Doppler Echocardiographic Data Research Articles

Pretransplant Left Ventricular Dysfunction Adversely Affects Perioperative Outcomes in Pediatric Liver Transplantation: A Retrospective Observational Study

BackgroundAlthough left ventricular diastolic dysfunction (LVDD) is a pronounced feature of adult cirrhotic cardiomyopathy and a major predictor of poor outcomes following liver transplantation (LT), little is known about if pretransplant cardiac dysfunction affects perioperative outcomes in pediatric LT. MethodsWe retrospectively evaluated pretransplant clinical and Doppler echocardiographic data for 45 consecutive pediatric LT recipients who were treated between 2007 and 2013 (median age = 15 months; interquartile range = 9 to 78 months). LVDD was defined according to the cirrhotic cardiomyopathy criteria, and the myocardial performance index (MPI) was measured using tissue Doppler imaging. Intraoperative data and hospitalization days following LT were compared. ResultsLVDD and MPI ≥0.5 (defined as a z score ≥2) were observed in 13% and 27% of patients, respectively. Patients with an MPI ≥0.5 demonstrated the increased accumulation of lactate at the end of their LT operation (mean = 2.48 vs 0.82; P = .026) compared with patients with an MPI <0.5. The hospital stay was longer in patients with LVDD (median = 46 days vs 30 days; P = .041) and patients with an MPI ≥0.5 (median = 38 days vs 29 days; P = .014) compared with patients without LVDD and MPI <0.5, respectively. ConclusionsLVDD might be less prevalent (13%) in pediatric patients compared with adults. However, pretransplant cardiac dysfunction in patients with LVDD and an MPI ≥0.5 adversely affects perioperative outcomes, necessitating that such pediatric LT recipients be cautiously observed perioperatively.

DIAGOSTICS OF FUNCTIONAL FETAL COMMUNICATION OF NEWBORN

Introduction. Open oval window and (or) patent ductus arteriosus (PDA) of infant continue to function in certain pathological conditions (persistent fetal communication). Diagnostic limit between persistent and physiologically fetal communications is uncertain. To determine the diagnostic and prognostic value of fetal circulation it is not always enough to use doppler echocardiography data. Fetal circulation is usually accompanied by cardiac murmurs. It is possible to increase the diagnostic abilities of functional fetal communications using computer analysis of heart sounds.Purpose. Diagnostics of functional fetal communications using computer analysis of heart sounds of newborn in comparison with doppler echocardiography at the age of 48-72 hours.Materials and methods. There were examined 44 full-term infants with gestational age from 37 to 42 weeks, were found functioning oval window, open PDA which using doppler echocardiography. Theу haven’t showed any acoustic phenomena during classical auscultation. To record heart sounds digital stethoscope Thinklabs Model ds32a +. Viewing, editing and post processing was performed in the program Thinklabs Phonocardiophy powered by Audacity.Results and discussion. 21 (47,0%) of newborn were diagnosed with an winking ductus (flow diameter - 1.1 mm to 6,0 mm), 3 infants (6.8%) had winking ductus with signs of hemo dynamically significant. Indicators of differential pulse oximetry were within 97-100%. Intermittent broadening of III-IV part of the first heart sound was in 15 (34%) infants (confidence interval 20,5-47,7), intermittent systolic murmur in 18 (40.9%) infants (confidence interval 27,3-54,5), intermittent diastolic murmur in 20 (45.4%) infants (confidence interval 31,8-59,1). Research of differences in the frequency of acoustic phenomena in groups of infants with the functioning oval window and oval window and arterial duct (calculation Fisher criterion) showed more registration of permanent systolic murmur, steady diastolic murmur, absence of splitting of the second sound by ultrasonic registration of functional arterial duct.Conclusions. Computer analysis of heart sounds significantly expands the diagnostic capabilities of the classic auscultation for the diagnosis of fetal functioning communications.Permanent systolic murmur, steady diastolic murmur, absence of splitting diastolic noise can be a sign of functioning ductus arteriosus.

