Risk factors for atherosclerosis in healthy employees-a multidisciplinary approach.

BACKGROUND: The aim of the study was to investigate the prevalence of early atherosclerosis in healthy workers and the relationship between classical, psychological, and immunological risk factors and atherosclerosis, as well as their predictive value. METHODS: One hundred healthy managers and 50 office workers aged 35-65 were studied. In all subjects, individual, family, and occupational stress/coping risk factors were evaluated, including plasma levels of biochemical (total cholesterol, LDL, HDL, TG, glucose) and inflammatory-immunological (aCL, anti-beta(2) GPI, oxLDL, HSP, HSCRP) parameters. Carotid artery intima-media thickness (IMT) and atherosclerotic plaques in carotid arteries were assessed with computer analysis of B-mode ultrasound images. RESULTS: In 107 persons (71%) no changes were found in ultrasound images and in 43 individuals (29%) the presence of plaque was shown. The mean IMT value was 0.0618+/-0.013 mm. Cross-domain analysis showed that core predictors for IMT were age, LDL level, smoking, and occupation (being a manager) (beta=0.33, 0.30, 0.23, and 0.20, respectively); the core predictors for plaque were age, total cholesterol level, and an occupational stressor home-work balance (Wald=7, 6.7, and 5.6, respectively). Immunological factors were not independent predictors. CONCLUSIONS: In atherosclerosis, not only traditional risk factors (age, lipid disorders, and lifestyle) but also occupational stress factors may play a role. Immunological factors do not seem to play a role in the development of atherosclerosis in a population of healthy workers. The interplay between occupational stress and atherosclerotic changes requires further investigation.

Comparison of transthoracic and transesophageal echocardiography in evaluation of 47 Starr-Edwards prosthetic valves.

OBJECTIVES: Our objectives were to characterize by transesophageal echocardiography the normal appearance of the Starr-Edwards prosthetic heart valve and to compare the utility of transesophageal and transthoracic echocardiography in detection of valve abnormality. BACKGROUND: The Starr-Edwards prosthetic heart valve, the first mechanical valve to be used, has demonstrated excellent durability. METHODS: Fifty transthoracic and transesophageal echocardiographic studies on 37 patients with 47 Starr-Edwards prosthetic valves were analyzed retrospectively. Six cases of surgically confirmed infective endocarditis were studied. RESULTS: Vegetation or abscess formation, or both, was identified by transesophageal echocardiography in all six cases of infective endocarditis but was found in only one of these cases by transthoracic echocardiography. Thrombus was detected by transesophageal echocardiography in 9 of 11 patients with transient ischemic attacks or stroke and in 2 patients by transthoracic echocardiography with 3 confirmed at surgery. In 26 of the 30 patients with a mitral Starr-Edwards valve, the valve demonstrated a trivial or mild "closing volume" early systolic or holosystolic leak on transesophageal echocardiography alone. Transthoracic evaluation identified significant mitral regurgitation in six of the eight patients who had this finding on transesophageal echocardiography. Serial studies were performed to assess response to treatment or need for surgical intervention in eight patients. Seventeen valves have been implanted for 12 years; six of these had significant leakage without apparent cause, a finding not observed more recently implanted valves. CONCLUSIONS: These observations demonstrated the unique utility of transesophageal echocardiography in patients with Starr-Edwards prosthetic valve dysfunction, endocarditis or thrombus formation, and of the clear superiority of transesophageal echocardiography over transthoracic echocardiography in these situations.

Echocardiographic evaluation of pulmonary artery distensibility.

The aim of this study was to verify the hypothesis that pulmonary artery (PA) distensibility may modify the pattern of right ventricular ejection. Pulmonary artery distensibility was evaluated with M-mode measurements of right pulmonary artery diameter from suprasternal notch simultaneous with pulmonary pressure measurements. Pulmonary artery pressure was measured in 19 subjects, 29 to 75 years old (mean age, 49 years). Pulmonary artery systolic pressure was 22 to 108 mm Hg (mean, 52 mm Hg). Pulmonary artery pressure strain modulus (Ep) was calculated as follows: PADD x (PASP-PADP)/PADD-PADS (PADS-PA diameter in systole, PADD-PA diameter in diastole, PASP-PA systolic pressure, PADP-PA diastolic pressure) was 6 +/- 8 10(5) dynes/cm2. Right ventricular outflow tract velocity was recorded with pulsed Doppler echocardiography and acceleration times (AT) and ejection times (ET) were measured. Log Ep was correlated with pulmonary artery systolic and mean pressure (r = 0.90 and r = 0.87, p < 0.0001) but not with age (r = 0.30, p = NS). Acceleration time and AT/ET ratio were correlated with log Ep (r = 0.73 and r = 0.76, p < 0.001) and with pulmonary artery mean pressure (r = 0.91 and r = 0.89, p < 0.0001). When pulmonary artery pressure was included in multiple analyses, the relationships between Doppler indices and elastic modulus did not prove to be significant. These findings emphasize the independence of Doppler right ventricular outflow tract velocity indexes used for noninvasive evaluation of pulmonary hypertension from pulmonary artery distensibility in a clinical setting.

