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Safety restraint usage in fatal motor vehicle crashes.

In 1987, following implementation of the Washington safety restraint mandatory usage law, collision statistics indicated an increase in motor vehicle crashes in which occupants had died while utilizing safety restraints. Because of concerns expressed by restraint use law advocates, a "Fatal Collision Research Team" was established to evaluate and reconstruct collisions in which restrained occupants had died. Collisions were analyzed over a three-year period and included 337 crashes involving 1,058 occupants, of whom 446 died. The team analyzed fatal collisions involving restrained occupants and documented restraint usage as well as severity of the crash. Crash severity was measured using either the Collision Deformation Classification (CDC) system, which defines the extent of crush to the vehicle, and/or intrusion into the passenger occupant area, or by measuring deceleration forces (delta v) acting on the vehicle, where sufficient data existed to do so. The survivability of the crash was determined individually for each occupant and independently of whether the occupant lived or died, as well as whether the occupant was restrained or not. The major findings were: (i) that in the majority of cases where a restrained occupant died, the fatality can be attributed to the extent of vehicle crush and deceleration forces, i.e. the crash forces and dynamics made the crash nonsurvivable, and (ii) restraint misuse seemed not to be a major contributory factor in fatal crash injuries.

Accidents, Traffic↗

Kinematics of aiming in direction and amplitude: a developmental study.

The patterns of aimed movements to visual targets were analyzed in children aged 6, 8 and 10. Tasks with direction and/or amplitude requirements were used. The tasks were performed both with and without vision. Peak velocity, acceleration and deceleration and their relative temporal occurrence were evaluated. Overall, the 6- and 10-year-olds exhibited higher peak velocity and acceleration when performing the pure directional task than when performing tasks with an amplitude or stopping requirement. On the contrary, 8-year-olds showed similar peak acceleration and velocity across all three tasks. Similarly, when performing the pure directional task, the 6- and 10-year-olds reached their peak velocity and acceleration relatively later in time than the 8-year-olds. Vision of movement increased the peak velocity in all experimental tasks and peak acceleration was increased only in the pure directional task. Thus, movement kinematics varied according to the task requirements and age. Eight-year-olds showed greater propensity to feedback control in all tasks, suggesting an over-inhibition in their approach patterns, whereas 10-year-olds tended to use feedforward processes, with a shortened deceleration phase.

Child↗

Does the production of letter strokes in handwriting benefit from vision?

In earlier studies the involvement of vision in handwriting was suggested by the finding that the production of a letter sequence in a condition without vision took more time and resulted in larger letter trajectories. The present study raises the question whether vision has an impact on the production of the individual up- and downstrokes constituting the letters. More specifically, the aim is to examine whether vision is employed either during the completion of a movement, or concurrent with the entire course of a stroke movement. Adult writers produced the letter sequence lelele under a no-vision and a vision condition, the latter serving as a base-line condition. It was found that movement time and trajectory size of acceleration and deceleration phases of a stroke movement increased under no vision, the magnitude of which depended on letter type. Letter e, with a smaller size and more frequently used in Dutch writing than letter l, was less affected by the no-vision condition. Although, close examination of downstrokes produced in later letter positions of the sequence revealed that the acceleration as compared to the deceleration phase took proportionally less time, the general finding was that increments in time and size proved to be equally distributed across entire stroke movements.

Adult↗

Evaluation of blood flow velocity in the ascending aorta and main pulmonary artery of normal subjects by Doppler echocardiography.

