Diagnostic Left Heart Catheterization Research Articles

Coronary microvascular dysfunction assessment: A comparative analysis of procedural aspects.

Full adoption of coronary microvascular dysfunction (CMD) assessment faces challenges due to its invasive nature and concerns about prolonged procedure time and increased contrast and/or radiation exposure. We compared procedural aspects of CMD invasive assessment to diagnostic left heart catheterization (DLHC) in patients with chest pain who were not found to have obstructive coronary artery disease. A total of 227 patients in the Coronary Microvascular Disease Registry were compared to 1592 patients who underwent DLHC from August 2021 to November 2023. The two cohorts were compared using propensity-score matching; primary outcomes were fluoroscopy time and total contrast use. The participants' mean age was 64.1 ± 12.6 years. CMD-assessed patients were more likely to be female (66.5% vs. 45.2%, p < 0.001) and have hypertension (80.2% vs. 44.5%, p < 0.001), history of stroke (11.9% vs. 6.3%, p = 0.002), and history of myocardial infarction (20.3% vs. 7.7%, p < 0.001). CMD assessment was safe, without any reported adverse outcomes. A propensity-matched analysis showed that patients who underwent CMD assessment had slightly higher median contrast exposure (50 vs. 40 mL, p < 0.001), and slightly longer fluoroscopy time (6.9 vs. 4.7 min, p < 0.001). However, there was no difference in radiation dose (209.3 vs. 219 mGy, p = 0.58) and overall procedure time (31 vs. 29 min, p = 0.37). Compared to DLHC, CMD assessment is safe and requires only slightly additional contrast use (10 mL) and slightly longer fluoroscopy time (2 min) without clinical implications. These findings emphasize the favorable safety and feasibility of invasive CMD assessment.

Abstract P2010: Relationship between echocardiographic parameters and invasively measured left ventricular filling pressure in the persistent atrial fibrillation with preserved left ventricular systolic function

Background: Among patients with normal systolic function, elevated left ventricular end diastolic pressure (LVEDP) could represent early diastolic dysfunction or could be the main physiological consequence of diastolic dysfunction. However, the evaluation of LVEDP using classic echocardiographic assessment has been challenging in the setting of atrial fibrillation (AF). The aim of this study was to investigate the methods for predicting LVEPD in patients with persistent AF. Methods: Clinical data, laboratory data, and echocardiography findings were assessed in 90 patients with chronic AF who were undergoing diagnostic left-heart catheterization. LVEDP and standard echocardiographic measurements including pulmonary arterial systolic pressure (PASP) were evaluated. Results: E/e’ (r=0.448, p&lt;0.001), E/Vp (r=0.471, p&lt;0.001) and PASP (r=0.421, p&lt;0.001) correlated well with LVEDP (figure 1). Using receiver operating characteristic analysis, the optimal cut-off for E/e’ was 13 (sensitivity, 88%; specificity, 65%) to predict LVEDP of &gt;15 mmHg (figure ). Conclusion: E/e’, E/Vp and PASP were well correlated with LVEDP in patients with AF with preserved EF. E/e’ greater than 13 may suggest elevated LVEDP (&gt;15 mmHg) in patients with persistent AF.

Severe functional mitral regurgitation and cardiogenic shock after transcatheter aortic valve replacement.

An 83-year-old woman with symptomatic severe aortic stenosis was referred for transcatheter aortic valve replacement. Diagnostic left heart catheterization documented diffuse 3-vessel coronary artery disease.

A Novel Approach to Diagnostic Left and Right Heart Catheterization in a Patient With a Mechanical Prosthetic Tricuspid Valve.

A 47-year-old patient was experiencing dyspnea and fatigue concerning for right ventricular hypertension and new heart failure. Because of the risks associated with catheter entrapment, prosthetic valve leaflet damage, and valve thrombosis associated with crossing a mechanical valve, a novel technique was used for diagnostic left and right heart catheterization in a patient with mechanical tricuspid valve replacement and tortuous pulmonary arteries. Using a percutaneous subxiphoid approach to avoid traversing the mechanical valve without discontinuing anticoagulation, a Volcano fractional flow reserve pressure wire (Philips Volcano) was advanced for distal measurements of pressures and saturations.

