Which factors have an impact on occurrence, clinical and echocardiographic characteristics of idiopathic chordae rupture?

BACKGROUND: The aim of this study was to determine which risk factors have an influence on occurrence, clinical and echocardiographic characteristics of patients with idiopathic rupture of the chordae tendineae (RCT). METHODS: The study included 149 patients with diagnosed RCT by transthoracic echocardiography: 90 (60.4%) patients with the idiopathic RCT and 59 (39.6%) subjects with a secondary RCT. Clinical and echocardiographic data were collected for each patient. RESULTS: The univariate logistic regression analysis showed that age > or = 65 (OR 3.76, 95% CI; 1.94-6.18), arterial hypertension (HTA) (OR 7.7, 95% CI: 3.43-16.84), duration > or = 15 (OR 1.14, 95%: 1.04-1.24), uncontrolled HTA (OR 4.72, 95% CI: 2.03-7.39), diabetes (OR 3.22, 95%CI: 1.4-7.37), hypercholesterolemia (OR 1.52, 95% CI: 1.05-2.2), hypertriglyceridaemia (OR 1.99, 95% CI: 1.2-3.28), coronary (OR 5.11, 95% CI: 2.34-9.01) and carotid artery disease (OR 4.35, 95% CI: 1.87-6.89), renal failure (OR 7.25, 95% CI: 1.01-15.23), thickness of interventricular septum (OR 3.25, 95% CI: 1.44-7.58), posterior wall (OR 4.67, 95% CI: 2.21-9.13), and relative wall thickness (OR 2.87, 95% CI: 1.65-4.21) correlated with idiopathic RCT. The multiple logistic regression revealed age > or = 65 (OR 1.06, p < 0.001), HTA (OR 4.93, p = 0.001), HTA > or = 15 years (OR 1.35, p = 0.021), uncontrolled HTA (OR 2.28, p=0.007), coronary artery disease (OR 2.78, p = 0.004), and relative wall thickness (OR 3.45, p = 0.005) as independent predictors of idiopathic RCT. CONCLUSION: Independent predictors of idiopathic RCT are advanced age, HTA, its duration, uncontrolled HTA, coronary artery disease, and relative wall thickness.

Systolic right ventricular adaptive changes in athletes as predictors of the maximal functional capacity: a pulsed tissue Doppler study.

AIM: The aim of this study was to extend the analysis of the systolic right ventricular (RV) adaptation to combined endurance and strength training, to assess the utility of tissue Doppler imaging in detecting the degree of these changes and to find independent RV predictors of the maximal functional capacity. METHODS: Standard Doppler and TDI were used to assess cardiac parameters at rest in 37 elite male athletes (16 wrestlers, 21 water polo players) and 20 sedentary subjects of similar age. Progressive maximal test on treadmill was used to assess VO2max. The obtained parameters were adjusted for HR, FFM, and BSA. RESULTS: Wrestlers showed higher VO2max than controls, but lesser than water polo players. RV diameter was larger in athletes. Right atrial pressure (RVE/e) was higher in water polo players than in other groups. Systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) and RVs' was the highest in wrestlers. Global RV systolic parameters myocardial performance index (MPI) and preejection time/ejection time index (PET/ET) were similar. On multivariate analysis systolic parameters were independent predictors of VO2max only in wrestlers: RVs' (beta=3.18, P=0.001) and RV ET (beta=2.32, P=0.001). RVE/e` correlated with RVs' (r=-0.57, P=0.000). TAPSE correlated with RV ET (r=0.32, P=0.015) and RVs` (beta=0.28, P=0.033). CONCLUSION: Systolic function assessed by TAPSE and RVs` has more improved in less endurance athletes. RVs`and TDI ejection time predict VO2max in wrestlers, and possibly in other athletes with lesser right atrial pressure. TDI enables quantifying RV adaptation degree in athletes, but complementary to M-mode technique.

Cardiac imaging in rheumatic diseases.

The majority of the imaging techniques in cardiology could be applied in rheumatic diseases (RDs), such as echocardiography, single-photon emission computed tomography (SPECT), radionuclide ventriculography, angiography, cardiovascular MRI and CT. Inflammatory pericardial involvement is the most common cardiac manifestation in various forms of RD. Echocardiography is the gold standard for diagnosis of pericardial abnormalities, demonstrating location and amount of pericardial effusion. Cardiac MRI and CT can be used to assess the features of pericardial effusions and pericardial structures. In patients with valvular heart disease in RD, transoesophageal echocardiography is a superior method and offers reliable information about valve morphology, the severity of the disease and left ventricular (LV) function. In addition, cardiac MRI is a valuable tool for the evaluation of valvular stenosis and regurgitation severity. Myocardial involvement in RD is demonstrated by abnormalities in LV size and function, indicating myocardial inflammation. In these patients Doppler echocardiography and myocardial tissue imaging can provide essential diagnostic information. Both LV angiography and cardiac MRI can provide reliable information on LV size, function and mass. In patients with coronary disease associated with RD, LV ejection fraction and ventricular wall motion can be assessed by echocardiography, radionuclide ventriculography, gated SPECT and MRI. Three-dimensional (3D) echocardiography is considered superior to 2D echocardiographic techniques. Stress echocardiography is the most used method for detection of myocardial ischaemia. The only accurate visualization of the coronary arteries is by selective coronary arteriography, which remains the gold standard. Although new non-invasive techniques have been developed, including CT and MRI angiography, some limitations apply.

[The role of echocardiography in the evaluation of cardiac damage in Lyme disease]. / Uloga ehokardiografije u proceni ostecenja srca u lajmskoj bolesti.

Lyme disease is an infectious, multisystem disease involving the skin, heart, joints, and nervous system. With its ability to assess cardiac anatomy, chamber sizes and myocardial and valvular function, echocardiography is a powerful noninvasive tool to investigate possible cardiac involvement in this disorder. We studied by echocardiography 15 patients, (6 women and 9 men, mean age 28.5 years, range 17 to 42) with clinical and electrocardiographic changes compatible with acute myocarditis or myopericarditis. 14 patients (pts) had transitory complete heart block and one patient had ventricular extrasystolic arhythmia. A first patient group (n = 6) who had a tick bite (Lyme antibody titers were found in three patents) was compared with a group (n = 9) without such confirmation. In first group two pts had small pericardial effusion and two pts had a nonspecific, discrete and small myocardial fibrosis after 3-6 months echocardiographic follow-up. Chambers sizes and indexes of left ventricular systolic and diastolic function were normal. Similar findings were found in the other group. We concluded that echocardiographic findings is not specific for Lyme disease, but echocardiography is an excellent tool for assessing the presence and degree of cardiac dysfunction and therefore provides essential information for the management of these patients.