RESUMEN
BACKGROUND: Although aortic valve replacement (AVR) when successfully performed boasts low mortality rates in selected patients, prosthesis-patient mismatch (PPM) can be found in the majority of these individuals. Limited research is available supporting the benefit of two-dimensional speckle tracking echocardiography (2D-STE) in patients with severe PPM. This study sought to assess myocardial strain using 2D-STE to determine the relationship between subclinical left ventricular (LV) dysfunction and aortic PPM in patients undergoing AVR with preserved LV ejection fraction. MATERIAL AND METHODS: We retrospectively examined all consecutive patients with isolated AVR who presented to our center from 2005 to 2018. The data of 1086 patients were analyzed. Severe PPM was defined as an indexed effective orifice area of 0.65â¯cm2/m2 or less. As a result of the detailed assessment, 54 patients meeting the eligibility criteria were included in the study. Baseline data were collected and compared between the two groups of patients with severe PPM (nâ¯= 27) and those with normofunctional aortic prosthesis valve as a control group (nâ¯= 27). All patients underwent baseline echocardiography. Global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 2D-STE. RESULTS: When compared with controls, patients with severe PPM had significantly decreased GLS (18.6⯱ 2.9 vs. 21.4⯱ 2.1; pâ¯<â¯0.01) and GCS (17.2⯱ 3.6 vs. 21.7⯱ 2.1; pâ¯<â¯0.01) values. CONCLUSION: In addition to standard clinical and echocardiographic parameters, GLS and GCS suggest subclinical dysfunction and have incremental value in patients with severe PPM.
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Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Disfunción Ventricular Izquierda , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Ecocardiografía , Humanos , Estudios Retrospectivos , Volumen Sistólico , Disfunción Ventricular Izquierda/diagnóstico por imagen , Función Ventricular IzquierdaRESUMEN
BACKGROUND: We aimed to evaluate the effect of surgical repair on right ventricular (RV) function in patients with pectus excavatum (PE) and RV compression by Doppler echocardiography. MATERIALS AND METHODS: Twenty-three patients who were admitted to our hospital for surgical correction of PE between 2009 and 2012 were included in the study. After transthoracic echocardiographic evaluation, 16 patients with RV compression were enrolled. All patients were males (100%) with a mean age of 20.5 ± 5.6 years. Transthoracic echocardiography was repeated 1 month after surgery. Echocardiographic evaluation included the assessment of RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), pulsed tissue Doppler systolic velocity (S'), RV isovolumic acceleration (RV IVA), systolic pulmonary artery pressure, left ventricular (LV) ejection fraction, and myocardial performance indexes of both the right and the left ventricles (Tei index). RESULTS: Following the surgery, the RV end-diastolic diameter, TAPSE, S', and RV IVA were found to be significantly increased in patients with PE. In addition, RV and LV Tei index significantly improved after surgical correction. CONCLUSIONS: RV function significantly improved after corrective surgery. Quantitative echocardiographic examination provides accurate estimation when deciding for corrective surgery and also should be used in the assessment of postoperative improvement.
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Ecocardiografía Doppler de Pulso , Tórax en Embudo/cirugía , Procedimientos Ortopédicos , Disfunción Ventricular Derecha/etiología , Función Ventricular Derecha , Adolescente , Adulto , Presión Arterial , Tórax en Embudo/complicaciones , Tórax en Embudo/diagnóstico , Tórax en Embudo/fisiopatología , Humanos , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/fisiopatología , Función Ventricular Izquierda , Adulto JovenRESUMEN
The concept that coronary artery ectasia (CAE) is an inflammatory-related disease has been increasingly recognized. Periodontitis induced low-grade chronic systemic inflammation has been shown to be associated with cardiovascular diseases. The aim of the present study was to evaluate the association between periodontitis and CAE.Thirty-two patients with isolated CAE, and 28 age, sex and smoking status-matched subjects with normal coronary arteries (NCA) underwent full dental examinations. Periodontal disease was evaluated using the following clinical parameters; number of remaining teeth, plaque index (PI), gingival index (GI), bleeding on probing (BOP), and pocket depth (PD).Cases and controls did not differ according to their baseline characteristics and prevalence of traditional cardiovascular risk factors. Patients with isolated CAE had higher periodontal indices when compared to subjects with NCA (PD: 3.6 ± 1.26 mm versus 2.3 ± 0.79 mm; GI: 2.29 ± 0.86 versus 1.43 ± 1.19; BOP (%): 52.18 ± 20.1 versus 27.8 ± 10.9, P < 0.001, P < 0.05 and P < 0.05, respectively). Moreover, in multivariate analysis higher values for PD were found to be significant predictors for the likelihood of having coronary ectasia.The results of the present study demonstrate for the first time that there is an association between periodontitis and isolated CAE.