Left Ventricular Filling Pressure in Chronic Thromboembolic Pulmonary Hypertension

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is characterized by obstruction of major pulmonary arteries with organized thrombi. Clinical risk factors for pulmonary hypertension due to left heart disease including metabolic syndrome, left-sided valvular heart disease, and ischemic heart disease are common in CTEPH patients. ObjectivesThe authors sought to investigate prevalence and prognostic implications of elevated left ventricular filling pressures (LVFP) in CTEPH. MethodsA total of 593 consecutive CTEPH patients undergoing a first diagnostic right and left heart catheterization were included in this study. Mean pulmonary arterial wedge pressure (mPAWP) and left ventricular end-diastolic pressure (LVEDP) were utilized for assessment of LVFP. Two cutoffs were applied to identify patients with elevated LVFP: 1) for the primary analysis mPAWP and/or LVEDP >15 mm Hg, as recommended by the current pulmonary hypertension guidelines; and 2) for the secondary analysis mPAWP and/or LVEDP >11 mm Hg, representing the upper limit of normal. Clinical and echocardiographic features, and long-term mortality were assessed. ResultsLVFP was >15 mm Hg in 63 (10.6%) and >11 mm Hg in 222 patients (37.4%). Univariable logistic regression analysis identified age, systemic hypertension, diabetes, atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume as significant predictors of elevated LVFP. Atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume remained independent determinants of LVFP in adjusted analysis. At follow-up, higher LVFPs were measured in patients who had meanwhile undergone pulmonary endarterectomy (P = 0.002). LVFP >15 mm Hg (P = 0.021) and >11 mm Hg (P = 0.006) were both associated with worse long-term survival. ConclusionsElevated LVFP is common, appears to be due to comorbid left heart disease, and predicts prognosis in CTEPH.

Abstract 15535: A Case of Suspected Menstruation Induced QTc Prolongation Leading to Torsades De Pointes

Estrogen is known to produce changes in cardiac electrophysiology specifically in premenopausal women, increasing the risk of arrhythmias. We report a case of Torsades de Pointes (TdP) in a young premenopausal female. A 25-year-old female with a history of anxiety presented to the emergency room (ED) with several days of vomiting. While in the ED, she had an unwitnessed syncopal event, and was found to be in pulseless ventricular fibrillation (V-Fib) . She required one defibrillation to obtain return of spontaneous circulation (ROSC). Initial work up showed calcium 7.6 mg/dl, phosphorous 1.1 mg/dl, magnesium 2.4 mg/dl, potassium 4.0 mg/dl. Remainder of electrolytes were normal. Toxicology screen was positive for cannabinoids. Post ROSC EKG showed sinus tachycardia at a rate of 103bpm with a prolonged QTc of 531ms. Patient was not on any medications outpatient. On further discussion, patient reported no prior history of syncopal episodes, palpitations, and denied any family history of sudden cardiac death. She did report she was presently on her menses. Shortly after admission, she had recurrent polymorphic ventricular tachycardia which degenerated to TdP. She was loaded with magnesium. Echocardiogram showed an ejection fraction (EF) of 35-39% and global hypokinesis. Diagnostic left heart catheterization was performed revealing clean coronaries. Cardiac MRI revealed EF of 43% without any late gadolinium enhancement. Her QTc remained prolonged even with electrolyte normalization. She underwent successful ICD placement and remained event free during the remainder of the hospital course. She will undergo genetic work up for long QT syndrome. Female sex hormones, specifically estrogen, have been described in literature as pro-arrhythmic given its effects on QT prolongation and ion gated channels. Prior cases of menstruation dependent arrhythmias have speculated that the abrupt reduction in estradiol prior to menstruation is associated with increased cyclic adenosine monophosphate dependent arrhythmogenicity. This case highlights the multifactorial etiology of sudden V-Fib arrest in a young female, and the importance of understanding the role that sex hormones play in the underlying pathogenesis.

