Doppler Echocardiography In Patients Research Articles

Impact of coronary revascularization on coronary flow capacity measured by transthoracic Doppler echocardiography in patients with chronic coronary syndrome

Coronary flow capacity (CFC) integrates quantitative assessment of hyperemic myocardial blood flow and coronary flow reserve. We aimed to evaluate the effect of elective percutaneous coronary revascularization (PCI) on CFC using serial stress transthoracic Doppler echocardiography (STDE). Overall, 148 stable patients underwent STDE of the left anterior descending arteries (LAD), before and after elective PCI. Coronary flow velocity reserve (CFVR) was measured using basal and hyperemic diastolic peak velocity (hDPV). Vessels were classified into four CFC categories: severely, moderately, or mildly reduced CFC, and normal flow. Changes in hDPV and CFC status post-PCI, as well as predictors of hDPV increase, were assessed. Despite improvements in fractional flow reserve (FFR) in all cases, 31 cases (20.9%) showed a decrease in hDPV following PCI. Vessels with ischemic CFC, defined as moderately or severely reduced CFC, decreased from 46.6% (69/148) to 19.6% (29/148) post-PCI. Conversely, CFC worsened in 15.5% of patients. Multivariable analysis showed lower pre-PCI hDPV and ischemic CFC were independently predictive of higher-level (> 50%) hDPV increase after PCI. Approximately 20% of FFR-guided LAD PCI resulted in decreased hDPV. CFC deterioration was not uncommon despite FFR improvement. Preprocedural non-invasive STDE may help identify lesions that benefit from revascularization.

Sex differences in diastolic function following myocardial infarction on doppler echocardiography

Abstract Background Whilst females have relatively greater preservation of left ventricular ejection fraction (LVEF) following myocardial infarction (MI), they have higher rates of heart failure, presumably due to diastolic dysfunction (DD). Objectives This study sought to assess sex differences in LV diastolic function on Doppler echocardiography following MI. Methods Data on 2505 consecutive patients with a first-ever MI were included. Echocardiography was performed within 24 hours of admission. Significant DD was defined as grade 2+3 DD according to current ASE/EACVI guidelines. Diastolic function score (DFS) was calculated by summing the number of abnormal parameters out of the 4 key diastolic parameters (e’ velocity, E/e’ ratio, left atrial volume index [LAVI], tricuspid regurgitation velocity [TRV]). Results Compared to males, females were older, had greater co-morbidity, less 3-vessel disease, and a higher LVEF (55.0+9.8% versus 52.7±9.8%, p<0.001). LAVI, e’ velocity, E/e’ ratio, significant DD and DFS were significantly associated with female sex on univariate group comparisons. In multivariable models incorporating clinical, angiographic and echocardiographic data to determine independent predictors of diastolic parameters, female sex was independently associated with abnormal LAVI (OR 1.42, p=0.013), E/e’ ratio (OR 2.86, p<0.001), TRV (OR 1.83, p=0.005), significant DD (OR 2.12, p<0.001) and DFS (OR 2.60, p<0.001). Conclusions Female sex is a strong independent correlate of diastolic dysfunction on Doppler echocardiography in patients with a first-ever MI. This may explain the higher incidence of heart failure despite relatively preserved LVEF in females following MI.

Critical Appraisal of Pulmonary Artery Systolic Pressure by Doppler Echocardiography in Patients With Severe Tricuspid Regurgitation

Critical Appraisal of Pulmonary Artery Systolic Pressure by Doppler Echocardiography in Patients With Severe Tricuspid Regurgitation

Prognostic value of the severity of tricuspid regurgitation on Doppler echocardiography in patient with heart failure with reduced ejection fraction