Evolution and prognostic impact of low flow after transcatheter aortic valve replacement

ObjectiveLow flow (LF), defined as stroke volume index (SVi) <35 mL/m2, prior to the procedure has been recently identified as a powerful independent predictor of early and late mortality in...

Right ventricular geometry and mechanics in patients with obstructive sleep apnea living at high altitude.

Repetitive obstruction of larynx during sleep can lead to daytime pulmonary hypertension and alterations in right ventricular morphology and function in a small fraction of obstructive sleep apnea syndrome (OSAS) patients. Environmental effects, particularly high altitude, can modify the effects of OSAS on pulmonary circulation, since altitude-related hypoxia is related with pulmonary vasoconstriction. This potential interaction, however, was not investigated in previous studies. A total of 41 newly diagnosed OSAS patients were included in this study after pre-enrolment screening. Two-dimensional, three-dimensional, and Doppler echocardiographic data were collected after polysomnographic verification of OSAS. Three-dimensional echocardiograms were analyzed to calculate right ventricular volumes, volume indices, and ejection fraction. Systolic pulmonary artery pressure (38.35 ± 8.60 vs. 30.94 ± 6.47 mmHg; p = 0.002), pulmonary acceleration time (118.36 ± 16.36 vs. 103.13 ± 18.42 ms; p = 0.001), right ventricle (RV) end-diastolic volume index (48.15 ± 11.48 vs. 41.48 ± 6.45 ml; p = 0.009), and RV end-systolic volume index (26.50 ± 8.11 vs. 22.15 ± 3.85; p = 0.01) were significantly higher in OSAS patients, with similar RV ejection fraction (EF) between groups. No significant differences were noted in other two-dimensional, Doppler or speckle-tracking strain, measurements. Both RVEF and pulmonary acceleration time were predictors of disease severity. A greater degree of RV structural remodeling and higher systolic pulmonary pressure were observed in OSAS patients living at high altitude compared to healthy highlanders. The reversibility of these alterations with treatment remains to be studied.

Altered Spatial Distribution of the Diastolic Left Ventricular Pressure Difference in Heart Failure

The left ventricle fills in early diastole because of a progressive intraventricular pressure difference (IVPD) that extends from the left atrium to the left ventricular (LV). The aim of this study was to test the hypothesis that in patients with symptomatic heart failure (HF) regardless of LV ejection fraction (EF), an increase in left atrial (LA) pressure maintains early diastolic filling because of a preserved IVPD from the left atrium to the mid left ventricle, while the IVPD from the mid left ventricle to the apex is diminished because of reduced LV suction. One hundred fifty-one patients with HF (50 with HF with preserved EF [HFpEF; EF ≥ 50%] and 101 with HF with reduced EF [HFrEF; EF < 50%]) and 28 normal controls were prospectively enrolled. The IVPDs from the left atrium to the LV apex (total IVPD), the left atrium to the mid left ventricle (basilar IVPD), and the mid left ventricle to the apex (apical IVPD) were determined using color M-mode Doppler echocardiographic data to integrate the Euler equation. The propagation of early diastolic filling was also assessed by color M-mode Doppler. The mean LV EF was 0.63±0.07 in patients with HFpEF, 0.32±0.09 in those with HFrEF, and 0.64±0.06 in controls. Peak early diastolic transmitral flow velocities (E) were similar among the groups, and basilar IVPDs were maintained in the HFpEF and HFrEF groups (HFpEF, 1.59±0.62mm Hg; HFrEF, 1.49±0.75mm Hg; controls, 1.80±0.61mm Hg; P= NS, analysis of variance). However, apical IVPDs were decreased in both HF groups (HFpEF, 1.18±0.56mm Hg [P<.01 vs controls]; HFrEF, 0.87±0.48mm Hg [P<.01 vs controls]; controls, 1.65±0.62mm Hg), resulting in decreased total IVPDs in patients with HF (HFpEF, 2.55±0.80mm Hg [P<.01 vs controls]; HFrEF, 2.16±0.80mm Hg [P<.01 vs controls]; controls, 3.17±0.91mm Hg). E/e' ratios were increased in patients with HF, consistent with elevated LA pressure. In patients with HF, E was correlated with basilar IVPD but not with apical IVPD, whereas propagation of the filling was correlated with the apical IVPD but not with the basilar IVPD. In patients with HFpEF and those with HFrEF, apical IVPDs were reduced while basilar IVPDs were maintained by elevated LA pressure, resulting in preserved E.