Blood flow velocity measurements were made in the ascending aorta and proximal main pulmonary artery of 20 adult normal subjects (12 men and eight women, age range 21 to 46 years) with the use of a commercial prototype ultrasound instrument combining a spectrum analyzer-based, pulsed Doppler velocimeter with a two-dimensional sector scanner. The sector scanner was used to produce two-dimensional images of the main pulmonary artery so that the Doppler sample volume could be placed parallel to the flow stream. A 2.25 MHz right-angle M-mode ultrasound transducer was positioned in the suprasternal notch and was used to measure blood flow velocity in the ascending aorta. There were significant differences (p less than 0.001) between the ascending aorta and main pulmonary artery (PA) in the following blood flow parameters: peak flow velocity (aorta = 92 cm/sec, PA = 63 cm/sec), average acceleration (aorta = 940 cm/sec2, PA = 396 cm/sec2), acceleration time (aorta = 98 msec, PA = 159 msec), deceleration time (aorta = 197 msec, PA = 172 msec), average deceleration (aorta = 473 cm/sec2, PA = 356 cm/sec2), and ejection time (aorta = 294 msec, PA = 331 msec). These data indicate that despite a four to five times higher arterial resistance in the systemic circuit compared to the pulmonary circuit, blood is accelerated two to three times more rapidly in the ascending aorta than in the main pulmonary artery. Also, the peak flow velocity is higher in the aorta and is achieved earlier in systole than in the pulmonary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The relationship between systolic anterior motion of the mitral valve and the left ventricular outflow tract Doppler in hypertrophic cardiomyopathy.

In an attempt to investigate the role of left ventricular blood outflow in the generation of systolic anterior motion (SAM) of the mitral valve in patients with hypertrophic cardiomyopathy, we precisely analyzed the temporal relation of SAM and the left ventricular outflow tract (LVOT) systolic Doppler events obtained at the maximal mitral-septal apposition or equivalent area in eight patients with severe SAM, in five patients with mild/moderate SAM, and in seven patients with no SAM, using M-mode and pulsed Doppler echocardiography; the results were compared with those in 10 normal subjects. In all 13 patients with SAM, the timing of SAM generation corresponded to the LVOT Doppler events either between the onset of SAM and the onset of Doppler (r = 0.834, p less than 0.0001) or between the peak of SAM and the peak of Doppler (r = 0.836, p less than 0.0001). The excursion rate of the development of SAM showed a correlation with the LVOT blood outflow acceleration (r = 0.828, p less than 0.0001). The timing of SAM resolution also correlated with the Doppler events, either between the offset of SAM and the offset of Doppler (r = 0.795, p less than 0.001) or the end of SAM and the end of Doppler (r = 0.859, p less than 0.0001). The LVOT blood outflow deceleration showed a correlation with the regression rate of SAM (r = 0.668, p less than 0.013). The LVOT blood outflow acceleration was significantly higher in patients with severe SAM than in patients with mild/moderate SAM or no SAM. This study suggests that the high LVOT blood outflow acceleration in early systole possibly plays an important part in the generation of the Bernoulli pressure drop and results in anterior motion of the mitral valve. At mid-systole, a drag force and/or suction effect of pressure drop produced by continuous outflow blood may sustain the anterior motion of the mitral valve. At late systole, as the blood flow decelerates, the regression of SAM then occurs.

Cardiomyopathy, Hypertrophic↗

Diastolic dysfunction is a feature of the antiphospholipid syndrome.

Recurrent thrombi, thrombocytopenia, pregnancy loss, and stroke in association with medium to high concentrations of anticardiolipin antibodies are well-recognized features of antiphospholipid syndrome. Cardiac manifestations of primary antiphospholipid syndrome (PAPS) also have been documented but involve structural and valvular heart disease. Diastolic dysfunction in PAPS has not been well described. Therefore, 10 patients with PAPS (nine women and one man) of mean age 30 +/- 7 years (range 20 to 46 years) and 10 healthy age-, sex-, weight-, and height-matched control subjects were studied by echocardiography. Anticardiolipin antibody concentrations of patients with PAPS were > 80 immunoglobulin G phospholipid units as determined by enzyme-linked immunosorbent assay. Doppler-derived parameters of left ventricular filling showed a significant association between PAPS and diastolic dysfunction compared with control, as evidenced by a decrease in peak early filling velocity (52 +/- 10 cm/sec vs 67 +/- 12 cm/sec; p < 0.01), a decrease in the ratio of peak early to peak atrial filling velocities (1.03 +/- 0.40 vs 1.52 +/- 0.28; p < 0.005), a decrease in the mean deceleration rate of early filling (338 +/- 75 cm/sec2 vs 590 +/- 227 cm/sec2; p < 0.005), and an increase in the percentage of atrial contribution to filling and deceleration time. Left ventricular mass, diastolic filling time, and heart rate did not differ between groups. Left ventricular systolic function was normal and ejection fraction did not differ between patients with PAPS and control subjects (63% +/- 2% vs 65% +/- 7%; p not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity.

