RESUMO
BACKGROUND: Due to paucity of literature data, we aimed at evaluating the prognostic role of the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (SPAP) in idiopathic pulmonary fibrosis (IPF) patients without severe pulmonary hypertension and at assessing its correlation with effective arterial elastance index (EaI). METHODS: Multi-instrumental data obtained in 60 IPF patients (73.2 ± 6.8 years) and 60 matched controls were retrospectively analysed. Primary endpoint was all-cause mortality, while secondary endpoint was the composite of all-cause mortality and re-hospitalisations for all-causes over medium-term follow-up. RESULTS: ;At baseline, TAPSE/SPAP was significantly lower in patients with IPF than in controls (0.36 ± 0.25 vs. 0.77 ± 0.18 mm/mmHg; P < 0.001). TAPSE/SPAP was inversely correlated with EaI (r = -0.96) in IPF patients. During follow-up (3.5 ± 1.5 years), 21 patients died and 25 were re-hospitalised due to cardiopulmonary causes. TAPSE/SPAP was independently associated with both primary (HR 0.79, 95%CI 0.65-0.97) and secondary (HR 0.94, 95%CI 0.92-0.97) endpoints. A TAPSE/SPAP ratio of <0.20 and <0.44 mm/mmHg showed the greatest sensitivity and specificity for predicting primary (AUC 0.98) and secondary (AUC 0.99) endpoints, respectively. CONCLUSIONS: TAPSE/SPAP is a strong predictor of adverse outcomes in mild-to-moderate IPF. The strong correlation between TAPSE/SPAP and EaI might be an expression of a systemic fibrotic process which involves the heart, lungs and circulation.
Assuntos
Fibrose Pulmonar Idiopática , Humanos , Estudos Retrospectivos , Prognóstico , Sensibilidade e EspecificidadeRESUMO
Microbial diversity of caves is largely understudied and its possible applications are still unknown. Autochthonous fungi, in particular, may have the potential to biomineralize metals and may be used as promising agents for bioremediation of polluted sites; thus, unearthing the fungal diversity in hypogean ecosystems is nowadays of utmost importance. To start addressing this knowledge gap, the cultivable mycobiota of two neighbouring caves-one natural and one exploited for touristic purposes-were characterised and compared by studying fungi isolated from sediments collected at increasing distances from the entrance. Overall, 250 fungal isolates ascribable to 69 taxa (mainly Ascomycota) were found, a high percentage of which was reported in caves for the first time. The sediments of the touristic cave displayed a richer and more diversified community in comparison with the natural one, possibly due to visitors carrying propagules or organic material. Considering that these environments are still poorly explored, chances to detect new fungal lineages are not negligible.
Assuntos
Ascomicetos , Ecossistema , Ascomicetos/genética , Itália , FilogeniaRESUMO
In seven patients with different types of neoplasm, secondary myocardial infiltration was diagnosed in vivo by two-dimensional echocardiography and confirmed by direct inspection. In all patients, clinical and electrocardiographic findings were suggestive but nonspecific for myocardial involvement. Two patients had cardiac tamponade and three had pericardial effusion. In three patients, the echocardiographic diagnosis made it possible to plan specific therapy. Clinical, electrocardiographic and echocardiographic aspects are discussed. A two-dimensional echocardiographic examination should be performed in all patients when cardiac metastatic involvement is suspected from clinical electrocardiographic findings, because the in vivo diagnosis of such a condition may have important therapeutic implications for such patients.
Assuntos
Neoplasias Cardíacas/secundário , Adulto , Idoso , Tamponamento Cardíaco/etiologia , Ecocardiografia , Eletrocardiografia , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologiaRESUMO
OBJECTIVES: The aim of this study was to describe the electrocardiographic (ECG) evolutionary changes after an acute myocardial infarction (AMI) and to evaluate their correlation with left ventricular function and remodeling. BACKGROUND: The QRS complex changes after AMI have been correlated with infarct size and left ventricular function. By contrast, the significance of T wave changes is controversial. METHODS: We studied 536 patients enrolled in the GISSI-3-Echo substudy who underwent ECG and echocardiographic studies at 24 to 48 h (S1), at hospital discharge (S2), at six weeks (S3) and six months (S4) after AMI. RESULTS: The number of Qwaves (nQ) and QRS quantitative score (QRSs) did not change over time. From S2 to S4, the number of negative T waves (nT NEG) decreased (p < 0.0001), wall motion abnormalities (%WMA) improved (p < 0.001), ventricular volumes increased (p < 0.0001) while ejection fraction remained stable. According to the T wave changes after hospital discharge, patients were divided into four groups: stable positive T waves (group 1, n = 35), patients who showed a decrease > or =1 in nT NEG (group 2, n = 361), patients with no change in nT NEG (group 3, n = 64) and those with an increase > or =1 in nT NEG (group 4, n = 76). The QRSs and nQ remained stable in all groups. Groups 3 and 4 showed less recovery in %WMA, more pronounced ventricular enlargement and progressive decline in ejection fraction than groups 1 and 2 (interaction time x groups p < 0.0001). CONCLUSIONS: The analysis of serial ECG can predict postinfarct left ventricular remodeling. Normalization of negative T waves during the follow-up appears more strictly related to recovery of regional dysfunction than QRS changes. Lack of resolution and late appearance of new negative T predict unfavorable remodeling with progressive deterioration of ventricular function.