Do we understand cardiovascular issues in children and adolescents with metabolic syndrome?

REFER TO THE PAGE 10-19 The cardiovascular functional assessment with metabolic syndrome has been reported with many aspects in adult patients. On the contrary, in children and adolescents patients, the metabolic syndrome and other combined issues have not been much investigated. In general, the concept of metabolic syndrome has not been often implicated in pediatric age group, yet. Instead, specific metabolic disease could be diagnosed in case of metabolic pathway problem. However, recently, the importance to inspect metabolic issues including obesity has been emphasized in children and adolescents.1),2),3),4) The potential cardiovascular functional alteration might be the high priority to be considered for these patients, especially for their healthy growth and development.5),6),7),8) For detail evaluation of cardiac function, conventional echocardiographic measurement, tissue Doppler echocardiographic data and strain imaging should be assessed with regional myocardial analysis.9),10) In children and adolescents, their standard values have been established according to their age and body surface area, the measurement data with metabolic syndrome could be compared. In this study, relative ventricular systolic and diastolic functional decrement was noticed in metabolic syndrome group compared to the control group, which is similar to the previous published studies in adults.11) The tissue Doppler echocardiographic E' velocity demonstrated negative correlation with body mass index (BMI), fat %, fat mass, significant positive correlation with high-density lipoprotein-cholesterol. Significant correlation was observed at global longitudinal strain with insulin, homeostasis model of assessment for insulin resistance index and triglyceride, global circumferential strain with weight, waist circumference, fat mass, BMI, and fat %, left ventricular mass with alanine aminotransferase and glupcose. However, the study individuals are just between 14 to 15 years old without specific symptom, their echocardiographic measurements and laboratory data are continued to change with growth. If the yearly follow-up data will be acquired, we would better interpret the characteristics with metabolic pathway issues in this challenging period. Moreover, all the other categories of metabolic syndrome, such as dyslipidemia, diabetes, micro-vascular or macro-vascular disease, mitochondrial disease, should be respectively clarified with the children's growth.1),2),3) Meanwhile, the interesting point of these results is quite parallel to the reports in adult metabolic syndrome patients. Even though, the myocardial function has been preserved within normal range, it would be vulnerable with progress of the underlying metabolic pathway issues. Nevertheless, the growing children and adolescents have much various unique factors for their metabolism rather than grown-up adults, the pattern of cardiovascular characteristics revealed comparable with some metabolic deterioration. According to the results of this study, left ventricular mass index, strain and strain rate are practical values for assessment of ventricular function in children and adolescents metabolic syndrome. These parameters should be recommended to measure for the routine echocardiographic examination in these patients group, so that we might predict their subtle cardiovascular functional alteration over time.

Abstract 14928: Adverse Outcomes Following Transcatheter Aortic Valve Replacement (TAVR) in Patients with Low Flow-Low Gradient (LFLG) Aortic Stenosis (AS)

