Cross-sectional Echocardiographic Study Research Articles

Subclinical myocardial disfunction detected by left ventricle myocardial work impairment in patients with long standing human inmmunodeficiency virus infection

Abstract Heart failure is a known complication in patients living with human inmmunodeficiency virus (HVI) infection. Detection of subclinical disfunction is nowadays possible by echocardiographic strain techniques. Myocardial work is a novel technique based on global longitudinal strain (GLS) that measures global work efficiency of left ventricle (GWE) and would allow early detection of subclinical myocardial damage. Methods We performed a cross sectional echocardiographic study of patients with long standing HIV infection, and no previous cardiopathy, assessing GLS of left ventricle (LV), left atrium (LA) and free wall of right ventricle (RV-FW GLS). We identified patients with subclinical disfunction expressed by an impaired GWE , and studied its determinants by lineal regression. Results 110 patients, 78.2% male, median age 53.3 (51.2-55.4) were included. Time from diagnosis was 20.5 (18.6-22.3) years. Myocardial work strain analysis showed an impaired GWE: 91.9% (90.9-92.9);p<0.001) and a GW index of 1840.8 mmHg%(1758.7-1922.9):p<0.001. The rest of deformation parameters laid into normal range: LV GLS was -19.5% (-19.0- -20.0) GLS dispersion 55.1 (50.1-60.1), LA GLS (reservoir) 32.8% (31.2-34.5), and RV free wall GLS -22.3% (-21.4 - -23.2). By univariate analysis, determinants of impaired GWE were age, Score2 risk, time from HIV diagnosis, QRS Interval duration, long QTc Interval, LV ejection fraction (LVEF),diastolic disfunction by doppler tissue imaging, CD4 count nadir, initial and maximun viral load, and exposure to didanosine treatment. After adjustment by cardiovascular risk and diastolic function (Ea velocity by tissue Doppler) , GWE impaired depended on duration of infection (Beta 0.3;95%CI:0.04-0.56;p=0.023), initial viral load (Beta -1.1;95%CI:-2.1- -0.02;p=0.046) and exposure to stavudine (Beta -6.3;95%IC: -11.5- -1.1;p=0.019). Conclusions Subclinical myocardial disfunction is prevalent in long standing HIV infection. Global work efficiency is a very sensitive parameter for detection, even in patients with normal GLS values, and it was related to duration of infection, initial viral load, and exposure to stavudine in our patients.Determinants of Global Work Efficiency

Atrial remodelling associated with sporting discipline, sex and duration in elite sports: a cross-sectional echocardiographic study among Danish elite athletes

BackgroundElite endurance training is characterised by a high-volume load of the heart and has been associated with atrial fibrillation (AF) in middle-aged men. We compared left atrial (LA) remodelling among...

Echocardiographic assessment of morphofunctional and hemodynamic changes of rheumatic mitral valve dysfunction in the young. Morphological changes in rheumatic valve lesions