Assuntos
Ecocardiografia , Eletrocardiografia , Infarto do Miocárdio/fisiopatologia , Remodelação Ventricular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão , Ponte de Artéria Coronária , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Stents , Função Ventricular Esquerda/fisiologiaRESUMO
The rate of red blood cell sodium-lithium countertransport is elevated only in a subgroup of patients with essential hypertension. We have therefore compared renal and cardiac function and morphology in two groups of hypertensive patients with high (n = 23) or normal (n = 22) sodium-lithium countertransport (mean +/- SEM: 0.61 +/- 0.10 versus 0.29 +/- 0.07 mmol/l red blood cells.hr). The two groups were similar in age, sex distribution, body mass index, smoking habit, duration of hypertension, and actual levels of untreated blood pressure. Hypertensive patients with elevated sodium-lithium countertransport activity showed elevated glomerular filtration rate (118 +/- 2 versus 109 +/- 2 ml/min.1.73 m2; p less than 0.001), albumin excretion rate (23 +/- 3 versus 14 +/- 2 micrograms/min; p less than 0.001), larger kidney volume (250 +/- 15 versus 203 +/- 13 ml.1.73 m2; p less than 0.01), lower lithium clearance rate (26.7 +/- 0.3 versus 28.9 +/- 0.3 ml/min.1.73 m2; p less than 0.01), and higher total body exchangeable sodium (2,716 +/- 33 versus 2,485 +/- 41 mmol.1.73 m2; p less than 0.01). Left ventricular mass index (139 +/- 6 versus 119 +/- 6 g/m2; p less than 0.05), relative wall thickness (0.39 +/- 0.05 versus 0.29 +/- 0.04 cm; p less than 0.001), and left posterior wall plus intraventricular septum thickness (2.02 +/- 0.04 versus 1.76 +/- 0.03 cm; p less than 0.05) were also higher in patients with high sodium-lithium countertransport. Hypertensive patients with normal sodium-lithium countertransport had renal and cardiac parameters similar to those of a normotensive control group (n = 21) except for a higher glomerular filtration rate and left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Coração/fisiopatologia , Hipertensão/fisiopatologia , Rim/fisiopatologia , Lítio/metabolismo , Sódio/metabolismo , Adulto , Albuminúria , Análise de Variância , Transporte Biológico Ativo , Pressão Sanguínea , HDL-Colesterol/sangue , Ecocardiografia , Eritrócitos/metabolismo , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Masculino , Taxa de Depuração Metabólica , Volume Sistólico , Triglicerídeos/sangueRESUMO
OBJECTIVE: To compare endocardial and midwall measurement of left ventricular fractional shortening in assessing cardiac systolic function in hypertension. SETTING: Seventeen hypertension clinics in northeast Italy. MAIN OUTCOME MEASURES: Left ventricular endocardial fractional shorteningcircumferential stress relationship versus midwall shortening-stress relationship in the subjects divided according to relative wall thickness (RWT) and left ventricular mass indexed by body surface area. PATIENTS: Borderline-to-mild hypertensives [n = 635, aged 33 +/- 0.3 years (mean +/- SEM), office blood pressure 146 +/- 0.4/94 +/- 0.2 mmHg (means +/- SEM)] in the Harvest Study and 50 normotensive controls with similar age and sex distributions. METHODS: Blood pressure was measured by 24 h ambulatory monitoring. Left ventricular dimensional and functional indices were assessed by M-mode echocardiography. RESULTS: In the subjects divided into quintiles of RWT, the left ventricular shortening-stress relationship was increased in a parallel fashion when calculated by endocardial and by midwall measurements for RWT < or = 0.35. Instead, for greater RWT values (> or = 0.37) endocardial measurement constantly gave large values than did midwall measurement. Both the endocardial and the midwall shortening-stress relationships progressively decreased with increasing RWT. However, the endocardial shortening-stress relationship remained greater than normal at any RWT, whereas the midwall shortening-stress relationship was decreased for RWT > or = 0.37. In a multiple-regression analysis RWT was the most potent predictor of the endocardialmidwall shortening difference, left ventricular mass and 24 h systolic blood pressure being the second and third most potent predictors. CONCLUSIONS: We found a parallel increase in indices of cavity emptying and of myocardial contractility in mild hypertensive subjects with normal left ventricular geometry. When the RWT is increased, ejection phase indices may be normal in the presence of decreased myocardial contractility.
