This study evaluated the usefulness of echocardiographic evaluation in the selection of optimal atrioventricular delay (AVD) in DDD-paced patients. We discussed the influence of various AVD programming on systolic and diastolic left ventricle function. The detrimental effect of diastolic mitral regurgitation (DMR) on stroke volume was emphasized. Clinically useful echocardiographic methods of optimal AVD selection and prevention of DMR was discussed.

Atrioventricular Node↗

PubMed2002

[Cardiopulmonary exercise capacity in adult patients with atrial septal defect].

UNLABELLED: The aim of the study was to evaluate cardiopulmonary exercise capacity (WTS) in adult patients with atrial septal defect (ASD). After excluding 10 patients with additional cardiac, pulmonary or muscle diseases, 53 patients with ASD (Gr-ASD; mean age 37.8 +/- 14.9 years; 35 women, 19 men) were enrolled in our study. In addition, we evaluated 22 healthy age and gender matched control subjects (Gr-K; mean age 36.6 +/- 14.9 years; 13 women, 9 men). First, all subjects underwent resting spirometry and forced vital capacity--(FVC; % of predicted value), one-second forced expiratory volume--(FEV1; % of predicted value) and FEV1/FVC (%) were determined. Then each subject performed a symptom-limited, incremental exercise test (modo Bruce). We evaluated the following parameters of resting metabolism: respiratory rate--(RR; L/min), minute ventilation--(VE; L/min), tidal volume--(Vt; L), oxygen uptake--(VO2; ml/kg/min), end-tidal carbon dioxide pressure--(PET CO2; mmHg), end tidal oxygen pressure--(PET O2; mmHg), ventilatory equivalent for carbon dioxide--(VE/VCO2) and ventilatory equivalent for oxygen--(VE/VO2). The following exercise parameters were analysed: peak oxygen uptake--(VO2 peak; ml/kg/min), VO2 peak expressed as % of predicted value--(VO2 %N), anaerobic threshold--(AT; % VO2 max), ventilatory equivalent for carbon dioxide--(VE/VCO2), end-tidal carbon dioxide pressure--(PET CO2; mmHg), O2 pulse, time of exercise--(T; min) and time to AT--(TAT; min). In addition, we performed a subgroup analysis for ASD patients below and > or = 40 years of age. All values were expressed as mean +/- SD. RESULTS: Although there was no significant difference in FVC, FEV1, FEV1/FVC, VO2, VE, Vt, RR between ASD patients and controls, the ASD patients aged 40 or older showed significantly lower FEV1/FVC and significantly higher RR. Expiratory gas exchange analysis showed significant differences between the ASD patients and controls (higher VE/VCO2, VE/VO2, PET CO2, and lower PET O2 respectively). Moreover, VO2 peak, VO2%N, AT, PET CO2 and O2 pulse were significantly lower while VE/VCO2 was significantly higher in ASD patients than in normal subjects. On average, VO2%N in ASD patients was only 61% of the predicted value for age and sex. Total time of exercise and time to AT were significantly shorter in ASD patients as well. CONCLUSIONS: WTS allows appropriate evaluation of cardiopulmonary capacity in ASD patients, though the mechanisms underlying ventilatory and hemodynamic abnormalities are still not fully understood. Adult patients with ASD reveal ventilatory abnormalities with an age-related trend towards deterioration. Cardiopulmonary exercise capacity in adults with ASD is markedly reduced in comparison with healthy population and deteriorates with age. WTS complements echocardiographic and hemodynamic evaluation of patients with ASD, and is helpful in indicating patients for ASD closure and their follow up.

Adult↗

PubMed2002

[Comparison of quantitative echocardiographic methods with angiography for assessment of mitral regulation].

UNLABELLED: The aim of this study was to compare echocardiographic assessment of the severity of mitral regurgitation (MR) with angiographic grading. MATERIAL: 51 patients (patients) with MR (43 men and 8 women), aged from 38 to 75 (mean 56 +/- 9 years), were used in the study. The etiology of MR was: Coronary artery disease (28 pts), infective endocarditis (3 patients), rheumatic disease (5 patients), dilated cardiomyopathy (7 patients), mitral valve prolapse (8 patients). EXCLUSION CRITERIA: Aortic stenosis and/or aortic insufficiency, mitral stenosis, mechanical prostheses and atrial fibrillation. METHODS: The mitral regurgitant volume (RV) and effective regurgitant orifice (ERO) were estimated by the proximal convergence method (PISA), regurgitant fraction (RF) and vena contracta width (VCW) by color Doppler quantitative method and compared to the cine ventriculographic grades. The angio-graphic severity of MR was classified as 1 to 4 grades according to the Sellers criteria. RESULTS: There was a good correlation between the angiographic grading and ERO (r = 0.855, p < 0.001), RV (r = 0.868, p < 0.001), RF (r = 0.923, p < 0.001) and VCW (r = 0.846, p < 0.001). CONCLUSIONS: 1. PISA method is clinically useful in routine evaluation of the severity of MR. 2. VCW provides a simple method for the identification of patients with severe MR. 3. These methods offer an alternative approach in quantifying MR noninvasively.