Background- Rheumatic fever and its sequel rheumatic heart disease remain a major health problem across the globe. This investigation aims to analyse the mitral valve morphofunctional changes, stratified by severity, and the magnitude of the mitral regurgitation and stenosis through a simplified echocardiographic scoring system in patients with rheumatic heart disease. Methods- As cross-sectional echocardiographic study was carried out in 98 consecutive patients with confirmed rheumatic heart disease. Patients undergoing outpatient clinical care over an 18-month period (mean follow-up period of 9,7±2,9 years) were selected for echocardiographic investigation. After a double-blind echocardiograms review, the inter-rater reliability was calculated (Kappa=0.875 (0.775- 0.974; CI 95%). The morphofunctional data of mitral apparatus were scored on a rating scale from one to fifteen, encompassing three categories (1-5: mild; 6-10: moderate; 10-15: severe) to quantify the degrees of severity. Pearson's Chi-squared test with Yates' continuity correction were performed for comparative analysis and the Wilcoxon test and the Cliff's Delta effect size was calculated to examine differences related to morphological features. Results- The majority of patients had rheumatic heart disease with clinical evidence and twenty patients (20,4%) had subclinical disease.The thickening of both mitral valve leaflets and the restrictive motion of the posterior leaflet were most frequently found in contrast with the low percentage of chordal and/or commissural fusion. The degree of the anterior mitral valve leaflet thickening was proportional to the magnitude of the mitral valve regurgitation (p=0.021). The higher degrees of mitral valve dysfunction were associated with more severe carditis (mitral valve regurgitation, p: 0.000; mitral valve stenosis, p: 0.031). No association was found between the severity of valvular lesions and patient age or length of the disease (p=0.320). The presence of beading was only observed in the acute phase (p=0,000); coaptation defect of the mitral valve was associated with significant left ventricle enlargement (p=0.000). The morphofunctional score of mitral apparatus, stratified by severity, was associated with the magnitude of mitral valve regurgitation (p=0,000) and of mitral valve stenosis (p=0,031) also quantified by severity. The highest scores were observed in patients with the most severe degrees of carditis (p=0,000); however, no association was found with either, the patients’ age (p=0.373) or the duration of the disease (p=0.361). Conclusions- In the analysis of severity of the mitral apparatus deformities and the resulting valve dysfunction, the morphofunctional score stratification was highly associated with the magnitude of mitral regurgitation and stenosis. In this young cohort, the higher scores were associated to severe carditis, but not to the patients’ age or the duration of the disease. Taking into account the low prevalence of severe valve dysfunctions, these results highlight the importance of early intervention and adequate prevention.

Ahletic adaptations of thin-walled structures of the heart: a cross-sectional echocardiographic study of elite athletes

Abstract Background Cardiac adaptation to exercise is characterized by eccentric remodeling due to increased volume load[1], it is however unclear how systolic function is affected in all chambers. Endurance sports is a known risk factor for later onset atrial fibrillation[2]. Moreover, recent studies of the acute effects of exercise have reported reversable right ventricular (RV) dilation and reduced function in triathletes resembling ARVC, while the left ventricle (LV) was unchanged[3]. These findings have raised concern regarding the long-term adaptations in the thin-walled chambers of the heart. Purpose The aim of the current study was to assess atrial and RV remodeling by echocardiography in elite athletes. Methods A cross-sectional study of 482 healthy active elite athletes from 30 sports was investigated with a standard resting echocardiogram. Using the Mitchell sports classification, athletes were grouped according to levels of endurance demands for their sport into low (Mitchel 1A), intermediate (Mitchel 1B-C, 2A-B-C), and high endurance demand (3A-B-C). All measures were adjusted for body surface area (BSA), sex, and age. Analysis of Covariance models was used to allow for adjustments for categorical variables and continuous covariates. Results Left atrial minimum volume/BSA (LAminV/BSA) was higher in athletes who performed high endurance demanding sports than in the intermediate and low groups (High: 11.3 ml/m2, confidence interval (CI): 10.1-12.5; Int: 8.9 ml/m2, CI: 8.3-9.5, p<0.01; Low: 7.7 ml/m2, CI: 5.8-9.7, p<0.01). We found no difference between the low and intermediate groups. RV systolic area/BSA (RVsysA/BSA) was significantly higher in the high and intermediate groups compared to the low group (high 9.5 ml/m2, CI: 9.1-9.8, p=0,014; Int 9.3 ml/m2, CI: 9.1-9.5, p=0.04; Low: 8.3 ml/m2, CI: 7.7-9.0). The LA/RV minimum size ratio showed a larger size difference between the groups in the LA compared to the RV (High 1.183, CI: 1.063-1.303; Int 0.968, CI: 0.906-1.029, p<0.01, Low 0.921, CI: 0.726-1.116 p=0.02). A comparison of LA and LV size (LAminV/LVsysV) showed a significant decrease between high and intermediate groups, but not the low group (High: 0.366; Int: 0.296, p<0.01; Low: 0.302, p=0.16). The LA/RA size ratio was equal in all groups. LA strain analysis showed reduced contraction in the high and intermediate groups compared to the low group (High -10.2, CI: -10.9-(-9.4), p<0,01, Int -10.6, CI: -11.1-(-10.2), p<0.01, Low: -12.9, CI: -14.2-(-11.6)), the same pattern was not found in RA function, RV freewall and LV GLS (table 1). Conclusion We found a bilateral increase in atrial size while LA (but not RA) also showed reduced contraction in athletes from intermediate and high endurance demanding sports. Athletes from sports with high and intermediate endurance demands exhibited dilated ventricles but no decreased function was detected. Adaptations of atrial size and function were more pronounced than that of either ventricle.Table 1:Population characteristicsTable 2:Echocardiographic measures

