bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Intravenous Myocardial Contrast Echocardiography Predicts Recovery of Left Ventricular Function After Revascularization in Chronic Coronary Artery Disease
Authors: Fukuda Shota , Hozumi Takeshi , Muro Takashi , Watanabe Hiroyuki , Hyodo Eiichi , Yoshiyama Minoru , Takeuchi Kazuhide , Yoshikawa Junichi 
Published: February 2004

Background: Quantitative intravenous myocardial contrast echocardiography (MCE) has been shown to measure regional myocardial blood flow velocity noninvasively. Purpose: To determine whether quantitative intravenous MCE could be used clinically to predict functional recovery after revascularization in patients with chronic coronary artery disease. Methods: Twenty‐eight patients with chronic stable coronary artery disease and resting regional left ventricular dysfunction were included in this study. The study permits myocardial perfusion analysis by intravenous MCE before revascularization with continuous infusion of Levovist and intermittent ultrasonic exposure. Wall motion assessment by echocardiography at rest was repeated after long‐term follow‐up period (7 ± 2 months). In dysfunctional segments, we analyzed myocardial perfusion quantitatively by fitting to an exponential function, Y = A(1 − e−βt) to obtain the rate of rise (β) of background‐subtracted intensity, which represented myocardial blood flow velocity. Results: Of the 101 revascularized dysfunctional segments, MCE was adequately visualized in 91 (90%) segments, and wall motion was recovered in 45 (49%) segments. The value of β in the recovery segments was significantly higher than that in nonrecovery segments (0.80 ± 0.50 vs 0.39 ± 0.24, P < 0.001). The value of β > 0.5 predicted recovery of segmental function with a sensitivity of 71%, specificity of 78%. Conclusion: Quantitative intravenous MCE can predict functional recovery after revascularization in patients with chronic coronary artery disease. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
DIFFERENT CLINICAL FEATURES OF AORTIC INTRAMURAL HEMATOMA VERSUS DISSECTION INVOLVING THE DESCENDING THORACIC AORTA
Authors: Mariano F. , Pablo O. , Vicente C. , Alberto D. , Daniel B. , Rodolfo. P. 
Published: February 2004

Background: Although indicators of surgical and medical treatment have been applied to patients with typical dissection (AD) of the descending thoracic aorta, the natural history of descending aortic intramural hematoma (AIH) is not yet clearly known. Objective: The goal of this study was to test the hypothesis that the absence of flow communication through the intimal tear in AIH involving the descending aorta has a different clinical course compared with AD. Methods: We prospectively evaluated clinical and echocardiographic data between AD (76 patients) and AIH (27 patients) of the descending thoracic aorta. Results: Patients had no differences In age, gender, or clinical presentation. The development of pleural effussion or periaortic hematoma was more frequent in patients with AIH than it was in patients with AD. AIH and AD had same predictors of complications at follow‐up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Although medical treatment was selected in the same proportion between groups, surgical treatment was more frequently selected in AD (39% vs. 22%, p < 0.01). AD patients who received surgical treatment had higher mortality than those with AIH (36% vs. 17%, p < 0.01). There was no difference in mortality between patients who received medical treatment (15% in AD vs 14% in AIH, p = 0.7). In follow‐up imaging studies of 23 patients with AIH,6 patients (25%) showed complete resolution and 6 patients (25%) increased the descending aortic diameter. Typical AD developed in 3 patients (13%). A three‐year survival rate did not show significant difference (82 ± 6% in AIH vs 75 ± 7% in AD, p = 0.37). Conclusion: AIH of the descending thoracic aorta have relatively frequent complications at follow‐up including dissection and aneurysm formation. Medical treatment with very close imaging follow‐up and timed elective surgery in cases with complications allow better management for patients with AIH of the descending thoracic aorta.
QUANTIFICATION OF REGIONAL MYOCARDIAL FUNCTION: IMPROVED DETECTION OF MYOCARDIAL ISCHEMIA IN DIABETIC PATIENTS DURING DOBUTAMINE DOPPLER MYOCARDIAL IMAGING ECHOCARDIOGRAPHY
Authors: Ilic S. , Ilic M.D. , Petrovic D. , Bosiljka T.V. , Ljubisa. N. 
Published: February 2004