Assuntos
Hipertensão/fisiopatologia , Função Ventricular Esquerda , Adolescente , Adulto , Feminino , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Análise de RegressãoRESUMO
Mediastinal paracardiac tumors may cause both cardiovascular complications and problems in differential diagnosis of cardiac diseases. Transesophageal echocardiography (TEE) may give an additional new window to mediastinal neoplasms, but only a few studies have been reported. TEE was performed in 70 patients with paracardiac neoplastic masses. The procedure was indicated to solve particular clinical problems in 20 patients, and as a prospective study on 50 unselected patients with mediastinal neoplasms. Twenty-three patients underwent follow-up studies; a total of 101 echocardiograms were recorded. The procedure was tolerated well or very well by most patients, and provided additional anatomic or hemodynamic data in every patient in group a and in 45 of 50 in group b. The additional data were relevant for clinical management in 14 of 20 patients in group a, and in 3 of 45 in group b. Based on the results of this study, TEE is useful in association with other radiologic techniques in patients with paracardiac neoplasms. As an imaging technique, it may represent a reliable alternative to computed tomography whenever the latter is not feasible.
Assuntos
Ecocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Adolescente , Adulto , Idoso , Ecocardiografia/efeitos adversos , Ecocardiografia/instrumentação , Ecocardiografia/métodos , Esôfago , Estudos de Avaliação como Assunto , Feminino , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/secundário , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/patologia , Humanos , Metástase Linfática , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/patologia , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/patologiaRESUMO
Although pectus excavatum (PE) is thought to impair right ventricular (RV) performance, the degree of RV dysfunction, if any, produced by this chest wall deformity remains controversial. To address this issue, we performed 2-dimensional echocardiography and chest wall radiography in 28 subjects with mild-to-severe degrees of PE to assess RV morphology and function in relation to the degree of the chest wall deformity. Measurements of RV anatomy and function obtained in these patients were compared to those of 24 normal control subjects of similar age and sex. In subjects with PE, mean RV outflow tract diameter at the aortic root level was narrower (1.4 +/- 0.3 cm/m2) and end-diastolic (10 +/- 2.3 cm2/m2) and end-systolic (5.8 +/- 1.4 cm2/m2) areas were larger than those in normal controls (1.6 +/- 0.3, 8.6 +/- 1.7, and 4.5 +/- 1.2 cm2/m2, respectively; p < 0.013). The magnitude of these abnormalities was related to the degree of the chest wall deformity evaluated on the chest radiogram (r = 0.54, 0.51, and 0.49, respectively). RV planar emptying fraction, an index of RV systolic function, was reduced in subjects with PE (42 +/- 10%) compared to the normal controls (48 +/- 10%; p = 0.047). No relation could be found, however, between this index and the severity of the chest wall deformity.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Ecocardiografia , Tórax em Funil/fisiopatologia , Miocárdio/patologia , Função Ventricular Direita , Adolescente , Adulto , Criança , Feminino , Tórax em Funil/diagnóstico por imagem , Tórax em Funil/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Our case suggests that a negative transesophageal contrast echocardiographic study during stable hemodynamic conditions does not definitively rule out the possibility of a functional PFO with transient right-to-left shunting in situations of increased right heart pressures. In addition, we confirm that thrombolysis can be considered as an alternative to surgery in high-risk patients with impending paradoxical embolism. The risk-to-benefit ratio of this choice, however, should be individually evaluated.