Introduction: LFLG severe AS (stroke volume index &lt;35 mL/m2 or cardiac index &lt;3.0 L/min/m2 and transvalvular aortic gradient &lt;40 mmHg) is associated with worse clinical outcomes following surgical aortic valve replacement. However, there is paucity of data regarding impact of low left ventricular flow and transvalvular gradient on outcomes following TAVR. We evaluated the impact of baseline LFLG on outcomes following TAVR in patients with severe AS at our institution. Hypothesis: Patients with LFLG severe AS undergoing TAVR will have a higher rate of adverse clinical outcomes. Methods: In a retrospective single center registry, we analyzed the clinical, 2D doppler-echocardiographic and outcome data in consecutive patients who underwent TAVR with the Edwards Sapien transcatheter aortic valve for symptomatic severe AS at our tertiary care hospital from March 2012 to April 2014. Patients with LFLG were compared to non-LFLG patients. Background medical data, clinical endpoints (defined by the Valve Academic Research Consortium-2), length of stay (LOS), readmissions and mortality, were compared between the two groups. Wilcoxon rank-sum and Fisher’s exact tests were used to evaluate the hypothesis. Results: LFLG was found in 66 (32%) out of 206 patients. Baseline characteristics were comparable between the LFLG and non-LFLG group, except significant difference in STS scores (12.1±8 vs. 9.9±8, p=0.011), prior aortic valve surgery (16.7% vs. 6.4%, p=0.041) and atrial fibrillation/flutter (57.6% vs. 29.3% (p&lt;0.001). Overall, peri-procedural complications were similar between both groups, however, LFLG patients required: longer ICU monitoring (113.8±175 vs. 67.3±97 hours, p=0.01), longer hospital LOS (14.2±11.7 vs. 10.5±7.7 days, p=0.032). These patients had a non-significant trend toward 30 day mortality (7.6 vs. 4.3%, p=0.335) but a significantly higher 1-year all-cause mortality (19.7% vs. 9.3% p=0.044). Conclusions: LFLG patients had higher co-morbidities but comparable peri-procedural complications and short-term mortality. However this group was associated with longer hospitalizations and higher 1-year all-cause-mortality following TAVR. Further studies are needed to fully define outcomes in LFLG patients.

Heterogeneity of ventricular repolarization in newborns with intrauterine growth restriction

BackgroundIntrauterine growth restriction (IUGR) is associated with structural and functional cardiac alterations but the electrophysiological consequences of these disturbances remain unknown. AimsTo explore the distribution of ventricular repolarization and its relation to myocardial mechanics in newborns with IUGR. Study design, subjects and outcome measurementsConventional and tissue Doppler echocardiographic data, and electrocardiographic parameters used to describe the distribution of ventricular repolarization (dispersion of QT [QTd] and JT [JTd]), were obtained on the second (D2) and fifth (D5) postnatal day and compared between 25 IUGR newborns and 25 matched-for-gestational age controls. ResultsIUGR was associated with relative interventricular septum hypertrophy, increased left ventricular (LV) E/E′ ratio and higher LV myocardial performance index (MPI). On both study days, the IUGR infants presented higher QTd and JTd compared to controls (QTd-D2: 66±20ms vs. 36±12ms, P<0.001; JTd-D2: 54±13ms vs. 34±9ms, P<0.001; QTd-D5: 61±14ms vs. 27±12ms, P<0.001; JTd-D5: 54±13ms vs. 27±9ms, P<0.001). The association between QTd and LV E/E′ (D2: regression coefficient beta 0.747, R2 0.585; D5: beta 0.843, R2 0.646) and QTd and MPI (D2: beta 0.680, R2 0.576; D5: beta 0.698, R2 0.650) was also significant (P<0.001 for all analyses). ConclusionsOur findings suggest that IUGR is associated with electrophysiological remodeling of the neonatal heart, a process which is closely related to the underlying alterations in ventricular mechanics and might predispose to adverse electrophysiological events.

Comparison of Doppler echocardiographic and tissue Doppler velocity data in beta-thalassaemia major with high and normal NT-proBNP levels of children in the south-east region of Turkey.

