The Greek version of the 9-item European Heart Failure Self-care Behaviour Scale: a multidimensional or a uni-dimensional scale?

OBJECTIVES: To evaluate the dimensionality of the Greek version of the European Heart Failure Self-care Behaviour Scale (Gr9-EHFScBS) in a Greek-Cypriot population. BACKGROUND: EHFScBS is a valid and reliable scale which is widely used for assessing heart failure (HF) patients' self-care behaviors. METHODS: EHFScBS was translated into Greek and was administered to 128 Greek-Cypriot HF patients. The internal consistency, construct validity and discriminant validity of the scale were assessed. RESULTS: Confirmatory factor analysis failed to capture the proposed theoretical structure. Further exploratory factor analysis provided a three-factor solution accounting for 53.35% of the variance, though the scale is better used as a whole. Cronbach's alpha was moderate 0.66, but deletion of any item decreased the alpha coefficient. Discriminant validity was supported by the poor correlation between EHFScBS and Minnesota Living with Heart Failure Questionnaire scores. CONCLUSION: Even though results do not conform to the multidimensionality of the scale, assessment of the tool provided acceptable validity and reliability measures to support its usage among Greek speaking populations.

Evaluation of the psychometric properties of the Greek version of the Minnesota Living With Heart Failure questionnaire.

PURPOSE: One of the major challenges for health care professionals in heart failure (HF) management is to maintain and/or improve HF patient health-related quality of life. The Minnesota Living With Heart Failure Questionnaire (MLHFQ) is one of the most comprehensive and widely used tools for measuring health-related quality of life among patients with HF. The aim of the study was to assess the psychometric properties of the Greek version of the tool. METHODS: The MLHFQ was administered among 128 Greek-Cypriot HF patients to assess the internal consistency, content validity, and contrast validity of its Greek version. Exploratory factor analysis was undertaken to establish its construct validity. RESULTS: The factor analysis in this study provided support for a 3-factor solution explaining 64.15% of the variance (physical, emotional, and social subscales). The internal consistency for the Greek version of the MLHFQ total scale (0.95) and subscales (0.80-0.94) were found to be high. The contrast validity of the Greek version of the MLHFQ was explored through cumulative MLHFQ scores and comparisons that were able to distinguish among all different levels of HF severity, as defined by the New York Heart Association functional class grouping. CONCLUSION: This study provides support for the reliability and validity of the Greek version of the MLHFQ.

Dobutamine stress echocardiography for the evaluation of cardiac reserve late after Fontan operation.

INTRODUCTION: This study aimed to assess the potential role and safety of dobutamine stress echocardiography (DSE) in the evaluation of cardiac reserve in asymptomatic patients several years after a Fontan operation. METHODS: We studied 10 asymptomatic patients, 28 +/- 5 years old, 14 +/- 6 years after their Fontan operation. All patients and 10 healthy, matched controls underwent two-dimensional and Doppler echocardiography at baseline and throughout dobutamine infusion (given in 3-minute increments of 5, 10, 20, 30, and 40 microg/kg/min). Multivariate analysis for repeated measurements was used to detect differences between patients and controls. RESULTS: There were no adverse events during dobutamine infusion. Heart rate increased appropriately in both patients and controls. Patients reached peak stroke volume at infusion rates of 20 microg/kg/min, whereas controls peaked at 10 microg/kg/min. Mean stroke volume, cardiac output and cardiac index were significantly different between the two groups only up to infusion rates of 10 microg/kg/min. The velocity time integral of the left ventricular outflow tract flow was significantly lower in patients than controls throughout the study. CONCLUSION: DSE is a safe method of stress testing for the assessment of adult Fontan patients and provides insights into the pathophysiology of their cardiac performance. Cardiac reserve in these patients is impaired compared to healthy controls.

Acute thoracic aortic thrombosis after intra-aortic balloon pumping.

We present two transesophageal echocardiographic images of a patient with acute myocardial infarction, demonstrating a large thrombus attached to the thoracic aortic wall, considered to be a complication of intra-aortic balloon pumping. The patient had received the device because of hemodynamic instability due to an infarct-related ventricular septal defect. Clinical manifestations which led to the diagnosis of thromboembolism were abdominal pain and deterioration of renal function, without signs of limb ischemia.

Hepatocellular carcinoma with right atrial extension in a young patient with congenitally unguarded tricuspid orifice.

We report a case of a young female patient with congenitally unguarded tricuspid orifice and underdeveloped pulmonary valve leaflets, who had developed severe right-sided congestive heart failure and cardiac cirrhosis early in life. She was admitted to our hospital with deterioration of dyspnea and abdominal tenderness. Hepatocellular carcinoma was diagnosed on the basis of computed tomography findings, high plasma alpha-fetoprotein levels and evidence of chronic hepatitis B viral infection. Transthoracic echocardiogram revealed a mass into the right atrium, considered to be an extension of the tumor.