Assuntos
Embolia/prevenção & controle , Comunicação Interatrial , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica , Ecocardiografia Transesofagiana , Eletrocardiografia , Embolia/diagnóstico , Feminino , Seguimentos , Heparina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Fatores de Tempo , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoRESUMO
A new echocardiographic method for the evaluation of aortic stenosis (AS) severity has recently been introduced: the fractional shortening-velocity ratio (FSVR = fractional shortening/4 Vmax(2)). An important advantage of the method is the possibility of avoiding the difficulties related to the measurement of left ventricular outflow tract in calcific AS for assessing the continuity equation. FSVR, however, also shows some significant limitations especially in patients with regional wall motion abnormalities and conduction defects. To overcome this problem, we developed a new index: the ejection fraction-velocity ratio (EFVR = ejection fraction/4 Vmax(2)), where percent ejection fraction and Vmax have been obtained with an apical echocardiographic approach. In 343 consecutive patients with AS, aortic valve area was measured by cardiac catheterization (Gorlin), whereas FSVR and EFVR were calculated by echo-Doppler examination performed within 24 hours. Mean valve area was 0.70 +/- 0.30 cm(2), mean EFVR was 0.78 +/- 0.41, and mean FSVR was 0.45 +/- 0.26. The linear correlation area-EFVR was highly significant (r = 0.88). Correlation valve area-FSVR was also significant (r = 0.82). EFVR allowed identification of patients with severe AS (area =0.8 cm(2)) with good sensitivity (88%) and specificity (85%), whereas FSVR demonstrated sensitivity of 88% and specificity of 73%. Thus, the EFVR, a very simple and not time-consuming index, is strongly related to aortic valve area in patients with AS. It allows identification of patients with severe AS with good sensitivity and specificity (better than FSVR). The EFVR, taking into consideration both ejection fraction and transvalvular pressure gradient, may be very useful in the evaluation of patients with AS and left ventricular dysfunction.
Assuntos
Estenose da Valva Aórtica/classificação , Volume Sistólico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
From 71 consecutive patients with paracardiac neoplastic masses who underwent transesophageal echocardiography (TEE), obstruction of individual right upper pulmonary venous flow by compression by contiguous mass was detected by TEE in 4 patients before and disappeared after anti-neoplastic treatments. Pulmonary vein, contiguous neoplastic mass and their relation could be clearly visualized and assessed by TEE. Pulmonary venous obstruction was assessed as moderate degree by combination of Doppler flow characteristics and diameter of pulmonary vein. Before therapy, peak velocities and time-velocity integrals in obstructed right upper pulmonary venous flow were increased, whereas deceleration times of systolic flow were prolonged. After therapy, peak velocities and time-velocity integrals were reduced and deceleration times of systolic flow were shortened, with normalization of the diameter of the right upper pulmonary veins. Thus, TEE may be used to detect and evaluate pulmonary venous obstruction by neoplastic masses and its changes after antineoplastic treatments.
Assuntos
Ecocardiografia , Pneumopatia Veno-Oclusiva/etiologia , Neoplasias Torácicas/complicações , Adulto , Constrição Patológica/diagnóstico por imagem , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Pulmonary hypertension (PH) has been reported in patients with valvular aortic stenosis (AS) and has been found to be associated with a more severe clinical picture and a poor prognosis after aortic valve replacement. The aim of this study was to assess the prevalence of PH in adult patients with symptomatic AS undergoing cardiac catheterization, and to evaluate the relation between pulmonary artery (PA) systolic pressure and hemodynamic and clinical variables to further clarify the pathogenetic mechanisms. We assessed right-sided heart hemodynamics during cardiac catheterization in 388 patients with symptomatic isolated or predominant AS. PA systolic pressure between 31 and 50 mm Hg was used to define mild to moderate PH, whereas PA systolic pressure >50 mm Hg was used to define severe PH. PA systolic pressure showed no significant difference according to age and sex, although it was significantly higher in patients in New York Heart Association functional classes III and IV and in patients with coexistent systemic hypertension than in the others. PH was absent in 136 patients (35%, group 1), mild to moderate in 196 patients (50%, group 2), and severe in 58 patients (15%, group 3). Only the prevalence of overt heart failure was significantly higher in group 3 patients. AS severity was similar among the 3 groups, and PA systolic pressure showed no relation to aortic valve area in the entire population. Also, a poor correlation was found between PA pressure and left ventricular (LV) ejection fraction (r = -0.28), with several patients having moderate or severe PH despite a preserved LV systolic function. PA systolic pressure significantly correlated with LV end-diastolic pressure (r = 0.50) and with PA wedge pressure (r = 0.84). Furthermore, transpulmonary pressure gradient, an index of resistance across the pulmonary vascular bed (obtained as the difference between PA mean and PA wedge pressure), was significantly higher in patients with PH, especially in those with a marked increase in PA systolic pressure, suggesting a reactive component of PH.