It has been reported that N-terminal pro-brain natriuretic peptide (NT-proBNP) is early biomarker of iron- induced cardiomyopathy in β-thalassemia major (β-TM). In this study, we aimed to assess the Doppler echocardiographic, tissue Doppler velocity datas and clinical characteristics in β-TM patients with high and normal NT-proBNP levels who have normal systolic function. Fifty-eight β-TM patients who were on regular transfusion in every 3-4 weeks for more than one year and 20 healthy children were included into the study. According to NT-proBNP levels, β-TM patients are divided in two groups. Group I: the patients with high NT-proBNP levels; Group II: the patients with normal NT-proBNP levels. The mean serum NT-proBNP levels were significantly increased in patients with β-TM compared to control group (P<0.05). The serum ferritin levels were ranged between 676-9,476 ng/mL (mean: 3,716±2,003 ng/mL) in β-TM. No correlation was found between ferritin and NT-pro BNP in patients with β-TM. The mean age and body surface area (BSA) were significantly low in group with high NT-proBNP compared to group with normal NT-proBNP (P<0.01). The mean heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were elevated, but not significantly in group with high NT-proBNP. Also, the mean ferritin and hemoglobin levels were decreased in this group compared to group with normal NT-proBNP, but statistically not significant. The left ventricular end diastole (LVED) diameters and left ventricular mass index (LVMI) values were found significantly decreased in group with high NT-proBNP compared to other group respectively (P<0.001, P<0,05). Right ventricular early diastolic tricuspid inflow velocity/early diastolic tissue Doppler indices (TDI) tricuspid annular velocity (RV E/E') were found increased in group with high NT-proBNP levels and difference was statistically significant (P<0.05). In addition, NT-pro BNP was found correlated with RV E/E' (r: 0.320). According to our result, elevated NT-proBNP level was correlated with RVE/E', but it was not associated with ferritin level. The serum NT-proBNP level may be increased as a response to increased myocardial workload and decreased hemoglobin level in patients who have an increased need for transfusion.

Right ventricular function in late-onset Pompe disease

Pompe's disease is a glycogen storage disease (type II) characterized by inherited autosomal recessive transmission. The right ventricular (RV) function is a determinant parameter of clinical outcome in patients with heart failure. We sought to characterize the RV function using Doppler-echocardiography completed by Doppler tissular imaging and tricuspid annular plane systolic excursion (TAPSE) measurement. We analyzed retrospectively clinical and Doppler-echocardiographic data of patients with adult late onset Pompe disease and compared to a control group. Ten patients with late onset Pompe disease were included in our study and were compared to a control group (seven patients). Mean age was 56.7± 10.2years in late onset Pompe disease versus 55±21years in control group (p =0.65). Left ventricular ejection fraction (LVEF) was similar in the two groups (LVEF 63.7± 9 vs 63.7± 6.6% in control group p =0.99). LV end diastolic diameter was 40.8±6mm in Pompe disease versus 45.8±6mm in control group (p =0.11). Mean TAPSE was similar in the two groups (25.6±6.2 vs 21.5 ±2.7mm p=0.23). Mean peak systolic RV velocity Sm was not significantly different in the two groups (17.11±3.4cm/s in Pompe disease vs 16.14±3.8cm/s in control group p=0.61). Mean peak early diastolic Ea velocity in the RV were not significantly different in the two groups (15.6±5.6 vs 18.2±4.9cm/s p=0.34). According to our data, RV systolic function seems preserved in late-onset Pompe disease.

Impact of hypertension and renin–angiotensin system inhibitors in aortic stenosis

Experimental studies revealed that renin-angiotensin system (RAS) could play a crucial role in the pathophysiology of aortic stenosis (AS). The objectives of this study were to examine (i) the impact of hypertension on AS progression and clinical events and (ii) the effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs). In this observational study, we retrospectively analysed clinical and Doppler echocardiographic data prospectively collected in 338 patients with AS. Patients were separated into four groups: patients without hypertension and not treated by RAS medication (Ctrl group), patients with hypertension but not treated by RAS medication (HTN group), patients treated with ACEIs, and patients treated with ARBs. AS progression rate was assessed by the annualized increase in peak aortic jet velocity. Compared with Ctrl group, patients in HTN group had faster stenosis progression (P=0·01). Patients on ARBs had slower AS progression compared with Ctrl (trend P=0·10) and HTN (P=0·002) groups, whereas patients on ACEIs had similar progression rate compared with Ctrl group (P=NS) but lower compared with HTN group (P=0·02). On multivariable analysis, compared with Ctrl group, HTN group was associated with faster AS progression rate (P=0·002), whereas ARBs with slower progression (P=0·0008). During a mean follow-up of 6·2±2·4years, HTN (hazard ratio [HR]=2·45; P=0·006) and ACEI (HR=2·30; P=0·01) groups were associated with a significant increase in all-cause mortality compared with Ctrl group, whereas ARB group (HR: 0·89; P=0·80) not. In multivariable analysis, HTN and ACEI groups remained associated with increased mortality. Hypertension is associated with significantly faster stenosis progression and higher incidence of clinical events in patients with AS. ARBs but not ACEs were found to abolish the increased risk of mortality associated with hypertension.

