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S Mohr-Kahaly

Publications and source records attributed to S Mohr-Kahaly.

At least 19 recordsLinked to original sources
PubMed2004

Second-generation real-time three-dimensional echocardiography. Finally on its way into clinical cardiology?

Three-dimensional (3D) echocardiographic imaging has been introduced as a tool to improve the assessment of both morphologic and functional parameters of the cardiovascular system. In the past, data acquisition was limited due to time-consuming sequential acquisition of multiple triggered 2D image planes from 10-60 heart cycles using transesophageal rotational, transthoracic rotational or transthoracic freehand approaches. Recent improvements in the size of matrix array probes and in computing power of modern ultrasound equipment have significantly increased both spatial and temporal resolution of "second-generation" real-time 3D scanners. Although the superiority of 3D echocardiography in the determination of ventricular volume, ventricular mass or valvular orifice area had already been demonstrated in the late 1990s, widespread use in clinical cardiology was limited on account of difficulties in acquisition and post-processing. Clinical use of modern 3D echocardiography is boosted by the marked reduction in acquisition time and the unique possibility of on-line rendering on the ultrasound system. The ability to visualize a virtual 3D surface in real time-although limited to a sector size of about 30 degrees-offers new insights into cardiac pathomorpholgy even in patients with arrhythmias and may in realtime 3D-contrast flow analysis. Analysis of wide-angle 3D datasets (90 by 90 degree pyramidal shape) is possible by combining the 3D information of several [4-7] consecutive heart cycles. 3D datasets including the complete left ventricle provide comprehensive information on ventricular and mitral valve morphology and function. Qualitative and quantitative analyses of regional wall motion at rest and during stress become possible. Combination with 3D color Doppler data allows additional assessment of valvular function as well as determination of flow in the left ventricular outflow tract and across septal defects. The integration and future quantification of these new parameters together with on-line review allows new insights into cardiac function, morphology and synchrony that offer great potentials in the evaluation of right and left ventricular global and regional function, diagnosis of small areas of ischemia, congenital and valvular heart disease and effects of biventricular pacing in dilated heart asynchrony.

Echocardiography, Doppler, Color↗
PubMed2003

[Primary adenocarcinoma of the left atrium mimicking benign myxoma].

Primary tumors of the heart are rare, whereas cardiac metastases, most frequently from adenocarcinomas, occur in up to 20% of malignant tumors. We report about a 61-year-old female patient who was admitted with recurrent stress-induced dizziness, intermittent tachycardia and a fall due to a pre-syncope. Echocardiography showed a left atrial tumor with the typical features of a pediculated myxoma, leading to open heart surgery. However, histopathology revealed a 2.2 x 1.5 cm adenocarcinoma. The subsequent search for a primary tumor, including tumor markers and (18)F-FDG-PET, was unsuccessful, as was a second thorough diagnostic workup half a year later. The tumor was therefore classified as a primary cardiac adenocarcinoma.

Adenocarcinoma↗
PubMed2002

[Quantitative analysis of the left main coronary artery by 3D echocardiography. Role, possibilities and limitations of noninvasive imaging of the left coronary artery].

The left main coronary artery was investigated in 30 patients using a transesophageal approach, and a 3D reconstruction of the 2D databases was performed. Two groups of patients were analyzed. First, patients with calcified aortic stenosis were investigated and the reconstructed data obtained were compared to the left ventricular angiogram of the left coronary artery. Second, the 2D databases of patients with non-calcified aortic valve and aortic anulus were reconstructed using the 3D technique. In group 1 the estimate in size of the left ventricular coronary artery was closely related to the diameter of the left coronary artery as obtained by the coronary angiogram (mean difference 0.08 mm, interval of confidence at 95%, -0.48 and +0.32 mm). In both groups a substantial increase in imaging of the left coronary artery was obtained compared to the standard 2D echocardiographic view (% in group 1, and % in group 2, respectively). Independent of the 3D reconstruction of the left coronary artery in the any-plane mode, an orthogonal imaging of the artery could be obtained in only 15% of patients in group 1 but in 40% of patients in group 2. We conclude that 3D reconstruction of the left coronary artery (LAD) is superior to 2D echocardiography in echo-imaging of the proximal part of the LAD and correlates strongly to the diameters measured in the left coronary angiogram. In patients with major calcification of the aortic anulus and/or a calcified native aortic valve this approach is associated with multiple artifacts in imaging. The rapid technical evolution in this technique including improvement in computer technology and appropriate software may ensure a further important role of 3D echo imaging in noninvasive visualization of the normal and diseased left main coronary artery.

