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PubMed1995

Early detection by non-invasive monitoring of abnormally elevated systolic blood pressure in newborns with a positive familiarity for hypertension.

This study investigates 263 full-term clinically healthy newborn babies: subdivided into two groups depending on a positive (113 individuals) or negative (150 subjects) family history for hypertension. The babies were comparable for body weight and statural height and equipartitioned into males and females. The infants underwent a non-invasive, automated monitoring of blood pressure during the first three days of their life, according to protocol in which the systolic and diastolic measurements were performed at 1 min intervals over 15 minutes. The babies of the two groups showed superimposable mean values for systolic and diastolic blood pressure. However, the neonates with a positive familiarity for hypertension showed a higher number of systolic readings above the reference limit of 90 mmHg. The higher incidence of the abnormally-elevated systolic values (> 13%) in babies with a positive familiarity for hypertension was seen to be significant, suggesting that their blood pressure pattern is characterized by a larger variability at least in the systolic component. Such a wider variability may be regarded as a phenotypic expression of the genetic predisposition to hypertension, whose risk can be detected by a short-term monitoring of BP soon after the birth.

Age Factors↗
PubMed1993

Body mass index as a predictor of systolic blood pressure in a multiracial sample of US schoolchildren.

We examine the relationship between body mass index (weight divided by height squared) and systolic blood pressure and the implications of using obesity as a criterion for blood pressure screening in a multiracial sample of 11,370 schoolchildren. For the entire sample, the zero-order correlation between body mass index and systolic blood pressure was 0.39. Correlations were strongest among Hispanics (r = .51) and weakest among blacks (r = .29). Among white, black, Asian, and Hispanic boys with body mass index values in the upper decile, the odds of having elevated systolic blood pressure (above the 95th percentile) were significantly higher than among individuals in the bottom decile. Among girls with body mass index values in the top decile, higher odds of hypertension were observed only for whites and Hispanics. For the entire population, the sensitivity of screening only children with body mass index values in the top quartile was 52%. The sensitivity of this cutpoint was higher for Hispanics, although 36% of those with elevated systolic blood pressure would still be missed. These data confirm that overweight children are significantly more likely to have elevated systolic blood pressure and total blood cholesterol levels and that weight reduction may play an important role in the primary prevention of coronary heart disease among children of various ethnic backgrounds. Selective screening of overweight children, however, does not appear warranted.

Blood Pressure↗
PubMed1994

Determining the accuracy of calculating systolic wall thickening using a fast Fourier transform approximation: a simulation study based on canine and patient data.

UNLABELLED: The high court yields of 99mTc-sestamibi make possible the acquisition of multiple gated SPECT studies with relatively high count densities. By reorienting these studies into gated short-axis slices, and extracting the three-dimensional myocardial perfusion distribution, we can study wall thickening using an amplitude and phase analysis methodology that examines the change in counts throughout the cardiac cycle. There have been two main concerns raised about this count-based technique: (1) What effect does the sampling rate have on the calculation of systolic wall thickening? and (2) What effect does count density have on the calculation of systolic wall thickening? METHODS: We designed a simulation study using myocardial wall thickening data obtained from ultrasonic crystals implanted in the myocardium of a normal canine. This data was modified to produce wall thickening curves with various percent systolic wall thickening measurements, sampling rates and count densities. RESULTS: The results show that using at least eight frames per cardiac cycle, systolic wall thickening can be calculated with enough accuracy to separate normal patients from those with cardiac dysfunction, even in areas of hypoperfused myocardium. Also, the results show the importance of calculating and interpreting phase (onset of contraction) information. CONCLUSIONS: This count-based technique continues to show promise as a tool for calculating systolic wall-thickening from multiple gated myocardial perfusion SPECT studies, but needs to be validated in a prospective multi-center trial before being applied in a clinical setting.

Animals↗
PubMed1993

[Simultaneous measurement of systolic pulmonary artery pressure by catheterization and contrast enhancement doppler echocardiography].