Resting level of plasma brain natriuretic peptide and response to exercise as predictors of outcomes in asymptomatic patients with aortic stenosis

Purpose: Exercise stress echocardiography is useful in the management and risk stratification of patients with asymptomatic aortic stenosis (AS). Resting brain natriuretic peptides (BNP) level is associated with increased risk of adverse events in AS patients. The incremental prognostic value of BNP response during exercise is unknown. The objectives of this study were to assess the correlates of the plasma level of BNP during exercise as well as its usefulness to predict outcomes in asymptomatic patients with AS. Methods: Resting and exercise Doppler-echocardiographic data and BNP levels were prospectively collected in 211 asymptomatic AS patients in 2 centers. Results: Plasma BNP level increased significantly from rest to exercise (65±86 to 91±111 pg/mL, p<0.0001). The factors independently related to peak-exercise BNP were systemic arterial compliance (SAC: β=-0.76±0.32, p=0.02), resting mean gradient (MG: β=0.01±0.005, p=0.04), and change in stroke volume index (SVi) during exercise (β=0.01±0.005, p=0.02). During a mean follow-up of 1.8±1.3 years, 7 patients died and 97 underwent AVR motivated by development of symptoms or LV dysfunction. Higher peak-exercise BNP level was associated with higher occurrence of adverse events (2-yrs event-free survival according to tertiles of peak-exercise BNP: T1: 84±5% vs. T2: 60±7% vs. T3: 29±6%, p<0.0001). Stenosis was slightly more severe in T2 and T3 compared to T1 (MG: 43±15 and 43±16 vs. 37±13 mmHg, respectively; p=0.03). In multivariable analysis, after adjustment for age, gender, hypertension, MG, and valvulo-arterial impedance, T2 (HR=2.3; 95% CI: 1.3-4.3; p=0.005) and T3 (HR=5.3; 95% CI: 3.0-9.6; p<0.0001) tertiles of peak-exercise BNP were powerful independent predictors of events. Further adjustment for resting BNP, exercise-induced increase in MG and SVi led to similar results (T2: HR=2.2; 95% CI: 1.2-4.2; p=0.007; and T3: HR=4.8; 95% CI: 2.5-9.3; p<0.0001). The association between highest tertiles of peak-exercise BNP and outcomes remained highly significant (p<0.0001) in both subsets of patients with low or high resting BNP (i.e. ≤ or >43 pg/mL; median value). Conclusion: This study reports that, in asymptomatic patients with AS, peak-exercise BNP level provides important incremental prognostic value beyond what is achieved by demographic and echocardiographic data, as well as resting BNP level. These findings lend support to the measurement of BNP during exercise to enhance risk stratification in asymptomatic AS.

Topology of Blood Transport in the Human Left Ventricle by Novel Processing of Doppler Echocardiography

Novel processing of Doppler-echocardiography data was used to study blood transport in the left ventricle (LV) of six patients with dilated cardiomyopathy and six healthy volunteers. Bi-directional velocity field maps in the apical long axis of the LV were reconstructed from color-Doppler echocardiography. Resulting velocity field data were used to perform trajectory-based computation of Lagrangian coherent structures (LCS). LCS were shown to reveal the boundaries of blood injected and ejected from the heart over multiple beats. This enabled qualitative and quantitative assessments of blood transport patterns and residence times in the LV. Quantitative assessments of stasis in the LV are reported, as well as characterization of LV vortex formations from E-wave and A-wave filling.