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Enfermedad de la Arteria Coronaria/diagnóstico , Periodontitis/diagnóstico , Angiografía Coronaria , Dilatación Patológica , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Índice Periodontal , Periodontitis/complicaciones , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: The aim of this study was to assess long-term left ventricular (LV) systolic function using 3D speckle tracking echocardiography in patients with complete LV recovery following peripartum cardiomyopathy (PPCM). METHODS: A total of 20 PPCM patients who exhibited LV recovery (ejection fraction ≥50%) in the follow-up period and 20 age-matched, healthy women were included in the study. Standard 2D echocardiographic examinations were performed. Global longitudinal strain and global circumferential strain were analyzed. RESULTS: Age, weight, body surface area, smoking, heart rate, and systolic and diastolic blood pressure were similar in both groups. Echocardiographic examination showed no significant difference between both groups. Only the global longitudinal strain (18.1 ± 2.7 vs 20.16 ± 1.7, p = 0.02) and global circumferential strain (22.1 ± 2.9 vs 24.4 ± 1.19, p = 0.01) were significantly lower in PPCM patients. The lowest values for longitudinal strain belonged to the basal and mid regions of anterior, anteroseptal and lateral walls in the PPCM patients. CONCLUSION: Subclinical myocardial damage may persist in PPCM patients with full LV systolic recovery. 3D Speckle Tracking strain analysis is a useful method for detecting subtle myocardial dysfunction.
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Cardiomiopatías , Trastornos Puerperales , Disfunción Ventricular Izquierda , Cardiomiopatías/diagnóstico por imagen , Ecocardiografía/métodos , Femenino , Humanos , Periodo Periparto , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
OBJECTIVE: The aim of this study was to assess the value of the neutrophil-to-lymphocyte ratio (NLR) in predicting left ventricular (LV) recovery in patients with peripartum cardiomyopathy (PPCM). METHODS: Patients with PPCM (n = 40), who were admitted to our tertiary reference hospital between 2007 and 2015 were retrospectively analyzed. All patients were followed-up for at least 12 months after the diagnosis. All patients had standard echocardiographic examination at baseline and the last follow-up visit. Recovery of LV function was defined as the presence of LV ejection fraction (EF) >45%. Data on blood parameters were also collected at baseline. Univariate and multivariate analysis were used to assess the significant predictive variables for persistent LV systolic dysfunction. RESULTS: Of the patients 21 (52.5%) did not recover LV function at the last follow-up visit (nonrecovery group), while 19 of the patients (47.5%) exhibited LV recovery (recovery group). The LV EF and fractional shortening (FS) were significantly lower in the nonrecovery group. The baseline LV end-diastolic diameter, LV end-systolic diameter (LVESD) and systolic pulmonary arterial pressure were significantly increased in the nonrecovery group. The NLR, Creactive protein and troponin levels were significantly higher in the nonrecovery group. In multivariate logistic regression analysis only NLR and LVESD were identified as independent predictors of persistent LV systolic dysfunction in patients with PPCM (p = 0.020 and p = 0.009 respectively). CONCLUSION: Elevated NLR and increased LVESD were independent prognostic factors in predicting persistent LV dysfunction in patients with PPCM. The NLR might assist in identifying high risk patients with PPCM.
