral (L-LCA) branches could be visualized and coronary flow velocity was reproducibly recorded in all animals. Peak flow velocity was 31.3 +/- 1.5 and 20.7 +/- 2.3 cm/s in the mid LCA and L-LCA branches, respectively. Mean flow velocity was 18.4 +/- 0.7 and 13.8 +/- 1.5 cm/s in the respective vessels. Both the peak and mean flow velocities were higher in the mid LCA than in the distal part of the L-LCA (p = 0.006 and 0.01, respectively). Measurements of the velocity time integral show percentage systolic flow was 15.7 +/- 1.6% and 10.2 +/- 1.4% in the mid LCA and L-LCA, respectively. CONCLUSION: Despite the extremely high heart rate in mice, there are striking similarities between murine and human coronary flow velocity profiles. The presented technique and findings confirm the relevance of the mouse as an animal model in cardiovascular research.
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Vasos Coronarios/anatomía & histología , Vasos Coronarios/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Hemodinámica/fisiología , Animales , Animales Recién Nacidos , Circulación Coronaria/fisiología , Ecocardiografía Doppler en Color , Femenino , Masculino , Ratones , Ratones Endogámicos C57BL , Modelos Animales , Probabilidad , Sensibilidad y Especificidad , Volumen Sistólico/fisiologíaRESUMEN
OBJECTIVE: The aim of the present study was to evaluate maximal longitudinal relaxation velocity of the left ventricle as an index of diastolic function. DESIGN: Sixty-four consecutive patients with known or suspected heart failure, referred to echocardiography, were investigated by M-mode recordings and pulsed tissue Doppler recordings of the maximal early diastolic velocity of the mitral annulus. The classification as true positive or true negative cases was done using age-related reference values of mitral inflow and pulmonary vein flow. RESULTS: A rather high sensitivity of 89% was found for M-mode recordings and a slightly lower sensitivity of 81% for pulsed tissue Doppler recordings. A moderate high specificity was found: 81% for M-mode recordings and 78% for tissue Doppler recordings. The velocities recorded by pulsed tissue Doppler were about 30% higher than velocities recorded by M-mode. CONCLUSION: Maximal relaxation velocity in the long axis of the left ventricle, recorded by either M-mode or tissue Doppler, can be used for assessment of diastolic function but reference values cannot be used interchangeably.
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Velocidad del Flujo Sanguíneo/fisiología , Contracción Miocárdica/fisiología , Adulto , Factores de Edad , Anciano , Ecocardiografía Doppler de Pulso , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/fisiopatología , Sensibilidad y Especificidad , Estadística como Asunto , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular , Función Ventricular Izquierda/fisiologíaRESUMEN
OBJECTIVE: During recent years, the amplitude and the maximal systolic velocity of the mitral annulus motion (MAM) have been established as indices of the left ventricular systolic function and the maximal diastolic velocity of the annulus motion has been suggested as an index of diastolic function. The main aims of the present study were to investigate the feasibility of these techniques in rabbits and to investigate age-related changes concerning these variables. METHODS: Twenty-one New Zealand white rabbits were investigated by echocardiographic M-mode and pulsed tissue Doppler. One subgroup (I) included 11 still-growing, 3.0 +/- 0.2 month-old, animals and another group (II) included 10 young grown up rabbits, 12.1 +/- 1.5 months old. RESULTS: The amplitude (4.8 +/- 0.6 and 3.5 +/- 0.3 mm, respectively) and maximal systolic (98 +/- 14 and 66 +/- 7 mm/s, respectively) and diastolic (111 +/- 21 and 80 +/- 12 mm/s, respectively) velocities of the MAM were significantly (P < 0.001) higher in group I than in group II, despite a bigger heart in the animals in the latter group. A coefficient of variation of <5% was found for both inter- and intraobserver variability for both amplitude and velocities. CONCLUSIONS: The amplitude and velocities of MAM are easily recorded in rabbits with excellent reproducibility and the changes with age seem to be very similar to those in humans. These noninvasive M-mode and tissue Doppler methods are therefore suitable for the investigation of left ventricular function in experimental studies in rabbits.