Abstract 14633: A Case of Acute Coronary Syndrome With Incidental Acquired Factor VIII Deficiency With Inhibitor Present: How to Navigate Being Between a “Rock” and a Bleeding Disorder

Introduction: Acute coronary syndrome (ACS) occurring in the presence of a bleeding diathesis can make clinical decision-making difficult. We present a case of a non-ST elevation MI in the presence of an acquired factor VIII deficiency with an inhibitor present. Case: A 66-year-old male with a medical history significant for coronary artery disease and COPD presented with a 4-day history of persistent, profuse bleeding after attaining a laceration on his arm. Shortly after admission, he reported pressure-like chest pain relieved by sublingual nitroglycerin. His 5th generation troponin level was 61 ng/L on presentation and peaked at 600 ng/L 36 hours later. The EKG revealed ST depressions in leads V3 and V4 and T-wave flattening in leads V5 and V6. Transthoracic echocardiography revealed preserved ejection fraction but could not exclude wall motion abnormalities due to poor windows. Hematology was consulted due to uncontrolled bleeding, and the patient was diagnosed with acquired factor VIII deficiency with an inhibitor present. Low-dose heparin infusion was initiated. He was taken for a diagnostic left heart catheterization, which revealed left main with moderate obstruction, left anterior descending (LAD) with 70% proximal stenosis, and a small diagonal branch with 90% stenosis. The patient had been previously offered evaluation for coronary artery bypass graft(CABG) surgery but declined. CABG work up was ultimately deferred in favor of percutaneous coronary intervention based on literature review extrapolated from hemophiliac patients. The patient’s hematologic care is ongoing with recombinant antihemophilic factor, porcine sequence, prednisone, cyclophosphamide, and rituximab administration. Discussion: Choosing the type of coronary revascularization in coagulopathic patients poses a significant challenge. To avoid complications, a multidisciplinary approach to short- and long-term anticoagulation management is necessary. In this case we decided to use existing data that is based on hemophilia patients in the past with myocardial infarction where dual antiplatelet therapy is limited to 1 month with factor 8 activity maintained above 30%. Then transition to aspirin alone for maintenance with factor 8 levels maintained above 10%.

Chronic thromboembolic pulmonary hypertension and left ventricular filling pressures

Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic obstruction of major pulmonary arteries with organized thrombi and is classified as pre-capillary pulmonary hypertension (PH) by the current hemodynamic definition of the guidelines. However, clinical risk factors for PH due to left heart disease including features of the metabolic syndrome, left-sided valvular heart disease and stable ischemic heart disease can be frequently observed in patients with CTEPH. The aim of this study was to investigate the prevalence, mechanisms and prognostic implications of elevated left ventricular filling pressures (LVFP) in patients with CTEPH. Methods 394 consecutive CTEPH patients undergoing a first diagnostic right and left heart catheterization were included in this study. mPAWP and LVEDP were utilized for assessment of LVFP. Two cutoffs were applied to identify patients with elevated LVFP: (1) mPAWP and/or LVEDP &amp;gt;15 mmHg as recommended by the current PH guidelines and (2) mPAWP and/or LVEDP &amp;gt;11 mmHg, which is the upper limit of normal in healthy subjects. Clinical and echocardiographic features as well as long-term mortality data were assessed. Results LVFP was &amp;gt;15 mmHg in 41 (10.4%) and &amp;gt;11 mmHg in 155 patients (39.3%). Univariable logistic regression analysis identified age, body mass index, systemic hypertension, diabetes, atrial fibrillation, mitral regurgitation and left atrial volume as significant clinical predictors of elevated LVFP. Systemic hypertension, atrial fibrillation, mitral regurgitation and left atrial volume remained independent determinants of LVFP in adjusted analysis. LVFP &amp;gt;11 mmHg was associated with worse long-term survival (p-logrank = 0.020). Conclusions Elevated LVFP is common in patients with CTEPH at the time of diagnosis. Elevated LVFP in CTEPH appears to be due to comorbid left heart disease. CTEPH patients with LVFP &amp;gt;11 mmHg have worse outcomes. Funding Acknowledgement Type of funding sources: None.

The Self Sabotaging Vessel: A Case Report and Literature Review of Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndrome. Despite the recent advances in the management of cardiovascular diseases, the diagnoses and management of SCAD remain a dilemma. It has been described to majorly affect females of childbearing age, immediately post-partum or on oral contraceptives. Recent cases have also identified underlying connective tissue disease as a risk factor. Since its discovery, only a limited number of cases affecting males have been reported in the literature. This makes our case unique. In this, we present a 31-year-old male without any traditional risk factors who presented with atypical chest pain. Electrocardiogram showed ST-segment changes with echocardiogram revealing apical left ventricular akinesis. A diagnostic left heart catheterization showed multiple lumens in the distal left anterior descending artery (LAD). The patient was managed conservatively and discharged home on guideline-directed medical therapy.