Prevalence of latent structural heart disease in Nepali schoolchildren.

The present study aimed to quantify the burden of structural heart disease in Nepali children. We performed a school-based cross-sectional echocardiographic screening study with cluster random sampling among children 5-16 years of age. Between December 2012 and January 2019, 6573 children (mean age 10.6 ± 2.9 years) from 41 randomly selected schools underwent echocardiographic screening. Structural heart disease was detected in 14.0 per 1000 children (95% CI 11.3-17.1) and was congenital in 3.3 per 1000 (95% CI 2.1-5.1) and rheumatic in 10.6 per 1000 (95% CI 8.3-13.4). Rates of rheumatic heart disease were higher among children attending public as compared to private schools (OR 2.8, 95% CI 1.6-5.2, p = 0.0001). Rheumatic heart disease accounted for three out of four cases of structural heart disease and was more common among children attending public as compared to private schools.

Aortic regurgitation and aortic root systolic excursion in patients with severe arterial hypertension in Sub-Saharan Africa: A cross sectional echocardiographic study

Arterial hypertension is one of the main cardiovascular risk factors. Hypertensive heart disease refers to heart conditions caused by high blood pressure. Aortic regurgitation and Aortic Root Systolic Excursion (ARSE), which are parameters altered early in the course of the disease can be used to rapidly evaluate the heart function of patients presenting with severe hypertension. To describe patients presenting with severe hypertension, and to find the prevalence of aortic regurgitation, and of an abnormal ARSE. This was a cross sectional study including patients with severe hypertension attending cardiology outpatient consultation in two tertiary hospitals of Yaoundé, Cameroon. Clinical data were recorded and echocardiography were done by two experienced cardiologists to evaluate cardiac function. Ninety-two patients were recruited. The mean age was 60.8 ± 13.1 (23–96) years. The median blood pressure values were 189 (IQR 180–207) for systolic and 114 (103–123) for diastolic. The main antihypertensive medication class used were calcium channel blockers. In this sample 16(17.4%; 95% CI: 9.8–25) patients had aortic regurgitation, 6(6.5%; 95% CI: 2.2–12) patients had an abnormal ARSE and 16(17.4%; 95% CI: 9.8–25) patients had a left ventricular systolic dysfunction given by a left ventricular ejection fraction <50% calculated using biplane Simpson's method respectively 6.5% (95% CI: 2.2–12), 17.4% (95% CI: 9.8–25) and 17.4% (95% CI: 9.8–25). A low prevalence of aortic regurgitation and ARSE were found in this sample of patients with severe hypertension. These results suggest that aortic regurgitation and an abnormal ARSE are probably linked more to the duration that to the severity of hypertension.

Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening.

Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town. Prospective, cross-sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register. People aged 5-20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018. Echocardiographic screening for RHD by an expert cardiologist or cardiac sonographer. Definite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF. The screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8-14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5-20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF. Passive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.