The aim of this study was to assess the value of echocardiographic contrast in measuring systolic pulmonary artery pressures. Thirty-four patients with an average age of 61 +/- 15 years undergoing right heart catheterisation had a simultaneous measurement of systolic pulmonary artery pressures by catheter and colour-coded Doppler echocardiography under basal conditions and after injection of 5% dextrose agitated with 1 cm3 of air to form microcavitations. The Doppler echocardiographic measurements were performed after withdrawal of the catheter into the inferior vena cava before and after injection of contrast. Patients were divided into two groups according to the pulmonary artery pressures at catheterisation: Group I, comprising 11 patients with systolic pulmonary artery pressures of less than 35 mmHg; Group II, comprising 23 patients with systolic pulmonary artery pressures of over 35 mmHg; The injection of contrast significantly increased the number of patients in whom systolic pulmonary artery pressures could be calculated from the Doppler signal of tricuspid regurgitation (TR) in Group I (control: 18%; contrast: 100%, p < 0.01) and Group II (control: 65%; contrast: 96%, p < 0.05). There was a close correlation between the catheter and Doppler measurements of the trans-tricuspid valve pressure gradients before and after injection of contrast in Group I (n = 11, r = 0.85, p = 0.001, with an estimated standard error (ESE) = 3.8 mmHg) and in Group II (control: n = 15, r = 0.89, p = 0.001, ESE = 10.5 mmHg, and after contrast: n = 22, .r = 0.90, p = 0.001, ESE = 7.95 mmHg) with the catheter in the right ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Amlodipine in isolated systolic hypertension in the aged].

The authors studied the efficacy and safety of a long half-life dihydropyridine calcium-antagonist--amlodipine--in a single daily dose in the treatment of isolated systolic hypertension in the elderly. Ninety-seven subjects, age range 65-85 years, with isolated systolic hypertension were randomized into two groups, similar for age, weight and height, of 47 subjects submitted to active therapy and 50 subjects to placebo, respectively. The study was divided into two phases: in the first one, of three weeks, the first group was administered amlodipine at the dose of 5 mg/day; in the second period, which lasted 9 weeks also in case of systolic pressure normalization, amlodipine at the dose of 10 mg/day was administered. Forty-one subjects of the active drug group and 41 of the control group completed the study. The results were determined as mean +/- standard deviation; statistical analysis was completed by the Student T test. In the amlodipine group, at the end of the third week, a significant decrease in systolic arterial pressure was reported; at the end of the follow-up a further decrease in systolic arterial pressure was observed in the active treatment group as compared to the control group (p < 0.001). The other parameters considered (E.C.G., routine haematochemical tests) did not show significant changes in the two groups during the whole study period. Furthermore, during the follow-up, neither orthostatic hypotension nor reflex tachycardia, events which require particular attention during antihypertensive therapy in the elderly, were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

[Effects of preserving mitral apparatus on left ventricular systolic function and geometry in mitral valve replacement].

We investigated the left ventricular (LV) systolic function and geometry in mitral valve replacement (MVR) with and without preservation of mitral apparatus. Five patients had conventional MVR without mitral annulus papillary muscle continuity (group C) and five patients had MVR with preservation of the continuity (group P). LV cineangiograms were assessed before and one month after surgery. LV volume was calculated by the method of Kennedy. Long axis dimension is defined as the distance between the apex and the center of mitral orifice in right anterior oblique projection. Short axis dimension is defined as the cross-sectional dimension at the middle point of the long axis. Paired Student's t tests were employed to compare the preoperative and postoperative data. LV ejection fraction decreased significantly from 69.4 +/- 9.5 to 51.8 +/- 10.5% in group C (p < 0.05) and did not change significantly in group P (from 51.6 +/- 19.9 to 56.8 +/- 12.9%). Fractional shortening of the long axis increased significantly from 15.0 +/- 11.8 to 21.2 +/- 14.0% in group P (p < 0.02) and did not change significantly in group C (from 16.5 +/- 8.6 to 13.1 +/- 3.3%). Ratio of LV end-systolic long axis to short axis dimension increased significantly from 1.76 +/- 0.31 to 2.12 +/- 0.21 in group C (p < 0.05) and did not change significantly in group P (from 1.90 +/- 0.22 to 1.95 +/- 0.22). We conclude that the ratio of systolic long to short axis increases, i.e., systolic LV shape changes to become longer and slender, and ejection fraction decreases after surgery in MVR without preservation of mitral apparatus. Conversely, preserving the mitral apparatus in MVR results in no significant change in systolic LV function and geometry, because of preserving fractional shortening of long axis.