The Impact of Low Level of High Density Lipoprotein Cholesterol on Adverse Clinical Outcomes in Patients with Mild to Moderate Aortic Stenosis

The American Journal of Cardiology APRIL 23e26, 2013 AN lipoprotein cholesterol (HDL) is associated with atherosclerosis and known to be a risk factor of cardiovascular disease. However, there have been limited data whether the impact of low HDL on echocardiographic characteristics in patients (pts) with mild to moderate AS. Methods: A total of 241 consecutive pts with mild to moderate AS were enrolled between January 2004 and May 2010. The pts were divided into two groups according to HDL level: Low HDL group (HDL-C<40mg/dl in male and HDL-C < 50mg/dl in female, n1⁄4 408) and control group (n1⁄4391). Baseline clinical and echocardiographic characteristics were compared between two groups. Results: Baseline clinical characteristics were similar between two groups. Echocardiographic data in M-mode and 2D image showed that left ventricle end systolic diameter (LVESD, 29.4 4.5 vs 29.5 3.7, pvalue 1⁄40.006), left ventricle end diastolic diameter (LEDD, 48.2 4.3 vs 45.2 4.4, p-value <0.001), and left ventricle mass index (LVMI, 119.8 30.0 vs 118.2 24.0, p-value 1⁄40.037) were higher in Low HDL group. Doppler echocardiographic data showed that E’ were lower in Low HDL group (0.04 0.01vs 0.05 0.01, p-value 1⁄40.002). However, ejection fraction, left atrium diameter, aortic valve peak velocity and mean pressure gradient were similar between two groups. Pearson correlation analysis by showed that low HDL was not correlated with LVESD (p1⁄40.410), LVEDD (p1⁄40.267), and LVMI (p1⁄40.327). But, low HDL was correlated with aortic valve peak velocity (p1⁄40.024). Conclusion: In this study, Low HDL is associated with LVEDD, LVESD, and LVMI. And low HDL was correlated with aortic valve peak velocity (p1⁄40.024).

Comparison of Hemodynamic Performance of Self-Expandable CoreValve Versus Balloon-Expandable Edwards SAPIEN Aortic Valves Inserted by Catheter for Aortic Stenosis

Transcatheter aortic valve implantation with the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN (ES) bioprostheses has been widely used for the treatment of severe aortic stenosis. However, a direct comparison of the hemodynamic results associated with these 2 prostheses is lacking. The aim of the present study was to compare the hemodynamic performance of both bioprostheses. A total of 41 patients who underwent transcatheter aortic valve implantation with the CV prosthesis were matched 1:1 for prosthesis size (26 mm), aortic annulus size, left ventricular ejection fraction, body surface area, and body mass index with patients who underwent transcatheter aortic valve implantation with the ES prosthesis. Doppler-echocardiographic data were prospectively collected before the intervention and at hospital discharge, and all examinations were sent to, and analyzed in, a central echocardiography core laboratory. The mean transprosthetic residual gradient was lower (p = 0.024) in the CV group (7.9 ± 3.1 mm Hg) than in the ES group (9.7 ± 3.8 mm Hg). The effective orifice area tended to be greater in the CV group (1.58 ± 0.31 cm(2) vs 1.49 ± 0.24 cm(2), p = 0.10). The incidence of severe prosthesis-patient mismatch was, however, similar between the 2 groups (effective orifice area indexed to the body surface area ≤0.65 cm(2)/m(2); CV 9.8%, ES 9.8%, p = 1.0). The incidence of paravalvular aortic regurgitation was greater with the CV (grade 1 or more in 85.4%, grade 2 or more in 39%) than with the ES (grade 1 or more in 58.5%, grade 2 or more in 22%; p = 0.001). The number and extent of paravalvular leaks were greater in the CV group (p <0.01 for both comparisons). In conclusion, transcatheter aortic valve implantation with the CV prosthesis was associated with a lower residual gradient but a greater rate of paravalvular aortic regurgitation compared to the ES prosthesis. The potential clinical consequences of the differences in hemodynamic performance between these transcatheter heart valves needs to be addressed in future studies.

Successful application of a PressureWire retrogradely across an ATS prosthetic aortic valve to diagnose constrictive pericarditis

Assessment of the left ventricular pressure measured across an aortic valve prosthesis is occasionally necessary when noninvasive imaging and Doppler echocardiographic data are inconclusive or differ from the clinical findings for specific scenarios, such as diagnosing constrictive or restrictive physiology. We present a case in which we safely and effectively replicate the previous successful application of a PressureWire in diagnosing constrictive pericarditis in a patient with a bileafltet mechanical aortic and mitral valves.

