[Echocardiographic assessment of left atrial volume in asymptomatic ambulatory patients with metabolic syndrome and/or arterial hypertension - is it parameter worth into considerate?]. / Echokardiograficzna ocena objetosci lewego przedsionka u pacjentów bezobjawowych z nadcisnieniem tetniczym i/lub z zespolem metabolicznym w opiece ambulatoryjnej - czy warto oceniac ten parametr?

INTRODUCTION: Early identification of high-risk patients, including those with arterial hypertension (AH) andlor metabolic syndrome (MS), have a positive effect on the treatment and the cost. Left atrial volume is a well-known, easy to examine prognostic factor in cardiovascular diseases. Impaired function and enlargement of the left atrium could be present in even when asymptomatic patients with AH, but in subjects with MS has not been well documented. OBJECTIVE: The aim of the study was to estimate the left atrial volume index (LAVI) among asymptomatic patients with AH and/or MS. PATIENTS AND METHODS: One hundred and fourteen consecutive patients were divided into three groups as follows: 54 patients with MS, 34 with AH and 26 in a control group; next they were underwent the echocardiographic examination. A statistical analysis of LAVI was carried out using the Whitney-Mann test. RESULTS: The mean LAVI was: 25.20 ml/m2 for the AH group (woman 24.90 ml/m2; men 25.49 ml/m2); 24.90 ml/m2 for the MS (woman 25.78 ml/m2; men 23.63 ml/m2) and 19.20 ml/m2 for the control group (woman 21.77 ml/m2; men 17.97 ml/m2). There was a positive correlation between increased LAVI and AH or/and MS presence. CONCLUSIONS: The results suggest that left atrial volume index enlargement is more common among even asymptomatic patients suffering from hypertension andlor metabolic syndrome. The estimation of LAVI is possible in a routine echocardiographic examination and seems to be an additional useful parameter in description of risk in cardiovascular diseases.

Assessment of resting perfusion defect in patients with acute myocardial infarction: comparison of myocardial contrast echocardiography with contrast-enhanced magnetic resonance imaging.

BACKGROUND: Contrast-enhanced magnetic resonance imaging (CE-MRI) can identify myocardial scarring following acute myocardial infarction (AMI). AIM: To compare myocardial contrast echocardiography (MCE) and CE-MRI in detection of resting perfusion defect in patients with acute myocardial infarction. METHODS: Twenty four patients (21 men, 3 women, mean age 58.7 +/- 11.4 years) underwent primary percutaneous coronary angioplasty (PCI) for anterior AMI. All patients underwent MCE: segmental perfusion was estimated in real time before and immediately after PCI and on third day after PCI, using low mechanical index (0.3) after 0.3-0.5 ml bolus injections of intravenous OptisonTM. The MCE was scored semiquantitatively as: 1--homogenous contrast enhancement, 2--patchy contrast enhancement, 3--no contrast (non-viable myocardium). All patients underwent CE-MRI on a 1.5 T scanner (SONATA, Siemens) on the third day after PCI. Acquisition of short axis slices was performed before and 20 min after injection of Gd-DPTA (0.15 mmol/kg) with an inversion recovery TurboFLASH sequence (TE 1.1 ms, TR 700 ms, flip angle 300) in multiple breath-holds. The pattern of hyperenhancement representing MI (which intensity was more than 150% intensity of myocardium) was quantified by planimetry. The CE-MRI was scored according to the severity of myocardial scar as: 1--without scar, 2-- <50% of myocardial thickness, 3 - > 50% of myocardial thickness. RESULTS: Myocardial perfusion was analysed using MCE and contrast-enhanced MRI in 362 segments. Agreement between MCE and CE-MRI for identification of viable versus necrotic myocardium on third day after PCI was 86% (kappa = 0.73). Thirteen (54%) patients showed transmural necrosis at CE-MRI while 11 (46%) showed non-transmural necrosis. Patients from the transmural necrosis group showed a higher creatine kinase peak (p = 0.0001), higher CK-MB (p = 0.00002) and higher troponine level (p = 0.008), and more impaired baseline regional contractile function (p = 0.045). All angiographic parameters were less favourable in this group before as well as after PCI than in patients with non-transmural necrosis. CONCLUSIONS: Myocardial contrast echocardiography correlates very well with CE-MRI in the assessment of myocardial perfusion after PCI in AMI. Contrast-enhanced MRI is accurate technique for assessing the infarct zone. Identification by CE-MRI of transmural necrosis was associated with more impaired left ventricular function, non-reperfused MI, and presence of Q waves in ECG.

[Comparison of myocardial contrast echocardiography and 99mTc MIBI single photon emission computed tomography in the assessment of myocardial perfusion in patients with acute myocardial infarction]. / Porównawcza analiza przydatnosci echokardiografii kontrastowej i badania scyntygraficznego w ocenie perfuzji miesnia sercowego u chorych ze swiezym zawalem serca.