Echocardiographic Characterization of Female Professional Basketball Players in the US

There is a paucity of data detailing cardiac remodeling in female athletes compared with male athletes. The lack of reference cardiac data for elite female basketball players or female athletes of similar size makes it difficult to differentiate athletic remodeling from potential underlying cardiac disorders in this population of athletes. To assess cardiac structure and function in elite female basketball players. This cross-sectional echocardiographic study included 140 Women's National Basketball Association (WNBA) athletes on active rosters for the 2017 season. The WNBA mandates annual preseason stress echocardiograms for each athlete. The WNBA has partnered with Columbia University to annually perform a review of these studies. Data analysis was performed from June 7, 2017, to October 5, 2017. Echocardiographic variables included left ventricular (LV) dimensions, wall thickness, mass, prevalence of LV hypertrophy, aortic dimensions, right ventricular (RV) dimension, and right and left atrial size. Linear regression was used to assess the associations between cardiac structure and function with body size quantified as body surface area (BSA) in the primary analysis. A total of 140 female athletes (mean [SD] age, 26.8 [3.9] years; 105 [75.0%] African American) participated in the study. Mean (SD) athlete height was 183.4 (9.0) cm, and mean (SD) BSA was 2.02 (0.18) m2. Compared with guideline-defined normal values, LV enlargement was present in 36 athletes (26.0%) and 57 athletes (42.2%) had RV enlargement. There was a linear correlation between LV and RV cavity sizes and BSA extending to the uppermost biometrics (LV cavity size: r, 0.48; RV cavity size: r, 0.32; P < .001 for both). Maximal left ventricular wall thickness (LVWT) ranged from 0.6 to 1.4 cm, with 78 athletes (55.7%) having LVWT of 1.0 cm or greater and only 1 athlete (0.7%) having LVWT greater than 1.3 cm. Twenty-three athletes (16.4%) met the criteria for left ventricular hypertrophy (LVH) (>95 g/m2). Eccentric LVH was present in 16 athletes (69.6%), concentric LVH in 7 athletes (30.4%), and concentric remodeling in 27 athletes (19.3%). Mean aortic root diameter was 3.1 cm (95% CI, 3.0-3.2). Only 2 athletes (1.4%) had guideline-defined aortic enlargement compared with a range of 18% to 42% for left and right ventricular and atrial enlargement. In this study, increased cardiac dimensions were frequently observed in WNBA athletes. Both BSA and physiologic remodeling affected cardiac morphologic findings. This study may provide a framework to define the range of athletic cardiac remodeling exhibited by elite female basketball players.

Z-score reference ranges for pulsed-wave Doppler indices of the cardiac outflow tracts in normal fetuses.

To determine Z-score equations and reference ranges for Doppler flow velocity indices of cardiac outflow tracts in normal fetuses. A prospective cross-sectional echocardiographic study was performed in 506 normal singleton fetuses from 18 to 40weeks. Twelve pulsed-wave Doppler (PWD) measurements were derived from fetal echocardiography. The regression analysis of the mean and the standard deviation (SD) for each parameter were performed against estimated fetal weight (EFW) and gestational age (GA), in order to construct Z-score models. The correlation between these variables and fetal heart rate were also investigated. Strong positive correlations were found between the twelve PWD indices and the independent variables. A linear-quadratic regression model was the best description of the mean and SD of most parameters, with the exception of the velocity time interval (VTI) of ascending aorta against EFW, which was best fitted by a fractional polynomial. Z-score equations and reference values for PWD indices of fetal cardiac outflow tracts were proposed against GA and EFW, which may be useful for quantitative assessment of potential hemodynamic alternations, particularly in cases of intrauterine growth retardation and structural cardiac defects.

Correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE): A cross-sectional echocardiographic study.

BackgroundHeart failure (HF), is a major public health issue globally. Echocardiography is cost–effective in the diagnosis in expert hands. This study was conducted to estimate the usefulness of Aortic Root Systolic Excursion (ARSE) as a simple and accurate measure to estimate Left Ventricular (LV) function.MethodsThis was a cross-sectional echocardiographic study among adults aged ≥ 18 years, with or without heart failure, in sinus rhythm, and with no LV out–let obstruction. We studied the correlations of ARSE with some selected indices of LV Systolic Functions. We determined optimal cut–offs of ARSE in detecting LV dysfunction. We generated a simple regression equation to best estimate LV ejection fraction according to the modified Simpson method.ResultsOverall 213 echocardiograms were included from 106 males (49.8%), with mean age of the participants being 52.4 (SD: 18.3) years. The rate of LV systolic dysfunction was highest with Teicholz method (17.4%) and lowest with MAPSE method (5.2%). ARSE correlated with the LV functions. This was highest for the Simpson method (r = 0.619, p<0.001), and lowest for the ITV method (r = 0.319, p<0.001). Optimal cut-offs to detect LV systolic dysfunction was ≈ 6.6 mm. For an LV ejection fraction < 55%, the sensitivity was 82.9%, and the specificity was 97.2%, with an AUROC of 91.6%.The logarithmic regression equation was best in predicting LV ejection fraction (AUC: 60.2%), followed by the power model (AUC: 56.7%), and the linear model (AUC: 53.6%).ConclusionARSE correlated well with LV systolic function. The cut–off ≤ 6.5 mm suggest LV systolic dysfunction. LV Ejection Fraction was best estimated with the generic equation: LVEF (%) = 29 x In [ARSE].

