PURPOSE: Recently developed handheld ultrasound devices (HHUD) represent a promising method to evaluate the cardiovascular abnormalities at the point of care. However, this technology has not been rigorously evaluated. The aim of this study was to explore the correlation and the agreement between the LVEF (Left Ventricular Ejection Fraction) visually assessed by a moderately experienced sonographer using an HHUD compared to the routine LVEF assessment performed at the Echocardiography Laboratory. METHODS: This was a prospective single center study which enrolled 120 adult inpatients and outpatients referred for a comprehensive Echocardiography (EC). RESULTS: The mean age of the patients was 69.9 ± 12.5 years. There were 47 females (39.2%). The R-squared was r 0.94 (p < 0.0001) and the ICC was 0.93 (IC 95% 0.91-0.95, p ≤ 0.0001). The Bland-Altman plot showed limits of agreement (LOA): Upper LOA 10.61 and Lower LOA - 8.95. The overall agreement on the LVEF assessment when it was stratified as "normal" or "reduced" was 89.1%, with a kappa of 0.77 (p < 0.0001). When the LVEF was classified as "normal", "mildly reduced", "moderately reduced", or "severely reduced," the kappa was 0.77 (p < 0.0001). The kappa between the HHUD EC and the comprehensive EC for the detection of RWMAs in the territories supplied by the LAD, LCX and RCA was 0.85, 0.73 and 0.85, respectively. CONCLUSION: With current HHUD, an averagely experienced operator can accurately bedside visual estimate the LVEF. This may facilitate the incorporation of this technology in daily clinical practice improving the management of patients.
Ventricular Dysfunction, Left , Ventricular Function, Left , Adult , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Stroke Volume , Prospective Studies , Predictive Value of Tests , Echocardiography/methods
BACKGROUND AND OBJECTIVES: Because of the serious nature of potential complications, screening for pulmonary arteriovenous malformations is required in patients with hereditary hemorrhagic telangiectasia. The aim of this study was to evaluate the utility of contrast echocardiography and compare the performance of two contrast agents: agitated saline and Gelofusine. MATERIAL AND METHODS: Two hundred and five patients screened for PAVMs using TTCE and computed tomography (CT) performed with an interval of less than 180days. Contrast echocardiography studies were graded on a 4-point semiquantitative scale based on the amount of microbubbles seen in left heart chambers. RESULTS: Positive TTCE findings were seen in 137 (66.8%) patients, whereas CT confirmed PAVMs in 59 (43.1%). Two of 67 grade 1 patients; 18 of 42 grade 2; 17 of 22 grade 3 and all grade 4 had PAVMs on CT. Embolotherapy was feasible in 38.9% patients in grade 2 and 82.3% and 95.2% in grades 3-4. No patients in grade 1 were embolized. The mean cardiac cycle in which bubbles were first seen in the left heart in patients without and with PAVMs on CT was 6.1 and 3.9 (p<0.0001). Compared to saline, Gelofusine produced an overall increase in grade. CONCLUSIONS: No grade 1 patients had treatable PAVMs. There is a need for improvement in the selection of patients for CT in grade 2, where less than half have PAVMs on CT. The cardiac cycle may help to differentiate between patients with and without PAVMs. Gelofusine was not better than saline for PAVM screening.
Arteriovenous Fistula/diagnostic imaging , Arteriovenous Malformations/diagnostic imaging , Echocardiography/methods , Pulmonary Artery/abnormalities , Pulmonary Veins/abnormalities , Telangiectasia, Hereditary Hemorrhagic/complications , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Contrast Media , Female , Humans , Infant , Male , Middle Aged , Pulmonary Artery/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Spain , Young Adult
BACKGROUND: Aging is accompanied by an alteration in myocardial contractility. However, its noninvasive detection is difficult. The effect of chronic exercise on this decrease is unknown. Murine models of senescence are increasingly used to test therapies in aging. We tested whether strain rate imaging detected left ventricular (LV) systolic dysfunction in aging mice and was able to assess a potential improvement after exercise. METHODS AND RESULTS: Young (3 weeks), adult (2 to 3 months), and old (6 to 18 months) C57BL6 male mice underwent echocardiograms with strain rate imaging, either in sedentary conditions or before, 2 weeks and 4 weeks after chronic swimming. Hemodynamic parameters of LV function including maximal and end-systolic elastance were obtained before euthanizing. LV fibrosis was measured using Sirius red staining. Conventional echocardiography was unable to detect LV systolic dysfunction in old mice, whereas both systolic strain rate and load-independent hemodynamic parameters such as preload recruitable stroke work and end-systolic elastance were significantly decreased. Both strain rate and load-independent hemodynamic parameters normalized after 4 weeks of exercise. Both endocardial and epicardial fibrosis were increased in the LV of aging mice. Endocardial fibrosis decreased in exercised aged mice. CONCLUSIONS: Strain rate noninvasively detects LV systolic dysfunction associated with aging in mice, whereas conventional echocardiography does not. Chronic exercise normalizes LV systolic function and decreases fibrosis in old mice. Strain rate imaging in mice may be a useful tool to monitor the effect of new therapeutic strategies preventing the myocardial dysfunction associated with aging.
