Accuracy and sensitivity of three-dimensional echocardiography to detect changes in right ventricular volumes: comparison study with cardiac magnetic resonance.

We aimed to investigate the ability of three-dimensional transthoracic echocardiography (3DE) to detect changes in RV volumes compared to cardiac magnetic resonance (CMR). Eighty-five subjects including 45 with no known cardiac disease and 40 patients with a variety of cardiac diseases were included. Two- and three-dimensional echocardiography as well as CMR of the RV was performed before and after infusion of on average two litres of saline. Examinations were analysed with estimation of RV dimensions, volumes and ejection fraction (RVEF). Intra- and inter-examiner variability was evaluated in 25 patients randomly selected from the cohort. Three-dimensional echocardiography underestimated volumes and RVEF compared to CMR with mean differences and 95% limits of agreement of 110.3 ± 59 mL for RV end-diastolic volume (RVEDV), 43.3 ± 32 mL for RV end-systolic volume (RVESV) and 3.5 ± 10.7% for RVEF. CMR was more reproducible than 3DE, with intra-observer coefficient of variation (CV) of 4% vs. 14.2% for RVEDV, 9.7% vs. 16.7% for RVESV and 6.3% vs. 8.6% for RVEF. The RVEDV, RVESV and RV stroke volume (RVSV) by CMR significantly increased after saline infusion by 15.3 ± 16.2 mL, 3.5 ± 14.2 mL and 11.8 ± 12.6 mL, respectively, as well as RVEF by 1.5 ± 4.6% (p < 0.05). However, 3DE was not able to detect any of these changes in RV volumes (p ≥ 0.05). Compared to CMR imaging of the RV, three-dimensional echocardiography appears unable and unreliable in detecting RV volume changes of less than 15%, highlighting the need for cautious utility of 3DE in these circumstances.

Screening performance for trisomy 21 comparing first trimester combined screening and a first trimester contingent screening protocol including ductus venosus and tricuspid flow.

OBJECTIVE: To compare the standard first trimester combined risk assessment for trisomy 21 with a contingent screening protocol including tricuspid flow and ductus venosus flow. MATERIAL AND METHOD: Women with singleton pregnancies and a first trimester combined risk assessment>1:1000 were included. They all had additional assessment of the ductus venosus and the tricuspid flow. We compared screening performance in two screening strategies: (a) First trimester combined screening strategy based on the individual risk results from the routine screening test and (b) Contingent screening strategy based on a combination of the routine test results and additional ultrasound markers. RESULTS: We included 917 women in the study, 894 in the euploid group and 23 in the trisomy 21 group. Using a contingent screening strategy resulted in a significant decrease in screen positive rate from 48.3% to 17.7% (p<0.001) in the studied population. There was no statistical difference in detection rate between the two screening strategies. CONCLUSION: There is increasing evidence in favour of using additional ultrasound markers as part of contingent screening protocols in the first trimester. We do suggest performing further studies in routine clinical settings to provide validation of the available risk algorithms.

Adenocarcinoma of the small intestine mistaken as a primary ovarian cancer.

A case of primary adenocarcinoma of the small intestine metastazing to the ovary is described. The patient was erroneously thought to suffer from a primary ovarian malignancy. To avoid unnessessary surgery, severe gastrointestinal symptoms in a patient thought to have an ovarian cancer should warn the surgeon against a possible gastrointestinal cancer.

[The effect of thrombolytic therapy on the outcome of early exercise test in patients with acute myocardial infarction]. / Effekt af trombolytisk behandling på udfaldet af tidlig arbejdstest hos patienter med akut myokardieinfarkt.

UNLABELLED: Exercise test variables, such as an impaired heart rate response, are known to be related to left ventricular function and patient prognosis following acute myocardial infarction. The present study was performed to compare exercise test variables in acute myocardial infarct patients following either intravenous thrombolysis or placebo. Symptom-limited bicycle ergometer tests, carried out one to two weeks from the infarction, were performed in 85 patients randomized to intravenous streptokinase (n = 41) or placebo (n = 44) given within 12 hours from onset of symptoms. Resting heart rate, systolic blood pressure and rate-pressure product were similar in the two groups. At maximum workload the streptokinase treated patients had a significantly higher median maximal heart rate than controls (136 vs. 126 min-1; p < 0.01) but only a trend towards higher systolic blood pressure was seen (175 vs. 163 mmHg; p = 0.09). Rate-pressure product at maximal exercise was 23.620 vs. 20.100 mmHg x min-1; p < 0.01). A significantly smaller number of patients in the streptokinase group had exercise capacity below 50 W (0% vs. 15.9%; p < 0.01). IN CONCLUSION: patients treated with intravenous streptokinase for acute myocardial infarction reach both higher heart rates and rate-pressure products at maximum workload than their controls thus indicating that the beneficial effects of thrombolysis after acute myocardial infarction are reflected in an improved heart rate response during exercise.

Changes in left ventricular ejection fraction during transient myocardial ischaemia in patients with angina pectoris and silent ischaemia.

We compared the change in left ventricular ejection fraction during rest and exercise in 14 patients with angina pectoris and 14 patients with silent ischaemia. All patients had ischaemia defined as reversible defects at an exercise thallium myocardial scintigraphy. In the patients with angina pectoris the ejection fraction decreased from 44.0% (+/- 1 SD 13.4) at rest to 39.5% (+/- 1 SD 11.2) during exercise (p = 0.044). In the patients with silent ischaemia the ejection fraction decreased from 43.5% (+/- 1 SD 14.0) to 39.8% (+/- 1 SD 13.9) (p = 0.045). The fall in left ventricular ejection fraction in the two groups was almost identical (p = 0.77). This study confirms with a sensitive detection of transient ischaemia that silent ischaemia is accompanied with a fall in ejection fraction during exercise.

Heart rate index: an indicator of left ventricular ejection fraction. Comparison of left ventricular ejection fraction and variables assessed by exercise test in patients studied early after acute myocardial infarction.

The present study compares the variables assessed by standard exercise test with the left ventricular ejection fraction (LVEF) measured by multigated radionuclide angiocardiography (MUGA) in 77 patients early after myocardial infarction. The exercise test and MUGA were performed within two weeks after the myocardial infarction. A significant correlation (Spearman's correlation coefficient rs, p less than 0.05) was found between LVEF at rest and the following variables assessed at exercise test: 1) the heart rate at rest, 2) rise in heart rate, 3) ratio between maximal heart rate and heart rate at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR%)) and a significant correlation was found between 1) the HR% at rest, 2) the rise in HR% and the LVEF. A simple method to identify patients with an abnormal LVEF is described.