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V L Roger

Publications and source records attributed to V L Roger.

45 records · Page 3Linked to original sources
PubMed1995

Stress echocardiography. Part I. Exercise echocardiography: techniques, implementation, clinical applications, and correlations.

OBJECTIVE: To describe the techniques and applications of exercise echocardiography. DESIGN: We review pertinent experimental and clinical studies from the literature and present our experience with the first 2,000 patients who underwent exercise echocardiography in our laboratory. MATERIAL AND METHODS: The indications for and contraindications to exercise echocardiography and the advantages, limitations, and accuracy of this procedure in comparison with other techniques for detecting coronary artery disease are discussed. RESULTS: Exercise echocardiography is increasingly used for the noninvasive evaluation of coronary artery disease because, in addition to its diagnostic capabilities, it offers attractive features such as portability, versatility, rapid availability of results, and relatively low cost. For accurate interpretation of the results, the workload achieved and the time between completion of exercise and image acquisition must be considered. The major limitation of exercise echocardiography is the high degree of operator dependence. For accurate interpretation of regional wall motion abnormalities and recognition of ischemic changes, specific training and extensive experience are necessary. CONCLUSION: Although exercise echocardiography has only relatively recently become a widely used technique, it has proved to have considerable accuracy in the diagnosis of coronary artery disease (mean sensitivity, 84%; mean specificity, 87%). In high-volume laboratories, feasibility studies have shown success rates between 90 and 99%; thus far, reproducibility has been satisfactory. Other applications of exercise echocardiography being studied are follow-up monitoring after revascularization, determination of prognosis, and assessment of valvular heart disease.

Contraindications↗
PubMed1995

Stress echocardiography. Part II. Dobutamine stress echocardiography: techniques, implementation, clinical applications, and correlations.

OBJECTIVE: To describe the rationale, methods, and clinical applications for dobutamine stress echocardiography. DESIGN: We review our experience with the first 1,000 Mayo Clinic patients who underwent this procedure and discuss studies from the literature that have assessed the accuracy of dobutamine stress echocardiography in determining the presence and extent of coronary artery disease. MATERIAL AND METHODS: The Mayo protocol for dobutamine stress echocardiography is presented, and the indications for use of this test and comparisons of sensitivity and specificity with other tests are summarized. RESULTS: Although exercise stress testing is the usual noninvasive method for the detection and assessment of coronary artery disease, a substantial number of patients are unable to perform adequate exercise because of physical limitations. In these patients, dobutamine stress echocardiography has emerged as a feasible, safe, and accurate method for the evaluation of coronary artery disease. The test has been proved to be valuable in the noninvasive diagnosis of coronary artery disease and to have an accuracy comparable to that of tomographic perfusion imaging. Other indications for dobutamine stress echocardiography include risk stratification before noncardiac surgical procedures, risk stratification after myocardial infarction, and identification of viable myocardium in patients with left ventricular dysfunction. CONCLUSION: Dobutamine stress echocardiography is an accurate, safe, cost-effective, and portable procedure for the noninvasive diagnosis of coronary artery disease and for the preoperative assessment of patients with such disease, especially those who are unable to perform adequate exercise tests.

Adult↗
PubMed1995

Cardiac echinococcosis: case report of unusual echocardiographic appearance.

An unusual echocardiographic appearance of a cardiac echinococcal lesion confirmed intraoperatively is described in a patient with nonspecific cardiac complaints. Although previous reports have emphasized the echolucent, often multiseptated nature of echinococcal lesions, such characteristics were absent in this case. Thus, in the appropriate clinical setting, echinococcal infection should be included in the differential diagnosis of solid mass lesions of the heart because the surgical approach may need to be altered.

Adult↗
PubMed1994

Identification of multivessel coronary artery disease by exercise echocardiography.

OBJECTIVES: This study examined the ability of exercise echocardiography to identify multivessel coronary artery disease and ascertain its incremental value when combined with clinical and exercise test variables. BACKGROUND: Although exercise echocardiography has been shown to be accurate for the detection of coronary artery disease, little is known about its utility for identifying multivessel involvement, and its incremental value when combined with clinical and exercise test variables has not been studied. METHODS: One hundred fifty consecutive patients were selected on the basis of having had an exercise echocardiographic and a coronary angiographic study within 6 months without any revascularization procedure. Significant coronary artery disease (> or = 50% diameter stenosis in any major coronary artery) was present in 117 patients, and multivessel (two- or three-vessel) disease was present in 90 patients. The exercise echocardiographic studies were reviewed by an experienced observer unaware of the results of the coronary angiogram. RESULTS: The overall sensitivity and specificity of exercise echocardiography for the identification of multivessel disease were 73% and 70%, respectively. A stepwise logistic regression analysis identified the number of abnormal regions on the postexercise images as the strongest independent predictor of multivessel disease; also significant were a history of myocardial infarction and ST segment depression of at least 2 mm on the peak exercise electrocardiogram. CONCLUSIONS: Exercise echocardiography adds independent and incremental information to clinical and exercise test variables for identifying multivessel coronary artery disease.

Aged↗
PubMed1993

Progression of aortic stenosis in adults: new insights provided by Doppler echocardiography.