Adult↗
PubMed2002

Quantitative assessment of right ventricular volumes in severe chronic thromboembolic pulmonary hypertension using transthoracic three-dimensional echocardiography: changes due to pulmonary thromboendarterectomy.

AIMS: Evaluation of a three-dimensional reconstruction method to show the changes of right ventricular volume and systolic function when patients undergo pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. METHODS AND RESULTS: In the examination of 11 patients (four female, seven male; age 56+/-10 years) before and after pulmonary thromboendarterectomy, end-diastolic and end-systolic right ventricular volumes were determined as a sum total of the calculated volumes of derived parallel slices of the right ventricle. Using a Tomtec workstation and a Vingmed CFM 800 echocardiography device, the acquired data were ECG-and respiration-triggered in the course of transthoracic examination, using step intervals of 5 degrees. The ventricular outline was traced manually on 5mm slices from longitudinal cut planes. For subsequent correction, their area measurements were displayed and the volume cross-checked against the volume from orthogonal cut planes. End-diastolic and end-systolic volumes could be quantified in 11/11 cases before surgery, but data could only be attained for 9/11 patients after surgery, because a limited apical window rendered the postoperative three-dimensional reconstruction impossible in two cases. Before surgery, right ventricular size was larger than normal and systolic function was clearly impaired in all of the patients (end-diastolic volume: 121+/-37 ml; end-systolic volume 91+/-30 ml; ejection fraction 25+/-8%). The decrease in mean pulmonary artery pressure after surgery was significant (47+/-8 vs 26+/-8 mmHg; P<0.05). End-diastolic and end-systolic right ventricular volumes had been reduced (80+/-33 ml and 54+/-31 ml respectively), and the ejection fraction had increased (36+/-9%). CONCLUSIONS: Successfully performed pulmonary thromboendarterectomy leads to a significant reduction of right ventricular chamber size and improvement of systolic function, which can be determined with great precision and quite easily, using transthoracic three-dimensional echocardiography. Published by Elsevier Science Ltd. All rights reserved.

Adult↗
PubMed2001

Contrast-enhanced three-dimensional MR angiography of the thoracic aorta: experiences after 118 examinations with a standard dose contrast administration and different injection protocols.

The aim of this study was to test three injection protocols for contrast-enhanced magnetic resonance angiography (MRA) of the thoracic aorta with a standard-dose application. Ninety-three patients with a total of 118 examinations underwent MRA of the thoracic aorta at 1.5 T. There were three injection protocols: in 24 cases, no test bolus was performed and contrast was injected manually; in 14 cases, contrast was injected manually after a test bolus; and in 80 cases, a MR-compatible injector was used after a timing examination. All patients received 20 ml of Gd-DTPA. Quantitative signal-to-noise (SNR) measurements were obtained at different locations in the thoracic aorta, the pulmonary arteries, and the superior vena cava. Two readers in conference retrospectively evaluated each examination with respect to overall image quality and quality of bolus timing. Bolus timing was considered optimal in 70 cases, and either too early or too late in 11 cases. In 37 examinations the bolus was broadened. The SNR measurements of the thoracic aorta revealed that examinations after bolus testing were significantly superior to examinations without a test bolus (p < 0.001). Signal intensity ratios of the aorta and the pulmonary trunk were significantly higher in examinations with an optimal contrast timing (p < 0.001). Magnetic resonance angiograms of the thoracic aorta with a timing run are significantly superior to non-timed examinations with respect to image quality and SNRs. The administration of 20 ml of Gd-DTPA is sufficient for adult patients.

Adolescent↗
PubMed2001

Value of echocardiography in patient follow-up after surgically corrected type A aortic dissection.

