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OBJECTIVE: Atrial mechanical dysfunction may be an alternative mechanism underlying the increased risk of systemic embolism in patients with atrial septal aneurysm (ASA). This study aimed to evaluate left atrial (LA) and right atrial (RA) function using two-dimensional speckle tracking echocardiography (2D STE) in patients with isolated ASA. METHODS: Fifty-four patients with ASA (mean age 50.3 ± 12.48, 37% male) and 48 healthy individuals of similar age and gender (mean age 48.3 ± 10.84, 39.6% male) were included in the study. To assess atrial mechanical function, measurements of left and right atrial reservoir strain (RS), peak contraction strain (PCS), and conduit strain (CS) were conducted using 2D STE, in addition to conventional evaluation with transthoracic echocardiography. RESULTS: LA RS and PCS values were significantly lower in the ASA group than in the controls (37.52 ± 2.89 vs. 40.16 ± 2.68%, P < 0.001 and 17.29 ± 2.5 vs. 19.18 ± 2.23%, P < 0.001, respectively). Similarly, RA RS and RA PCS were significantly lower in patients with ASA (36.97 ± 2.19 vs. 39.77 ± 2.36%, P < 0.001 and 16.78 ± 2.10 vs. 18.54 ± 2.43%, P < 0.001, respectively). A multivariate regression analysis revealed a strong independent association between ASA and the measures LA RS, LA PCS, RA RS, and RA PCS. CONCLUSION: Our findings indicate that bi-atrial function are diminished in patients with isolated ASA. This may be a possible cause for the increased risk of arterial embolism in this patient group, aside from atrial arrhythmias and patent foramen ovale. Validating these results with larger studies may influence the treatment and follow-up strategies for patients with isolated ASA.
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BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) can develop left ventricular (LV) systolic dysfunction and geometric changes due to several reasons. AIM: To investigate subclinical LV systolic dysfunction and structural features in patients with COPD, and its correlation with the severity of airway obstruction, identified by GOLD classification. METHODS: We studied 52 patients with COPD and 29 age and sex-matched controls, without any cardiac disease. In addition to conventional echocardiographic evaluation speckle tracking echocardiography (STE)-based strain imaging were performed to analyse sub-clinical LV systolic dysfunction. Also LV volumes were measured by using three-dimensional real time echocardiography (3DRTE). All patients underwent spirometry. RESULTS: Conventional echocardiographic parameters (LV wall thickness and diameters, LV EF) and LV volume measurements were similar between the groups. LV global longitudinal peak systolic strain (-14.76 ± 2.69% to -20.27 ± 1.41%, P < 0.001) and strain rate (0.75 ± 0.25 1/s to 1.31 ± 0.41 1/s, P < 0.001) were significantly impaired in patients, compared to controls demonstrating sub-clinical ventricular systolic dysfunction. Significant positive correlation was obtained between LV strain/strain rate and spirometry parameters (FEV1, FEV%, FEV1/FVC, PEF%) (r = 0.78/0.68, P < 0.001; r = 0.83/0.70, P < 0.001); r = 0.74/0.55, P < 0.001; r = 0.72/0.65, P < 0.001 respectively). In addition, there was significant negative correlation between LV strain/strain rate and GOLD classification (r = -0.80/ -0.69, P < 0.001 respectively). CONCLUSION: Subclinical LV systolic dysfunction can occur in COPD patients despite normal EF. STE is a technique that provides additional information for detailed evaluation of subtle changes in LV myocardial contractility, significantly associated with the severity of the disease in COPD patients.
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Doença Pulmonar Obstrutiva Crônica , Disfunção Ventricular Esquerda , Humanos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Ecocardiografia/métodos , Sístole , Ventrículos do Coração/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Função Ventricular EsquerdaRESUMO
OBJECTIVE: Determining optimal timing for surgery in asymptomatic mitral regurgitation (MR) remains a challenge. The aim of this study was to evaluate subclinical changes in left ventricular (LV) systolic functions using velocity vector imaging (VVI) during follow-up of patients with chronic mitral regurgitation (MR). METHODS: A total of 54 patients (mean age: 57.9±8 years; 55% male) with moderate-to-severe MR and normal LV ejection fraction (EF), and 30 healthy controls (mean age: 56±6.5 years; 55% male) were evaluated using conventional echocardiography and VVI at baseline. RESULTS: At the end of 12 months, measurements of 45 MR patients were repeated. There was no significant change in LV dimensions or EF on follow-up. LV peak systolic strain and strain rate (SR) were decreased in patients with MR compared with controls (strain: 16.29±3.30 to 23.4±1.9; p=0.0001 and SR: 0.93±0.39 to 4.9±0.6; p=0.0001) at baseline. Impairment was more significant on follow-up. (strain: 13.76±2.68 and SR: 0.27±0.14; p=0.0001). CONCLUSION: VVI-derived strain imaging might be used in the assessment of subclinical LV dysfunction and its progression during follow-up of patients with chronic MR especially in the decision of optimal timing for surgery.