The aim of the study was to evaluate the value of pulsed wave Doppler myocardial imaging (PW DMI) in detecting myocardial ischemia (mi) during dobutamine stress echocardiography (DSE) in diabetic patients. Methods: We studied 40 diabetic patients with known or suspected coronary artery disease. In all patients DSE (from 5 up to 40 mcg/kg/min infused in 3‐minute stages, plus atropine 1 mg if needed) was performed. DSE identified ischemia by the occurrence of wall motion abnormalities (WMA) with stress (positive DSE). Apical views were used to assess myocardial velocities (mv; Acuson‐ Sequoia, PW DMI) on baseline and at peak stres. The left ventricle was divided into 11 segments. The sample volume was placed in each adequately visualized segment and in each segment we measured peak mv of systolic (S), early (E), and late (A) diastolic waves and calculated their ratio (E/A) as an index of regional diastolic function. Results: Myocardial velocities were measured in 374 (85%) of 440 possible myocardial segments. During DSE in 21 (52.5%) patients WMA were detected in 73 (37%) of 197 adequately visualized segments, while in 19 (47.5%) patients WMA did not appear. Of 21 patients with DSE‐provoked WMA, in 9 (42.9%) patients symptomatic and in 12 (57.1%) patients silent mi appeared. In segments with DSE‐provoked symptomatic and silent WMA the ratio of E/A decreased by 23.7% and 20.1% (p < 0.001 for both) and S decreased by 18.7% (p < 0.005) and 14.4% (p < 0.02) compared to baseline values. Of 301 segments without DSE‐induced WMA in 13 (4.3%) segments (6 in patients with positive and 7 segments in patients with negative DSE) we also found inversion of the E/A ratio (from 1.04 ± 0.08 to 0.94 ± 0.09, p < 0.005). In 288 other segments without WMA ratio E/A and S mv significantly increased (p < 0.001 for both). Conclusion: Quantification of regional myocardial function during conventional DSE in diabetic patients showed that symptomatic as well as silent mi is associated with significant decrease of E/A ratio and S mv but changes are more pronounced in symptomatic mi. Inverted regional E/A ratio may uncover super‐silent mi, which is not sufficient to provoke WMA.
EFFECTS OF DOBUTAMINE ON TISSUE DOPPLER VELOCITIES IN PATIENTS WITH NORMAL WALL MOTION AT REST
Authors: Pariona M. , Mendoza A. , Rivara. G. 
Published: February 2004

Background: Dobutamine stress echocardiography (DSE) is a well‐recognized test to diagnose myocardial ischemia; however, it depends on operator subjective evaluation: it has been reported that pulsed Tissue Doppler (PTD) velocities at the mitral annulus provide information of both left ventricular systolic and diastolic function; we therefore evaluated the effect of dobutamine (DOB) on PTD in search of markers of ischemia. Methods: We prospectively studied 139 patients with normal wall motion (male: 54%; age: 65 ± 10 years) referred to a dobutamine stress echocardiography (DSE). Measurements were done at the lateral (L) and septal (S) annulus and included early diastolic filling velocity (Em), late diastolic filling velocity (Am), systolic velocity (Sm), and the ratio of early‐to‐late diastolic filling velocities (Em/Am). Results: One hundred and six (76%) patients had a normal response to DOB and 33 (23%) had an ischemic response. The PTD differences between the patients with either normal or ischemic response,respectively,were: rest L Em 11.6 ± 3.1 vs. 12.± 3.8 (p = 0.1207), peak L Em 14 ± 3.9 vs. 12.7 ± 4 (p < 0.0206); rest S Em 9.6 ± 2.1 vs. 9.1 ± 2.6 (p < 0.4335), peak S Em 12 ± 4.6 vs. 10.7 ± 2.3 (p = 0.0473). Both S and L Sm were significantly different at rest and at peak. A trend to a more negative E/A ratio was found in both groups. PTD velocities (mean ± SD) are shown in table.