Background: Tricuspid regurgitation severity has recently gained attention as a prognostic predictor of outcome events in patients who have leftsided heart failure. This study sought to define the relationship between tricuspid regurgitation and outcome in patients with heart failure with reduced ejection fraction. Objective: To investigate the characteristics of tricuspid regurgitation by Doppler echocardiography in patients with heart failure and reduced ejection fraction. To explore the association between the severity of tricuspid regurgitation and short-term mortality and hospital readmission in the study patients. Methods: 116 heart failurereduced ejection fraction patients were enrolled in this study, followed up, and evaluated after 3 - 6 months. Results: 48.3% of patients have mild tricuspid regurgitation, 33.6% of patients have moderate tricuspid regurgitation, and 18.1% of patients have severe tricuspid regurgitation. 47 events (40.5%) occurred: 11 deaths (9.5%) and 38 readmissions (32.8%). A Kaplan - Meier curve showed that the survival rate of the severe tricuspid regurgitation group was significantly lower than the group with mild to moderate tricuspid regurgitation. A multivariate Cox regression model identified that tricuspid regurgitation severity was an independent predictor of 3-to-6-month mortality or readmission (HR 1.94; CI 95% 1.30 - 2.91). Conclusion: Tricuspid regurgitation severity was an independent predictor of reduced ejection fraction in patients with heart failure.

Comparison of echocardiographic pulmonary flow Doppler markers in patients with massive or submassive acute pulmonary embolism and control group: A cross-sectional study.

Computed tomography angiography (CTA) is the gold standard for the diagnosis of massive (MPE) and submassive pulmonary embolism (SMPE). Ultrasound has not been accepted as a diagnostic tool. We aim to evaluate the pattern of pulmonary Doppler echocardiography in patients with pulmonary embolism (PE). From 2020 to 2022, 30 patients with acute MPE or SMPE confirmed by CTA and normal pulmonary pressures were selected. A control group was created with 30 individuals without PE. All patients had an echocardiography Doppler study of the pulmonary flow with a focus on early systolic notching (ESN), McConnell's (MC) sign, Right ventricular outflow tract velocity time integral (RVOTVTI), segmental thickness variability (STV), right ventricular end-diastolic diameter (RVEDD), tricuspid regurgitation (TR) gradient, pulmonary artery pressure (PAP), and acceleration (AT) or ejection time (ET). ESN was identified in 96.6% of PE patients and 0% of the control group (p < 0.001). In comparison with the control group, STV (p < 0.001), RVOT VTI (p < 0.001), ET (p = 0.04), and AT (p < 0.001) values were lower in patients with PE while RVEDD, TR gradient, PAP, ESN, MC sign, and d-shape were higher (p < 0.001). Identification of the ESN pattern and AT/ET < 0.4 showed excellent predictive ability for MPE and SMPE with a sensitivity of 97.0% and 100%, specificity of 99.0% and 97%, and an area under the ROC curve of 0.967 (95% CI 0.914-1.00) and 0.933 (95% CI 0.844-1.00), respectively. Doppler echocardiography with particular attention to ESN, may be a suitable noninvasive method for the diagnosis of MPE and SMPE. Further studies with more sample sizes are needed to confirm its diagnostic benefit.

Diabetic cardiomyopathy: current state of the problem. Review

The literature review describes the evolution of views on diabetic cardiomyopathy (DCM): from a pathological condition with myocardial hypertrophy and fibrosis in patients with diabetes mellitus (DM) to the development of heart failure (HF) in the absence of other cardiovascular diseases (CVD). It has been demonstrated that DCM is a staged pathophysiological condition inherent in patients with DM and impaired glucose tolerance, caused by hyperglycemia, hyperinsulinemia, and insulin resistance, characterized by molecular changes, remodeling of the left chambers of the heart, a decrease in the systolic‑diastolic reserve of the ventricular myocardium, the development of HF, and is associated with dysfunction of the autonomic nervous system, disruption of energy metabolism and increased inflammation. The features of heart damage in both type 1 and type 2 DM were analyzed, and the importance of glycemic control to prevent the development and progression of HF was noted. The results of experimental and clinical studies (CARVAR 92 cohort, LIFE, RENAAL, the Framingham study, HyperGEN, the Strong Heart Study, RECORD trial, PRO active Study) gave the ground to claim that secondary DM prevention reduces the risks of death from CVD and the progression of pump function deterioration of the heart. Screening of DCM biomarkers (long non‑coding RNA and galectin‑3) and carrying out of Doppler echocardiography in patients with DM and impaired glucose tolerance will allow timely and adequate initiation of DCM treatment. Ways to correct changes in the heart that develop in patients with DM are given. Metformin, empagliflozin, canagliflozin, liraglutide, and semaglutide are listed as promising medications for drug correction of DCM.