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Cardiomiopatías , Linfocitos , Neutrófilos , Disfunción Ventricular Izquierda , Adulto , Cardiomiopatías/terapia , Femenino , Humanos , Masculino , Periodo Periparto , Embarazo , Pronóstico , Estudios Retrospectivos , Disfunción Ventricular Izquierda/terapia , Adulto JovenRESUMEN
The aim of this study was to evaluate the effects of the combination of enalapril and losartan in patients with left ventricular systolic dysfunction by means of cardiopulmonary exercise test (CPET). Patients with left-ventricular systolic dysfunction and ejection fractions of 40% or less were included to the study. All patients were under the treatment of enalapril 20 mg once daily. The study group consisted of 20 patients (18 men, 2 women; mean age +/- standard deviation: 62.4 +/-6.5 years) and the comparison group consisted of 10 (8 men, 2 women; mean age 59.3 +/-11.9 years). The dose of 50 mg of losartan once daily was given additionally to the study patients. Breath-by-breath CPET was performed before administration of losartan and then 6-8 weeks later in the study group and 2 times with an interval of 6-8 weeks in the control group without any change in the treatment protocol. In the study group the average exercise times were 361 +/-192 and 454 +/-205 seconds (p = 0.001) before and after the study. Peak oxygen consumption ( VO2) values were 1,209 +/-366 and 1,284 +/-398 mL/minute before and after the study (p = 0.01). Anaerobic threshold VO2 values were 785 +/-187 and 855 +/-217 mL/minute before and after the study, respectively (p = 0.01). Peak heart rates (HR) were 141 +/-28 and 143 +/-22/minute (p = 0.35); peak VO2/HR values were 9.02 +/-3.1 and 9.3 +/-3 mL/minute (p = 0.4) before and after the study, respectively. On the other hand, in the control group, average exercise times were 556 +/-250 and 528 +/-251 seconds (p = 0.8); peak VO2 values were 1,502 +/-537 and 1,450 +/-501 mL/minute (p = 0.2); and anaerobic threshold VO2 values were 1,005 +/-338 and 975 +/-319 mL/min (p = 0.7), before and after the study respectively. At the highest comparable exercise stage for both tests in the study group the expired volume/oxygen consumption ( VE/ VO2) ratio declined from 35.1 +/-6.2 to 32.4 +/-5.6 (p = 0.007). VE values declined from 37.5 +/-10.9 to 33.9 +/-10.1 L (p = 0.02); heart rate declined from 140 +/-27 to 132 +/-21/minute (p = 0.02). No significant change was observed in the mentioned values for the control group. Addition of losartan to the standard therapy in patients with left ventricular systolic dysfunction improved exercise capacity and caused lower heart rate and ventilation requirements for the same exercise level.
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Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Enalapril/uso terapéutico , Prueba de Esfuerzo/métodos , Losartán/uso terapéutico , Disfunción Ventricular Izquierda/tratamiento farmacológico , Umbral Anaerobio/efectos de los fármacos , Umbral Anaerobio/fisiología , Quimioterapia Combinada , Tolerancia al Ejercicio/efectos de los fármacos , Tolerancia al Ejercicio/fisiología , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico/efectos de los fármacos , Volumen Sistólico/fisiología , Resultado del Tratamiento , Disfunción Ventricular Izquierda/metabolismo , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
This study examined the relationship between nocturnal blood pressure (BP) dipping and chronotropic dose25 (CD25) as an indicator of beta-adrenergic receptor functioning in normotensive people. In addition, the authors evaluated the influence of beta-receptor functioning on heart rate recovery after exercise. The sample consisted of 41 participants (18 men, 23 women). Ambulatory BP monitoring took place in each patient's home. On a separate occasion, beta-adrenergic receptor sensitivity was determined by response to isoproterenol infusion. Heart rate (HR) recovery was defined as the change from peak HR to that measured after 1 and 2 minutes of recovery. Relationships between dipping and CD25 were found such that participants with higher CD25 values had less nocturnal decline in systolic BP, diastolic BP, and mean arterial pressure (r = -0.445, -0.533, -0.510, respectively; p < 0.004, 0.001, 0.001, respectively). Heart rate recovery at 1 and 2 minutes after exercise was 28.8 +/- 5 and 49.9 +/- 6 beats/minute, respectively. Participants with higher CD25 values had more heart rate decline during the first 2 minutes of recovery (r = 0.407, p < 0.008). In addition, heart rate recovery was inversely related to systolic, diastolic, and mean nocturnal blood pressure dipping (r = -0.348, -0.432, -0.408, respectively, p<0.028, 0.005, 0.009, respectively). Normotensive people with an abnormal circadian pattern of blood pressure may have desensitized beta-adrenergic receptors. This desensitization may contribute to blunted nocturnal blood pressure and increased heart rate recovery as measured at 2 minutes following exercise testing.