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Insuficiência da Valva Mitral/fisiopatologia , Função Ventricular Esquerda , Idoso , Estudos de Casos e Controles , Doença Crônica , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Variações Dependentes do Observador , Volume Sistólico , SístoleRESUMO
PURPOSE: Right ventricular (RV) function plays an important role in the development of clinical symptoms, exercise capacity, prognosis, and survival in patients with mitral stenosis (MS). The purpose of this study was to evaluate global and regional RV systolic functions using a novel technique, VVI, in mild-to-moderate MS patients without clinical symptoms of heart failure. METHODS: The study population consisted of 60 patients (mean age 51.7 ± 11.6 years; 85% female) with isolated rheumatic mitral valve stenosis and 40 age- and sex-matched control subjects (mean age 49.1 ± 10.5 years; 76.7% female). Conventional echocardiography, tissue Doppler imaging (TDI), strain (S), and strain rate (SRs) analysis were performed in all patients. RESULTS: Transmitral mean pressure gradient was 6.1 ± 3.0 mmHg and mean mitral valve area was 1.41 ± 0.31 cm(2) in patients with MS. TDI systolic velocity was significantly lower in MS patients compared to control subjects (0.13 ± 0.03 m/sec vs. 0.17 ± 0.03 m/sec; P < 0.0001). RV-isovolumic acceleration was reduced in MS patients (3.75 ± 1.09 m/sec(2) vs. 4.62 ± 1.0 m/sec(2) ; P = 0.006). RV-myocardial performance index was significantly increased in patients with MS (0.75 ± 0.05 in MS and 0.29 ± 0.04 in controls; P < 0.0001) revealing impaired RV systolic and diastolic function. The mean longitudinal peak systolic S and SR were significantly reduced in patients with MS (P < 0.0001). CONCLUSION: Our data revealed that RV systolic performance is reduced in patients with mild-to-moderate MS.
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Algoritmos , Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Interpretação de Imagem Assistida por Computador/métodos , Estenose da Valva Mitral/complicações , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: Right ventricular systolic pressure is crucial for both treatment and prognosis of cardiovascular and pulmonary diseases. The proper measurement of right ventricular systolic pressure depends on an accurate estimation of right atrial pressure (RAP). There is no standard method for estimating RAP noninvasively. The purpose of this study was to compare different noninvasive methods, namely, inferior vena cava (IVC) size and inspiratory collapse, tissue Doppler derived E/E' (TV E/E') for estimating RAP, and their correlation with catheter-based measurements in patients with mitral valve stenosis with atrial fibrillation (AF) or normal sinus rhythm (NSR). METHODS: The study group consisted of 39 patients (13 men, mean age 58.9 ± 11.8 years) with rheumatic mitral valve stenosis. We performed cardiac catheterization and transthoracic echocardiography on all patients. RESULTS: Mean RAP measured by catheterization was 9.7 ± 3.8 mmHg. No correlation was found between RAP and TV E/E' ratio, but there was a significant correlation between RAP and IVC diameter (r = 0.51, p < 0.05). Seventeen patients (43.6%) were in AF and 22 patients (56.4%) were in NSR. There was no correlation between TV E/E' ratio and RAP in patients with AF and in patients with NSR. RAP was correlated with collapsibility index in patients with AF (r = 0.56, p < 0.05). RAP was significantly correlated with IVC diameter (r = 0.62, p < 0.005) and collapsibility index (r = 0.49, p < 0.05) in patients with NSR. CONCLUSIONS: The combination of IVC diameter and collapsibility index is a simple a semiquantitative approach that might provide a better estimation of RAP.
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Função Atrial , Cateterismo , Ecocardiografia , Cardiopatia Reumática , Veia Cava Inferior/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/patologia , Estenose da Valva Mitral/cirurgia , Tamanho do Órgão , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/patologia , Cardiopatia Reumática/cirurgia , Veia Cava Inferior/patologiaRESUMO
Transesophageal echocardiography (TEE) has become a unique imaging technique that provides improved visualization of aorta because of its proximity to the esophagus. It is a reliable method for the diagnosis of thoracic aorta diseases and detection of protruding atheromas or thrombi as sources of systemic emboli. We report a case in which TEE revealed a floating aortic thrombus located in the ascending aorta in a patient with chronic renal failure.