BACKGROUND: To identify patients (pts) at risk of late complications, follow-up after surgery for type A aortic dissection is essential. We assessed the value of echocardiography to monitor patients after surgery for type A aortic dissection. METHODS: 80 out of 108 pts operated between 1989 and 1999 for type A aortic dissection survived surgery. 62 pts with at least one TEE, CT or MRI examinations during follow-up were included in this study. All pts had transthoracic echocardiography (TTE), 53 transesophageal echocardiography (TEE), 51 had CT, and 39 had MRI. RESULTS: At the first follow-up, 12 of 48 pts with aortic valve sparing surgery presented with aortic insufficiency >I degrees detected using echocardiography. 16 pts evolved a distal aortic aneurysm of over 5 cm, all seen in TEE, CT and MRI. A distal intimal flap was present in 39 pts and could be seen in TEE, CT and MRI in all patients. A new proximal aortic root dissection took place in 5 pts. Progressive aortic pathology led to reoperation in 9 pts. TEE was especially useful in 2 pts to confirm redissection, in 1 pt to rule out redissection assumed by CT, and in 1 with paraprosthetic blood flow after ascending aortic replacement. MRI led to additional information in 1 patient with false aneurysm of the distal anastomosis and 1 with redissection not seen in TEE 6 month before. CT and MRI were superior to TEE in demonstrating aortic arch pathology, whereas TEE was more effective in showing the flow pattern and residual entry sites. CONCLUSIONS: Echocardiography is an effective and cost-saving diagnostic tool to monitor pts after surgery for type A aortic dissection, and should be the method of choice to ascertain aortic pathology initially after surgery. Follow-up intervals and need for additional CT or MRI should be determined afterwards according to specific pathologies.

Adult↗
PubMed2001

Diagnosis of culture-negative endocarditis: the role of the Duke criteria and the impact of transesophageal echocardiography.

BACKGROUND: The Duke criteria have been shown to be more sensitive than the von Reyn criteria in the diagnosis of culture-positive endocarditis but to date have not been fully validated for culture-negative endocarditis (CNE). The aim of this study was (1) to compare the diagnostic accuracy of the Duke criteria versus clinical judgment and the von Reyn criteria in CNE and (2) to assess the diagnostic impact of transesophageal echocardiography (TEE) on the Duke criteria in CNE. METHODS: The study group consisted of 49 patients with suspected CNE in whom the presence (n = 32) or absence (n = 17) of endocarditis was confirmed by surgery, autopsy, or both. All patients underwent transthoracic echocardiography (TTE) and TEE. They were classified into a Duke category initially with TTE data only, and then the Duke categories were reevaluated with the additional TEE data. RESULTS: The Duke criteria demonstrated a significantly higher sensitivity (72%) than the von Reyn criteria (28%; P =.0008) and a higher specificity (100%) than clinical judgment (76%; P =.02). No major differences were noted between sensitivities of the Duke criteria and clinical judgement. TEE significantly augmented the capacity to diagnose CNE by Duke criteria versus TTE (P <.05). CONCLUSIONS: The Duke criteria are of high diagnostic validity for the conduction of clinical studies on CNE. They have the potential to affect clinical decision-making, based on the higher specificity versus clinical judgment. TEE appears to be crucial for the diagnosis of CNE when the Duke criteria are applied. The diagnostic differentiation between CNE, sclerotic valve degeneration, and nonbacterial thrombotic endocarditis remains a challenge.

Adult↗
PubMed2001

Aortic valve preservation in acute type A dissection: mid-term results.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the long-term effectiveness of a strategy for managing the aortic valve, aortic root and ascending aorta according to the pathology in acute aortic type A dissection. Results after surgery for acute type A dissection with preservation of the aortic valve were reviewed. METHODS: The patient group included 57 hospital survivors operated on according to a surgical strategy of aortic valve resuspension and supracoronary ascending aortic graft implantation. Reinforcement of the aortic stumps with gelatin-resorcinol-formaldehyde glue was performed in all patients. Aortic valve function in all survivors was investigated by echocardiographic follow up at 30 days, 6 and 12 months after surgery, and yearly thereafter. RESULTS: During the follow up period, nine patients (16%) died without reoperation. Actuarial probability of freedom from reoperation for aortic valve failure in the complete series was estimated as 100% after both 30 days and 12 months. Postoperatively, one patient underwent reoperation 14 months for aortic regurgitation, and three patients for aortic regurgitation with sinus of Valsalva dilatation between 48 and 88 months. The hospital mortality rate at reoperation was 50% (n = 2). CONCLUSION: Valve-sparing surgery is possible and can be recommended for the majority of patients with acute type A aortic dissection.

Actuarial Analysis↗
PubMed2000

[A standardized documentation structure for data documentation in echocardiography. Work Team on Standards and LV Function of the Work Group on Cardiovascular Ultrasound of the German Society of Cardiology, Heart and Circulation Research].