UNLABELLED: The myocardial perfusion assessment in myocardial infarction is crucial to proper therapeutical decisions and patient's prognosis. The aim of the study to assess the efficacy of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with acute myocardial infarction compared with 99mTc MIBI SPECT study. MATERIAL AND METHODS: 86 patients (mean age 58.4 +/- 11.2) underwent primary percutaneous coronary (PCI) for acute anterior myocardial infarction. TIMI grade flow, myocardial blush grade (TMPG), corrected TIMI frame count (cTFC) and segmental contractility and segmental perfusion were estimated in real time before and immediately after PCI, using injections of intravenous Optison. MCE performed before PCI described the risk area as the sum of segments with the lack of perfusion. A MCE perfusion defect size after PCI < 25% of the MCE perfusion defect size before PCI was used to define myocardial reperfusion. MCE was repeated on the third day after PCI. All patients underwent a rest 99mTc MIBI SPECT study (SPECT) on the third day after PCI. RESULTS: Based on MCE, 54 patients had reperfusion ("reflow" group) and 32 had non-reperfusion ("no-reflow" group). Patients from the non-reperfusion group showed a higher creatine kinase peak (p = 0.0034), higher kinase-MB (p = 0.0033) and higher troponine level (p = 0.0629), longer time span between the onset of pain and reperfusion (p = 0.003), and worse baseline regional contractile function (p = 0.0022). All angiographic parameters were worse in this group before as well as after PCI: more often TIMI 0 or 1, TMPG 0 or 1 in patients from "no-reflow" group was observed. These patients had higher cTFC than ones from "reflow" group. The agreement between MCE and SPECT for detecting perfusion abnormality was 87%. CONCLUSIONS: MCE facilitated identification of myocardial perfusion abnormalities in patients with acute myocardial infarction, whereas serial MCE facilitated identification of patients with early and late improvement of myocardial perfusion. MCE correlated very well with SPECT images in assessing perfusion defect.

[Systolic and diastolic left ventricle function assessment by tissue Doppler echocardiography in patients with perfusion defects in SPECT study]. / Ocena funkcji skurczowej i rozkurczowej lewej komory serca metoda tkankowej echokardiografii Dopplerowskiej u chorych z zaburzeniami perfuzji w badaniu SPECT.

INTRODUCTION: Tissue Doppler imaging (TDI) facilitates the quantitative assessment of the regional systolic and diastolic left ventricle function. Heart scintigraphy (SPECT) facilitates the assessment of regional perfusion of the myocardium. The aim of the study was the evaluation of the correlation between the regional myocardial perfusion defects observed in the SPECT study and the regional systolic and diastolic left ventricle function observed in TDI examination in the ischaemic heart disease patients. MATERIAL AND METHODS: In 40 patients (33 men and 7 women) aged 43-74 years (mean age 56 years) diagnosed of ischaemic heart disease on the basis of coronary angiography, rest TDI examination was performed. Maximal systolic and maximal early-diastolic myocardial velocities were assessed in 13 myocardial segments of the left ventricle, supplied by respective coronary arteries (left anterior descending artery--LAD, circumflex artery--Cx, right coronary artery--RCA). During rest and exercise perfusion scintigraphy of the heart (Tc99 MIBI SPECT) myocardial perfusion was evaluated in the segments analysed previously during TDI study. On the basis of the SPECT examination results the patients were divided into three groups: group I) patients with fixed perfusion defects, group II) patients with exercise-induced perfusion defects and normal rest perfusion, group III) patients with normal perfusion during rest and exercise. RESULTS: Systolic and diastolic myocardial velocity in LAD and Cx supplied segments were significantly higher in group II and group III as compared with group I. Systolic and diastolic velocities of myocardium supplied by LAD were significantly lower in group II as compared with group III. In Cx supplied region the diastolic myocardial velocity was significantly lower in group II as compared with group Ill. CONCLUSIONS: In the left ventricle myocardial regions with fixed perfusion defects, statistically significant decrease of systolic and diastolic myocardial velocities was observed. Moreover, the decrease of diastolic myocardial velocity in the rest TDI examination was found in patients with normal rest perfusion and exercise-induced perfusion defects.

Clinical and echocardiographic assessment of pregnant women with valvular heart diseases--maternal and fetal outcome.