To identify factors influencing left ventricular (LV) diastolic filling in patients with morbid obesity, we performed transthoracic and Doppler echocardiography on 50 subjects whose actual body weight was > or = twice their ideal body weight and on 50 normal lean control subjects. The transmitral Doppler E/A ratio and E wave deceleration half-time were used to assess LV diastolic filling. Significant negative correlations were seen between the E/A ratio and the LV internal dimension in diastole (r = 0.819, p = 0.0001), systolic blood pressure (r = 0.751, p = 0.0001), LV end-systolic wall stress (r = 0.782, p = 0.0001), and LV mass/height index (r = 0.901, p = 0.0001). Significant positive correlations were seen between the E wave deceleration half-time and the LV internal dimension in diastole (r = 0.743, p = 0.0001), systolic blood pressure (r = 0.789, p = 0.0001), LV end-systolic wall stress (r = 0.828, p = 0.0001), and LV mass/height index (r = 0.831, p = 0.0001). No correlation was seen between diastolic blood pressure and either index of LV diastolic filling. Thus increasing LV mass is associated with progressive impairment of LV diastolic filling in morbidly obese individuals. The aforementioned alterations in LV loading conditions may contribute to impairment of LV diastolic filling directly or by increasing LV mass.

Adult↗

Doppler evaluations of left ventricular diastolic filling and pulmonary wedge pressure provide similar prognostic information in patients with systolic dysfunction after myocardial infarction.

Previous studies have demonstrated that in patients with various types of cardiac diseases and left ventricular dysfunction, left ventricular filling patterns assessed by Doppler of mitral flow are correlated to ventricular filling pressure, the prognostic value of which is well known. The current study was carried out to determine the prognostic importance of a noninvasive evaluation of left ventricular filling by Doppler of mitral flow in patients with systolic dysfunction after myocardial infarction and to compare its value with that of pulmonary wedge pressure. One hundred seven patients with a left ventricular ejection fraction < 40% were studied 3 to 12 weeks after myocardial infarction. All patients underwent a complete clinical examination, a standard two-dimensional and Doppler echocardiographic examination, and right-sided heart catheterization at rest and during a cardiopulmonary bicycle exercise test. Early and late diastolic peak flow velocities, their ratio, and the deceleration time of early diastolic velocity were measured from pulsed-wave Doppler of mitral flow. Follow-up data were obtained for 101 patients. During a mean period of 25 (median 21, range 12 to 60) months cardiac events (death, heart transplantation, or heart failure requiring hospitalization) occurred in 43 (42%) patients. Patients with cardiac events during follow-up were in a worse functional class and had a more impaired exercise capacity and higher capillary pulmonary wedge pressure at baseline examination. Among Doppler echocardiographic variables, in patients with cardiac events a greater early to late diastolic peak velocity ratio of mitral flow (1.9 +/- 0.9 pl/min vs 1.2 +/- 0.8 pl/min, p < 0.001) and a shorter early diastolic deceleration time (112 +/- 35 vs 145 +/- 42 msec, p < 0.001) were found. Cox analysis revealed that the combination of early to late diastolic peak flow velocity ratio of mitral flow and New York Heart Association functional class were the strongest noninvasive independent predictors of cardiac events. One-year event-free probability of survival was 90% in patients with an early to late diastolic peak velocity ratio < or = 1 (all but 1 in New York Heart Association functional class I or II) but was significantly less in patients with an early to late diastolic peak velocity ratio > 1 (64% in functional class I or II and 36% functional class III). Similar results were obtained when mean pulmonary wedge pressure was considered instead of the ratio between peak flow velocities of mitral flow.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood Flow Velocity↗

Variable responses of mitral valve motion and flow in systemic hypertension and in idiopathic dilated cardiomyopathy.