Abstract 12399: Don’t Burst My Blood: Ticagrelor Induced Thrombotic Thrombocytopenic Purpura

Background: Dual antiplatelet therapy, a fundamental component of the treatment of acute coronary syndromes (ACS), increases bleeding risk. Patients with thrombocytopenia and ACS are difficult to manage as thrombocytopenia increases the risk both of bleeding and ischemic events. Case: A 47 year old male with a medical history most significant for coronary artery disease (requiring multiple stents) and stroke who presented with chest pain and was found to have a NSTEMI. Notably, the patient stopped his ticagrelor six weeks prior to presentation. The initial CBC demonstrated clumped platelets. The patient was loaded with aspirin and ticagrelor, placed on a heparin drip and admitted. Decision Making: Exam on the morning after presentation demonstrated jaundice as well as petechiae on the patient’s extremities. He then exhibited altered mental status concerning for a seizure. Repeat labs demonstrated new severe thrombocytopenia, confirmed on a dedicated platelet count, anemia and indirect hyperbilirubinemia. A peripheral smear did not demonstrate schistocytes; however, the PLASMIC score indicated a high risk of thrombotic thrombocytopenic purpura (TTP) and he was started on plasmapheresis and steroids. His ADAMTS13 activity level returned low, confirming TTP. Common causes of TTP were excluded and Ticagrelor was deemed responsible. With continued plasmapheresis and steroids, his platelets normalized. A diagnostic left heart catheterization demonstrated patent prior stents as well as a 90% mid circumflex lesion. The patient was discharged on aspirin and rivaroxaban per the COMPASS trial, and was advised to avoid further P2Y12 inhibitors. Conclusion: This case demonstrated ticagrelor induced TTP, which has been infrequently reported in the literature. The patient was likely previously sensitized to ticagrelor and then developed TTP when he was loaded on presentation. It also demonstrates the importance of not ignoring clumped platelets and obtaining a true platelet count prior to starting triple therapy. In normal circumstances, his circumflex lesion would likely have been intervened upon; however, the patient’s intolerance of P2Y12 inhibitors limited management options during this presentation and will likely limit future interventions.

A case report: percutaneous management of high-output heart failure from iatrogenic aortocoronary venous grafting to the coronary sinus

BackgroundAortocoronary arteriovenous fistula (ACAVF) due to iatrogenic bypass grafting to a cardiac vein is an exceedingly rare complication resulting from coronary artery bypass grafting (CABG) surgery. If not identified in a timely fashion, ACAVF has known significant clinical consequences related to left to right shunting and possible residual myocardial ischemia.Case presentationAn 82-year-old male with a history of CABG, presented with dyspnea. Over the span of 2 years following CABG, the patient experienced progressive exertional dyspnea and peripheral edema. The patient was found to have a new cardiomyopathy with a severely reduced ejection fraction at 30–35%. The patient underwent diagnostic left heart catheterization, and an ACAVF was discovered between a saphenous vein graft and the coronary sinus. The patient underwent successful percutaneous coiling of the ACAVF with no residual flow. Follow-up echocardiography at 3 months revealed restoration of left ventricular systolic function to 50% and significant improvement in heart failure symptoms.ConclusionsACAVF is an exceedingly rare iatrogenic complication of CABG that may result in residual ischemia from the non-grafted myocardial territory and other sequelae relating to left to right shunting and a high-output state. Management for this pathology includes but is not limited to the use of percutaneous coiling, implantation of covered stents, graft removal and regrafting, and ligation.

Severe myocardial ischemia in a patient with diabetes mellitus and left bundle branch block

We present the case of a 69-year-old woman with diabetes mellitus, left bundle branch block, and obesity who develops cardiogenic shock after undergoing myocardial perfusion imaging and diagnostic left heart catheterization, but prior to coronary revascularization. This case highlights the risk of cardiac decompensation awaiting surgery in patients with multivessel coronary artery disease. It also emphasizes the subtleties involved in imaging patients with diabetes mellitus and left bundle branch block, as well as the risk of developing complete heart block in the setting of ischemia with underlying conduction disease.