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Velocidad del Flujo Sanguíneo/fisiología , Válvula Mitral/fisiología , Animales , Diástole/fisiología , Ecocardiografía , Femenino , Masculino , Válvula Mitral/diagnóstico por imagen , Modelos Animales , Modelos Cardiovasculares , Variaciones Dependientes del Observador , Conejos , Reproducibilidad de los Resultados , Sístole/fisiología , Función Ventricular Izquierda/fisiologíaRESUMEN
OBJECTIVE: To evaluate the usefulness of M-mode measurement of circumflex artery motion (CAM) for assessment of left ventricular (LV) function. DESIGN: Seventy-two patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and systolic and diastolic parameters of CAM were measured by M-mode from coronary angiography. Twenty-three patients, examined by echocardiography of mitral annulus motion (MAM) within 24 h before the angiographic examination, formed a subgroup for comparison between angiographic M-mode of CAM and echocardiographic M-mode of MAM. RESULTS: In addition to previous reported CAM amplitude and longitudinal fractional shortening (FSL) the maximal systolic velocity of CAM can be reliably recorded by M-mode. The diastolic indices, atrial contribution to the total amplitude and maximal early and late diastolic velocities, are also well monitored by M-mode of CAM in comparison with echocardiographic MAM. CONCLUSION: LV systolic and diastolic function can be assessed by M-mode of CAM.
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Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Función Ventricular Izquierda , Adulto , Anciano , Circulación Coronaria/fisiología , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Diástole/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiología , Sístole/fisiología , UltrasonografíaRESUMEN
OBJECTIVE: In the present study, we evaluate our ability to predict surgical procedure repair or replacement using preoperative echocardiography. DESIGN: The reports from transthoracic echocardiographic examinations of 298 patients were analyzed and the gross anatomic lesions and the mechanisms involved were classified into one of three main groups (functional with normal valves, organic degenerated with hypermobile valve or organic degenerated without hypermobility). RESULTS: It was possible to assess the likelihood of repair in 226 patients (76%). The criteria used were institution based and reflect the surgical procedures during the study period (1995-1999). The proportion of patients undergoing repair was 58%. In patients with a high likelihood, repair was performed in 86%. The corresponding figures in the intermediate- and low-likelihood groups were 63 and 23%, respectively. Hypermobility in the posterior leaflet and functional mitral regurgitation led to repair in the majority of patients, while patients with hypermobility in the anterior or both valves more frequently underwent replacement. CONCLUSION: We conclude that it is possible to identify patients with a high likelihood of repair using transthoracic echocardiography.
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Ecocardiografía , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patología , Anciano , Puente de Arteria Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/fisiopatología , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/cirugíaRESUMEN
OBJECTIVE: To evaluate the usefulness of circumflex artery motion (CAM) for assessment of left ventricular (LV) function. DESIGN: Seventy-three consecutive patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and CAM was measured from coronary angiography. RESULTS: The ratio between CAM and the end-diastolic length of the ventricle, which can be denominated long-axis fractional shortening (FS(L)), was found to be a better index of LV function than CAM per se. There was a significant linear correlation between EF and FS(L) (r = 0.81, SEE = 8.2, p < 0.001). When values of FS(L) > or =10% were selected to define a normal EF (> or =50%) there was a sensitivity of 95% and a specificity of 93%. Visual estimation of EF from CAM was not as good as the use of calculated FS(L) but may me useful as a fast screening method. CONCLUSION: LV systolic function can be assessed by studying CAM recorded by coronary angiography.
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Angiografía Coronaria/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Arterias/fisiopatología , Arteriosclerosis/fisiopatología , Humanos , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Infarto del Miocardio/fisiopatología , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Maximal long-axis relaxation velocity (RV(m)), measured from the mitral annulus motion (MAM), has recently been suggested as an index of left ventricular (LV) diastolic function. M-mode recording and pulsed tissue Doppler have been used. Regarding the M-mode method, reference values have not been presented previously. In the current study, therefore, the influence on RV(m) of such variables as age, body size, heart rate, and blood pressure was investigated to obtain adequate reference values. METHODS AND RESULTS: Fifty-seven healthy subjects were included in the study. RV(m) was recorded by M-mode echocardiography from apical 4- and 2-chamber views from 4 sites of the mitral annulus. Multiple regression analysis showed that heart rate ought to be taken into account when reference values are calculated for children and adolescents, and age must be considered in adults. For reference values in children and adolescents, the following equation is suggested: RV(m) = 171 - 0.54 x heart rate (SEE = 18.7). In adults over 18 years, the suggested equation is RV(m) = 163 - 1.29 x age (SEE = 8.4.)