Aged↗
PubMed1997

Echocardiographic evaluation of systolic and diastolic left ventricular function following arterial switch operation in the neonatal period for transposition of the great arteries. Midterm results.

BACKGROUND: Neonatal arterial one-stage switch operation (ASO) for transposition of the great arteries (TGA) is currently the procedure of choice for TGA. There is a potential risk of myocardial damage related to coronary artery reimplantation and sudden pressure overload imposed on the left ventricle after discontinuation of the cardiopulmonary bypass. OBJECTIVES: This study was carried out in order to evaluate left ventricular systolic and diastolic function in children following ASO. METHODS: We studied 32 children (22 M, 10 F), mean age 23.7 +/- 24.6 months (range 0.5-97.2) following ASO, without any hemodynamically significant residual stenosis by 2D- and Doppler-echocardiography. Twenty-five had TGA with intact ventricular septum and 7 with ventricular septal defect. Mean age at time of one-stage repair was 8.9 +/- 6.9 days (range 2-30) and the mean time of follow-up 23.5 +/- 24.6 months (range 0.3-96). At the time of evaluation all the children were asymptomatic. Regional wall motion of the left ventricle was assessed by 2D-echo. Volumes, mass index, M/V ratio, afterload, systolic function (FS% and VCFc), contractility (stress-velocity SVI and stress-shortening SSI relations) and preload (functional preload index FPI = SSI-SVI) of the left ventricle were determined by m-mode echo together with non-invasive blood pressure monitoring. Left ventricular diastolic function was determined by PW Doppler of transmitral flow. All parameters were compared with those of 32 normal controls matched for age, sex and body surface area. RESULTS: Left ventricular regional wall motion was normal in all but 5 cases who showed a slight reduction of the septal systolic motion. Volumes and EF% did not differ in post-ASO group vs controls. There was a small increase of the mass index in the post-ASO group vs controls (62.8 +/- 14.1 vs 56.2 +/- 6.5 g/m2; p = 0.02) and the M/V ratio did not differ. FS% and VCFc were not different between the 2 groups. Peak and end-systolic meridional stress also did not differ in the 2 groups. A normal contractile state was present in the post-ASO group. The preload was slightly reduced in the post-ASO children (FPI -0.6 +/- 0.94 vs 0.07 +/- 0.63; p = 0.001). Parameters of left ventricular diastolic function were not significantly different between the 2 groups. CONCLUSIONS: In conclusion in children undergoing neonatal ASO for TGA with intact septum or ventricular septal defect, evaluated after a mean post-surgical follow-up of 2 years, systolic and diastolic performance of the left ventricle was normal. Regional wall motion abnormalities with slightly reduced septal motion were detected in 5 cases. The reason for the small increase in mass index is unknown. The slight reduction of the preload is related to the routine drug therapy in the patients studied early after surgical repair.

Child, Preschool↗
PubMed1997

[Isolated systolic hypertension and cognitive function in the aged. Experience of the Syst-Eur study].

OBJECTIVE: To determinate cognitive status and its correlates in older patients with isolated systolic hypertension. METHODS: Syst-Eur is a double-blind placebo-controlled outcome trial conducted in European patients over 60 years of age with isolated systolic hypertension. Moreover, a side-project--the Vascular Dementia Project--is designed to assess cognitive functions and to follow-up their evolution to determine the influence of antihypertensive therapy on vascular dementia incidence. Cognitive functions were evaluated at entry with the MiniMental State Examination (MMSE) in 2250 patients included in Syst-Eur. Cognitive impairment was defined with a MMSE score < or = 23 and led to further evaluation. Baseline blood pressure (BP) was based on the average of six sitting blood pressure readings at three run-in visits 1 month apart. Statistical analysis used Spearman correlation. RESULTS: The MMSE was analysed in 1374 women and 751 men whose mean age was 70 years (range: 60-100). The median level of education expressed as the age at which they stopped their education at school, was 15 years. Baseline blood pressure averaged 173 +/- 10/86 +/- 6 mmHg. Before randomisation in the trial, 899 (40%) patients had received antihypertensive therapy and 602 (27%) had experienced cardiovascular complications. The MMSE-scores ranged from 15 to 30 (median = 29). The maximal score of 30 was reached by 609 (30%) subjects. Among the 59 (3%) patients with a MMSE-score of 23 or less, 5 were considered to be demented according to the DSM IIIR criteria. The MMSE-scores decreased with advancing age in men (r = -0.16; p < 0.001) and women alike (r = -0.24; p < 0.001). In both men and women, they were positively correlated with the level of education (r = 0.30 and 0.32, respectively; p < 0.001). They were negatively correlated with systolic blood pressure (r = 0.10; p < 0.001) and slightly positively correlated with diastolic blood pressure (r = 0.05; p = 0.03). Previously treated patients or patients reporting cardiovascular complications at baseline had lower MMSE-scores than their non-treated counterparts or subjects without cardiovascular complications (median = 28 and 29, respectively, p < 0.003). CONCLUSION: In a European cohort of 2225 patients over 60 years of age with isolated systolic hypertension, the level of cognitive functions evaluated with the MMSE decreases with advancing age or lesser educational level. It also decreases with higher systolic blood pressure or lower diastolic blood pressure. The influence of antihypertensive therapy on cognitive status will be prospectively evaluated in Syst-Eur Vascular Dementia Project.