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects.

OBJECTIVE: The aim of the study was to compare the efficacy and safety of two stress echocardiography methods, exercise and dobutamine, in the diagnosis of coronary artery disease in hypertensive patients with angina. PATIENTS AND METHODS: A total of 197 treated hypertensive patients, age 53 +/- 9 years (65 women) with no history of myocardial infarction referred for coronary angiography were prospectively investigated with exercise electrocardiography (ECG), exercise and dobutamine echocardiography. RESULTS: Sensitivity of the exercise ECG, exercise echocardiography and dobutamine echocardiography did not differ (77%, 82% and 75%). Negative predictive value of exercise ECG was significantly lower than exercise echocardiography (64% vs 79%, P < 0.01). Specificity and positive predictive value of exercise ECG were markedly lower than exercise and dobutamine echocardiography (57%, 96%, 98% and 72%, 97%, 98%, P < 0.0001 for both stress echocardiography vs ECG). Specificity and sensitivity of diagnostic methods were not influenced by the presence of echocardiographic left ventricular hypertrophy. Dobutamine infusion in comparison to exercise was more often associated with substantial arterial blood pressure rise or fall (7% vs 2%, P < 0.05) and with simple ventricular ectopy (15,7% vs 6,1%, P < 0.05). CONCLUSIONS: In hypertensive patients with the symptoms of angina, both stress echo methods are significantly more specific than the exercise ECG test. Maximal exercise is associated with less frequent side effects than infusion of dobutamine, so exercise echocardiography may be preferred in the diagnosis of angina in hypertensive patients.

A comparison between the automatized impedance cardiography and pulsed-wave Doppler echocardiography methods for measurements of stroke volume (SV) and systolic time intervals (STI).

Stroke volume (SV) and systolic time intervals (STI) were measured automatically using impedance cardiography signals (ICG) and compared with those obtained by pulsed-wave Doppler echocardiography using the apex approach. The comparison was made in 9 healthy male subjects, mean age 24.9 +/- 12.2 years, using recordings of 10 heart cycles simultaneously obtained by the two methods. During measurements the subjects rested in the supine position. There were no differences between mean values of SV determined by the two methods as well as between mean values of ejection time (ET) (p > 0.8 and p > 0.9, respectively). The pre-ejection period (PEP) estimated by ICG was 22 ms longer than that determined by echocardiography (p < 0.001). The relationship between SV values measured by impedance cardiography (SVA) vs those calculated by echocardiography (SVE) was found to be close to the line of identity in the range of measurements. The regression equation for SV was: SVA = 0.784.SVE + 15 (r = 0.69, p < 0.001, SEE = 10.7 ml). We conclude that automatic determination of SV and ET from ICG signals provides results comparable in absolute values with those obtained by the pulsed wave Doppler ultrasonocardiography using the apex approach for subjects remaining in the supine position.

Resolution of an aortic mobile mass with anticoagulation without evidence of arterial embolism.

The prognostic significance of aortic mobile debris detected by transesophageal echocardiography (TEE) in patients without history of embolism has not been established. A mobile aortic arch mass was found by TEE in a 59-year-old man with coronary artery disease, and with rheumatic mitral valve disease, and with no embolic symptoms. The patient was anticoagulated for 6 weeks and the mass was no longer seen on repeated TEE. He had no embolic symptoms during 9 months of follow-up. Different therapeutic approaches to mobile aortic debris are discussed and anticoagulant treatment of asymptomatic cases is advocated.

[Adaptation of the left ventricle to increased load in primary arterial hypertension]. / Adaptacja lewej komory serca do zwiekszonego obciazenia w pierwotnym nadcisnieniu tetniczym.