Presently, there are no well-defined standards for documentation of echocardiographic studies. Nevertheless, standards are essential to provide comparability of data and to realize electronic communication, both essential for quality management in echocardiography. Therefore, the working group "Standards and LV function" of the German Society of Cardiology developed a consensus for documentation of echocardiographic studies. In the present paper this consensus is presented and illustrated by typical clinical examples. Additionally, a prototype of a user-oriented software based on this data set is presented. The complete data set for transesophageal and transthoracic echocardiography and the software prototype can be downloaded at http:@echo.ma.uni-heidelberg.de.

Aortic Valve Stenosis↗
PubMed2000

Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension: changes after pulmonary thromboendarterectomy.

STUDY OBJECTIVES: This study sought to evaluate the pathophysiology of left and right heart failure in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were hospitalized to undergo pulmonary thromboendarterectomy (PTE). DESIGN: Thirty-nine patients (16 women and 23 men; mean +/- SD age, 55+/-12 years) with severe CTEPH were examined before and 13+/-8 days after PTE by way of transthoracic echocardiography and right heart catheterization. MEASUREMENTS AND RESULTS: Examination results confirmed in all cases that before surgery the right ventricles were enlarged and systolic function was impaired. Moderate to severe tricuspid valve regurgitation was observed. Left ventricular eccentricity indexes reflected a leftward displacement of the interventricular septum. End-diastolic left ventricular size and systolic function had decreased, and the left ventricular filling pattern showed impaired diastolic function. After surgery, mean pulmonary artery pressure was significantly lower (48+/- 10 mm Hg vs. 25+/-7 mm Hg; p<0.05). The calculated end-diastolic and end-systolic right ventricular areas had decreased: 30+/-7 cm(2) vs 21 +/-5 cm(2) (p<0.05) and 24+/-6 cm(2) vs. 14+/-4 cm(2) (p<0.05), respectively. Right ventricular fractional area change had increased (20+/-7% vs. 33+/-8%; p<0.05). Most of the patients exhibited a marked decrease in the severity of tricuspid regurgitation. Septal motion, left ventricular systolic function, and diastolic filling pattern returned to normal values (early to late diastolic left ventricular inflow ratio, 0.70+/-0.33 vs. 1.35+/-0.51; p<0.05). The mean cardiac index also improved (2.7+/-0.6 L/min/m(2) vs. 3.7+/-0.8 L/min/m(2)). CONCLUSIONS: In CTEPH, functions are impaired in the right as well as the left ventricles of the heart. Improved lung perfusion and the reduction of right ventricular pressure overload are direct results of PTE, which in turn bring a profound reduction of right ventricular size and a recovery of systolic function. Normalization of interventricular septal motion as well as improved venous return to the left atrium lead to a normalization of left ventricular diastolic and systolic function, and the cardiac index improves.

Adult↗
PubMed1999

[Cardiopulmonary parameters in hyperthyroidism].

BACKGROUND: Hyperthyroid patients often suffer from impaired exercise capacity with dyspnoea. Two well established, non-invasive methods were used to evaluate the influence of hyperthyroidism on cardiopulmonary function. PATIENTS AND METHODS: In 42 patients with hyperthyroidism we performed spirometry and cardiopulmonary exercise testing before and after 7 days of propranolol therapy as well as in euthyroidism. RESULTS: In hyperthyroidism reduced vital capacity and 1-second capacity were observed (95.5 +/- 2.4% vs 102.6 +/- 1.5%; p = 0.0087; 89.4 +/- 2.3% vs 95.2 +/- 2.2%; p = 0.0179). No changes showed during beta-blockade. At the anaerobic threshold reduced tidal volume and enhanced respiratory frequency were noted (1119.8 +/- 48.9 ml vs 1289.3 +/- 62.7 ml; p = 0.0227; 28.3 +/- 0.8 vs 25.4 +/- 0.9; p = 0.0012). A significant tachycardia could be shown. Impaired response to exercise in pulse and respiratory frequency were observed. Work at the anaerobic threshold was impaired in hyperthyroidism (70 +/- 5 watts vs 86.9 +/- 5.7 watts; p = 0.016) and did not change during propranolol therapy. Oxygen pulse at the anaeorbic threshold was reduced in hyperthyroidism (7.7 +/- 0.4 ml O2/beat vs 9.1 +/- 0.4 ml O2/beat; p = 0.0012) and increased with propranolol (8.9 +/- 0.4 ml O2/beat; p = 0.0001). CONCLUSION: In hyperthyroidism significant changes in cardiopulmonary function were noted at rest and exercise. High resting function and impaired response to exercise suggest a cardiopulmonary work with low efficiency. Propranolol leads to economization and lowers patients complaints.