Aged↗
PubMed1997

Systolic function of the univentricular heart: comparison of the Simpson's rule with acoustic quantification.

BACKGROUND: Acoustic quantification (AQ) is a new method of obtaining real-time information about systolic ventricular function. This method establishes a ;blood-tissue interface' and computes an intraventricular blood volume in real time to derive a beat to beat instantaneous ejection fraction. AQ assessment of systolic function has been reported previously in patients with normal cardiotypes and varying degrees of myocardial dysfunction. OBJECTIVE: To determine the potential utility of AQ in patients with abnormal ventricular morphology, in whom systolic function may be difficult to measure by traditional methods. PATIENTS AND DESIGN: Seventeen children (nine females) ranging in age from five days to 18 years (mean 6.9 years) with univentricular left ventricle heart morphology underwent a prospective and comparative echocardiographic study of ventricular function with the use of AQ and manual planimetry (single plane Simpson's rule). Imaging was done during steady state without sedation. Routine scan planes were performed, followed by repeat scanning of the univentricle from the apical four-chamber view in the AQ mode. Subsequently, manual planimetry using Simpson's rule was performed from an online graphical analysis package to measure systolic and diastolic frames from the conventional replay images. These data were used to calculate ejection fraction using standards previously established. The results were then compared with real-time AQ results. SETTING: Tertiary care referral center. RESULTS: Scan time for the combined standard and AQ imaging averaged 45 mins (range 35 to 65 mins). Measured ejection fraction by AQ and manual planimetry were 44 +/- 11% and 46 +/- 10%, respectively. Statistical analysis by repeated measures ANOVA with Bonferroni/Dunn correction (F = 0.6, df = 1,32, P = 0.44) demonstrated significant agreement between AQ and manual planimetry with an intraclass correlation coefficient of 0.93. Bland-Altman analysis was used to provide a graphic display of the clinical significance of differences in the comparison of the two methods of measurement. CONCLUSIONS: These findings support the use of AQ for continuous online determination of indexes of systolic function for patients with univentricular left ventricle morphology. The variability in the morphology inherently present within this group of patients results in a wider variability of determined ejection fraction. Particular attention must be directed to the technical aspects of image acquisition and AQ application to ensure accuracy.

Adolescent↗
PubMedDate not supplied

Hyperinsulinemia in non-obese, non-diabetic subjects with isolated systolic hypertension.

To investigate the inter-relationship of hyperinsulinemia and isolated systolic hypertension, 15 patients with isolated systolic hypertension (Group I) were compared to those having systolic and diastolic hypertension (Group II), and 14 age- and sex-matched controls (Group III). Significantly high triglycerides and total cholesterol were observed in Groups I and II (p < 0.001) and low high-density lipoprotein cholesterol in Group II (p < 0.001), when compared to controls. Significantly high number of patients had impaired glucose tolerance (80%; p = 0.0002 and 60%; p = 0.05) on oral glucose tolerance test in Groups I and II, respectively. Higher blood glucose values were observed in Group I as compared to Group III, at 0, 30, 60 (p < 0.05) and 120 minutes (p < 0.001). Subjects in all the three groups showed fasting normo-insulinemia. At 60 minutes during oral glucose tolerance test, higher insulin levels were seen in Groups I and II as compared to controls (p = NS). Peak insulin levels and area under curve for insulin were higher in Groups I and II as compared to controls (p = NS). The observations of the present study indicate that, similar to systolic and diastolic hypertension, several features of insulin resistance syndrome such as hyperinsulinemia, dyslipidemia and glucose intolerance accompany isolated systolic hypertension.