Pulse Tissue Doppler Velocities at Rest and at Peak Stress

Normal
Ischemic
P Value

Rest lateral Em
11.6 ± 3.1
12 ± 3.8
0.1207

Peak lateral Em
14 ± 3.9
12.7 ± 4
0.006

Rest septal Em
9.6 ± 2.1
9.1 ± 2.6
0.4335

Peak septal Em
12 ± 4.6
10.7 ± 2.3
0.0473

Rest lateral Sm
10.2 ± 2.4
8.73 ± 3.2
0.0139

Peak lateral Sm
21.9 ± 6.1
16.7 ± 5
0.005

Rest septal Sm
10.6 ± 2.6
8.8 ± 4.7
0.0081

Peak septal Sm
21.5 ± 5
16.7 ± 6.2
0.0183

Conclusion: Pulse tissue Doppler Em could be a useful marker of ischemic response during dobutamine stress echocardiography.
SAFETY OF STRESS ECHOCARDIOGRAPHY. THE RESULTS OF THE INTERNATIONAL STRESS ECHO COMPLICATION REGISTRY
Authors: Lowenstein J. , Varga A. , Rodriguez G.M.A. , Picano. E. 
Published: February 2004

Background: The safety of any diagnostic test is a major issue in deciding its practicability and cost‐effectiveness. Aim: To evaluate the safety of various stress echo modalities in the “real life” an international stress echo complication registry was started. Methods: Up to January 2001, a simple written questionnaire was distributed to 300 echo laboratories known to perform stress echo. Of these 300, 71 echo laboratories were “responders” and reported on 85,997 examinations. Results: Exercise was used in 26,295, dobutamine in 35,103, and dipyridamole in 24,599 cases. Life‐threatening events occurred in 86 patients: during exercise in 4 patients (event rate: 1/6,574), during dobutamine infusion (low dose for viability and/or high dose for ischemia) in 63 patients (event rate 1/557), and during dipyridamole stress test in 19 patients (event rate 1/1,294). Of the 86 patients with complications, 5 died during dobutamine stress test (ventricular fibrillation n=2 and cardiac rupture n = 3), and 1 following a dipyridamole test (uncontrollable hypotension). Conclusion: Stress echocardiography is a safe method in the “real life,” as well, but dreadful complications may occur. Possibly due to preselection criteria, exercise seems safer than pharmacological stress and dipyridamole safer than dobutamine.
OVERWEIGHT IS NOT A LIMITATION FOR CORONARY FLOW MEASUREMENTS BY TRANSTHORACIC DOPPLER ECHOCARDIOGRAPHY
Authors: Lowenstein J. , Quiroz C. , Montaña. O. 
Published: February 2004