The relation between transmitral flow and diastolic mitral valve motion were examined in 17 normal persons, 14 patients with hypertension and 12 patients with idiopathic dilated cardiomyopathy. M-mode echograms were analyzed for early and late diastolic mitral leaflet separations, their ratio and E-F slope. Pulsed Doppler transmitral flow was analyzed for early and late velocities, their ratio and early flow deceleration. Early diastolic mitral valve leaflet separation was reduced in patients with hypertension (at 28 +/- 5 mm [p less than 0.05] ) and in patients with cardiomyopathy (at 22 +/- 3 mm [p less than 0.01] ). Flow velocity was also reduced in patients with hypertension (at 52 +/- 11 cm/s [p less than 0.05] ) and in patients with cardiomyopathy (at 48 +/- 15 cm/s [p less than 0.01] ). However, early leaflet separation and flow velocity were not related (r = 0.26). Late diastolic leaflet separation was similar (at 25 +/- 5 mm) in normal subjects and in those with hypertension (at 23 +/- 6 mm), but was reduced in patients with cardiomyopathy (at 18 +/- 3 mm [p less than 0.01] ). In contrast, late flow velocity was increased in patients with hypertension (at 52 +/- 12 cm/s [p less than 0.05] ) but unchanged in patients with cardiomyopathy (at 42 +/- 16 cm/s). The ratio of early to late leaflet separation was similar in all groups, whereas the ratio of flow velocities was reduced in hypertensive patients. Neither the E-F slope not early flow deceleration was altered in either pathologic group. Thus, hypertension and cardiomyopathy had similar effects in early rather than late diastole.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography.

Pulsed Doppler echocardiography was used to examine the relation between pulmonary valve motion and pulmonary artery (PA) flow velocity patterns in 39 adults. In 16 patients with normal PA pressure (mean pressure less than 20 mm Hg), PA flow velocity accelerated slowly to a peak flow velocity at midsystole (time to peak flow velocity, or acceleration time = 134 +/- 20 ms [mean +/- standard deviation]), followed by a slow deceleration to the end of ejection, producing a "dome-like" appearance. In contrast, in 23 patients with elevated PA pressure (mean pressure 20 mm Hg or more), flow velocity accelerated rapidly to a peak flow velocity in early systole (acceleration time = 88 +/- 25 ms, p less than 0.01), followed by rapid flow velocity deceleration to a nadir in midsystole. In 13 of these patients, a transient increase in flow velocity occurred in late systole, producing a "spike and dome" appearance. In patients with an acceleration time of 120 ms or less, there was a negative linear correlation with mean PA pressure, expressed by the equation: mean PA pressure = 90 - (0.62 X acceleration time). The standard error of the estimate was 8.3 mm Hg. A similar negative linear correlation was found between PA acceleration time and total pulmonary resistance. Using a PA acceleration time of 100 ms or less resulted in a 78% sensitivity and a 100% specificity for detection of elevated PA pressure. Although this Doppler method cannot precisely estimate PA pressure, it can be helpful in separating patients with normal pressure from those with elevated PA pressure.

Adult↗

Effect of mitral regurgitation on diastolic filling with left ventricular hypertrophy.