Adult↗
PubMedDate not supplied

[The effect of acetylsalicylic acid and streptokinase on the restoration of systolic heart function in patients after a myocardial infarct].

Time course was studied of changes in left ventricular systolic function in those patients with prior acute myocardial infarction (AMI) who were exposed to thrombolytic therapy and aspirin. A total of 127 AMI patients were examined; they were randomized into 3 groups: group I ("A + CK", n = 15) received thrombolytic therapy and aspirin; group II ("A", n = 49) were taking aspirin; group III (control, n = 63) received neither aspirin nor thrombolytic therapy. All patients were evaluated for left ventricular systolic function on the day they entered the study, at day 10, 21 and six months later. Both thrombolytic therapy and aspirin were found out to accelerate the renewal of left ventricular systolic function in AMI patients. Those patients not treated with aspirin and thrombolytics experience somewhat slower comeback of indices for left ventricular systolic function. Six months of the onset of the condition the values for left ventricular systolic function became identical in all groups studied.

Adult↗
PubMed1998

Postexercise systolic blood pressure response: clinical application to the assessment of ischemic heart disease.

Stress test parameters indicating the presence and extent of coronary artery disease have traditionally included such variables as exercise duration, and the blood pressure and ST-segment responses to exercise. The three-minute systolic blood pressure ratio, another important indicator of significant coronary artery disease, is a useful and readily obtainable measure that can be applied in all patients who are undergoing stress testing for the evaluation of known or suspected ischemic heart disease. The ratio is calculated by dividing the systolic blood pressure three minutes into the recovery phase of a treadmill exercise test by the systolic blood pressure at peak exercise. A three-minute systolic blood pressure ratio greater than 0.90 is considered abnormal and has a diagnostic accuracy of approximately 75 percent for the detection of coronary artery disease (i.e., an accuracy comparable to that of ST-segment depression). Higher values for the ratio are associated with more extensive coronary artery disease, as well as an adverse prognosis after myocardial infarction. Thus, the three-minute systolic blood pressure ratio provides information that is complementary to the traditional exercise test parameters for identifying high-risk ischemic heart disease.

Blood Pressure↗
PubMed1993

Differences of intravenous nitroglycerin responses in left ventricular systolic and end-diastolic pressures and coronary artery diameters during long-term treatment with cutaneous nitroglycerin patches.

The differences of intravenous nitroglycerin responses in left ventricular (LV) systolic and end-diastolic pressures and in coronary artery diameters (cross-tolerance) were investigated in patients receiving nitroglycerin patches. During diagnostic cardiac catheterization, graded doses of 50, 100, and 150 mcg of intravenous nitroglycerin were given. Left ventricular systolic and end-diastolic pressures and left coronary arteriograms were obtained during each dose. Twenty patients with coronary artery disease were studied. Before cardiac catheterization, 10 received nitroglycerin patch (patch group), and 10 did not (control group). In the control group, graded intravenous nitroglycerin doses of 50, 100, and 150 mcg caused decrease in LV systolic pressure of 18 +/- 7%, 20 +/- 5%, and 23 +/- 6%, respectively. In the patch group, the same intravenous nitroglycerin doses decreased LV systolic pressure by 12 +/- 6% (p < 0.05), 19 +/- 7% (NS), and 18 +/- 6% (p < 0.05), respectively, (p value: vs. control group). At the same intravenous nitroglycerin doses, LV end-diastolic pressures were decreased by 48 +/- 14%, 52 +/- 17%, and 56 +/- 9%, respectively, in the control group. However, there were no significant differences in LV end-diastolic pressure between the two groups for any of the three intravenous nitroglycerin doses. The same intravenous nitroglycerin doses caused increase in diameter of the left anterior descending coronary artery and circumflex coronary artery in the control group, which was attenuated significantly in the patch group. Tolerance may develop in LV systolic pressure and coronary artery diameters, whereas it may not develop in LV end-diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1997

Detection of left ventricular systolic and diastolic abnormalities in patients with coronary artery disease by color kinesis.