Invasive cardiovascular magnetic resonance (iCMR) for diagnostic right and left heart catheterization using an MR-conditional guidewire and passive visualization in congenital heart disease

BackgroundToday’s standard of care, in the congenital heart disease (CHD) population, involves performing cardiac catheterization under x-ray fluoroscopy and cardiac magnetic resonance (CMR) imaging separately. The unique ability of CMR to provide real-time functional imaging in multiple views without ionizing radiation exposure has the potential to be a powerful tool for diagnostic and interventional procedures. Limiting fluoroscopic radiation exposure remains a challenge for pediatric interventional cardiologists.This pilot study’s objective is to establish feasibility of right (RHC) and left heart catheterization (LHC) during invasive CMR (iCMR) procedures at our institution in the CHD population. Furthermore, we aim to improve simultaneous visualization of the catheter balloon tip, MR-conditional guidewire, and cardiac/vessel anatomy during iCMR procedures.MethodsSubjects with CHD were enrolled in a pilot study for iCMR procedures at 1.5 T with an MR-conditional guidewire. The CMR area is located adjacent to a standard catheterization laboratory. Using the interactive scanning mode for real-time control of the imaging location, a dilute gadolinium-filled balloon-tip catheter was used in combination with an MR-conditional guidewire to obtain cardiac saturations and hemodynamics. A recently developed catheter tracking technique using a real-time single-shot balanced steady-state free precession (bSSFP), flip angle (FA) 35–45°, echo time (TE) 1.3 ms, repetition time (TR) 2.7 ms, 40° partial saturation (pSAT) pre-pulse was used to visualize the gadolinium-filled balloon, MR-conditional guidewire, and cardiac structures simultaneously. MR-conditional guidewire visualization was enabled due to susceptibility artifact created by distal markers. Pre-clinical phantom testing was performed to determine the optimum imaging FA-pSAT combination.ResultsThe iCMR procedure was successfully performed to completion in 31/34 (91%) subjects between August 1st, 2017 to December 13th, 2018. Median age and weight were 7.7 years and 25.2 kg (range: 3 months – 33 years and 8 – 80 kg). Twenty-one subjects had single ventricle (SV) anatomy: one subject was referred for pre-Glenn evaluation, 11 were pre-Fontan evaluations and 9 post-Fontan evaluations for protein losing enteropathy (PLE) and/or cyanosis. Thirteen subjects had bi-ventricular (BiV) anatomy, 4 were referred for coarctation of the aorta (CoA) evaluations, 3 underwent vaso-reactivity testing with inhaled nitric oxide, 3 investigated RV volume dimensions, two underwent branch PA stenosis evaluation, and the remaining subject was status post heart transplant. No catheter related complications were encountered. Average time taken for first pass RHC, LHC/aortic pull back, and to cross the Fontan fenestration was 5.2, 3.0, and 6.5 min, respectively. Total success rate to obtain required data points to complete Fick principle calculations for all patients was 331/337 (98%). Subjects were transferred to the x-ray fluoroscopy lab if further intervention was required including Fontan fenestration device closure, balloon angioplasty of pulmonary arteries/conduits, CoA stenting, and/or coiling of aortopulmonary (AP) collaterals.Starting with subject #10, an MR-conditional guidewire was used in all subsequent subjects (15 SV and 10 BiV) with a success rate of 96% (24/25). Real-time CMR-guided RHC (25/25 subjects, 100%), retrograde and prograde LHC/aortic pull back (24/25 subjects, 96%), CoA crossing (3/4 subjects, 75%) and Fontan fenestration test occlusion (2/3 subjects, 67%) were successfully performed in the majority of subjects when an MR-conditional guidewire was utilized.ConclusionFeasibility for detailed diagnostic RHC, LHC, and Fontan fenestration test occlusion iCMR procedures in SV and BiV pediatric subjects with complex CHD is demonstrated with the aid of an MR-conditional guidewire. A novel real-time pSAT GRE sequence with optimized FA-pSAT angle has facilitated simultaneous visualization of the catheter balloon tip, MR-conditional guidewire, and cardiac/vessel anatomy during iCMR procedures.

Safety and Risk of Major Complications With Diagnostic Cardiac Catheterization.

