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Biomedical subjects

Robert C Bahler

Publications and source records attributed to Robert C Bahler.

8 recordsLinked to original sources
PubMed2006

B-type natriuretic peptide and cardiac dysfunction in Duchenne muscular dystrophy.

Serum levels of B-type natriuretic peptide have moderate utility for detection of early ventricular dysfunction in adults and in experimental muscular dystrophy. To determine if B-type natriuretic peptide levels are useful in the detection of early left ventricular dysfunction in Duchenne muscular dystrophy patients, measurements were obtained in 21 patients being evaluated by echocardiography for left ventricular dysfunction. Two patients with clinical evidence of heart failure were excluded (mean B-type natriuretic peptide level of 352 pg/ml). Age range of the remaining 19 patients was 9-21 yrs. Fractional shortening was abnormal (<30%) in 14/19 and early diastolic tissue Doppler velocities were abnormal in 13/16. In these patients B-type natriuretic peptide levels were clearly normal (<30 pg/ml) in 15/19 and only mildly elevated (30-80 pg/ml) in 4/19. The 4 patients with mildly elevated B-type natriuretic peptide had significantly lower fractional shortening (12.6+/-5.9 versus 19.8+/-5.3, p<0.05). In conclusion, B-type natriuretic peptide levels are normal in the majority of Duchenne muscular dystrophy patients with asymptomatic left ventricular dysfunction and only mildly elevated when fractional shortening is markedly reduced.

Adolescent↗
PubMed2006

Characteristics and impact of obesity on the outpatient echocardiography laboratory.

The impact of the growing obesity epidemic on the outpatient echocardiography laboratory and the characteristics of these patients were retrospectively investigated. Over a 6-month period, 916 patients were referred for study, 49.7% of whom were obese (body mass index >29.9 kg/m(2)), whereas only 22.3% were normal weight (body mass index 18.5 to 25 kg/m(2)). The obese patients were more likely to be female, black, older, and referred because of dyspnea or suspected heart failure (58.1% vs 36.8%, p <0.001). Despite a poorer quality of echocardiographic studies requiring more use of intravenous left heart contrast, the left ventricular ejection fraction was estimated in a similar proportion of these patients (93.9% vs 96.6%, p = 0.016). However, pulmonary artery systolic pressure measurement was less successfully obtained (66.6% vs 80.6%, p = 0.002). Thus, the demographics and referral diagnoses of obese patients differ significantly from normal weight patients, and body habitus presents unique imaging challenges that were only partially met while consuming greater resources.

Adult↗
PubMed2005

Contribution of Doppler tissue imaging and myocardial performance index to assessment of left ventricular function in patients with Duchenne's muscular dystrophy.

Doppler tissue velocities (DTV) are abnormal in a variety of cardiac conditions when standard measures of ventricular function are normal. Detection of left ventricular dysfunction in Duchenne's muscular dystrophy (DMD) has relied on 2-dimensional imaging yet often these images are suboptimal. This study was undertaken to determine if DTV and the myocardial performance index (MPI) could provide additional diagnostic information in DMD. We determined in 31 patients and 13 age-matched control subjects the prevalence of both abnormal DTV of the mitral annulus and abnormal MPI. Mean values for early diastolic DTV were significantly lower for patients compared with control subjects (P < .001) and were abnormally low in 86% of patients. The MPI was abnormal in 79% of patients. All but one patient with DMD had either abnormal DTV or abnormal MPI yet 19% had normal fractional shortening. DTV and MPI are important additions to the echocardiographic evaluation of patients with DMD.

Adolescent↗
PubMed2004

Prevalence of QRS prolongation in a community hospital cohort of patients with heart failure and its relation to left ventricular systolic dysfunction.

Adverse outcomes in heart failure occur more frequently with QRS prolongation. The results of our study have shown that 1/4 of community hospital patients with heart failure of sufficient severity leading to hospitalization have a QRS duration of > or =120 ms and that this degree of QRS prolongation is associated with substantially more severe left ventricular (LV) systolic dysfunction, LV dilation, and mitral regurgitation.

