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Biomedical subjects

P Spirito

Publications and source records attributed to P Spirito.

At least 55 records · Page 3Linked to original sources
PubMed1990

Relation between extent of left ventricular hypertrophy and occurrence of sudden cardiac death in hypertrophic cardiomyopathy.

Sudden unexpected death can be the first clinical manifestation of hypertrophic cardiomyopathy and is the most devastating feature of the natural history of the disease. Left ventricular hypertrophy appears to be an important determinant of many clinical features of hypertrophic cardiomyopathy, but the relation between its magnitude and the occurrence of sudden cardiac death has not been clearly defined. In this study, the magnitude of hypertrophy was assessed with two-dimensional echocardiography in 29 asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy who subsequently died suddenly or experienced cardiac arrest with documented ventricular fibrillation. Findings were compared with those obtained in a control group of 95 patients of similar age and symptomatic state. Maximal left ventricular wall thickness was significantly greater in patients with sudden death (26 +/- 7 mm) than in control patients (21 +/- 5 mm, p less than 0.001). Left ventricular wall thickness index, a quantitative expression of the overall extent of hypertrophy, was also greater in patients with sudden death (76 +/- 20 mm) than in surviving control patients (62 +/- 13 mm, p less than 0.001). Particularly marked and diffuse hypertrophy, with maximal wall thickness greater than or equal to 30 mm or wall thickness greater than or equal to 25 mm in two or more of the four segments into which the left ventricle had been divided, was eight times more common in patients with sudden death (11 [38%] of 29) than in control patients (5 [5%] of 95, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Restrictive diastolic abnormalities identified by Doppler echocardiography in patients with thalassemia major.

The consequences of transfusional iron overload on left ventricular diastolic filling have never been investigated systematically in patients with thalassemia major. In the present study, the pattern of left ventricular filling was assessed by Doppler echocardiography in 32 patients with thalassemia major (age, 17 +/- 5 years) who had not experienced symptoms of heart failure and had normal left ventricular systolic function. Data were compared with those obtained in 32 age-matched and sex-matched normal subjects. An abnormal Doppler pattern of left ventricular filling with increased flow velocity at mitral valve opening followed by an abrupt and premature decrease of flow velocity in early diastole was identified in the patients with thalassemia. Peak flow velocity in early diastole was increased in patients compared with controls (90 +/- 10 vs. 81 +/- 15 cm/sec; p less than 0.01), and rate of deceleration of flow velocity after the early diastolic peak and the ratio between the early and late (atrial) peaks of flow velocity were also increased (1,050 +/- 325 vs. 762 +/- 193 cm/sec2 and 2.7 +/- 0.7 vs. 2.2 +/- 0.5, respectively; p less than 0.001), whereas flow velocity deceleration time was reduced (97 +/- 22 vs. 119 +/- 19 msec; p less than 0.001). This Doppler pattern of diastolic filling is usually described as "restrictive" and reflects a decrease in left ventricular chamber compliance. A restrictive pattern of left ventricular filling was also identified in the subgroup of 16 study patients who had undergone optimal iron chelation therapy with deferoxamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Clinical course and prognosis of hypertrophic cardiomyopathy in an outpatient population.

Hypertrophic cardiomyopathy has been investigated mainly at referral institutions. Thus, the clinical history of the disease that emerges from published studies could be influenced by a bias in patient selection. In the present study, we compared the clinical features of an outpatient population of 25 patients who had hypertrophic cardiomyopathy with those reported in 78 studies published during the past five years. In the 25 study patients, age, sex, and the extent of left ventricular hypertrophy, as well as the prevalence of diastolic filling abnormalities, subaortic obstruction, and ventricular arrhythmias, were similar to those in patients described in the literature. Cardiac symptoms, however, were much less severe in the study patients. Eighteen patients (72 percent) were asymptomatic, six (24 percent) had mild symptoms, and only one (4 percent) had moderate-to-severe symptoms. Of 24 patients followed for a mean period of 4.4 years (range, 2.9 to 5.7), none died or had clinical deterioration. Of 3404 patients described in the 78 studies we reviewed, 2483 (73 percent) came from only two referral institutions. Of the 1721 patients in whom severity of symptoms was reported, 757 (44 percent) had moderate-to-severe symptoms. However, 727 (96 percent) of these patients were studied at one of the same two referral institutions. We conclude that the natural history of hypertrophic cardiomyopathy may be more benign than can be inferred from published reports.