Earlier studies have suggested that mitral regurgitation (MR) augments early left ventricular (LV) diastolic filling. To determine whether MR affects early diastolic filling in patients with abnormal diastolic filling, transmitral pulsed-wave Doppler recordings were used to study 32 normal subjects, 21 patients with LV hypertrophy, 23 with LV hypertrophy and MR and 15 patients with MR. Patients with MR had increased peak early filling velocities (MR 108 +/- 27 cm/s, normal 80 +/- 16 cm/s, p less than 0.01), peak atrial filling velocities (MR 72 +/- 18 cm/s, normal 55 +/- 12 cm/s, p less than 0.05) and increased deceleration rates (MR 5.0 +/- 1.9 m/s2, normal 3.5 +/- 1.2 m/s2, p less than 0.05). Patients with LV hypertrophy had reduced peak early filling velocities (69 +/- 14 cm/s, p less than 0.05) and increased peak atrial filling velocities (83 +/- 16 cm/s, p less than 0.001). There was also an increase in the atrial filling fraction and reduction in the rapid filling fraction as compared with normal patients. Patients with LV hypertrophy and MR had increased peak early filling velocities (98 +/- 26 cm/s, p less than 0.01 vs normal, p less than 0.001 vs LV hypertrophy patients), increased atrial filling velocities (84 +/- 27 cm/s, p less than 0.001 vs normal), increased deceleration rates (4.4 +/- 2.4 m/s2, p less than 0.05 vs normal) and a normal distribution of diastolic filling. Within the LV hypertrophy and MR group, diastolic filling parameters were similar when patients were subgrouped on the basis of auscultability of MR. MR augments early diastolic filling and may tend to normalize diastolic filling patterns in LV hypertrophy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomegaly↗

Diagnosis of constrictive pericarditis by pulsed Doppler echocardiography of the hepatic vein.

The diagnostic value of hepatic venous flow patterns was evaluated for constrictive pericarditis by pulsed Doppler. A characteristic flow pattern was assumed to be associated with the well-known atrial pressure curve. Thirteen patients with constrictive pericarditis were compared to 13 control subjects and to 25 patients with right ventricular pressure overload including 13 patients with tricuspid regurgitation. The characteristic finding in constrictive pericarditis was a W-wave pattern of flow velocities in the dilated hepatic veins, with abrupt reversal of flow late in systole and diastole before the A wave (100% specificity, 68% sensitivity). This depends, however, on the absence of tricuspid regurgitation (for its systolic component) or fast sinus rhythm (for its diastolic component). Additional diagnostic markers were systolic deceleration time of forward flow (40 to 130 ms) and systolic integral of flow velocities (4.3 to -4.0 cm) (sensitivity and specificity greater than or equal to 92%). In the presence of tricuspid regurgitation, diastolic deceleration time less than 150 ms and diastolic integral of flow velocities less than 6 cm were useful diagnostic signs. If combined, these criteria had 100% sensitivity and specificity for the diagnosis. Thus, pulsed Doppler assessment of flow velocities in the hepatic vein facilitates the diagnosis of constrictive pericarditis in clinical routine, using an auxiliary site with unlimited diagnostic access to the characteristic flow velocity pattern, which reflects right atrial pressure curve and filling abnormalities.

Adolescent↗

Doppler echocardiographic evaluation of left ventricular diastolic filling in isolated valvular aortic stenosis.

Doppler echocardiography was used to study left ventricular (LV) diastolic filling in 49 adults with isolated aortic stenosis (AS), selected from 155 consecutive patients with AS by excluding coexisting mitral disease (n = 41) and/or significant aortic regurgitation (n = 80). There were no differences between patients with AS and age-matched normal subjects for early diastolic filling (E) velocity (68 +/- 17 vs 67 +/- 13 cm/s), late diastolic filling (A) velocity (79 +/- 25 vs 67 +/- 21 cm/s), E/A ratio (1.00 +/- 0.78 vs 1.06 +/- 0.32) or early diastolic deceleration slope (264 +/- 151 vs 319 +/- 137 cm/s2, differences not significant for all). There was no correlation between any LV filling parameter and AS severity, but late diastolic filling velocity was higher in patients with AS who had LV hypertrophy (n = 33) vs those who did not (n = 16) (86 +/- 23 vs 65 +/- 26 cm/s, p less than 0.01). In the patients with AS and systolic dysfunction (LV ejection fraction less than 50%) (n = 6), early diastolic filling velocity was higher (88 +/- 20 vs 65 +/- 15 cm/s, p less than 0.01), late diastolic filling velocity lower (53 +/- 23 vs 83 +/- 23 cm/s, p less than 0.01), E/A ratio higher (2.20 +/- 1.80 vs 0.84 +/- 0.28, p less than 0.01), deceleration slope steeper (439 +/- 230 vs 240 +/- 121 cm/s2, p = 0.02) and LV end-diastolic pressure higher (23 +/- 9 vs 10 +/- 6 mm Hg, p less than 0.01) than in patients with AS and normal systolic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Right ventricular diastolic function in systemic hypertension.