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Presión Sanguínea/efectos de los fármacos , Ritmo Circadiano , Frecuencia Cardíaca/efectos de los fármacos , Receptores Adrenérgicos beta/efectos de los fármacos , Agonistas Adrenérgicos beta/administración & dosificación , Adulto , Presión Sanguínea/fisiología , Monitoreo Ambulatorio de la Presión Arterial , Ejercicio Físico/fisiología , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Isoproterenol/administración & dosificación , Masculino , Persona de Mediana Edad , Receptores Adrenérgicos beta/metabolismoRESUMEN
OBJECTIVE: The efficacy of angiotensin-converting enzyme (ACE) inhibitors in the treatment of heart failure (HF) is well documented. However, ACE inhibitors may provide incomplete blockade of the renin-angiotensin-aldosterone system due to the alternative pathways for the production of angiotensin II (Ang II). The aim of this study was to evaluate the efficacy of combined therapy of an ACE inhibitor and the Ang II receptor blocker losartan in patients with HF by using cardiopulmonary exercise testing (CPET) on a treadmill. METHODS AND RESULTS: Seventeen patients (ejection fraction < or = 40%) were included in the study group. At the start of the study, all participants were on chronic ACE inhibitors therapy. Fifty mg losartan was added to the treatment and CPET was performed before and 6-8 months after starting losartan therapy. Sixteen patients with HF were included in the control group. CPET was performed once at the beginning and repeated 6-8 months later without any change in the treatment protocol. The change in CPET values (walk-time (WT), peakVO2, anaerobic threshold (AT), minute ventilation (VE), VE/VO2, peak heart rate (HR),VO2/HR) was investigated. In the losartan-treated group a significant increase was noted in WT (393 +/- 157 vs. 507 +/- 155 sec, p < 0.01); peak VO2 (1205 +/- 240 vs. 1330 +/- 253 ml/min, p < 0.05); and AT (794 +/- 131 vs. 895 +/- 177 ml/min, p < 0.05). In the control group exercise parameters did not change significantly. The change from baseline to follow-up between the two groups is statistically significant for WT and peak VO2 (114 +/- 94 vs. -58 +/- 134 sec, p < 0.0 1 and 125 +/-183 vs. -116 +/- 221 ml/min, p <0.01). CONCLUSIONS: Addition of losartan to the ACE inhibitor therapy in patients with HF improves functional capacity in the long run.
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Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Losartán/uso terapéutico , Disfunción Ventricular Izquierda/tratamiento farmacológico , Prueba de Esfuerzo , Tolerancia al Ejercicio/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico/efectos de los fármacos , Resultado del TratamientoRESUMEN
OBJECTIVE: It was shown that percutaneous balloon mitral valvuloplasty (PMBV) has provided symptomatic improvement in cases with mitral stenosis. The purpose of this study was to investigate the influences of successful PBMV on cardiopulmonary exercise test (CPET) in patients with mitral stenosis early after intervention. METHODS: Twenty-nine patients with mitral stenosis were included in this study. Nineteen patients had undergone PBMV and ten patients were studied as control group. An incremental symptom limited CPET was carried out within the 24 hours before the PMVB procedure and within the five days thereafter. Breath by breath O2 uptake (VO2) and CO2 production (VCO2) were measured in these subjects. RESULTS: The mean mitral valve area (MVA) in the PBMV group before the procedure was 1.2 +/- 0.7 cm2 and the mean pressure gradient (PG) through the mitral valve was 12.63 +/- 4.87 mmHg; after the procedure, the mean MVA was 1.9 +/- 0.3 cm2 and the mean PG was 4.9 +/- 2.3 mmHg. The mean MVA in the control group was 1.4 +/- 0.16 cm2 and the mean PG was 7.2 +/- 3.54 mmHg. In the PBMV group, exercise time was 12.1 +/- 6 min before the procedure and increased to 18.75 +/- 5.5 min after the procedure (p = 0.0001); peak VO2 value rised from 1035 +/- 392 ml/min to 1178 +/- 373 ml/min (p = 0.0001) and VO2 at the anaerobic threshold from 667 +/- 286 ml/min to 772 +/- 268 ml/min (p = 0.006). Peak VO2/HR rised from 10.97 +/- 6.10 ml/min to 12.24 +/- 7.36 ml/min (p = 0.001). No significant difference was observed in the control group. CONCLUSIONS: The results of this study demonstrate that successful PBMV causes evident rise in exercise capacity, so that patients can manage the same exercise levels with lower heart rates and more economic ventilation.