Pulmonary Hypertension in Chronic Hypersensitivity Pneumonitis

The purpose of this study was to evaluate the prevalence and outcomes of pulmonary hypertension in chronic hypersensitivity pneumonitis and to examine the relationship between pulmonary function tests and pulmonary hypertension. We conducted a retrospective review of 120 patients with hypersensitivity pneumonitis seen at two centers for pulmonary diseases over a 5-year interval and identified patients with chronic hypersensitivity pneumonitis for whom both pulmonary function tests and Doppler echocardiography data were available. Chronic hypersensitivity pneumonitis was identified in 83 patients and Doppler echocardiography data were available for 73 of them. Pulmonary hypertension (sPAP ≥ 50 mmHg) was detected in 14 patients (19%), and was associated with a greater risk of death (median survival = 23 months vs. 98 months; P=0.003). Patients with pulmonary hypertension were older and had a significantly decreased PaO(2). There was a weak correlation between pulmonary function parameters and the underlying sPAP, with significance for FVC, FEV(1), and PaO(2) and inversely with PaCO(2). Using Doppler echocardiography for evaluation, pulmonary hypertension seems to be common in patients with chronic hypersensitivity pneumonitis, significantly impacts survival, and correlates with FVC, FEV(1), and PaO(2) and inversely with PaCO(2).

Left Ventricular Reverse Remodeling in Percutaneous and Surgical Aortic Bioprostheses: An Echocardiographic Study

Surgical aortic valve replacement (SAVR) is the definitive proven therapy for patients with severe aortic stenosis who have symptoms or decreased left ventricular (LV) function. The development of transcatheter aortic valve implantation (TAVI) offers a viable and "less invasive" option for the treatment of patients with critical aortic stenosis at high risk with conventional approaches. The main objective of this study was the comparison of LV hemodynamic and structural modifications (reverse remodeling) between percutaneous and surgical approaches in the treatment of severe aortic stenosis. Fifty-eight patients who underwent TAVI with the CoreValve bioprosthetic valve were compared with 58 patients with similar characteristics who underwent SAVR. Doppler echocardiographic data were obtained before the intervention, at discharge, and after 6-month to 12-month follow-up. Mean transprosthetic gradient at discharge was lower (P<.003) in the TAVI group (10±5 mm Hg) compared with the SAVR group (14±5 mm Hg) and was confirmed at follow-up (10±4 vs 13±4 mm Hg, respectively, P<.001). Paravalvular leaks were more frequent in the TAVI group (trivial to mild, 69%; moderate, 14%) than in the SAVR group (trivial to mild, 30%; moderate, 0%) (P<.0001). The incidence of severe prosthesis-patient mismatch (PPM) was significantly lower (P<.004) in the TAVI group (12%) compared with the SAVR group (36%). At follow-up, LV mass and LV mass indexed to height and to body surface area improved in both groups, with no significant difference. In patients with severe PPM, only the TAVI subgroup showed significant reductions in LV mass. LV ejection fraction improved at follow-up significantly only in TAVI patients compared with baseline values (from 50.2±9.6% to 54.8±7.3%, P<.0001). Hemodynamic performance after TAVI was shown to be superior to that after SAVR in terms of transprosthetic gradient, LV ejection fraction, and the prevention of severe PPM, but with a higher incidence of aortic regurgitation. Furthermore, LV reverse remodeling was observed in all patients in the absence of PPM, while the same remodeling occurred only in the TAVI subgroup when severe PPM was present.

Characterization of Static and Dynamic Left Ventricular Diastolic Function in Patients With Heart Failure With a Preserved Ejection Fraction

Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging. In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.

Clinical significance of unsuspected rise in cardiac troponin in the setting of falls in older people

ObjectivesTo assess the clinical significance of unsuspected rise in cardiac troponin I (cTnI) levels in elderly patients who have fallen.DesignMonocentre prospective observational pilot studyParticipantsConsecutive elderly patients (age >65 years) referred...