Long-term cardiac (valvulopathy) safety of cabergoline in prolactinoma.

Background:Clinical relevance of association of cabergoline use for hyperprolactinemia and cardiac valvulopathy remains unclear.Objective:The aim of the study was to determine the prevalence of valvular heart abnormalities in patients taking cabergoline for the treatment of prolactinoma and to explore any associations with the cumulative dose of drug used.Design:A cross-sectional echocardiographic study was performed in patients who were receiving cabergoline therapy for prolactinoma.Results:Hundred (61 females, 39 males) prolactinoma cases (81 macroprolactinoma and 19 microprolactinoma) were included in the study. The mean age at presentation was 33.9 ± 9.0 years (range: 16–58 years). The mean duration of treatment was 53.11 ± 43.15 months (range: 12–155 months). The mean cumulative dose was 308.6 ± 290.2 mg (range: 26–1196 mg; interquartile range: 104–416 mg). Mild mitral regurgitation was present in one patient (cumulative cabergoline dose 104 mg). Mild tricuspid regurgitation was present in another two patients (cumulative cabergoline dose 52 mg and 104 mg). Aortic and pulmonary valve functioning was normal in all the cases. There were no cases of significant valvular regurgitation (moderate to severe, Grade 3–4). None of the patients had morphological abnormalities such as thickening, calcification, and restricted mobility of any of the cardiac valves.Conclusion:Cabergoline appears to be safe in patients with prolactinoma up to the cumulative dose of ~300 mg. The screening for valvulopathy should be restricted to those with higher cumulative cabergoline exposure.

Association of serum calcium and heart failure with preserved ejection fraction in patients with type 2 diabetes.

BackgroundType 2 diabetes mellitus (T2DM) is a recognized trigger factor for heart failure with preserved ejection fraction (HFpEF). Recent studies show that higher serum calcium level is associated with greater risk of both T2DM and heart failure. We speculate that increased serum calcium is related to HFpEF prevalence in patients with T2DM.MethodsIn this cross-sectional echocardiographic study, 807 normocalcemia and normophosphatemia patients with T2DM participated, of whom 106 had HFpEF. Multinomial logistic regression was carried out to determine the variables associated with HFpEF. The associations between serum calcium and metabolic parameters, as well as the rate of HFpEF were examined using bivariate linear correlation and binary logistic regression, respectively. The predictive performance of serum calcium for HFpEF was evaluated using the area under the receiver operating characteristic curve (AUC).ResultsPatients with HFpEF have significantly higher serum calcium than those without HFpEF. Serum calcium was positively associated with total cholesterol, triglycerides, low-density lipoprotein cholesterol, serum uric acid, HOMA-IR and fasting plasma glucose. Compared with patients in the lowest serum calcium quartile, the odds ratio (OR) for HFpEF in patients in the highest quartile was 2.331 (95 % CI 1.088–4.994, p = 0.029). When calcium was analyzed as a continuous variable, per 1 mg/dL increase, the OR (95 % CI) for HFpEF was [2.712 (1.471–5.002), p = 0.001]. Serum calcium can predict HFpEF [AUC = 0.673, 95 % CI (0.620–0.726), p < 0.001].ConclusionsAn increase in serum calcium level is associated with an increased risk of HFpEF in patients with T2DM.