Background: Coronary flow velocities (CFV) can be measured in the left anterior descending artery (LAD) by transthoracic Doppler echocardiography (TTDE), but many echocardiographers believe that obesity could be a limitation in determining it. The aim of our study was to investigate the feasibility of the measurements of CFV in the distal LAD by TTDE in an unselected population of overweight patients. Methods: TTDE was performed in 1137 consecutive patients with a 4–7 MHz transducer, color map with a Nyquist scale average of 19.2 cm, without any contrast agent; 160 patients with a weight ≥100 kg, (mean 108.8 ± 9.7 kg, limits 100–150 kg) formed the study group (141 men ; mean age: 57.5 ± 9.8 years, mean body surface area of 2.25 ± 0.13 m2 (limits 1.91–2.64 m2). The baseline systolic velocity (BSV), basal diastolic maximal velocity (BDMV), and basal average diastolic velocity (BDAV) were measured in the distal LAD. Results: An interpretable Doppler diastolic signal was obtained in 90.6% (145/160) of the determinations in patients ≥ 100 kg, vs. 91.7% (896/ 977) of patients with < 100 kg. (p = NS). The BDAV of the total group was 16.8 ± 5.4 cm/s and in the obese patients was 17.4 ± 4.7 cm/s (p = NS), a BSV was obtained in 82.5% of the total group and 88% in the obese patients (p = NS) The average performing time of all the studies was 1.4 ± 2.0 minute. The population of the 15 obese patients in which it was not feasible to determine Doppler recording of the BDV was significantly older (62.4 ± 7.9 vs 56.9 ± 9.8 years old, p < 0.03). the feasibility in patients ≥ 65 years was 83%, while in patients younger than 65 years it was 93% (p = NS); in patients with a very bad acoustic window there were 26.6% of nonfeasible studies versus 7.6% of patients with good or regular 2D images; gender, height, body surface area, left diastolic ventricular diameter, and mass index did not mark a difference between the feasible and the nonfeasible studies in overweight patients. Conclusion: In daily practice, assessment of coronary flow velocity by transthoracic Doppler echocardiography of the left anterior descending coronary artery was highly feasible, independent of the body weight; only a very bad acoustic window and an age over 65 years could be considered a slight limitation in overweight patients.
PROGNOSTIC VALUE OF PACEMAKER STRESS ECHOCARDIOGRAPHY
Authors: Kudrle C. , Ferrari G. , Manuale O. , Ludueña C.E. , Figueroa G. , Estepo J. , Caceres M.C. , Gonzalez C. , Humphreys. J.D. 
Published: February 2004

Background: Transesophageal atrial pacing echocardiography is an accurate test for detection of coronary artery disease (CAD). In the expanding population of patients with permanent pacemakers, a pacing stress test can be administered noninvasively by external programming of the pacemaker. Objective: To establish the prognostic value of pacemaker stress echocardiography (PSE) to predict major adverse coronary events (MACE) in patients with suspected or known CAD. [MACE =CAD death, nonfatal myocardial infarction (MI), unstable angina (UA), or need of a myocardial revascularization procedure (MRP)]. Methods: From July 2000 to January 2003, 35 patients with a mean age of 73.9 ± 7 years with known or suspected CAD were consecutively submitted for PSE. Mean follow‐up was 12.8 ± 8 months. 31 patients (88.6%) with permanent implanted pacemakers (23 patients in DDD mode and 7 patients in VVI mode) underwent PSE by external programming and 4 patients (11.4%) had transesophageal atrial pacing performed. A 4‐stage protocol was used (base, 85%, 100% of maximum expected heart rate, and recovery), each lasting 3 minutes. Current medication was not discontinued. Patient features: men 19 (54.3%), hypertension 20 (57.1%), hypercholesterolemia 15 (42.9%), smoking 11 (31,4%), diabetes 10 (26.6%), atrial fibrillation: 5 (14.3%), previous MI 7 (20%), previous CABG 3 (8.6%), previous PCI 3 (8.6%), normal LVEF 27 (77.1%). Medical treatment: beta‐blockers 14 (40%), Ca‐antagonists 10 (28.6%), nitrates 1 (2.9%), ACE‐I/ARBS 11 (31.4%), aspirin 18 (51.4%), diuretics 5 (14.3%). Results: Ischemic PSE: 12 p (34,3%); High‐risk 1 patients (2.9%), intermediate‐risk 5 patients (14.3%), low‐risk 6 patients (17.1%). MACE: PCI: 1 patients (2.9%), non fatal MI: 1 patients (2.9%); CAD death and UA: 0 patients (0%). The negative predictive value (PV) of a non‐ischemic PSE was 95% and the positive PV of an ischemic PSE was only 8.3%.