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Angioplastia Coronaria con Balón/normas , Estenosis de la Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/terapia , Evaluación de Resultado en la Atención de Salud , Adulto , Estudios de Casos y Controles , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Consumo de Oxígeno , Periodo Posoperatorio , Respiración , TurquíaRESUMEN
Glycoprotein IIb/IIIa inhibitor therapy during primary percutaneous coronary intervention (PCI) decreases the incidence of major adverse cardiac events. These effects directly result from the level of platelet inhibition. It was shown that standard dosing of tirofiban is insufficient for optimal platelet inhibition. We sought to determine the efficacy and safety of single high-dose bolus (HDB) tirofiban with high-dose clopidogrel loading in primary PCI in acute ST elevation myocardial infarction. A total of 100 patients (mean age 55.2 +/- 9.9 years, male/female = 86/14) undergoing primary PCI, pretreated with clopidogrel (450 mg) and aspirin (325 mg), were consecutively randomized into two groups. Group I (n = 50) received a standard dose bolus of tirofiban (10 microg/kg/3 min) with 24-h infusion at a rate of 0.15 microg/kg/min. Group II received single HDB tirofiban (25 microg/kg/3 min). The assessed angiographic, clinical, and echocardiographic endpoints were: initial and final Thrombolysis in Myocardial Infarction (TIMI) grade flow (TGF), corrected TIMI frame count (CTFC), ST-segment resolution (STR) at 90 min, in-hospital bleeding complications, echocardiographic left ventricular ejection fraction (LVEF), death, reinfarction, and repeat target vessel revascularization at 1 month. Platelet function inhibition was measured using PFA-100 (Behring-Dade, Liederbach, Germany) with a test cartridge unit containing a membrane coated with 2 microg of equine Type I collagen and 50 microg adenosine diphosphate before, and 10 min, 2, 4, 6, 12, and 24 h after the bolus of the tirofiban in the first 10 cases of each group. There were no significant differences in baseline characteristics between groups. Initial TGF III was more frequent (24% vs 8%, P = 0.029) and the value of CTFC was lower (75 +/- 34 vs 89 +/- 25, P = 0.03) in group II. Postprocedural TGF, CTFC, STR, bleeding complications, and LVEF at 1 month were not different between the two groups. There was a higher rate of reinfarction in group II (8%) compared with group I (2%), but this difference was not statistically significant (P > 0.05). The results of platelet function analyses showed that group II patients had significantly prolonged platelet function assay closure times (299 +/- 6 s) compared with group patients (236 +/- 97 s) at 10 min after the bolus dose (P = 0.04). However, after the first dose between 2 and 24 h, PFA closure times were significantly prolonged in patients with tirofiban infusion. High-dose bolus of tirofiban seems to be safe and more effective than conventional dose at the periprocedural time, whereas continuous infusion of tirofiban may be necessary in the first 24 h before stable and safe antiplatelet status is reached with clopidogrel. However, safety and efficacy of HDB tirofiban and high-loading-dose clopidogrel together with tirofiban infusion requires further studies with a larger population.