Relation of elastic properties of pulmonary artery with left ventricular abnormalities and aortic stiffness in patients with moderate to severe obstructive sleep apnea: A cross-sectional echocardiographic study.

In this study, the associations between pulmonary artery stiffness (PAS) and aortic stiffness, left ventricular diastolic parameters, and left ventricular mass (LVM) index in moderate to severe obstructive sleep apnea syndrome (OSAS) patients without coexisting disorders were investigated. A total of 66 non-diabetic, non-hypertensive, and non-smoking volunteers were enrolled. Participants were categorized by apnea-hypopnea index (AHI; event/hour). The control group was defined as no OSAS: AHI<5 (n=35), and OSAS group had moderate to severe OSAS: AHI>15 (n=31).Echocardiographic and biochemical tests, including measurement of C-reactive protein (CRP), were performed. PAS (kHz/s) was calculated by dividing the maximal frequency shift of the pulmonary flow by the acceleration time. PAS (kHz/s), obtained by echocardiography, was statistically significantly higher in the OSAS group than the control group (28±5 vs 18±4, p<0.001), and was positively correlated with AHI, CRP, aortic stiffness index, E/E', and LVM index (p=0.034, p=0.039, p<0.001, p=0.040, and p<0.001, respectively), and negatively correlated with aortic strain (AS), aortic distensibility (AD), E/A, E'/A', and E' (p<0.001). Regression analyses indicated that CRP and PAS are independent predictors of aortic stiffness (p<0.05). E/A and LVM index were independent predictors of PAS (p=0.002 and p=0.001, respectively). Increased PAS is associated with aortic stiffness, left ventricular diastolic function, and increased LVM index. PAS may be a more effective indicator of aortic stiffness in OSAS patients than CRP.

A Cross-Sectional Study of the Prevalence of Cardiac Valvular Abnormalities in Hyperprolactinemic Patients Treated With Ergot-Derived Dopamine Agonists

Concern exists in the literature that the long-term use of ergot-derived dopamine agonist drugs for the treatment of hyperprolactinemia may be associated with clinically significant valvular heart disease. The aim of the study was to determine the prevalence of valvular heart abnormalities in patients taking dopamine agonists as treatment for lactotrope pituitary tumors and to explore any associations with the cumulative dose of drug used. A cross-sectional echocardiographic study was performed in a large group of patients who were receiving dopamine agonist therapy for hyperprolactinemia. Studies were performed in accordance with the British Society of Echocardiography minimum dataset for a standard adult transthoracic echocardiogram. Poisson regression was used to calculate relative risks according to quartiles of dopamine agonist cumulative dose using the lowest cumulative dose quartile as the reference group. Twenty-eight centers of secondary/tertiary endocrine care across the United Kingdom participated in the study. Data from 747 patients (251 males; median age, 42 y; interquartile range [IQR], 34-52 y) were collected. A total of 601 patients had taken cabergoline alone; 36 had been treated with bromocriptine alone; and 110 had received both drugs at some stage. The median cumulative dose for cabergoline was 152 mg (IQR, 50-348 mg), and for bromocriptine it was 7815 mg (IQR, 1764-20 477 mg). A total of 28 cases of moderate valvular stenosis or regurgitation were observed in 24 (3.2%) patients. No associations were observed between cumulative doses of dopamine agonist used and the age-corrected prevalence of any valvular abnormality. This large UK cross-sectional study does not support a clinically concerning association between the use of dopamine agonists for the treatment of hyperprolactinemia and cardiac valvulopathy.

