Biomedical subjects
Wieslawa Tracz
Publications and source records attributed to Wieslawa Tracz.
Assessment of myocardial perfusion in patients with coronary artery disease. Comparison of myocardial contrast echocardiography and 99mTc MIBI single photon emission computed tomography.
BACKGROUND: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical index (MI) and harmonic imaging following an intravenous injection of contrast agent. The aim of the study was to determine the feasibility and accuracy of the real-time imaging of contrast echocardiography (MCE) for detecting myocardial perfusion defects at rest and during dobutamine stress echocardiography (DE) compared with 99m Tc MIBI SPECT. The study group consisted of 44 patients (24 men, 20 women, mean age 58.9+/-7.8) with suspected coronary artery disease (CAD). All patients underwent DE. Wall motion (WM) and segmental perfusion were estimated in real time before and at peak stress using a low MI (0.4) after 0.3 ml bolus injections of intravenous Optison. All patients underwent a rest and exercise 99mTc MIBI SPECT study (SPECT). A 16-segment model of the left ventricle was used for the analysis of MP, WM and SPECT by a blinded reviewer. All patients underwent coronary angiography. Significant coronary artery disease was defined as >60% luminal diameter stenosis. RESULTS: All patients had significant CAD. Twenty-nine patients had single-vessel and 15 patients had double-vessel disease. For all patients, agreement between MCE and SPECT was 89%, between MCE and WM -86%, and between SPECT and WM -82%. The agreement between MCE and SPECT for LAD, RCA and Cx territories was 81, 91 and 73%, respectively. The sensitivity of MCE and SPECT for detecting perfusion defects due to significant CAD (confirmed angiographically) was 97% and 93%, respectively, and the specificity was 93 and 84%, respectively. CONCLUSION: MCE in real-time imaging with Optison has significant potential for the identification of MP abnormalities. MCE correlates very well with SPECT images.
Heart structure and function in systemic sclerosis.
INTRODUCTION: Systemic sclerosis (SSc) is a multisystem disorder characterised by connective tissue fibrosing with vascular abnormalities and autoimmune changes. Heart involvement is one of the main factors shortening the survival of SSc patients. AIM OF THE STUDY: (1) To assess structural and pathophysiological changes of the heart in SSc patients in standard echocardiographic examination. (2) To evaluate regional systolic and diastolic left ventricle disturbances in SSc patients by means of Tissue Doppler Imaging (TDI). MATERIAL AND METHODS: In 19 SSc women aged 22-72 years and 16 control healthy women aged 19-57 years M-Mode, 2D, Continuous Doppler, Colour Doppler and Tissue Doppler examinations were performed. Tissue Doppler myocardial velocities in systole and early diastole were evaluated in 14 myocardial segments in parasternal and apical views. RESULTS: No significant differences between both groups in left ventricle (LV) ejection fraction, LV end-diastolic and end-systolic diameter, LV wall thickness, valvular structure was observed. Mitral E/A ratio was significantly decreased in SSc women (p < 0.001), and pulmonary systolic pressure was significantly increased in this group (p < 0.001). In TDI examination no significant difference between the groups in systolic myocardial velocity was found. In SSc women early diastolic velocities were significantly lower than in controls (p < 0.00001). The detailed assessment of diastolic function in SSc group showed severe diastolic dysfunction of longitudinal myocardial fibers with normal function of circumflex myocardial fibers. CONCLUSIONS: In SSc patients significant left ventricle diastolic dysfunction was found. Diastolic dysfunction was observed only in longitudinal myocardial fibres and was not found in circumflex myocardial fibres. Thus, myocardial fibrosing and ischemia in SSc patients seem to be concentrated in the subendocardial region built by longitudinal muscle layer. Left ventricle diameter, walls thickness and systolic function in SSc patients are preserved.