MACE:
MACE (+)
MACE (−)
PV
Non‐ischemic  PSE(12p)
1

11
Neg.PV
Ischemic
1
22
Pos.PV

95%
PSE(23p)

8.3%

Conclusion: In this small cohort of patients with suspected or known CAD, a nonischemic PSE has a high negative PV.
DETECTION OF MYOCARDIAL VIABILITY USING DOBUTAMINE STRESS ECHOCARDIOGRAPHY AND MYOCARDIAL CONTRAST AFTER ACUTE MYOCARDIAL INFARCTION
Authors: Sbano J.C. , Tsutsui J.M. , Abreu E. , Nicolau J.C. , Meneghetti J. , Andrade J.L. , Mathias. W. 
Published: February 2004

Background: Both low‐dose dobutamine stress echocardiography (LDDE) and myocardial contrast echocardiography (MCE) are capable of identifying myocardial viability by different means. However, it is not well known which of them is more accurate in the setting of AMI. Objective: We evaluated the diagnostic value of LDDE and MCE using second harmonic with and without intermittent imaging in the detection of myocardial viability after acute myocardial infarction (AMI) treated with successful thrombolysis. Methods: We studied 50 patients in the first week after AMI, at rest with LDDE, with and without MCE. We evaluated the recovery of left ventricular ejection fraction (LVEF) at rest by two‐dimensional echocardiography as well as by myocardial scintigraphy (Gated Spect), between the fourth and sixth month of follow‐up. According to an absolute 5% increase in LVEF measured by the two Gated Spect studies, pts were divided in group I, with functional recovery (19 patients) and group II, without functional recovery (31 patients). To analyze the contractility and myocardial perfusion, we used a left ventricular wall motion score index and myocardial perfusion score index at rest and during dobutamine. Myocardial viability was defined by LDDE as an improvement segmental wall motion at least one grade in two or more contiguous infarct zones segments at any stage of dobutamine infusion and by MCE as myocardial perfusion grade 1 or 2 at least in one infarct segment, at any stage of the study. Results: Group 1 had a total of 103 dysfunctioning infarct‐related segments. LDDE revealed the myocardial viability in 61 segments while MCE demonstrated perfusion grade 1 or 2 in 79 of them. In group 2, of 173 dysfunctioning infarct‐related segments, viable myocardium was detected in 23 segments by LDDE and 98 segments by MCE. Only two of 99 segments without viability showed recovery of function at follow‐up. The overall results patient by patient of LDDE in order to predict the LVEF recovery, sensitivity was 95%, specificity 87%, positive predictive value 82%, negative predictive value 96% and diagnostic accuracy 90% (κ= 0.794). When we analyzed the overall results patient by patient of MCE, we demonstrated a sensitivity of 95%, specificity of 52%, positive predictive value of 54%, negative predictive value of 94%, and diagnostic accuracy of 68% (κ= 0.479). Conclusion: The detection of contractile reserve by the use of LDDE was accurate in predicting LVFR in patients after AMI treated with successful thrombolytic therapy, while MCE demonstrated high negative predictive value.
INCIDENCE OF VERRUCOUS VEGETATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS. THE ASSOCIATION WITH ANTIPHOSPHOLIPID ANTIBODIES
Authors: Moyssakis I. , Pantazopoulos N.J. , Tektonidou M. , Boki K. , Panagiotis M. , Votteas. V. 
Published: February 2004

Background: Valvular heart disease is prevalent in systemic lupus erythematosus (SLE) and is a common cause of morbidity and mortality. Valvular thickening and verrucous valvular vegetations (Libman–Sacks) are the most common lesions. The purpose of this prospective study was to analyze the incidence of Libman–Sacks vegetations in patients with SLE. Methods: Two hundred and seventeen consecutive patients (196 females, 21 males, aged 53 ± 11 years) with SLE were evaluated with M‐mode, 2D, and Doppler echocardiography. Libman–Sacks vegetations were defined as distinct localized masses of varying size and shape on the surface of the valve leaflets and exhibiting no independent motion. In 76 (35%) patients with SLE there were antiphospholipid antibodies (APL) present. Results: Thirty‐two (14.7%) patients with SLE had Libman–Sacks vegetations and in 21 (65.6%) of them there was a presence of antiphospholipid antibodies. In 22 patients the location of the masses was in the mitral, in 9 in the aortic, and in 1 in the tricuspid valve, whereas in 4 cases in BOTH valves. Valvular regurgitation was the predominant lesion in 18 mitral, 9 aortic, and 1 tricuspid, but only 2 cases had severe mitral regurgitation. Valvular stenosis was detected in 5 cases. Three patients had severe mitral stenosis and one of them died, while in the other two patients mitral stenosis was reversed with treatment of the underlying disease. The remaining two cases had severe aortic stenosis but one of them, also having severe mitral regurgitation, died suddenly. Conclusion: Our results show that Libman–Sacks vegetations are quite frequent in patients with SLE and are related to the presence of antiphospholipid antibodies. The most common lesion is valvular regurgitation and rarely valvular stenosis.
BILATERAL HOLODIASTOLIC REVERSAL FLOW IN COMMON CAROTID ARTERIES: A SIGN OF SEVERE AORTIC REGURGITATION
Authors: Glenny P. , Altamirano. C. 
Published: February 2004