Assuntos
Estenose da Valva Aórtica/complicações , Hipertensão Pulmonar/complicações , Idoso , Estenose da Valva Aórtica/fisiopatologia , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/fisiopatologia , Masculino , PrevalênciaRESUMO
The inter- and intraobserver variability, as well as the relation to left ventricular (LV) function indexes, of LV wall motion score calculated using the 16- and 11-segment models of LV segmentation were assessed in 105 patients with acute myocardial infarction who were examined at 36 +/- 7 hours from onset of symptoms. In these patients, the use of the 16-segment model of LV segmentation portends to a significantly higher inter- and intraobserver reproducibility of segmental wall motion score than the use of the 11-segment model. In addition, wall motion score assessed with the more detailed 16-segment model of LV segmentation showed a significantly higher correlation with LV ejection fraction than the wall motion score assessed using the 11-segment model.
Assuntos
Ventrículos do Coração/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Ecocardiografia , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Gravação em VídeoRESUMO
Endothelins (ETs) are potent vasoconstrictor peptides that also participate in the regulation of endocrine function. Indeed, immunoreactive ET, ET mRNA and ET receptors have been found in the brain and the pituitary gland and ETs stimulate arginine vasopressin, LH, FSH, TSH and gonadotrophin-releasing hormone and inhibit prolactin release in vitro. The present study was undertaken to evaluate the effects of ET-1 and ET-3, two members of this family, on corticotrophin-releasing hormone (CRH) release by explanted male rat hypothalami in vitro and on ACTH release by primary pituitary cell culture. ET-3 decreased basal CRH release in a concentration-related manner. The lowest effective concentration tested was 3 nmol/l but a more pronounced inhibitory effect was obtained at a concentration of 10 nmol/l. On the other hand, ET-1 did not have any detectable effect on basal CRH release. Neither ET-1 nor ET-3 had any effect on the release of CRH stimulated by potassium chloride. ET-1 increased basal ACTH release, whereas ET-3 did not have any effect. Both ET-1 and ET-3 suppressed the release of ACTH stimulated by 1 nmol CRH/l. These data suggest that both ET-1 and ET-3 are able to modulate the hypothalamic-pituitary-adrenal axis function in vitro. However, they act at different levels and seem to have opposite effects. Indeed, while ET-1 stimulated pituitary ACTH release, ET-3, the peptide produced mainly in the brain, inhibited hypothalamic CRH release in vitro.
Assuntos
Hormônio Adrenocorticotrópico/metabolismo , Hormônio Liberador da Corticotropina/metabolismo , Endotelinas/farmacologia , Hipotálamo/metabolismo , Hipófise/metabolismo , Animais , Células Cultivadas , Técnicas de Cultura , Hipotálamo/efeitos dos fármacos , Masculino , Hipófise/efeitos dos fármacos , Cloreto de Potássio/farmacologia , Ratos , Ratos Sprague-DawleyRESUMO
Fifty-one patients with mitral stenosis were studied by M-mode echocardiograms to verify the possibility of predicting if they will require mitral valve replacement or commissurotomy. Fifteen of 18 patients with heavy calcification and restricted or poor valvular mobility underwent mitral valve replacement. Twelve of 14 patients with normal valve amplitude underwent mitral commissurotomy regardless of the presence of valvular calcification. A newly derived measurement, the MT/ST, which is the ratio between the maximal thickness of the widest echo from the mitral valve and the maximal thickness of the left ventricular margin of the interventricular septum, was used to assess valvular calcification. Values above 1.7 were present only in valves with restricted or poor mobility and indicated mitral valve replacement in 14 of 15 cases. All of the patients undergoing mitral valve replacement who had MT/ST ratios between 1.5 and 1.7 had restricted or poor valvular mobility. Of the patients with MT/ST ratios less than 1.5, ten of 12 with normal valvular amplitude underwent mitral commissurotomy, and four of five with restricted valvular mobility underwent mitral valve replacement. We conclude that echocardiographic assessment of mitral valvular calcification and amplitude is useful in predicting patients who will require mitral valve replacement vs mitral commissurotomy.