Adult↗
PubMed1989

Relation between extent of left ventricular hypertrophy and age in hypertrophic cardiomyopathy.

This investigation was undertaken to determine whether a relation could be identified between left ventricular wall thickness and age in a large population of symptomatic patients with hypertrophic cardiomyopathy. Extent of left ventricular hypertrophy was assessed with two-dimensional echocardiography in 173 patients with hypertrophic cardiomyopathy who ranged in age from 21 to 74 years (mean 45) and had mild to severe cardiac symptoms. The overall study group was classified into five age subgroups (each corresponding to a decade); maximal left ventricular wall thickness and wall thickness index (a quantitative expression of the overall extent of hypertrophy) were assessed in each group. These two indexes were significantly higher in patients 21 to 30 years of age than in patients in each of the other four older age groups. The two indexes of left ventricular hypertrophy were also significantly higher in patients 31 to 40 years of age than in patients who were 61 to 74 years old. Multivariate regression analysis showed that the relation between wall thickness and age was not influenced by other clinical variables such as severity of symptoms, presence of subaortic obstruction, left ventricular cavity dimension and gender. In conclusion, the findings indicate that, in a population of symptomatic adult patients with hypertrophic cardiomyopathy, left ventricular hypertrophy is considerably more severe in younger than in older patients and that there is an inverse relation between left ventricular wall thickness and age.

Adult↗
PubMed1988

Doppler echocardiography for assessing left ventricular diastolic function.

During the last 2 years, the use of pulsed Doppler echocardiography for assessing left ventricular diastolic function has received increased attention. This method is based on measurements derived from a waveform that reflects the velocity of blood flow through the mitral valve during ventricular filling. The technique is particularly attractive because it is noninvasive and relatively simple. Technically satisfactory recordings can be obtained in most patients. In a relatively short period, numerous studies using the Doppler technique to assess diastolic function in children and adults with cardiac disease have been published. This review appraises the current status of applications of Doppler echocardiography and critically examines the strengths, limitations, and ultimate potentials of this new method.

Blood Flow Velocity↗
PubMed1988

Reproducibility of Doppler echocardiographic measurements of left ventricular diastolic function.

The present investigation was undertaken in 12 normal subjects to determine the magnitude of technical and biologic variability of six previously validated Doppler indexes of diastolic function. Variability due to the reader was small for each of the six Doppler indexes. Variability due to the technician was larger than for the reader, and day-to-day variability was larger than variability due to either the reader or technician for the great majority of the comparisons (i.e., 21 of 24). Four Doppler indexes assessing early diastolic events (isovolumic relaxation, duration of the early diastolic peak of flow-velocity, rate of decrease of flow-velocity in early diastole, and maximal early diastolic flow-velocity) did not show statistically significant changes due to day-to-day variability. The two Doppler indexes assessing late diastolic events [maximal late diastolic (atrial) flow-velocity, and the ratio between maximal early and late flow-velocity] showed greater change on a day-to-day basis (P less than 0.05). In conclusion, Doppler indexes that represent a measure of isovolumic relaxation and the early filling phases of diastole showed small variability. Indexes that measure the late filling phase of diastole, such as maximal late (atrial) diastolic flow-velocity and the ratio between early and late diastolic flow-velocities, showed relatively large day-to-day variability; therefore, serial changes in the atrial contribution to ventricular filling identified by these indexes should probably be interpreted with some caution.

Adult↗
PubMed1988

Influence of aging on Doppler echocardiographic indices of left ventricular diastolic function.