UNLABELLED: The study aimed to compare the outcome of pregnancy in women with valvular heart diseases. MATERIAL: Two hundred and fifty-nine pregnant women with cardiac diseases, aged 18-42, were observed. Group I-158 patients with mitral valve disease: 30 patients with mitral stenosis; 44 patients with mitral regurgitation, 33 patients with combined mitral valve disease, 51 patients with mitral valve prolapse; Group II-54 patients with aortic valve disease: 32 patients with aortic stenosis, 22 with aortic regurgitation; Group III-47 patients after valve replacement (36 mechanical; 11 homograft valves). Medical history and physical examination, NYHA class assessment, ECG, and echocardiography were performed during consecutive trimesters of pregnancy and after delivery. RESULTS: Clinical deterioration was observed in 38 patients-in 25 women of Group I, 6 women of Group II, and 7 women of Group III. Newborns outcome : 250 healthy (10 prematures, 12 with intrauterine growth retardation), 6 aborted, 2 stillbirths, 1 neonatal death. Method of delivery : 200 vaginally, 53 cesarean sections. CONCLUSIONS: (1). Pregnants with critical mitral valve stenosis form a high-risk group of life-threatening complications. (2) In women with severe aortic stenosis, pregnancy could lead to sudden clinical status deterioration. (3) Cardiac complications can be expected in patients with left ventricular enlargement and its depressed function. (4) Key factors influencing successful course of pregnancy and labour in patients with prosthetic valves: adequate left ventricular function, properly functioning valves, and effective anticoagulation.

[Assessment of ejection fraction by cardiovascular magnetic resonance in comparison with 99mTc gated SPECT]. / Ocena frakcji wyrzutowej lewej komory serca metoda rezonansu magnetycznego w porównaniu z bramkowana scyntygrafia z zastosowaniem 99mTc.

BACKGROUND: Impaired left ventricular (LV) function with decreased ejection fraction (EF) is a frequent finding in patients with ischaemic heart disease. As a non-invasive method, cardiovascular magnetic resonance (CMR) has become an important diagnostic method in cardiology within the past decade, especially for assessing myocardial function. AIM: The purpose of this study is to compare EF estimated with 99mTc gated SPECT (GSPECT) and with CMR. METHODS: The study was performed in a group of 35 patients (11 F, 24 M; mean age 57 SD 10) after myocardial infarction. EF in CMR procedure was calculated using cine gradient echo sequences. GSPECT measured EF was estimated by Tc 99. RESULTS: The mean value of EF measured with scintigraphy was 50.5 +/- 17%, and measured with CMR 48.3 +/- 15%. The difference in mean values of EF was not statistically significant. CONCLUSIONS: 1. EF in CMR was highly concordant with GSPECT. 2. The mean value of EF measured with CMR in 75% of study patients was smaller than in the scintigraphy group, but the difference was not statistically significant. 3. CMR is a simple, precise and reproducible diagnostic method for monitoring left ventricle systolic function, and which is an additional non-invasive imaging technique in cardiac diagnosis.

Assessment of myocardial perfusion in patients with coronary artery disease. Comparison of myocardial contrast echocardiography and 99mTc MIBI single photon emission computed tomography.

BACKGROUND: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical index (MI) and harmonic imaging following an intravenous injection of contrast agent. The aim of the study was to determine the feasibility and accuracy of the real-time imaging of contrast echocardiography (MCE) for detecting myocardial perfusion defects at rest and during dobutamine stress echocardiography (DE) compared with 99m Tc MIBI SPECT. The study group consisted of 44 patients (24 men, 20 women, mean age 58.9+/-7.8) with suspected coronary artery disease (CAD). All patients underwent DE. Wall motion (WM) and segmental perfusion were estimated in real time before and at peak stress using a low MI (0.4) after 0.3 ml bolus injections of intravenous Optison. All patients underwent a rest and exercise 99mTc MIBI SPECT study (SPECT). A 16-segment model of the left ventricle was used for the analysis of MP, WM and SPECT by a blinded reviewer. All patients underwent coronary angiography. Significant coronary artery disease was defined as >60% luminal diameter stenosis. RESULTS: All patients had significant CAD. Twenty-nine patients had single-vessel and 15 patients had double-vessel disease. For all patients, agreement between MCE and SPECT was 89%, between MCE and WM -86%, and between SPECT and WM -82%. The agreement between MCE and SPECT for LAD, RCA and Cx territories was 81, 91 and 73%, respectively. The sensitivity of MCE and SPECT for detecting perfusion defects due to significant CAD (confirmed angiographically) was 97% and 93%, respectively, and the specificity was 93 and 84%, respectively. CONCLUSION: MCE in real-time imaging with Optison has significant potential for the identification of MP abnormalities. MCE correlates very well with SPECT images.

[Assessment of myocardial perfusion using myocardial contrast echocardiography--case report]. / Analiza perfuzji miesnia sercowego przy uzyciu echokardiografii kontrastowej--opis przypadku.

A 58-year-old woman with symptoms of angina underwent coronary angioplasty, which showed critical narrowing of the right coronary artery (80%) and borderline narrowing of the left anterior descending coronary artery (50%). We decided to analyse myocardial perfusion in this patient to estimate the degree of atherosclerosis in the target arteries. She underwent myocardial contrast echocardiography at rest and during dobutamine stress. The examination showed a transient perfusion defect in the right coronary bed and in the left anterior descending coronary. A similar perfusion defect was revealed in scintigraphy. We carried out a successful two vessel percutaneous coronary revascularisation.