Assuntos
Ecocardiografia , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/diagnóstico , Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Calcinose/diagnóstico , Calcinose/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/patologia , Estenose da Valva Mitral/cirurgia , RadiografiaRESUMO
We evaluated the correlations between electrocardiographic ST-T changes (negative T waves, ST segment elevation) and echocardiographic diagnosis of neoplastic infiltration of the myocardium in 95 patients with neoplastic masses in contact with the heart. We compared echocardiographic results to computed tomography, nuclear magnetic resonance, surgery or autopsy data in 49 patients: the concordance was 86 percent. Significant ST-T changes were present in 77.7 percent of the patients with myocardial infiltration at echocardiography. The "false negatives" (normal ECG, nonspecific changes) were mainly related to infiltration limited to the right side of the heart; in some of these cases, the appearance of right bundle branch block was observed. The "false positives" (ST-T changes without echocardiographic signs of infiltration) were observed in the older patients and in those with pericardial effusion or other heart diseases. The ST segment elevation was a more specific sign of myocardial infiltration as compared to negative T waves (86 vs 47 percent). A progression or the disappearance of electrocardiographic and echocardiographic abnormalities was observed during follow-up in 24 cases. Serial electrocardiograms are useful for screening in clinical settings in neoplastic patients; the appearance of ST-T changes or of conduction disturbances should suggest the need for two-dimensional echocardiography in order to define the diagnosis.
Assuntos
Ecocardiografia , Eletrocardiografia , Neoplasias Cardíacas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Bloqueio Cardíaco/diagnóstico , Neoplasias Cardíacas/secundário , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
The effectiveness of two-dimensional echocardiography in assessing mitral valve calcification was compared to radiography of the surgically excised valves in 43 patients affected by rheumatic disease of the mitral valve. Mitral valve calcification was graded as absent or present if single thin or multiple dense conglomerate echoes defined the valvular orifice in short axis view, provided the sensitivity of the instrumentation was adequately optimized. The radiograph of the excised valve was similarly graded. The interobserver reproducibility for both two-dimensional echocardiography and radiography was 100 percent. There were 14 true positives, 19 true negatives, 10 false positives and no false negatives, thus giving, for two-dimensional echocardiography, a sensitivity of 100 percent and a specificity of 65 per cent. It is concluded that two-dimensional echocardiography is an extremely sensitive method for assessing mitral valve calcification, and is prospectively useful also in planning reconstruction versus replacement in mitral valve surgery. Nevertheless, the consistent number of false positives affecting two-dimensional echocardiography represents a definite limit to the specificity of the technique.
Assuntos
Calcinose/diagnóstico , Ecocardiografia/métodos , Estenose da Valva Mitral/diagnóstico , Adulto , Idoso , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia , Radiografia , Estudos RetrospectivosRESUMO
The M-mode and two-dimensional echocardiographic features of congenital absence of the pericardium are described in two cases that had been confirmed by clinical and radiological data. The M-mode echocardiogram showed right ventricular dilatation and abnormal systolic motion of the interventricular septum. Echo contrast studies with peripheral injection of saline solution revealed normal persistence of microbubbles in the right side of the heart. Two-dimensional short axis parasternal views showed some dilatation of the right ventricle, with anterior displacement of the left ventricular cavity in systole, which appeared to be wider than the posterior motion of the interventricular septum towards the posterior wall. The resulting positive motion of the interventricular septum toward the transducer could account for the abnormal pattern seen in the M-mode echocardiogram. Congenital absence of the left pericardium has particular echocardiographic features not diagnostic for the anomaly. However, the M-mode and two-dimensional echocardiographic studies, used in conjunction with the echocontrast techniques, seem to help in the differential diagnosis and for excluding associated anomalies.
Assuntos
Ecocardiografia/métodos , Pericárdio/anormalidades , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Função VentricularRESUMO
We describe a case of a large apical left ventricular thrombus evolving towards canalization and showing echocardiographic features mimicking a left ventricular pseudoaneurysm. Only serial echocardiographic studies allowed an appreciation of the changing morphologic features of the apical structure, permitting differential diagnosis between a canalization of an evolving thrombus and a myocardial free-wall rupture with pseudoaneurysm formation.
Assuntos
Aneurisma Cardíaco/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , Falso Aneurisma/diagnóstico por imagem , Diagnóstico Diferencial , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , MasculinoRESUMO
Hydropneumopericardium is an uncommon condition that requires prompt diagnosis and treatment if hemodynamic compromise is present. Chest roentgenography, computerized tomography, and echocardiography provide important information for the diagnosis. In this article a new distinctive echocardiographic sign of hydropneumopericardium is described: the direct demonstration of the air-fluid interface in the long-axis precordial view.