The influence of age on six Doppler echocardiographic indices of left ventricular diastolic function was assessed in 86 normal volunteers aged from 20 to 74 years (mean 36). Five of the six indices showed a linear relation with age. Duration of isovolumic relaxation and maximal late diastolic (atrial) flow velocity increased significantly with age (r = 0.34 and r = 0.69), respectively). Conversely, maximal early diastolic flow velocity, the rate of decrease (deceleration) of flow velocity in early diastole, and the ratio between maximal early and late diastolic flow velocities decreased significantly with age (r = -0.30, r = -0.40, and r = -0.63, respectively). Duration of the early diastolic flow velocity peak did not show a linear relation with age (r = 0.04). Comparison of Doppler indices of diastolic performance among different age groups (20 to 29 years, 30 to 49 years, and 50 to 74 years) also showed an influence of aging on these diastolic variables. Isovolumic relaxation was significantly longer in older subjects than in either the intermediate or the younger age groups. In addition, both the rate of decrease of flow velocity in early diastole and the ratio between maximal early and late diastolic flow velocities were significantly reduced in older subjects. Multivariate linear regression analysis showed that after adjustment for left ventricular wall thickness and cavity dimension, percentage systolic shortening, and heart rate, age continued to correlate significantly with most Doppler indices of diastolic function. The isovolumic relaxation phase and the early and late filling phases of diastole, as assessed by Doppler echocardiography, are importantly and independently affected by aging. Hence the effects of age should be taken into account when the normal limits for Doppler indices of left ventricular diastolic function are defined.

Adult↗
PubMed1987

Relation between extent of left ventricular hypertrophy and occurrence of ventricular tachycardia in hypertrophic cardiomyopathy.

This study was undertaken to determine whether the occurrence of ventricular tachycardia (VT) in patients with hypertrophic cardiomyopathy (HC) is related to the magnitude and extent of left ventricular (LV) hypertrophy. Extent of LV hypertrophy was assessed using 2-dimensional echocardiography in 30 patients with HC in whom VT had been documented on 24-hour ambulatory electrocardiographic (ECG) monitoring, and the extent of LV hypertrophy in these patients was compared with that of a control group of 61 patients with HC who had normal ambulatory ECG recordings. Severe LV hypertrophy, involving at least 3 of the 4 LV segments, occurred significantly more often in patients with documented VT (16 of 30, 53%) than in those with normal ambulatory ECG findings (13 of 61, 21%; p less than 0.002). Conversely, mild LV hypertrophy, involving only 1 LV segment, occurred significantly less often in patients with VT (5 of 30, 17%) than in the control subjects (32 of 61, 52%; p less than 0.001). Moderate LV hypertrophy, involving 2 of the 4 LV segments, occurred about as frequently in patients with VT (9 of 30, 30%) as in patients with normal ambulatory ECG findings (16 of 61, 26%; p greater than 0.05). In addition, the LV wall thickness index, a quantitative measure of overall extent of LV hypertrophy, was also significantly higher (thereby indicating a greater magnitude of hypertrophy) in patients with documented VT (72 +/- 17 mm) than in those with normal ambulatory ECG recordings (61 +/- 14 mm; p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Occurrence and significance of progressive left ventricular wall thinning and relative cavity dilatation in hypertrophic cardiomyopathy.