Adaptational mechanisms of the left ventricle to increased afterload in essential hypertension were studied in a group of 53 males with essential hypertension and in 32 normotensive males of the control group. M-mode echocardiograms were performed in all patients. The degree of hypertrophy, contractility, end-systolic stress index were assessed. The group with essential hypertension had increased peripheral vascular resistance and normal LV out put. In this group there was also increase of LV contractility. Increased LV contractility and LV hypertrophy are adaptational mechanisms maintaining normal cardiac output in patients with hypertension through a decrease in end-systolic stress.

[Primary arterial hypertension. Treatment with captopril and function of the left heart ventricle, concentration of catecholamine in blood and activity of renin]. / Pierwotne nadcsnienie tetnicze. leczenie kaptoprylem a czynnosc lewej komory serca, stezenie katecholamin we krwi i aktywnosc reniny.

We evaluated the effect of captopril treatment on left ventricular mass (LVM) and function in sustained mild-to-moderate primary hypertension. In 16 men aged 34.5 +/- 6.4 yrs. M-mode echo and pulsed wave Doppler recordings were obtained prior to and after 2 months captopril treatment (50-150 mg daily). No significant changes in heart rate, systolic blood pressure, ejection fraction, fractional shortening, cardiac output, LVM and Doppler-derived indices of mitral inflow were observed. Diastolic blood pressure measured during examination fell from 102.2 +/- 13.3 to 90.3 +/- 9 mmHg (p less than 0.026). No consistent correlations between catecholamines and indexes of left ventricular function were found. Two-month captopril therapy in mild-to-moderate hypertension results in diastolic blood pressure lowering with no effect on LVM or left ventricular function.

[The importance of transoesophageal echocardiography in establishing of the source of cerebral embolism]. / Znaczenie echokardiograficznego badania przezprzelykowego w ustaleniu zródla zatoru mózgowego.

Transesophageal echocardiography becomes widely used in patients suspected of cerebral embolism. This examination is characterized by higher than transthoracic echocardiography sensitivity for detection of left atrial thrombus. Patent foramen ovale and atrial septal aneurysm have been recognized more often in patients with embolic stroke than in control group. Another potential source of embolism is aortic atheroma especially when protruding or ulcerated. Transesophageal echocardiography allows for identification of embolic source in more than 50% of examined patients.

[Treatment of primary pulmonary hypertension with high doses of nifedipine controlled by Doppler echocardiography]. / Próba leczenia pierwotnego nadcisnienia plucnego wysokimi dawkami nifedypiny pod kontrola echokardiografii dopplerowskiej.

In a 22 year old female with primary pulmonary hypertension Doppler echocardiography revealed a systolic gradient between the right atrium and ventricle of 11.3 kPa (85 mmHg). A trial of high dose nifedipine therapy was started. It's efficacy was assessed by monitoring the tricuspid gradient. During therapy variations of the gradient were seen but without a favorable, steady, decrease trend. Although nifedipine did not produce any improvement during the "acute trial"--nifedipine therapy was continued--initially 60 mg, followed by 80 mg and finally 100 mg per day. Efficacy of this therapy was also controlled by Doppler echocardiography. Nifedipine was discontinued after 8 months due to lack of improvement in the patient's state. The patient died 30 months from the initial symptoms. Pathomorphological examination confirmed the clinical diagnosis. The use of Doppler echocardiography in assessing the vasodilators in primary pulmonary hypertension is discussed.

Initial clinical experience with a 48 by 48 element biplane transesophageal probe.

Recent technologic advances in ultrasound have resulted in the capability of transesophageal echocardiographic imaging in both transverse and longitudinal planes. Previous biplane probes suffered from inferior images because of reduced scan elements. We evaluated the utility of a prototype 48 X 48 element biplane transesophageal probe in 23 consecutive patients. Examinations were well tolerated with no side effects. In comparison to the single transverse plane, imaging with the longitudinal plane gave superior information on prosthetic valve pathology, atrial septal abnormalities, and pathoanatomy of the ascending aorta and mitral valve. Complementary information was provided by the longitudinal plane in patients with endocarditis and vegetations and in mitral protheses. Images obtained with this 48 X 48 element biplane probe along with color and spectral Doppler information were not perceptibly inferior to those obtained by single-plane probes. In conclusion, biplane transesophageal echocardiography with a 48 X 48 element probe indicates a great potential for enhanced three-dimensional understanding of cardiac pathology and diagnostic yield in specific pathologies.

Aortic root abscess--echocardiographic image.

Autopsy findings point to a high prevalence of perivalvular abscesses in patients with infective endocarditis. Diagnosis of this complication, which may have therapeutical implications, is difficult. The authors present echocardiographic image obtained in a patient with bacterial endocarditis in whom an aortic root abscess was subsequently found at operation.