BACKGROUND: Color kinesis (CK) is a recently developed echocardiographic technique based on acoustic quantification that automatically tracks and displays endocardial motion in real time and has been used in initial studies to improve the evaluation of global and regional wall motion. HYPOTHESIS: For further validation of the use of CK for analysis of segmental ventricular dysfunction, we assessed its sensitivity and specificity for detection of regional systolic and diastolic wall motion abnormalities in patients with coronary artery disease (CAD). METHODS: Two-dimensional (2-D) echocardiography and CK were used to study 15 normal subjects and 63 patients with technically good quality echocardiographic tracings, who underwent coronary arteriography within 1 month of echocardiography. Significant (> 70% luminal diameter stenosis) CAD was present in 50 patients (79%). RESULTS: Color kinesis tracked endocardial motion accurately in 93% of left ventricular segments. Wall motion score, systolic segmental endocardial motion (SEM), and the time of systolic SEM (tSEM) and diastolic (tDEM) segmental endocardial motion were calculated. Intra- and interobserver variability were within narrow limits. SEM and tSEM were significantly lower and tDEM was significantly higher in the patient population than in the control group (p < 0.001). Comparison between CK and 2-D echocardiography showed a correlation coefficient of 0.81 between the two techniques. The score was identically graded in 74% of segments, with concordance of 82% in diagnosing segments as abnormal. Interobserver concordance was 86% for CK (r = 0.85) and 81% for 2-D echocardiography (r = 0.80). The sensitivity and specificity of systolic and diastolic CK parameters for the detection of CAD were 88 and 92% and 77 and 85%, respectively. The positive predictive values were 93 and 96%, respectively, the negative predictive values were 63 and 73%, respectively, and the overall accuracy was 86 and 91%, respectively. CONCLUSIONS: Our data suggest that CK is a feasible and sensitive technique for identifying regional systolic as well as diastolic wall motion abnormalities in patients with CAD.

Adult↗
PubMed1998

Evaluation of left atrial filling using systolic pulmonary venous flow velocity measurements in patients with atrial fibrillation.

BACKGROUND: The pattern of pulmonary venous flow velocity is useful for understanding the hemodynamic relationship between the left atrium and left ventricle in patients with a variety of diseases, and the systolic flow wave, in particular, is considered a clinically important parameter that reflects left atrial filling. HYPOTHESIS: The study was undertaken to determine whether systolic pulmonary venous flow velocity patterns can be used to evaluate left atrial filling in patients with atrial fibrillation. METHODS: We performed transesophageal pulsed Doppler echocardiography and cardiac catheterization in 34 patients with chronic atrial fibrillation (10 with hypertrophic cardiomyopathy, 5 with dilated cardiomyopathy, 7 with previous myocardial infarction, and 12 with isolated atrial fibrillation) and 15 normal controls in sinus rhythm. RESULTS: Mean pulmonary capillary wedge pressure, V-wave height in the pulmonary capillary wedge pressure curve, and left ventricular end-diastolic pressure were significantly higher in the hypertrophic cardiomyopathy and dilated failing heart (previous myocardial infarction and dilated cardiomyopathy) groups than in the isolated atrial fibrillation and normal groups. The peak velocity and time-velocity integral of the systolic pulmonary venous flow velocity, and percent left atrial emptying fraction were significantly lower in the dilated failing heart group than in the isolated atrial fibrillation, hypertrophic cardiomyopathy, and normal groups. The peak velocity and time-velocity integral of the systolic pulmonary venous flow velocity, percent left atrial emptying fraction, and V-wave height were comparatively constant when the preceding R-R intervals were relatively stable in the isolated atrial fibrillation group and in 4 of the 10 patients with hypertrophic cardiomyopathy. However, changes in these variables correlated with the preceding R-R interval in all patients with dilated failing hearts and in 6 of the 10 patients with hypertrophic cardiomyopathy. CONCLUSION: Transesophageal pulsed Doppler echocardiographic measurements of systolic pulmonary venous flow velocity are valid indicators of left atrial filling in patients with atrial fibrillation.

Adult↗
PubMed2006

Systolic anterior motion of the mitral valve despite the sliding leaflet technique for repair of the mitral valve.