This investigation was undertaken to assess the prevalence of systolic dysfunction, left ventricular (LV) wall thinning and cavity enlargement in a large population of patients with hypertrophic cardiomyopathy (HC), and to determine the role of these conditions in the natural history of this disease. Of 217 consecutively studied patients with HC, most of whom were severely symptomatic, 197 (91%) had an LV ejection fraction of 50% or more and 20 (9%) had an ejection fraction of less than 50% as assessed with radionuclide angiography. Changes in LV wall thickness and cavity dimension were evaluated using serial M-mode and 2-dimensional echocardiography over an average follow-up of 3.6 years in 67 of the 217 patients (54 with ejection fraction of greater than or equal to 50% and 13 with ejection fraction less than 50%). A substantial decrease (at least 5 mm) in LV wall thickness was seen in 8 of the 13 patients (62%) with an ejection fraction greater than or equal to 50%, but in only 2 of the 54 patients (4%) with an ejection fraction greater than or equal to 50% (p less than 0.001). LV cavity dimension increased significantly over the period of follow-up in the 13 patients with depressed ejection fraction (from 44 +/- 5 to 49 +/- 7 mm, p less than 0.005); however, absolute cavity size remained normal (less than or equal to 52 mm or less) in 10 of these 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy is a primary myocardial disease in which symptoms may frequently result from impaired left ventricular relaxation, filling and compliance. In the present investigation, Doppler echocardiography was utilized to measure transmitral flow velocity and thereby assess left ventricular diastolic performance noninvasively in a group of 111 patients representative of the broad clinical spectrum of hypertrophic cardiomyopathy. In patients with hypertrophic cardiomyopathy, all Doppler indexes of diastolic relaxation and filling differed significantly (p less than 0.001) from those obtained in 86 control subjects without heart disease, namely, prolongation of isovolumic relaxation (94 +/- 24 versus 78 +/- 12 ms) and of the early diastolic peak of flow velocity (244 +/- 55 versus 220 +/- 28 ms), as well as slower deceleration (3.4 +/- 1.4 versus 4.9 +/- 1.3 m/s2) and reduced maximal flow velocity in early diastole (0.5 +/- 0.2 versus 0.6 +/- 0.1 m/s). As an apparent compensation for impaired relaxation and early diastolic filling, the atrial contribution to left ventricular filling was increased, as shown by increased late diastolic flow velocity (0.4 +/- 0.3 versus 0.3 +/- 0.1 m/s) and reduced ratio of maximal flow velocity in early diastole to that in late diastole (1.4 +/- 0.8 versus 2.1 +/- 0.9). The vast majority of patients with hypertrophic cardiomyopathy (91 [82%] of 111) showed evidence of impaired left ventricular diastolic performance, as assessed from the Doppler waveform. Abnormal Doppler diastolic indexes were identified with similar frequency in patients with (78%) or without (83%) left ventricular outflow obstruction, as well as in patients with (84%) or without (80%) cardiac symptoms. However, patients with nonobstructive hypertrophic cardiomyopathy showed more severe alterations in the Doppler indexes of diastolic function than did patients with obstruction. Thus, abnormal diastolic performance as assessed by Doppler echocardiography was apparent in the vast majority of the study patients with hypertrophic cardiomyopathy, independent of the presence or absence of cardiac symptoms or a subaortic pressure gradient. The high frequency with which diastolic abnormalities are identified in asymptomatic patients with hypertrophic cardiomyopathy suggests that impaired diastolic performance may be present at a time in the natural history of the disease when functional limitation is not yet evident.

Adolescent↗
PubMed1987

Absence of progression of left ventricular hypertrophy in adult patients with hypertrophic cardiomyopathy.

Development or progression of left ventricular hypertrophy has recently been described in children with hypertrophic cardiomyopathy. To determine whether similar changes in magnitude and distribution of left ventricular hypertrophy may also occur in adult patients with this disease, serial assessment of left ventricular wall thickness was obtained with M-mode and two-dimensional echocardiography in 65 patients with hypertrophic cardiomyopathy who were 23 to 50 years of age. The follow-up period was 3 to 6 years (mean 4). None of the 65 patients showed a substantial increase (greater than or equal to 5 mm) in left ventricular wall thickness; however, 9 (14%) demonstrated a substantial decrease (5 to 9 mm). Wall thinning most commonly involved the anterior ventricular septum (seven patients), but was also identified in the posterior septum (six patients), lateral free wall (two patients) and posterior free wall (one patient). In the nine patients with wall thinning, left ventricular end-diastolic diameter increased significantly (from 44 +/- 6 to 51 +/- 6 mm; p less than 0.001); however, in seven of the nine, absolute cavity size remained within normal limits (less than or equal to 52 mm) at the most recent evaluation. Eight of the nine patients with left ventricular wall thinning and relative cavity enlargement were severely symptomatic and one was mildly symptomatic. In conclusion, substantial progression of left ventricular hypertrophy was not identified in any of the study patients. Hence, if such progression occurs in adults with hypertrophic cardiomyopathy, it is probably rare. Conversely, an important minority of adult patients with hypertrophic cardiomyopathy may show progressive left ventricular wall thinning and relative cavity enlargement, which are usually associated with severe cardiac symptoms.