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Angioplastia Coronaria con Balón , Infarto del Miocardio/terapia , Inhibidores de Agregación Plaquetaria/administración & dosificación , Ticlopidina/análogos & derivados , Tirosina/análogos & derivados , Clopidogrel , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Función Plaquetaria , Estudios Prospectivos , Ticlopidina/administración & dosificación , Tirofibán , Resultado del Tratamiento , Tirosina/administración & dosificaciónRESUMEN
A 19 year-old woman who underwent corrective surgery for an atrial septal defect (ASD) and ventricular septal defect (VSD) 12 years previously presented with pulmonary hypertension. Cardiac catheterization showed a fistula between the right subclavian artery and vena jugularis interna. In this case, a rare example of secondary pulmonary hypertension due to acquired arteriovenous fistula after cardiac surgery is presented.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Hipertensión Pulmonar/etiología , Venas Yugulares , Arteria Subclavia , Fístula Vascular/complicaciones , Adulto , Femenino , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/cirugía , Humanos , Hipertensión Pulmonar/diagnóstico , Fístula Vascular/etiologíaRESUMEN
Left atrial (LA) function is associated with left ventricular (LV) diastolic filling and cardiac output response to exercise. But the relation between LA function and exercise performance has not been adequately evaluated. The aim of this study was to investigate the relation between LA function and exercise capacity in dilated cardiomyopathy (DCM) with cardiopulmonary exercise testing. Forty-four patients with a left ventricular end-diastolic dimension (LVDd) > or = 60 mm and an ejection fraction (EF) < or = 40%, and in normal sinus rhythm were included in this study. Patients were divided into group 1 and group 2 according to their exercise peak oxygen uptake (VO2) (group 1: peak VO2 >14 mL/kg/min, group 2: peak VO2 < or = 14 mL/ kg/min). LA function indices were defined as follows: LA end-systolic diameter (LASd), end-diastolic diameter (LADd), LA systolic volume (LASV), LA diastolic volume (LADV), LA ejection volume (LAEV), and LA ejection fraction (LAEF). LASd, LADd, LASV, and LADV were significantly increased in group 2 (P < 0.001, P < 0.001, P < 0.05, P < 0.005). Group 1 had significantly higher LAEF (P < 0.001 ) and LVEF (P < 0.05). Group 2 had significantly shorter exercise duration, and decreased anaerobic threshold levels and minute ventilation volumes (P < 0.001, P < 0.001, P < 0.005 ). There was a positive correlation between peak VO2 and LVEF (r = 0.46, P = 0.002), and LAEF (r = 0.61, P < 0.001), peak A wave velocity (r = 0.39, P = 0.009), E wave deceleration time (r = 0.56, P < 0.001), and isovolumic relaxation time (IVRT) (r = 0.35, P = 0.04). There was a negative correlation between peak VO2 and LASd (r = -0.53, P < 0.001) LADd (r = -0.59, P < 0.001), LASVI (r = -0.34, P = 0.027), LADVI (r = -0.37, P = 0.001), and the E/A ratio (r = -0.41, P = 0.006), Decreased LAEF and increased LA sizes were associated with decreased peak VO2. The results clearly demonstrate that LA functions at rest are related to exercise performance in patients with heart failure.
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Función del Atrio Izquierdo , Cardiomiopatía Dilatada/fisiopatología , Tolerancia al Ejercicio , Disfunción Ventricular Izquierda/fisiopatología , Cardiomiopatía Dilatada/diagnóstico por imagen , Estudios de Casos y Controles , Ecocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sístole , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
MRI of the small bowel is a new method for the assessment of inflammatory bowel diseases. However, inflammatory bowel disease can affect both the small and large bowel. Therefore, our goal was to assess the feasibility of displaying the small bowel and colon simultaneously by MR imaging. Eighteen patients with inflammatory bowel disease were studied. For small bowel distension, patients ingested a solution containing mannitol and locust bean gum. Furthermore, the colon was rectally filled with water. MR examinations were performed on a 1.5-T system. Before and after intravenous gadolinium administration, a T1w data set was collected. All patients underwent conventional colonoscopy as a standard of reference. The oral ingestion and the rectal application of water allowed an assessment of the small bowel and colon in all patients. By means of MRI (endoscopy), 19 (13) inflamed bowel segments in the colon and terminal ileum were detected. Furthermore, eight additional inflammatory lesions in the jejunum and proximal ileum that had not been endoscopically accessible were found by MRI. The simultaneous display of the small and large bowel by MRI is feasible. Major advantages of the proposed MR concept are related to its non-invasive character as well as to the potential to visualize parts of the small bowel that cannot be reached by endoscopy.