We aim to study the incidence of major complications related to procedure defined as in-hospital death, myocardial infarction, stroke, pericardial effusion or tamponade, percutaneous coronary intervention due to iatrogenic coronary dissection, or unplanned bypass surgery within 72 hours after diagnostic left heart catheterization (LHC; primary end point). Furthermore, all causes of in-hospital death after LHC were adjudicated and reported (secondary end point). Diagnostic LHC procedures (aortic angiography; coronary, including graft, angiography; and left ventricular angiography) from January 1, 2002, through December 31, 2013, were identified using the clinical scheduling system at Mayo Clinic, Rochester, and complications were identified through electronic records. International Classification of Diseases, Ninth Revision billing codes were used. Registration was queried to identify all-cause mortality. All events were reviewed and adjudicated. There were 43 786 diagnostic LHC procedures; 97.3% were coronary angiograms. The mean age of patients was 64.5 years (13.6), and the majority were male (61.5%). Primary end point was seen in 36 (0.082%) procedures or 8.2 of 10 000 LHCs. Combined right sided procedures with LHC did not increase the risk of major complications. Cardiogenic and septic shock, cardiac arrhythmia, and postsurgical complication were the most common causes of in-hospital death after LHC. The overall rates of major complications related to diagnostic cardiac catheterization procedures are extremely rare. The majority of the deaths occurring post-diagnostic LHC procedures were secondary to acute illness rather than directly related to diagnostic procedure.

Natriuretic Peptide Processing in Patients with and Without Left Ventricular Dysfunction.

This study aimed to examine the relationship between corin expression and circulating brain natriuretic peptide in patients with left ventricular (LV) dysfunction.Circulating levels of B-type natriuretic peptide (BNP) can be an indicator of LV dysfunction. The 32-amino-acid BNP is cleaved by corin, a cardiac serine protease, from its108-amino-acid pro-brain natriuretic peptide (proBNP) precursor.This study included 25 patients with idiopathic dilated cardiomyopathy (DCMP) and LV dysfunction and 44 heart transplant recipients with normal LV function who underwent diagnostic left and right heart catheterization. Blood samples were used to determine the ratio of plasma proBNP/BNP levels, and LV endomyocardial biopsies were used to determine the expression of NPPB, which encode BNP and corin, respectively, by quantitative reverse transcription-polymerase chain reaction.Patients with DCMP revealed worse hemodynamic profiles and higher plasma proBNP and BNP levels than those of the transplant recipients. Myocardial NPPB expression was higher and CORIN expression was lower in the DCMP patients than in the transplant recipients. CORIN expression significantly correlated with NPPB expression (r = -0.585; P < 0.001), ejection fraction (EF; r = 0.694; P < 0.01), LV end-diastolic pressure (r = -0.373; P < 0.05), and indexed end-diastolic LV volume (r = -0.452; P < 0.001). In addition, the plasma proBNP/BNP levels inversely correlated with the CORIN expression (r = -0.362; P < 0.005).Decreased myocardial CORIN expression and the corresponding higher levels of circulating unprocessed proBNP in DCMP may partly account for the relative BNP resistance observed in patients with LV dysfunction.

Risk factors for degenerative aortic valve disease in India: A case control study

BackgroundDegenerative aortic valve disease often co-exists with coronary artery disease (CAD) and studies done in western populations have shown that it shares the same risk factors which cause CAD. However little is known in this context among Asian Indians. The current study looks into the risk factors of degenerative aortic valve disease in Asian Indian population. MethodsNinety-one consecutive patients with severe aortic stenosis (AS) reporting for left heart catheterization prior to valve replacement surgery at a tertiary care centre were recruited for the study. They were compared with age and sex matched controls selected from a database of 3200 patients referred for elective diagnostic left heart catheterization for suspected CAD. Following traditional cardiovascular risk factors were assessed in all patients: age, gender, family history of CAD, smoking history, presence of diabetes, hypertension and dyslipidemia. ResultsThe mean age of the study population was 57.8±8.2 years (range, 40–80 years). Smoking, family history of CAD and hypercholesterolemia were significantly more prevalent in patients with degenerative AS compared to those with normal valves. No significant difference was noted in the presence of diabetes mellitus. On multivariate logistic regression, family history of premature CAD (OR 3.68; CI 1.38–9.78) smoking history (OR, 2.56; CI, 1.21–5.39), and raised LDL levels (OR, 5.55; CI, 2.63–11.69) were independently associated with the aortic stenosis patient cohort. ConclusionsThe study showed a significant association of cardiovascular risk factors with aortic stenosis independent of age and gender in Asian Indian patients.