Adult↗
PubMed1986

Noninvasive assessment of left ventricular diastolic function: comparative analysis of pulsed Doppler ultrasound and digitized M-mode echocardiography.

The relation between Doppler and digitized M-mode echocardiographic indexes of left ventricular (LV) diastolic function was analyzed. Diastolic variables obtained with these 2 techniques were compared in 19 normal volunteers and in 25 patients with a variety of cardiac diseases. The 2 techniques were in agreement in distinguishing normal from abnormal diastolic function in 20 of the 25 patients (80%) with cardiac disease. Furthermore, a close linear relation with a high correlation coefficient and a small standard error of the estimate was identified between measurements of isovolumic relaxation determined by Doppler and by M-mode echocardiography (r = 0.82, standard error of the estimate = 18 ms). Doppler indexes of diastolic filling such as the slope (descent) and the duration of the early diastolic flow-velocity peak did not show a close correlation with the peak rate and the time to peak rate of increase in LV internal dimension determined by digitized echocardiography. Thus, Doppler and digitized echocardiography were consistent in distinguishing normal from abnormal diastolic function in most of the study patients, although specific variables of LV ventricular filling determined by the 2 techniques were not closely related. In addition, Doppler and M-mode echocardiographic measurements of isovolumic relaxation showed an excellent correlation.

Adolescent↗
PubMed1986

Development and progression of left ventricular hypertrophy in children with hypertrophic cardiomyopathy.

Whether the magnitude and distribution of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy are established at birth, or whether they evolve during the first years of life, is unknown. Accordingly, we conducted serial echocardiographic studies in 39 children with a family history or morphologic evidence of hypertrophic cardiomyopathy. The patients were initially evaluated at 4 to 15 years of age (mean, 11) and most recently at 9 to 20 years (mean, 16). During a follow-up period of 2.5 to 6.8 years (mean, 4), the magnitude and extent of preexisting left ventricular hypertrophy markedly increased in 17 patients and the morphologic appearance of the heart evolved from normal to hypertrophic in 5 others. In these 22 patients the left ventricular wall thickness increased strikingly (by 6 to 23 mm, a change of 101 +/- 62 percent); these increases significantly exceeded those expected as a consequence of normal growth (13 +/- 10 percent; P less than 0.001) and were not associated with symptomatic deterioration or related to subaortic obstruction. We conclude that left ventricular hypertrophy may develop or progress spontaneously in patients with hypertrophic cardiomyopathy during childhood, when body growth is considerable. Since echocardiograms may be normal during childhood--before the morphologic features of hypertrophic cardiomyopathy develop--a single echocardiographic examination of young relatives of patients with hypertrophic cardiomyopathy may not exclude this disease.

Adolescent↗
PubMed1986

Severe functional limitation in patients with hypertrophic cardiomyopathy and only mild localized left ventricular hypertrophy.

Ten patients with nonobstructive hypertrophic cardiomyopathy and only mild localized left ventricular hypertrophy who had severe symptoms of cardiac failure are described. During a mean follow-up period of 7 years, 6 of these 10 patients showed a substantial increase in left ventricular internal dimension (6 to 15 mm, mean 10) as assessed with M-mode echocardiography, although absolute left ventricular cavity size remained within normal limits in 5 of the 6. Four patients demonstrated substantial septal thinning (5 to 14 mm, mean 8). Left ventricular diastolic function, assessed by radionuclide angiography in nine patients, was impaired in eight who showed decreased peak filling rate (less than 2.5 end-diastolic volumes/s) and prolonged time to peak rate of filling (greater than or equal to 180 ms). Furthermore, left ventricular systolic function, usually supernormal in patients with hypertrophic cardiomyopathy, was depressed (ejection fraction less than or equal to 45%) in six patients. Hence, a subset of patients was identified with nonobstructive hypertrophic cardiomyopathy and only mild localized left ventricular hypertrophy who experienced severe cardiac symptoms. The majority of these patients showed both systolic and diastolic left ventricular dysfunction in the presence of a progressive increase in left ventricular internal dimension (but without absolute left ventricular dilation) or ventricular septal thinning or both. Such patients may represent an important component of the natural history of hypertrophic cardiomyopathy which has not been previously fully appreciated.