Right (RV) and left ventricular (LV) diastolic function was evaluated in 50 patients with mild, uncomplicated essential hypertension using pulsed-wave Doppler echocardiography. Patients with pulmonary, valvular or coronary artery disease were excluded and antihypertensive drugs were discontinued for the 2 weeks preceding the study. Ten normotensive patients without heart disease acted as control subjects. In the hypertensive patients, RV peak velocity of atrial filling was higher (42 +/- 10 vs 31 +/- 7 cm/s, p less than 0.01) and deceleration half-time was prolonged (96 +/- 20 vs 83 +/- 10 ms, difference not significant); ratio of early/atrial filling velocity (1.1 +/- 0.3 vs 1.7 +/- 0.4, p less than 0.001) and peak filling rate corrected to stroke volume (3.6 +/- 0.7 vs 5.3 +/- 0.9 SV/s, p less than 0.001) were lower. LV filling parameters showed similar changes. RV filling parameters did not correlate with age, LV mass or septal thickness but correlated weakly with LV radius/thickness ratio. There was good correlation between RV and the following corresponding LV filling parameters: peak filling rate, r = 0.68, p less than 0.001; ratio of early/atrial filling, r = 0.88, p less than 0.0001; and deceleration half-time, r = 0.62, p less than 0.001. Data indicate that RV diastolic function is abnormal in essential hypertension and these abnormalities are closely related to those of LV diastolic function.

Adult↗

Reference values and reproducibility of Doppler echocardiography in the assessment of the tricuspid valve and right ventricular diastolic function in normal subjects.

The Doppler echocardiographic indexes of the tricuspid and mitral valves were assessed in 74 normal subjects (35 women and 39 men, mean age 45 years). A reproducibility study was also performed to examine the various sources of technical and biological variability. There were significantly higher peak early and late flow velocities across the mitral valve than across the tricuspid valve (0.67 +/- 0.13 and 0.47 +/- 0.12 vs 0.51 +/- 0.08 and 0.35 +/- 0.09 m.s-1, respectively; all p less than 0.0001). There was no significant difference between the early:late (E:A) velocity ratios of the 2 valves (1.65 +/- 0.73 vs 1.75 +/- 0.67, p less than 0.01). There was a steeper mitral early deceleration slope (-3.59 +/- 1.07 vs -2.95 +/- 0.91 m.s-2) but no significant difference in pressure half-times across the 2 valves (47 +/- 7 vs 51 +/- 12 ms, p less than 0.1). No influence of gender or body surface area could be demonstrated. There was a weak but significant relation between mitral peak early, peak atrial velocity and E:A ratio and age (r = -0.39, p less than 0.001, r = 0.23, p less than 0.01, and r = -0.245, p less than 0.01, respectively). There was no significant correlation between any of the tricuspid flow parameters and age. Respiration caused pronounced variability in the tricuspid Doppler indexes and all tricuspid flows were sampled and analyzed only during inspiration. The intra- and interobserver variabilities were small for all of the Doppler indexes measured, but the day-to-day variability was quite significant especially for the pressure half-time, deceleration and acceleration slope values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Intra- and interobserver reproducibility of Doppler-assessed indexes of left ventricular diastolic function in a population-based study (the Framingham Heart Study).