Aortic stenosis is a progressive disease. The mechanisms and patterns of progression have been studied over the years using clinical assessment, cardiac catheterization, and more recently, Doppler echocardiography. Doppler is the ideal tool with which to study the progression of aortic stenosis since it provides accurate hemodynamic data non-invasively and, hence, can be repeated serially over long follow up periods. Recent Doppler echocardiographic studies have shown that the progression of aortic stenosis occurs with a wide range of individual variations, and that its rate and pattern cannot be predicted at the time of initial evaluation. However, it does follow a linear pattern, and individual trends can therefore be determined in a given patient. Symptoms lack specificity and, at a given point in time, do not predict progression. However, new and/or worsening symptoms are a mark of significant hemodynamic progression. The relationship between the cause of aortic stenosis and its progression remains imperfectly documented, and further longitudinal studies should focus on this question.

Aortic Valve↗
PubMed1990

Progression of aortic stenosis in adults: new appraisal using Doppler echocardiography.

This study examined progression of aortic stenosis (AS) as assessed by Doppler echocardiography. One hundred twelve consecutive adult patients had calcific AS and underwent three examinations during a mean 25-month period (range 7 to 54 months). At the time of entry into the study, mean values for initial peak aortic velocity and ejection fraction (EF) were 2.9 +/- 0.7 m/sec and 63 +/- 10%, respectively; 52% of the patients were symptomatic. At the third examination the percentage of symptomatic patients increased to 65% (p = 0.0039 compared to baseline values), and the aortic peak velocity increased to 3.3 +/- 0.8 m/sec (p less than 0.001). Age, sex, and EF were not predictors of progression. Documented coronary artery disease (in 57 patients) did not affect progression, and neither did the aortic peak velocity at the time of entry into the study. Thirty-eight patients reported an increase in symptoms from the first to third examination, and their rate of progression was significantly different from that of the rest of the population: 0.33 +/- 0.50 m/sec/yr compared to 0.18 +/- 0.26 m/sec/yr (p less than 0.03).

Aged↗
PubMed1989

Influence of coronary artery disease on morbidity and mortality after abdominal aortic aneurysmectomy: a population-based study, 1971-1987.

The prognostic importance of coronary artery disease at the time of elective abdominal aortic aneurysmectomy was evaluated among 131 residents of Olmsted County, Minnesota who underwent elective aneurysmectomy from 1971 to 1987 and were followed up to 1988 for death and cardiac events (cardiac death, myocardial infarction, coronary bypass surgery and angioplasty). Before aneurysmectomy, 75 patients (Group 1) had no clinically recognized coronary disease, 47 patients (Group 2) had suspected or overt uncorrected coronary artery disease (history of prior myocardial infarction, angina or a positive stress test) and 9 patients (Group 3) had undergone coronary artery bypass grafting or coronary angioplasty. The 30 day operative mortality rate was 3% (2 of 75) in Group 1 and 9% (4 of 47) in Group 2 (p = 0.15). According to Kaplan-Meier analysis, estimated survival 8 years after aneurysmectomy was 59% (expected rate 68%, p = 0.29) in Group 1 versus 34% (expected rate 61%, p = 0.01) in Group 2. The cumulative incidence rate of cardiac events at 8 years was 15% and 61%, respectively, for patients without and with suspected/overt coronary artery disease (p less than 0.01). Using multivariable proportional hazards analysis, uncorrected coronary artery disease was associated with a nearly twofold increased risk of death (hazard ratio 1.79, 95% confidence interval 1.06 to 3.00) and a fourfold increased risk of cardiac events (hazard ratio 3.71, 95% confidence interval 1.79 to 7.69). These population-based data support an aggressive life-long approach to the management of coronary artery disease in patients undergoing abdominal aortic aneurysmectomy.

Aged↗
PubMedDate not supplied

Prognostic value of treadmill exercise testing: a population-based study in Olmsted County, Minnesota.

BACKGROUND: The prognostic value of treadmill exercise testing (TMET) has been studied in selected populations. The generalizability of these data to different populations and to women is uncertain. METHODS AND RESULTS: A retrospective, population-based cohort study of all persons (1452 men and 741 women) who underwent TMET in years 1987 to 1989 in Olmsted County, Minnesota, was undertaken. Individuals were followed up for all-cause mortality and cardiac events (cardiac deaths, nonfatal myocardial infarction, or congestive heart failure). Sex-specific analyses were performed to determine whether the predictors of outcome and the magnitude of the associations were similar in both sexes. In men, 77 deaths and 106 cardiac events occurred during 8956 person-years of observation; in women, 46 deaths and 54 cardiac events occurred during 4801 person-years of follow-up. Exercise-induced angina, ECG changes, and workload achieved on the TMET were strongly associated with all-cause mortality and cardiac events in both sexes, and the strength of the association was similar. After adjustment, workload was the only TMET variable associated with outcome. A higher workload was associated with a reduction in the risk of cardiac events and of all-cause mortality; the protective effect of exercise capacity was strong and was similar in both sexes. CONCLUSIONS: In this population-based cohort, exercise capacity was the TMET variable that exhibited the strongest association with all-cause mortality and cardiac events. This protective effect of exercise capacity was observed in both sexes.

Aged↗