Aging/physiology , Myocardial Contraction , Physical Conditioning, Animal , Animals , Echocardiography , Fibrosis , Heart Ventricles/pathology , Hemodynamics , Male , Mice , Mice, Inbred C57BL , Myocardium/pathology , Organ Size , Ventricular Function, Left
INTRODUCTION AND OBJECTIVES: Patients with acute coronary syndromes may have significantly stenotic nonculprit lesions that do not show complex lesion morphology. We investigated whether these lesions were prone to become unstable since they exist within a prothrombotic and inflammatory systemic milieu. PATIENTS AND METHOD: We evaluated the clinical course of 150 patients after successful angioplasty of a culprit lesion: 75 patients with a severely stenotic but uncomplicated nonculprit lesion (group A) and 75 patients without these lesions (group B). RESULTS: In group A, 1 patient (1.3%) required angioplasty of an initially nonculprit lesion, and in group B, 2 patients (2.6%) died in cardiogenic shock. After 1 year of follow-up, in group A, 4 patients (5.3%) died (cardiac deaths), 1 patient (1.3%) had a myocardial infarction, and 10 patients (13.3%) underwent a repeat revascularization procedure, which in 6 cases (8%) was angioplasty of an initially nonculprit lesion. In all 6 patients with angioplasty of the initially nonculprit lesion, revascularization was done within the first 4 months and was indicated for unstable angina. In group B, 1 patient (1.3%) died (noncardiac death) and 2 patients (2.6%) underwent a repeat revascularization procedure because of restenosis. Survival curves were significantly different between both groups. Belonging to group A was the only independent predictor for events, and within this group location of the lesion in the left anterior descending artery was the main predictor. CONCLUSIONS: The presence of nonculprit lesions of uncomplicated morphology at the time of a percutaneous revascularization procedure for a culprit lesion in patients with acute coronary syndrome is a short- and middle-term predictor of a moderate rate of recurrent events when these initially innocuous lesions become unstable.
Angioplasty, Balloon, Coronary , Coronary Disease/etiology , Coronary Disease/therapy , Acute Disease , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Severity of Illness Index , Syndrome
Introducción y objetivos. Los pacientes con síndrome coronario agudo pueden presentar lesiones coronarias no causantes que pueden ser severas y sin morfología compleja. Evaluamos si, a corto plazo, estas lesiones son proclives a la inestabilización al encontrarse en un entorno sistémico protrombótico e inflamatorio. Pacientes y método. Evaluamos la evolución clínica de 150 pacientes sometidos a angioplastia (ACTP) de la lesión causante, 75 pacientes (grupo A) con lesiones no causantes gravemente estenóticas no complicadas (LNC) y otros 75 pacientes (grupo B) con ausencia de estas lesiones. Resultados. En el grupo A, un paciente (1,3 por ciento) precisó ACTP de una LNC y en el grupo B, 2 pacientes (2,6 por ciento) fallecieron por shock cardiogénico. Al cabo de un año de seguimiento, en el grupo A, 4 pacientes (5,3 por ciento) murieron por causa cardíaca, uno (1,3 por ciento) sufrió un infarto y 10 (13,3 por ciento) precisaron revascularización, en 6 casos ACTP sobre LNC. Estos 6 procedimientos se efectuaron en los primeros 4 meses por angina inestable. En el grupo B, un paciente (1,3 por ciento) falleció de causa no cardíaca y 2 (2,6 por ciento) precisaron revascularización por reestenosis. Las curvas de supervivencia libre de acontecimientos fueron significativamente diferentes en ambos grupos. La pertenencia al grupo A fue la única variable predictora de acontecimientos y, dentro de este grupo, la localización de la lesión en descendente anterior (DA) fue el principal factor predictor de la necesidad de revascularización. Conclusiones. La presencia de LNC en pacientes con síndrome coronario agudo y ACTP de la lesión causante predice una moderada tasa de revascularización a cortomedio plazo por inestabilización (AU)
Middle Aged , Male , Female , Humans , Angioplasty, Balloon, Coronary , Syndrome , Prognosis , Retrospective Studies , Coronary Disease , Acute Disease , Follow-Up Studies , Severity of Illness Index