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Enfermedad de Crohn/diagnóstico , Intestino Grueso/patología , Intestino Delgado/patología , Imagen por Resonancia Magnética , Adulto , Anciano , Endoscopía Gastrointestinal , Estudios de Factibilidad , Femenino , Humanos , Aumento de la Imagen , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
The aim of the present study was to investigate the adverse effects of hypertension on the cardiovascular system in daily activities and the effect of acute blood pressure reduction on oxygen (O(2)) uptake kinetics. Twenty hypertensive patients were included in the study group. Patients performed treadmill exercise tests (2.5 km/hour and 5 inclines) twice, before and after blood pressure reduction with sublingual captopril. In the control group, ten hypertensive patients underwent two tests one hour apart without blood pressure reduction brought about by drug therapy. The changes in O(2) kinetic values (O(2) deficit and mean response time [MRT]) between the two tests were investigated. In the study group, the O(2) deficit and MRT values measured during the first exercise testing were found to be 547 +/- 183 mL and 40 +/- 9 seconds, while those in the second exercise testing were 401 +/- 127 mL and 34 +/- 7 seconds, respectively. In the control group, the O(2) deficit and MRT values measured during the first exercise test were 491 +/- 217 mL and 42 +/- 16 seconds and 515 +/- 159 mL and 41 +/- 13 seconds in the second exercise test. The differences in O(2) deficit and MRT in the study group were considered to be statistically significant (P = 0.008 and P = 0.004, respectively). Based on our findings, there was a significant improvement in O(2) kinetic values with an acute reduction in blood pressure in hypertensive patients, most likely as a result of an improved response in cardiac output.
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Presión Sanguínea/fisiología , Hemodinámica/fisiología , Hipertensión/fisiopatología , Consumo de Oxígeno , Anciano , Captopril/uso terapéutico , Gasto Cardíaco/fisiología , Prueba de Esfuerzo , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Tiempo de Reacción/fisiología , Volumen de Ventilación Pulmonar/fisiologíaRESUMEN
Controversy exists about the influence of patient age on the benefit of surgery in atrial septal defect (ASD). Tissue Doppler echocardiography (TDE) when applied to atrioventricular annuli provides variables reliably reflecting the performance of the corresponding ventricle. We sought to investigate the effect of timing of surgery on biventricular functions by comparing the conventional echocardiography variables and TDE profiles of right and left atrioventricular annuli in patients treated at various ages. Conventional echocardiography and TDE analysis of mitral and tricuspid annuli were performed in 20 controls and 61 patients who underwent surgical ASD closure 2.8 +/- 2.5 years before the study. Standard parameters included were right and left-sided dimensions, estimated pulmonary artery pressure, ejection fraction, and tricuspid annular motion amplitude. TDE variables were systolic, early and late diastolic peak velocities at tricuspid lateral-and mitral-annulus at lateral and septal corners. Two subsets of patients who underwent surgery before (group 1, n = 20) and after 25 years (group 2, n = 41) formed our subgroups. Peak systolic TDE velocity and tricuspid annular motion amplitude had the lowest value in group 2 (P < 0.01 and <0.02, respectively). Late diastolic TDE velocity was significantly lower in group 2 compared to group 1 (P < 0.05). Increased right ventricular and atrial dimensions (P < 0.001 for both) and the estimated pulmonary artery pressure (P < 0.03) were the conventional measurements discriminating group 2 from group 1. The TDE profile of the mitral annulus was similar between the groups. These results suggest that delayed ASD closure is a relatively less effective procedure to restore secondary right ventricular dysfunction, as demonstrated by significantly different TDE measurements reflecting right ventricular longitudinal contraction and relaxation.