Adult↗

PubMed2002

[Evaluation of the respiratory system in patients with heart failure based on spiro-ergometric exercise test parameters].

UNLABELLED: The objective of this study was to assess the ventilatory parameters of cardiopulmonary exercise test (CPX) in patients with moderate and severe heart failure (HF). MATERIAL AND METHODS: We investigated 110 patients (pts) (mean age 52.1 +/- 11.1 years) with chronic HF due to dilated cardiomyopathy (42 pts) or coronary artery disease (68 pts). Resting spiro-metry, CPX on a treadmill (modified Naughton protocol, 83 pts, or modified Bruce protocol, 26 pts) and echocardiography were performed. The following parameters were analyzed: left ventricle ejection fraction (EF), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Both FEV1 and FVC are expressed as a percentage of predicted normal values (FEV1-%N, FVC-%N), FEV1/FVC ratio, rest and peak parameters of CPX ratio of physiological dead space to tidal volume (VD/VTrest, VD/VTpeak), respiratory rate (RRrest, RRpeak), minute ventilation (VErest, VEpeak), tidal volume (VTrest, VTpeak), endtidal Pco2 (PETCO2rest, PETCO2peak), endtidal Po2 (PETO2rest, PETO2peak), ventilatory equivalent for carbon dioxide (VE/VCO2rest, VE/VCO2peak) and oxygen (VE/VO2rest' VE/VO2peak), exercise time (T), peak oxygen uptake VO2peak' VO2peak%N, heart rate reserve HRR, peak heart rate HRpeak%N. After the mean follow-up period of 28.5 +/- 12 months, the patients were divided into groups: Group I: n = 78 pts who survived without heart transplantation (HTX) and Group II: n = 32 pts; n = 20 pts who died while on the transplant list; n = 12 pts who underwent urgent HTX. RESULTS: The patients in the group II had lower EF, more reduced peak oxygen consumption and shorter duration of exercise. We found that FEV1, FVC, FEV1-%N, FVC-%N were more severely impaired in group II. The patients in group II also had lower PETCO2rest and higher PETO2rest. There were no differences in the FEV1/FVC ratio, VD/VTrest, RRrest, VTrest, VErest, VE/VCO2rest, VE/VO2rest between the groups. The value of VD/VTpeak, VE/VCO2peak, VE/VO2peak, PETCO2peak were significantly higher in group II when compared with group I, but the values of PETO2 were lower. Despite a shorter duration of CPX in group II there were no differences in HRpeak%N, HRR, RRpeak, VTpeak, or VEpeak, between the groups. CONCLUSION: At rest the patients with more severe HF appear to have a more restrictive pulmonary pattern and impaired pulmonary gas exchange. During exercise, the patients with severe HF have an increased dead space in the lung; more impaired pulmonary gas exchange and increased ventilatory response at a given workload.

Adult↗

PubMed2002

[Prognostic value of results from clinical tests, echocardiographic, electrocardiographic and spiro-ergometric exercise test examinations in patients with heart failure].

UNLABELLED: The aim of this study was to assess the importance of the non invasive procedures in determinating prognosis of patients with heart failure (HF). MATERIAL AND METHODS: We investigated 110 patients with a mean age of 52.1 (65 patients--59%) with chronic (HF) due to coronary artery diseases and dilated cardiomyopathy (45 patients--41%). All the patients underwent baseline evaluations including a clinical status, echocardiography, Holter monitoring and a cardiopulmonary exercise test (CPX). After the mean follow-up period of 28.5 +/- 12 months, the patients were divided into 2 groups: Group I--in which 78 patients survived without heart transplantation (HTX) and Group II--in which 20 patients died and 12 underwent HTX. The relationship between the variables derived from noninvasive procedures was assessed using multivariate Cox proportional hazards models. RESULTS: Compared to group I, Group II had a significantly higher number of patients that were classified into NYHA class III. In addition, a third heart tone was identified more often in group II and an increased number of HF etiology was due to ischemia. Electrocardiographic recording showed an increased frequency of left bundle branch block and complex ventricular arrythmias. Markedly increased values of WSLK, OKSLK, WLP, OKRLK and FW were found in group II, as compared to group I. Cardiopulmonary exercise tests in group II revealed lower values of T, VO2AT, SBPpeak, VO2peak, VO2peak%N, PETCO2peak as well as VD/VTpeak, VE/VO2peak, and VE/VCO2peak. After multivariate analysis lope VE/VCO2peak (p = 0.009), peak oxygen uptake VO2peak-%N (p = 0.035), (p = 0.036), left ventricle end systolic volume (p = 0.045) and left bundle branch block (p = 0.046) were independent predictors of survival without heart transplantation. CONCLUSION: On multivariate analysis by the Cox proportional hazards method, the variables: VE/VCO2peak, VO2peak%N, etiology--CAD, OKSLK, and left bundle branch block were independent prognostic predictors. The echocardio-graphic evaluation play a significant role in the assessment of prognosis in patients, with HF. The ejection fraction of the left ventricle was not confirmed as an independent prognostic factor in HF.

Adult↗