Measuring cardiac output in children undergoing cardiac catheterization: comparison between the Fick method and PRAM (pressure recording analytical method)

Pressure recording analytical method (PRAM) is a novel, arterial pulse contour method for measuring cardiac output (CO). Validation studies of PRAM in children are few, and have shown contradictory results. The aim of the study was to compare the MostCare® -PRAM vs the Fick method of cardiac output estimation (reference method). This is a single-center, prospective observational study in 52 pediatric patients who underwent diagnostic right and left heart catheterization. Cardiac index (CI) measurements with the MostCare® -PRAM vs the Fick method were obtained under hemodynamically stable conditions. Forty CI measurements were performed. The data showed good agreement between CIFick and CIPRAM : r2 = 0.90 (P < 0.001), mean bias -0.075, limits of agreement from -0.56 to 0.41. The percentage error was 17%. Comparable results were obtained for patients <20 kg (r2 = 0.87, P < 0.001), mean bias -0.135, limits of agreement from -0.35 to 0.62, percentage of error 17%. In pediatric patients undergoing diagnostic right and left heart catheterization, the MostCare® -PRAM was shown to estimate CI with a good level of agreement with the Fick method measurements.

Measurement of cardiac output in children: comparison between direct Fick method and pressure recording analytical method: preliminary report

There are few methods of cardiac output (CO) estimation validated in children. The aim of this study is to investigate the reliability of an uncalibrated pulse contour method of CO estimation, the pressure recording analytical method (PRAM), in pediatric patients scheduled for diagnostic right and left heart catheterization, compared with the oxygen-direct Fick method.

Pulmonary arterial systolic pressure and E/e’ in the evaluation of left ventricular filling pressure

Echocardiographic assessments including E/e' are a good predictor of elevated left ventricular (LV) filling pressure during sinus rhythm. However, the evaluation of LV filling pressure using classic echocardiographic assessment has been challenging in the setting of atrial fibrillation (AF). The aim of this study was to investigate the methods for predicting LV filling pressure in patients with chronic AF. Clinical data, echocardiography findings, and brain natriuretic peptide (BNP) levels were assessed in 59 patients with chronic AF who were undergoing diagnostic left-heart catheterization. LV end-diastolic filling pressure (LVEDP) and standard echocardiographic measurements including pulmonary arterial systolic pressure (PASP) were evaluated. Blood samples were taken for serum BNP measurements within 24 h of the echocardiographic examination. E/e' correlated well with LVEDP (r = 0.558, p < 0.001). Using receiver operating characteristic analysis, the optimal cut-off for E/e' was 16 (sensitivity, 64 %; specificity, 82 %) to predict LVEDP of > 15 mmHg. PASP was also well correlated with LVEDP (r = 0.503, p < 0.001). PASP greater than 32 mmHg predicted elevated LVEDP (> 15 mmHg) with a sensitivity of 64 % and a specificity of 71 %. E/e' and PASP were well correlated with LVEDP in patients with AF. PASP greater than 32 mmHg and E/e' greater than 16 may suggest elevated LVEDP (> 15 mmHg) in patients with chronic AF.

Electrical velocimetry for measuring cardiac output in children with congenital heart disease

The purpose of this study was to evaluate the agreement of cardiac output measurements obtained by electrical velocimetry (CO(EV)) and those that derived from the direct Fick-oxygen principle (CO(F)) in infants and children with congenital heart defects. Simultaneous measurements of CO(EV) and CO(F) were compared in 32 paediatric patients, aged 11 days to 17.8 yr, undergoing diagnostic right and left heart catheterization. For non-invasive measurements of cardiac output by electrical velocimetry, which is a variation of impedance cardiography, standard surface electrodes were applied to the left side of the neck and the left side of the thorax at the level of the xiphoid process. Cardiac output determined using direct Fick-oxygen principle was calculated by direct measurement of oxygen consumption (VO2) and invasive determination of the arterio-venous oxygen content difference. An excellent correlation (r=0.97) was found between CO(EV) and CO(F) (P<0.001). The slope of the regression equation [0.96 (SD 0.04)] was not significantly different from the line of identity. The bias between the two methods (CO(EV)-CO(F)) was 0.01 litre min(-1) and the limits of agreement, defined as the bias (2 SD), were -0.47 and +0.45 litre min(-1). CO(EV) demonstrates acceptable agreement with data derived from CO(F) in infants and children with congenital heart disease. The new technique is simple, completely non-invasive, and provides beat-to-beat estimation of CO.