Adrenergic beta-Antagonists↗
PubMed1999

[Left ventricular remodeling after aortic valve replacement].

The aim of the study was the assessment of left ventricular (LV) systolic function and left ventricular mass following aortic valve replacement (AVR) due to aortic valve stenosis as well as the influence of regression of LV hypertrophy in patients with normal and impaired LV systolic function prior to surgery. 74 patients with severe aortic valve stenosis (29 female, 45 male, mean age 66 +/- 18 years) were divided into 2 groups according to LV ejection fraction (EF): Group 1 with EF > 50% (n = 40); Group 2 with EF < or = 50% (n = 34). Furthermore, patients were differentiated into a group A without (n = 53) and a group B with aortic regurgitation (< or = II degrees, n = 21). All patients were examined by transthoracic echocardiography before and 1 month after surgery. There was a significant decrease of LV enddiastolic and endsystolic volume indices following AVR in group 2 and group B. Patients with preoperatively lower EF (group 2) showed an increase in LV ejection fraction from 39 +/- 10% before AVR to 47 +/- 11% after AVR (p < 0.001), whereas patients with preoperative normal EF (group 1) showed a significant decrease in EF (from 62 +/- 8% to 57 +/- 10%, p < 0.05). Also patients with combined aortic valve disease before AVR had an increase of EF after surgery (from 45 +/- 14% to 56 +/- 14%, p < 0.03). There were significant decreases of interventricular septum thickness and LV posterior wall thickness in group 1 and group A, whereas a significant decrease of LV enddiastolic diameter index was noted only in group B. Improvement of the NYHA functional class could be demonstrated in group 2 from 2.8 +/- 0.7 before to 2.2 +/- 0.6 after AVR, as well as in group B from 2.9 +/- 0.7 before to 1.9 +/- 0.7 after surgery. In conclusion, patients with impaired LV function or combined aortic valve disease showed a significant improvement of left ventricular systolic function after AVR, while patients with normal LV function presented a slight decrease of EF. There was a significant regression of left ventricular muscle mass in all groups independent of the left ventricular functional status.

Adult↗
PubMed1999

[Quantitative detection of changes in the thoracic aorta in patients with chronic aortic dissection using transesophageal echocardiography].

The aim of this serial 3 year follow-up study in 42 clinically stable patients with chronic aortic dissection was to assess quantitatively morphologic changes of the descending thoracic aorta (AD) using transesophageal echocardiography (TEE). Communicating dissections (ca) were present in 16/19 patients with operated type I and in 11/23 patients with type III AD whereas 12/23 type III AD according to De Bakey were non-communicating (nc). Diametral enlargement of the disc. thoracic aorta was 4 mm (mean value) at 1 year in all patients, 5.9 mm in type I ca, 7.2 mm in type III ca but only 3.1 mm in type III nc at 3 years. The ratio between true lumen and false lumen (FL) changed in ca AD from 1:2 to 1:3 over the period of 3 years but remained constant at 1:1 in ncAD. Progressive thrombosis of the false lumen (FL) occurred in 76% of patients but complete thrombosis of the FL occurred in only 6% of type I ca, 18% type III ca but in 84% of type III nc patients. Our results confirm observations that non-communicating dissections seem to have a more favorable outcome and less aneurysmal dilatation compared to ca dissection.

Adult↗
PubMed1999

[Determination of left ventricular mass by transthoracic three-dimensional echocardiography in patients with dilated cardiomyopathy].