Systolic and Diastolic Ventricular Function Assessed by Tissue Doppler Imaging in Children with Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with elevated cardiovascular risk even during childhood. Tissue Doppler is a sensitive technique for the assessment of ventricular dysfunction with relatively little data available in children with CKD. We report a prospective cross-sectional echocardiographic study at a tertiary center. Forty-nine patients with median (range) age 11.2 years (6.9-17.9), weight 39.6 kg (23.6-99.7) and height 146 cm (122-185). Thirty-one patients were male. Median duration of follow-up for CKD was 7.1 years (range 0.13-16.9). Patients were in CKD stage 3 (n = 37) or 4 (n = 12). Mitral valve E-wave, A-wave, and E/A ratio showed mean (SD) z-scores of 0.08 (0.93), 0.12 (0.82) and -0.13 (0.84), respectively. Tissue Doppler imaging (TDI) at the lateral mitral valve annulus showed e', a', s', and E/e' z-scores mean (SD) -1.10 (0.76), -0.29 (0.92), -1.2 (0.7), and 0.86 (1.1), respectively. There was a significant negative correlation of e' and s' z-score with patient age. E/e' ratio correlated positively with patient age. Blood pressure, left ventricular mass, and relative wall thickness did not correlate with tissue Doppler measurements. The e' and s' velocities correlated significantly with each other, suggesting an interaction of systolic and diastolic dysfunction. Children with CKD may have abnormalities of systolic and diastolic ventricular function on TDI, which are not evident on blood pool Doppler. The tissue Doppler results are consistent with worsening ventricular function in older patients.

Onset and progression of the Anderson–Fabry disease related cardiomyopathy

Background Cardiac involvement is responsible for substantial morbidity and mortality in Anderson–Fabry disease (AFD). We sought to document its onset and progression in a population of male and female AFD patients. Methods We performed a cross sectional echocardiographic study of a cohort of 177 male and female AFD patients with subsequent longitudinal follow-up of 76 patients (38 males and 38 females; mean follow-up 4.5 years) who did not receive enzyme replacement therapy. Results In this population, aged 3.3 to 70.8 years, a strong correlation between age and left ventricular mass indexed (LVMi, g/m 2.7) was found in both males and females ( P < 0.0001 for both). At the initial examination 48.6% of the male patients and 36.4% of the female patients were classified as having left ventricular hypertrophy (LVH). The cumulative prevalence of LVH peaked at age 40 years in males and 60 years in females. In patients with longitudinal follow-up, LVMi increased by 4.07 ± 1.03 g/m 2.7 per year in males and by 2.31 ± 0.81 g/m 2.7 in females ( P < 0.01, Wilcoxon rank sum). In patients with LVH at baseline, the median progression rate was 5.52 g/m 2.7 per year in males and by 1.80 g/m 2.7 in females ( P = 0.12). Conclusion AFD is associated with high prevalence of LVH in both genders. However, the age of onset is delayed in females and progression rate slower.

Cor pulmonale in children with human immunodeficiency virus infection.

A cross-sectional echocardiographic study of 50 black Zimbabwean children with clinical human immunodeficiency virus (HIV) infection was carried out. The median age was 9 months. Seventy per cent had chronic cough, 60% respiratory distress and 40% cyanosis. Sixty per cent had pericardial effusion and 48% right ventricular hypertrophy (RVH) and dilation. However, the clinical diagnosis of heart failure was difficult as most of these children (80%) had hepatomegaly. These findings suggest that respiratory disease plays a role in the causation of RVH in these children. As cardiac causes of RVH were absent, this was presumed to be due to cor pulmonale. HIV-infected children presenting with respiratory distress may have clinically unapparent cor pulmonale. Early and appropriate management may by beneficial.

Left ventricular function of survivors of a first complicated acute myocardial infarction. A prehospital discharge cross-sectional echocardiographic study