Aged↗
PubMed2003

Screening for left ventricular systolic dysfunction among patients with risk factors for heart failure.

BACKGROUND: The prevalence of left ventricular systolic dysfunction (LVSD) among individuals at risk for heart failure (HF) and the feasibility of screening have not been clearly defined. This study determined the prevalence of LVSD with the use of a limited screening echocardiogram among patients with risk factors for HF but no prior HF. METHODS: General medicine patients > or =60 years of age with hypertension, diabetes, coronary artery disease, or previous myocardial infarction (MI) but no history of HF or reduced left ventricular ejection fraction (LVEF) were eligible. Medical history and symptoms of breathlessness were determined by interview and chart review; consenting patients underwent electrocardiography and echocardiography. The outcome was LVEF < or =45%, based on visual estimation from the echocardiogram. RESULTS: Of the 482 patients who completed the study, only 1 patient could not have the LVEF visually estimated. A total of 7.9% of patients had LVEF < or =45%. The prevalence was 15.4% among those with a prior MI and 6.7% among those without prior MI. In multivariate analysis, prior MI (adjusted odds ratio, 2.75; 95% CI, 1.14 to 6.64) and probable or definite left ventricular hypertrophy by electrocardiography (adjusted odds ratio, 3.57; 95% CI, 1.22 to 10.48) were the strongest predictors of LVEF < or =45%. CONCLUSIONS: Screening for LVSD among high-risk patients is feasible and has substantial yield, even among patients without prior MI. In light of the low cost of screening and the available therapies to prevent progression of LVSD to overt HF, controlled clinical trials of screening high-risk subgroups appear to be justified.

Aged↗
PubMed2003

Unexplained pulmonary hypertension is associated with systolic arterial hypertension in patients undergoing routine Doppler echocardiography.

STUDY OBJECTIVE: To determine the validity of the association between systemic hypertension (HTN) and unexplained pulmonary hypertension (PHTN) as identified with Doppler echocardiography. METHODS: All patients with a reported systolic pulmonary artery pressure (SPAP) on routine Doppler echocardiography from our 1997 echocardiographic database were identified. Exclusions included all diseases known to be associated with PHTN. Of 1,174 patients, 503 had PHTN (defined as a SPAP of >/= 40 mm Hg), of whom 42 (8.4%) had unexplained PHTN. These PHTN patients were matched for age (mean [+/- SD] age, 70 +/- 11 years) with 84 randomly selected patients from the same database who had normal SPAP values and no diseases associated with PHTN. RESULTS: The mean SPAP of those patients with unexplained PHTN was 48 +/- 9 mm Hg vs 31 +/- 5 mm Hg for those without unexplained PHTN. HTN was more prevalent in those with PHTN (98% vs 72%, respectively; p = 0.0008). Patients with unexplained PHTN had significantly higher mean systolic BP, as routinely measured at the end of the echo (154 +/- 26 vs 138 +/- 21 mm Hg, respectively; p = 0.0006), but they did not differ in diastolic BP (80 +/- 14 vs 78 +/- 11 mm Hg, respectively; p = 0.39). PHTN patients and control subjects did not differ with respect to gender (women, 74% vs 70%, respectively), race (white, 64% vs 65%, respectively), body mass index (30 +/- 8 vs 28 +/- 8 kg/m(2), respectively), or left ventricular ejection fraction (64 +/- 6% vs 63 +/- 7%, respectively). When only those with known HTN were considered, PHTN patients still had higher systolic arterial BP (155 +/- 25 vs 143 +/- 21 mm Hg, respectively; p = 0.013) and tended to be on more BP medications (1.6 +/- 1.1 vs 1.2 +/- 0.9, respectively; p = 0.09). CONCLUSIONS: Unexplained PHTN occurs mostly in the elderly, is associated with systolic HTN, and those hypertensive patients with concomitant PHTN have higher systolic arterial pressures.

Age Factors↗