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2.
J Am Coll Cardiol ; 36(3 Suppl A): 1104-9, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10985712

ABSTRACT

OBJECTIVES: Our objective was to define the outcomes of patients with cardiogenic shock (CS) due to severe mitral regurgitation (MR) complicating acute myocardial infarction (AMI). BACKGROUND: Methods for early identification and optimal treatment of such patients have not been defined. METHODS: The SHOCK Trial Registry enrolled 1,190 patients with CS complicating AMI. We compared 1) the cohort with severe mitral regurgitation (MR, n = 98) to the cohort with predominant left ventricular failure (LVF, n = 879), and 2) the MR patients who underwent valve surgery (n = 43) to those who did not (n = 51). RESULTS: Shock developed early after MI in both the MR (median 12.8 h) and LVF (median 6.2 h) cohorts. The MR patients were more often female (52% vs. 37%, p = 0.004) and less likely to have ST elevation at shock diagnosis (41% vs. 63%, p < 0.001). The MR index MI was more frequently inferior (55% vs. 44%, p = 0.039) or posterior (32% vs. 17%, p = 0.002) than that of LVF and much less frequently anterior (34% vs. 59%, p < 0.001). Despite having higher mean LVEF (0.37 vs. 0.30, p = 0.001) the MR cohort had similar in-hospital mortality (55% vs. 61%, p = 0.277). The majority of MR patients did not undergo mitral valve surgery. Those undergoing surgery exhibited higher mean LVEF than those not undergoing surgery; nevertheless, 39% died in hospital. CONCLUSIONS: The data highlight opportunities for early identification and intervention to potentially decrease the devastating mortality and morbidity of severe post-myocardial infarction MR.


Subject(s)
Mitral Valve Insufficiency/complications , Registries , Shock, Cardiogenic/etiology , Aged , Catheterization , Coronary Angiography , Female , Heart Valve Prosthesis Implantation , Hospital Mortality , Humans , Male , Middle Aged , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/therapy , Myocardial Infarction/complications , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Myocardial Revascularization , Odds Ratio , Prospective Studies , Shock, Cardiogenic/mortality , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/therapy , Stroke Volume , Survival Rate
3.
Am J Cardiol ; 86(5): 573-6, A10, 2000 Sep 01.
Article in English | MEDLINE | ID: mdl-11009285

ABSTRACT

We examined the effect of tissue harmonic imaging on the echocardiographic splitability score and valve area measurement of 40 patients with rheumatic mitral stenosis. Planimetered valve areas were unaffected by the use of harmonic imaging, but valve scores were increased, particularly in patients with scores <10.


Subject(s)
Echocardiography/methods , Mitral Valve Stenosis/diagnostic imaging , Mitral Valve/diagnostic imaging , Rheumatic Heart Disease/diagnostic imaging , Evaluation Studies as Topic , Humans , Linear Models , Mitral Valve/pathology , Mitral Valve Stenosis/classification , Rheumatic Heart Disease/classification
4.
Nutr Diabetes ; 2: e39, 2012 Aug 06.
Article in English | MEDLINE | ID: mdl-23448803

ABSTRACT

BACKGROUND: Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD). METHODS: We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m(-2)), overweight (25-29.9 kg m(-2)), obese (30-39.9 kg m(-2)) and morbidly obese (40 kg m(-2)). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD. RESULTS: The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic function was present in 13 414 (61.9%) patients, with stage 1 being the most common. As BMI increased, the prevalence of normal diastolic function decreased (P<0.0001). Furthermore, there were 1733 patients with age <35 years; 460 (26.5%) and 407 (23.5%) were overweight and obese, respectively, and had higher prevalence of DD (P<0.001). Using multivariable logistic regression, BMI remained significant in both ordinal (all stages of diastolic function) and binary (normal versus abnormal). Also, obesity was associated with increased odds of DD in all patients and those aged <35 years. CONCLUSIONS: In patients with normal LVEF, higher BMI was independently associated with worsening DD.

7.
Heart ; 95(17): 1449-54, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19451139

ABSTRACT

BACKGROUND: Severe tricuspid regurgitation, constrictive pericarditis and restrictive cardiomyopathy can all present with signs and symptoms of right heart failure and similar haemodynamic findings of elevation and equalisation of diastolic pressures at catheterisation. Although catheterisation findings of enhancement of ventricular interaction are a reliable parameter to distinguish constrictive pericarditis from restrictive cardiomyopathy, this also may be present in severe tricuspid regurgitation. OBJECTIVE: To identify unique haemodynamic parameters that differentiate severe tricuspid regurgitation from constrictive pericarditis. METHODS: Haemodynamic findings from simultaneous right and left heart catheterisation of 14 patients (age 59 years; men 71%) with documented severe tricuspid regurgitation (group I) were compared with those of 14 patients with surgically proven constrictive pericarditis (group II). RESULTS: Findings of elevated right atrial pressure, early rapid ventricular filling and expiratory equalisation of ventricular diastolic pressures were similar in both groups. Ventricular interdependence, assessed by interaction of left ventricular (LV) and right ventricular (RV) systolic pressures, was also present in both groups. Relative changes in LV and RV diastolic pressures during respiration reliably distinguished group I from group II. During inspiration, the difference between the LV and RV diastolic pressures widened in group I but narrowed in group II. The height and slope of the early rapid filling wave in RV pressure trace was accentuated during inspiration in group I but did not change in group II. CONCLUSIONS: The haemodynamic findings at cardiac catheterisation in patients with severe, symptomatic tricuspid regurgitation are similar to those of constrictive pericarditis. Careful analysis of the relationship of the LV and RV diastolic pressures during respiration can help differentiate the two entities.