To assess the left ventricular function of patients who suffer from post-infarction angina and left ventricular failure in the coronary care unit, 79 consecutive survivors (mean age 48 years) of a first acute myocardial infarction were prospectively studied and followed-up for a mean 18- (10–34) month period. Forty-seven had an uncomplicated infarction, 17 suffered from post-infarction angina and 15 had left ventricular failure. The left ventricular function of these patients prior to discharge from hospital was assessed by cross-sectional echocardiography and radionuclide angiography. Analysis of left ventricular wall motion was performed in all patients using a 11-segment model of the left ventricle. The ejection fraction was determined by echocardiography in 47 patients and by radionuclide angiography in 50. The mean echocardiographic wall motion score of post-infarction angina patients (4.8 ± 0.8) (± SEM) was lower than that of patients with left ventricular failure (9.5 ± 0.5) ( P < 0.001), but was not different from patients suffering uncomplicated infarctions (4.6 ± 0.3). The mean echocardiographic ejection fraction was also similar in post-infarction angina (45.3 ± 4.0; n = 16) and patients with uncomplicated infarction (51.9 ± 2.7; n = 17), but was lowest in the group of patients with left ventricular failure (35.1 ± 3.3; n = 14). Similarly, the radionuclide ejection fraction of patients with post-infarction angina (41.4 ± 3.4; n = 17) and patients with uncomplicated infarction (45.6 ± 2.7; n = 19) did not differ, but was lower in patients with left ventricular failure (25.9 ± 2.8; n = 14). The echocardiographic ejection fraction correlated with that obtained by radionuclide angiography in all 46 patients ( r = 0.71, P < 0.001). The wall motion score correlated with the radionuclide ejection fraction in all 50 patients ( r = −0.73, P < 0.001) and with the echocardiographic ejection fraction in 47 patients ( r = −0.55, P < 0.001). During follow-up, 3 (18%) patients suffering post-infarction angina and 2 (13%) with left ventricular failure died. New infarction was seen in 2 (12%) and 1 (7%) patients in these groups, respectively. We conclude that the left ventricular function of patients who suffer from post-infarction angina in the coronary care unit is good, but is impaired in those with even transient left ventricular failure. Echocardiographic assessment of cardiac function prior to hospital discharge was highly successful and may be performed in all such patients.

Left atrial volume changes in mitral valve disease: a cross-sectional echocardiographic study.

We used cross-sectional echocardiography to study left atrial volume changes in 25 patients with mitral valve disease who underwent cardiac catheterisation. Satisfactory 4 chamber views were obtained in 21. Left atrial systolic overload measured as systolic expansion index did not correlate with the severity of mitral regurgitation as assessed by contrast ventriculography and indicator dilution. The left atrial systolic expansion rate, and the maximum volume increase during the first third of systole, measured as the early systolic expansion index, differentiated well between moderate and severe mitral regurgitation, but not between trivial and moderate regurgitation. Calculation of the early systolic expansion fraction (fraction of total expansion occurring in the first third of systole) gave the best correlation with the degree of mitral regurgitation estimated by other methods.

Prediction of the extent of coronary artery disease with the evaluation of left ventricular wall motion abnormalities during atrial pacing. A cross-sectional echocardiographic study

In patients with coronary artery disease, left ventricular performance during stress is affected by the degree of coronary stenosis. In order to verify whether there exists a relationship between the extent of wall motion abnormalities detectable during atrial pacing and the degree of coronary obstruction, 76 patients, without previous myocardial infarction, were studied. Each patient underwent cross-sectional echocardiography during transesophageal atrial pacing and exercise electrocardiography before coronary angiography. Of the 76 patients, 46 had significant coronary artery disease (stenosis ⩾ 75% of at least one major coronary vessel), while 30 had normal coronaries or a stenosis of less than 75%. Eighteen patients had single-, 14 had two-and 14 had three-vessel disease. For each patient a coronary score was obtained: the score used took into consideration the site, number and severity of the stenosis. This score was then correlated with the wall motion score, obtained from the analysis of 9 segments of the left ventricle. A weak correlation was obtained between wall motion score at rest and coronary score ( r = −0.42), while the correlation between coronary score and the difference between wall motion score at rest and during transesophageal atrial pacing was slightly better ( r = 0.53); this correlation further improved if wall motion score during pacing was considered ( r = −0.63). If the patients with discordant diagnostic tests (echocardiography during transesophageal atrial pacing and exercise electrocardiography) were excluded, the correlation coefficient between coronary score and wall motion score during pacing increased even more ( r = −0.77). In conclusion: (1) analysis of wall motion of the left ventricle during atrial pacing is useful for the non-invasive evaluation of the severity of coronary disease; (2) cross-sectional echocardiography during atrial pacing, apart from being a useful diagnostic tool, is also a help in judging the degree of severity of coronary artery disease.