Conventional echocardiographic methods of measuring left ventricular mass (LVM) are limited by assumptions of ventricular geometry and image plane positioning. Three-dimensional (3D) echocardiography offers a promising new approach for more accurate determination of LVM. This study was performed to compare LVM measurement by one- (1D), two- (2D), and 3D echocardiography with magnetic resonance imaging (MRI) in patients (pts) with dilated cardiomyopathy (DCM). 36 pts (age 18-74) with DCM underwent imaging by conventional 1D and 2D echocardiography as well as transthoracic 3D echocardiographic data acquisition. Also, pts were imaged with cardiac MRI. Due to echocardiographic and MRI quality and because of exclusion criteria's for MRI, it was not possible to accomplish each LVM determination method for each patient. LVM was determined by Devereux and area-length algorithm for the conventional echocardiography. 3D echocardiographic data was calculated after manual delineation of endo- and epicardial boundaries--slice by slice (5 mm)--in 3 perpendicular cut planes. LVM was determined by multiplying the myocardial volume by the specific density of the myocardium. To determine LVM in MRI, the even summation of slices method for myocardial volume measurement was used defined by the endo- and epicardium in short axis images. There was no significant correlation (r = 0.42) for measuring LVM between 1D echocardiography and MRI in pts with DCM. A significant correlation was obtained between 2D (r = 0.64, p < 0.01) echocardiography and MRI as well between 3D (r = 0.78, p < 0.01) and MRI in determination of LVM. Compared with 1D and 2D echocardiography, the 3D analysis achieved a significantly higher agreement with the results of the MRI (1D: 399.2 g, 2D: 285.9 g, 3D: 172.6 g versus MRI: 199.1 g). Interobserver variability was 5.1% for measuring LVM by 3D echocardiography (1D: 11.2%, 2D: 9.1%). In conclusion, in pts with DCM the determination of LVM was incompletely characterized by 1D and 2D echocardiography compared with results of MRI. The best correlation and high agreement for determination of LVM was obtained with 3D echocardiography compared with MRI.

Adolescent↗
PubMed1999

The presence of infection-related antiphospholipid antibodies in infective endocarditis determines a major risk factor for embolic events.

OBJECTIVES: The impact of infection-associated antiphospholipid antibodies (APA) on endothelial cell activation, blood coagulation and fibrinolysis was evaluated in patients with infective endocarditis with and without major embolic events. BACKGROUND: An embolic event is a common and severe complication of infective endocarditis. Despite the fact that APAs are known to be associated with infectious diseases, their pathogenic role in infective endocarditis has not been clearly defined. METHODS: The relationship among the occurrence of major embolic events, echocardiographic vegetation size, endothelial cell activation, thrombin generation, fibrinolysis and APA was examined in 91 patients with definite infective endocarditis, including 26 patients with embolic events and 65 control subjects without embolic events. RESULTS: Overall, 14.3% of patients exhibited elevated APA levels. Embolic events occurred more frequently in patients with elevated levels of APA than in patients without (61.5% vs. 23.1%; p = 0.008). Patients with elevated levels of APA showed higher levels of prothrombin-fragment F1 +2 (p = 0.005), plasminogen-activator inhibitor 1 (p = 0.0002), von Willebrand factor (p = 0.002) and lower levels of activated protein C (p = 0.001) than patients with normal levels of APA. Thrombin generation and endothelial cell activation were both positively correlated with levels of APA. The occurrence of elevated APA levels was frequently associated with structural valve abnormalities (p = 0.01) and vegetations >1.3 cm (p = 0.002). CONCLUSIONS: Infection-associated elevated APA levels in patients with infective endocarditis are related to endothelial cell activation, thrombin generation and impairment of fibrinolysis. This may contribute to the increased risk for major embolic events in these patients.

Adult↗
PubMed1999

Stress echocardiography in hyperthyroidism.

Exertion symptoms occur frequently in subjects with hyperthyroidism. Using stress echocardiography, exercise capacity and global left ventricular function can be assessed noninvasively. To evaluate stress-induced changes in cardiovascular function, 42 patients with untreated thyrotoxicosis were examined using exercise echocardiography. Studies were performed during hyperthyroidism, after treatment with propranolol, and after restoration of euthyroidism. Twenty-two healthy subjects served as controls. Ergometry was performed with patients in a semisupine position using a continuous ramp protocol starting at 20 watts/min. In contrast to control and euthyroidism, the change in end-systolic volume index from rest to maximal exercise was lower in hyperthyroidism. At rest, the stroke volume index, ejection fraction, and cardiac index were significantly increased in hyperthyroidism, but exhibited a blunted response to exercise, which normalized after restoration of euthyroidism. Propranolol treatment also led to a significant increase of delta (delta) stroke volume index. Maximal work load and delta heart rate were markedly lower in hyper- vs. euthyroidism. Compared to the control value, systemic vascular resistance was lowered by 36% in hyperthyroidism at rest, but no further decline was noted at maximal exercise. The delta stroke volume index, delta ejection fraction, delta heart rate, and maximal work load were significantly reduced in severe hyperthyroidism. Negative correlations between free T3 and diastolic blood pressure, maximal work load, delta heart rate, and delta ejection fraction were noted. Thus, in hyperthyroidism, stress echocardiography revealed impaired chronotropic, contractile, and vasodilatatory cardiovascular reserves, which were reversible when euthyroidism was restored.

Adult↗