Subject(s)
Pericarditis, Constrictive/diagnosis , Tricuspid Valve Insufficiency/diagnosis , Adult , Aged , Blood Pressure/physiology , Cardiac Catheterization , Diagnosis, Differential , Female , Hemodynamics/physiology , Humans , Male , Middle Aged , Pericarditis, Constrictive/physiopathology , Respiratory Mechanics/physiology , Tricuspid Valve Insufficiency/physiopathology , Ventricular Function, Left/physiology , Ventricular Function, Right/physiology
8.
Heart ; 95(7): 564-9, 2009 Apr.
Article in English | MEDLINE | ID: mdl-18952634

ABSTRACT

OBJECTIVES: To examine whether percutaneous alcohol septal ablation affects coronary flow reserve (CFR) in patients with hypertrophic cardiomyopathy (HCM). METHODS: CFR was measured immediately before and after septal ablation in patients with symptomatic obstructive HCM. CFR was also obtained in normal subjects (NL) for comparison. RESULTS: Patients with HCM (n = 11), compared with NL (n = 22), had a lower mean (SD) baseline CFR (1.96 (0.5) vs 3.0 (0.7), p<0.001), a lower coronary resistance (1.04 (0.45) vs 3.0 (2.6), p = 0.002), a higher coronary diastolic/systolic velocity ratio (DSVR; 5.1 (3.0) vs 1.8 (0.5), p = 0.04) and a lower hyperaemic coronary flow per left ventricular (LV) mass (0.73 (0.4) vs 1.1 (0.6) ml/min/g, p = 0.007). Septal ablation in the HCM group (n = 7) reduced the outflow tract gradient but not the left atrial or LV diastolic pressures. Ablation resulted in immediate normalisation of CFR (to 3.1 (1), p = 0.01) and DSVR (to 1.9 (0.8), p = 0.09) and an increase in coronary resistance (to 1.91 (0.6), p = 0.02). This was probably related to an improvement in the systolic coronary flow. CONCLUSIONS: This study demonstrates that successful septal ablation in patients with symptomatic HCM results in immediate improvement in CFR, which is reduced in HCM partly because of the increased systolic contraction load.


Subject(s)
Cardiomyopathy, Hypertrophic/therapy , Catheter Ablation/methods , Coronary Circulation/physiology , Ethanol/administration & dosage , Aged , Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/physiopathology , Case-Control Studies , Chi-Square Distribution , Echocardiography, Doppler , Female , Heart Septum , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
9.
Am Heart J ; 140(1): 150-6, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10874278

ABSTRACT

BACKGROUND: Transesophageal echocardiography (TEE) is the gold standard for evaluation of the left atrium and the left atrial appendage (LAA) for the presence of thrombi. Anticoagulation is conventionally used for patients with atrial fibrillation to prevent embolization of atrial thrombi. The mechanism of benefit and effectiveness of thrombi resolution with anticoagulation is not well defined. METHODS AND RESULTS: We used a TEE database of 9058 consecutive studies performed between January 1996 and November 1998 to identify all patients with thrombi reported in the left atrium and/or LAA. One hundred seventy-four patients with thrombi in the left atrial cavity (LAC) and LAA were identified (1.9% of transesophageal studies performed). The incidence of LAA thrombi was 6.6 times higher than LAC thrombi (151 vs 23, respectively). Almost all LAC thrombi were visualized on transthoracic echocardiography (90.5%). Mitral valve pathology was associated with LAC location of thrombi (P <.0001), whereas atrial fibrillation or flutter was present in most patients with LAA location of thrombi. Anticoagulation of 47 +/- 18 days was associated with thrombus resolution in 80.1% of the patients on follow-up TEE. Further anticoagulation resulted in limited additional benefit. CONCLUSIONS: LAC thrombi are rare and are usually associated with mitral valve pathology. Transthoracic echocardiography is effective in identifying these thrombi. LAA thrombi occur predominantly in patients with atrial fibrillation or flutter. Short-term anticoagulation achieves a high rate of resolution of LAA and LAC thrombi but does not obviate the need for follow-up TEE.


Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Echocardiography, Transesophageal , Heart Atria/diagnostic imaging , Thromboembolism/diagnostic imaging , Thromboembolism/prevention & control , Adult , Aged , Atrial Fibrillation/complications , Atrial Function, Left , Confidence Intervals , Echocardiography , Female , Heart Atria/physiopathology , Heart Diseases/diagnostic imaging , Heart Diseases/epidemiology , Heart Diseases/etiology , Heart Diseases/prevention & control , Humans , Incidence , Male , Middle Aged , Probability , Prognosis , Registries , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Thromboembolism/epidemiology , Thromboembolism/etiology
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