The reproducibility of a variety of Doppler indexes of diastolic function in an epidemiologic setting and in atrial fibrillation have not been reported. This study examined the reproducibility of left ventricular inflow in subjects in sinus rhythm (n = 80) and atrial fibrillation (n = 12), randomly selected from the original cohort of the Framingham Heart Study. The following Doppler indexes were assessed for all subjects: peak and integral of early (E) diastolic inflow velocity, acceleration slope and time, deceleration slope and time, and pressure half-time. For subjects in sinus rhythm, the following parameters also were measured: the peak and integral of late (A) diastolic inflow velocity, ratios of peak velocities and integrals E/A, and atrial filling fraction. Intraobserver and interobserver variability were evaluated by statistical methods including Student's t test of the systematic differences (bias), percent bias, correlation coefficients, measurement precision, and percent precision. In subjects in sinus rhythm, although the interobserver bias was statistically significant for most of the parameters, it was < 10% for all but 1 parameter (acceleration time). For the peak and integral measures, the intra- and interobserver correlations were > or = 0.89, with intra- and interobserver percent precision measures within 2.2 to 13.0% of the corresponding mean values. The acceleration, deceleration and pressure half-time measures had somewhat lower correlations (interobserver correlations ranging from 0.59 to 0.96), with percent precision measures further from the corresponding means (interobserver percent precision ranging from 10.1 to 19.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Role of transesophageal echocardiography in evaluation of pulmonary venous obstruction by paracardiac neoplastic masses.

From 71 consecutive patients with paracardiac neoplastic masses who underwent transesophageal echocardiography (TEE), obstruction of individual right upper pulmonary venous flow by compression by contiguous mass was detected by TEE in 4 patients before and disappeared after anti-neoplastic treatments. Pulmonary vein, contiguous neoplastic mass and their relation could be clearly visualized and assessed by TEE. Pulmonary venous obstruction was assessed as moderate degree by combination of Doppler flow characteristics and diameter of pulmonary vein. Before therapy, peak velocities and time-velocity integrals in obstructed right upper pulmonary venous flow were increased, whereas deceleration times of systolic flow were prolonged. After therapy, peak velocities and time-velocity integrals were reduced and deceleration times of systolic flow were shortened, with normalization of the diameter of the right upper pulmonary veins. Thus, TEE may be used to detect and evaluate pulmonary venous obstruction by neoplastic masses and its changes after antineoplastic treatments.

Adult↗

Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis.

Although cardiac involvement in the form of conduction abnormalities or aortic regurgitation occurs in 5 to 10% of patients with ankylosing spondylitis, few studies have assessed left ventricular (LV) function. This study assesses the prevalence of both systolic and diastolic LV dysfunction and other cardiac abnormalities in patients with ankylosing spondylitis who have no clinical cardiac manifestations. Fifty-nine patients (49 men and 10 women, mean age 42 +/- 10 years) underwent full clinical examination, electrocardiography, 24-hour Holter monitoring and 2-dimensional, M-mode and Doppler echocardiography. Mean disease duration was 17 +/- 9 years (range 1 to 42). Seventeen patients had evidence of noncardiac extraarticular manifestations. Precordial examination was normal in all. An age- and sex-matched control group of 44 healthy subjects was also studied. On echocardiography, abnormal LV diastolic function was detected in 12 patients (20%). Prolonged isovolumic relaxation time, prolonged deceleration time, reduced rate of descent of flow velocity in early diastole (EF slope) and reversal of the early and late peak transmitral diastolic flow velocities (E/A ratio) were noted in 9 patients. In 3 patients there was an increased E/A ratio, reduced deceleration time and increased EF slope. Mild aortic regurgitation and mitral regurgitation was seen in 1 and 3 patients, respectively. No abnormalities of left atrial size, LV systolic or diastolic dimensions or wall thicknesses were noted. There was no correlation between the presence of LV diastolic dysfunction and age, disease severity, disease duration, or the presence of extraarticular manifestations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