Precedents: Doppler echocardiography is an important tool in the quantification of aortic regurgitation (AR). No single echocardiographic technique is without limitations, and in clinical practice it is reasonable to use a combination of them to estimate the severity of AR. Objectives: The aim of this study is to determine if the presence of bilateral holodiastolic reversal flow (BHRF) in the common carotid arteries can be used to assess the severity of AR, and if it can be evaluated with the same transducer used to perform the cardiac doppler. Material and method: BHRF and the severity of AR were evaluated prospectively in 77 patients with a cardiac Doppler and a Doppler study of the common carotid flow, both with a 2.5 MHz cardiac transducer. Among the 77 patients, 20 had no AR, in an other 20 it was mild, in 24 it was moderate and 13 had severe AR. The degree of AR was classified using color Doppler mapping of the depth of the regurgitant jet into the left ventricle, the color cross‐sectional area of the regurgitant jet relative to that of the left ventricular outflow tract (less than 25, less than 50, and greater than 50%), the slope of the spectral signal (less than 2, less than 4, and greater than 4 m/s2), and the detection of holodiastolic reversal flow in abdominal aorta. Carotid flow was easily detected in all 77 patients while abdominal aortic flow was not clearly defined in 5 patients (due to obesity and presence of gas). Carotid BHRF was detected in 10 of the 13 patients with severe AR and in none of the 64 patients with no, mild, or moderate AR (sensibility: 77% and specificity: 100%). Conclusions: The finding of BHRF in the common carotid arteries may be a very helpful sign of severe AR; it can be easily evaluated with the cardiac transducer and it is not time consuming.
CARDIAC FUNCTION BY STRAIN IMAGING: KEY TO THE INCREASED PERFORMANCE CAPACITIES OF ENDURANCE‐TRAINED ATHLETES
Authors: Claessens P. , Claessens C. , Claessens M. , Claessens M. , Claessens. J. 
Published: February 2004

Background: To increase the performance capacity of a triathlete (Tri), a variety of adaptations are necessary. The heart is the central and the most important limiting factor. The structural heart adaptations in Tri have important repercussion on cardiac function. The left ventricular diastole shows specific characteristics that determine performance capacity. Methods: 40 male Tri were compared with 31 active male controls and with 112 patients with ischemic heart disease. All subjects underwent tissue Doppler and strain imaging. Results: The late diastolic filling period in Tri has specific characteristics. Tissue imaging demonstrated in Tri specific characteristics of both the late passive diastolic filling period and the early active diastolic relaxation period. The significant differences between the three groups concerning the strain values at the basal and the mid septum in the longitudinal axis by aortic valve closure and by mitral valve opening were extremely striking. The values of the end‐diastolic strain by the end of the a‐wave: negative in Tri, near‐zero in normal controls, and marked positive in coronary patients were fascinating (fig. 1). Conclusions: The marked negative end‐diastolic strain in Tri can be explained by an increased muscular tone after a rapid and almost complete early diastolic filling of the left ventricle. This increased muscular tone is caused by an increase in the sarcomere length and by an increase in the number of actin‐myosin cross‐bridge interactions. These specific systolic and especially supernormal diastolic properties of the left ventricle with an increased diastolic reserve, enhance the aerobic capacities, resulting in an increased performance capacity.