We report a systolic anterior motion of the anterior mitral leaflet despite employing the sliding leaflet technique for repair of mitral valve regurgitation. A 65-year-old man with chronic, symptomatic mitral regurgitation due to ruptured chordae tendineae underwent mitral valve repair by quadrangular resection of the posterior leaflet and sliding leaflet technique with ring annuloplasty. After weaning from cardiopulmonary bypass, left ventricular outflow obstruction developed and transesophageal echocardiography demonstrated systolic anterior motion of the mitral valve and severe mitral regurgitation. Non-operative treatment resolved the outflow tract obstruction, systolic anterior motion and mitral regurgitation. We conclude that post-repair systolic anterior motion can still occur after the sliding plasty procedure and that medical treatment can successfully resolve systolic anterior motion and outflow tract obstruction in most patients.

Aged↗
PubMed1997

Left ventricular systolic and diastolic function in septic shock.

OBJECTIVE: The identification of myocardial dysfunction in septic shock has not yet been fully elucidated. We therefore studied patients with persistently vasopressor-dependent septic shock, both with invasive haemodynamic monitoring and transoesophageal two-dimensional and Doppler echocardiography (TEE). DESIGN: Prospective study. SETTING: General ICU in University Hospital. PATIENTS AND METHODS: All patients were monitored with arterial and pulmonary artery catheters. Haemodynamics were obtained concomitantly with TEE measurements. TEE was performed at three levels: a) a midpapillary short axis view of the left ventricle (LV) in order to measure end-systolic and end-diastolic areas; b) at the level of both the mitral valve for early (E) and late (A) filling parameters and c) the level of the right upper pulmonary vein for systolic (S) and diastolic (D) filling characteristics. Each parameter was characterised by maximal flow velocity and time velocity integral. RESULTS: Although the measurements of cardiac index demonstrated a wide range, three subsets of patients were identified post hoc after analysis on the basis of different Doppler patterns: first, patients with a LV without regional wall motion abnormalities and both E/A and S/D greater than 1 (group 1); second, patients with a comparable haemodynamic condition, apparently normal LV systolic function but with altered Doppler patterns: S/D less than 1 in conjunction with E/A more than 1 (group 2); finally, patients with compromised global LV systolic function, E/A less than 1 and S/D less than (group 3). CONCLUSIONS: Notwithstanding the known various interfering factors which limit the broad applicability of TEE to determine LV function in septic shock, our data suggest that cardiac dysfunction in septic shock shows a continuum from isolated diastolic dysfunction to both diastolic and systolic ventricular failure. These data strengthen the need of including the evaluation of pulmonary venous Doppler parameters in each investigation in order to obtain supplementary information to interpret diastolic function of the LV in septic shock patients.

Adult↗
PubMedDate not supplied

X-chromosomal (p21) muscular dystrophy and left ventricular diastolic and systolic function.

In order to screen for cardiac abnormalities, we prospectively studied 15 patients (age 8-25 years, mean 15.5 years) with Duchenne's (DMD) (n = 9) and Becker's (BMD) (n = 6) muscular dystrophy using the echocardiogram. Data were compared to a control group of 92 healthy individuals (age 7.9-25 years, mean 14.3 years). Left ventricular filling in diastole showed a different pattern when comparing echocardiographic Doppler results in patients and controls: Patients had lower peak velocity of early left ventricular diastolic filling (E-vmax)(P < 0.0001) and smaller time velocity integral of the E-wave (E-tvi)(P < 0.0001). In contrast, the atrial component (A-vmax, A-tvi) of diastolic filling in DMD/ BMD showed no significant difference to controls. The mean area of the mitral valve orifice was significantly larger in patients (P < 0.0001) without presence of mitral regurgitation. Systolic left ventricular function was significantly impaired in the DMD/BMD group; we found lower heart rate corrected fiber shortening velocity VCFc (P < 0.001) and higher peak systolic wall stress (P < 0.001) in DMD/BMD. In 8 of 15 patients, peak systolic wall stress was above 95th percentile of controls. In 6 of 15 patients, VCFc was lower than the 5th percentile of controls. Systolic and diastolic myocardial impairment was found even in young patients and at low stages of disability--equally among patients with DMD or BMD. Diastolic left ventricular impairment predominantly affected the early diastolic filling, but atrial compensation was poor. Peak systolic wall stress measurements were particularly useful in patients with CMP, reflecting the left ventricular afterload.

Adolescent↗