Adolescent↗
PubMed1986

Noninvasive assessment of left ventricular diastolic function: comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques.

This investigation was performed to determine whether variables obtained directly from the Doppler left ventricular diastolic flow velocity profile provide a reliable estimate of diastolic function. Measurements of diastolic flow velocity obtained by Doppler echocardiography were compared with volumetric measurements of left ventricular diastolic filling determined by radionuclide angiography in 12 subjects without cardiac disease and in 25 patients with a variety of cardiac diseases. The two methods were in agreement in distinguishing normal from abnormal diastolic function in 21 (84%) of the 25 patients with cardiac disease, identifying diastolic function as normal in 8 and abnormal in 13 of these patients. Good correlations were observed between certain Doppler variables of left ventricular diastolic flow velocity and radionuclide angiographic variables of left ventricular filling. The time interval from the aortic closing component of the second heart sound to the end of the early diastolic flow velocity peak, assessed with Doppler echocardiography, correlated well with the time interval from end-systole to the end of rapid filling, assessed with radionuclide angiography (r = 0.83). Descent of the Doppler early diastolic flow velocity peak correlated well with the radionuclide angiographic peak filling rate (r = 0.79). The ratio between the heights of the early and late (due to atrial systole) peaks of diastolic flow velocity showed good correlation with the ratio between percent of left ventricular filling during rapid filling and during atrial systole (r = 0.76). These findings demonstrate that the left ventricular diastolic flow velocity profile obtained with Doppler echocardiography compares favorably with radionuclide angiographic variables in the evaluation of left ventricular diastolic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Unusual distribution of left ventricular hypertrophy in obstructive hypertrophic cardiomyopathy: localized posterobasal free wall thickening in two patients.

Two patients with hypertrophic cardiomyopathy and a previously unreported distribution of left ventricular hypertrophy are described. Each patient showed substantial wall thickening that was confined to the posterobasal segment of the left ventricular free wall, as well as evidence of dynamic subaortic obstruction. This observation emphasizes the fact that hypertrophic cardiomyopathy is characterized by a broad morphologic spectrum. Furthermore, it demonstrates a unique circumstance in which left ventricular outflow tract obstruction may occur in the absence of anterior and basal septal hypertrophy.

Adult↗
PubMed1985

Diastolic abnormalities in patients with hypertrophic cardiomyopathy: relation to magnitude of left ventricular hypertrophy.

To investigate the relationship between diastolic abnormalities and left ventricular hypertrophy, 52 patients with hypertrophic cardiomyopathy (HCM) and 22 normal subjects were studied with digitized M mode echocardiography and two-dimensional echocardiography. Echocardiographic indexes of diastolic function were compared in patients with different extent of left ventricular hypertrophy. Time interval from minimum left ventricular internal dimension to mitral valve opening and time to peak rate of increase in left ventricular internal dimension were significantly prolonged (80 +/- 31 and 100 +/- 37 msec, respectively) in patients with HCM and the most extensive left ventricular hypertrophy compared with those in patients with mild left ventricular hypertrophy (59 +/- 25 and 74 +/- 34 msec, respectively; p less than .01). Furthermore, peak rate of posterior wall diastolic excursion was significantly reduced in those patients with HCM and posterior wall hypertrophy (8.3 +/- 4.0 cm/sec) compared with that in patients with HCM but normal posterior wall thickness (11.2 +/- 3.4 cm/sec; p less than .002). However, abnormal M mode echocardiographic indexes of diastolic function were also identified in a substantial proportion of patients (i.e., 73%) with HCM and only mild left ventricular hypertrophy. In these patients, time interval from minimum left ventricular internal dimension to mitral valve opening (59 +/- 25 msec), peak rate (12 +/- 4 cm/sec), and time to peak rate of increase in left ventricular internal dimension (74 +/- 34 msec) were significantly different from normal (25 +/- 12 msec, 21 +/- 3 cm/sec, and 49 +/- 12 msec, respectively; p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