Automated 4D flow cardiac MRI pipeline to derive peak mitral inflow diastolic velocities using short-axis cine stack: two centre validation study against echocardiographic pulse-wave doppler

BackgroundMeasurement of peak velocities is important in the evaluation of heart failure. This study compared the performance of automated 4D flow cardiac MRI (CMR) with traditional transthoracic Doppler echocardiography (TTE) for the measurement of mitral inflow peak diastolic velocities.MethodsPatients with Doppler echocardiography and 4D flow cardiac magnetic resonance data were included retrospectively. An established automated technique was used to segment the left ventricular transvalvular flow using short-axis cine stack of images. Peak mitral E-wave and peak mitral A-wave velocities were automatically derived using in-plane velocity maps of transvalvular flow. Additionally, we checked the agreement between peak mitral E-wave velocity derived by 4D flow CMR and Doppler echocardiography in patients with sinus rhythm and atrial fibrillation (AF) separately.ResultsForty-eight patients were included (median age 69 years, IQR 63 to 76; 46% female). Data were split into three groups according to heart rhythm. The median peak E-wave mitral inflow velocity by automated 4D flow CMR was comparable with Doppler echocardiography in all patients (0.90 ± 0.43 m/s vs 0.94 ± 0.48 m/s, P = 0.132), sinus rhythm-only group (0.88 ± 0.35 m/s vs 0.86 ± 0.38 m/s, P = 0.54) and in AF-only group (1.33 ± 0.56 m/s vs 1.18 ± 0.47 m/s, P = 0.06). Peak A-wave mitral inflow velocity results had no significant difference between Doppler TTE and automated 4D flow CMR (0.81 ± 0.44 m/s vs 0.81 ± 0.53 m/s, P = 0.09) in all patients and sinus rhythm-only groups. Automated 4D flow CMR showed a significant correlation with TTE for measurement of peak E-wave in all patients group (r = 0.73, P < 0.001) and peak A-wave velocities (r = 0.88, P < 0.001). Moreover, there was a significant correlation between automated 4D flow CMR and TTE for peak-E wave velocity in sinus rhythm-only patients (r = 0.68, P < 0.001) and AF-only patients (r = 0.81, P = 0.014). Excellent intra-and inter-observer variability was demonstrated for both parameters.ConclusionAutomated dynamic peak mitral inflow diastolic velocity tracing using 4D flow CMR is comparable to Doppler echocardiography and has excellent repeatability for clinical use. However, 4D flow CMR can potentially underestimate peak velocity in patients with AF.

Assessment of aortic valve area on cardiac computed tomography in symptomatic bicuspid aortic stenosis: Utility and differences from Doppler echocardiography.

In this study, we investigate the utility of geometric orifice area (GOA) on cardiac computed tomography (CT) and differences from effective orifice area (EOA) on Doppler echocardiography in patients with bicuspid aortic stenosis (AS). A total of 163 patients (age 64 ± 10 years, 56.4% men) with symptomatic bicuspid AS who were referred for surgery and underwent both cardiac CT and echocardiography within 3 months were studied. To calculate the aortic valve area, GOACT was measured by multiplanar CT planimetry, and EOAEcho was calculated by the continuity equation with Doppler echocardiography. The relationships between GOACT and EOAEcho and patient symptom scale, biomarkers, and left ventricular (LV) functional variables were analyzed. There was a significant but modest correlation between EOAEcho and GOACT (r = 0.604, p < 0.001). Both EOAEcho and GOACT revealed significant correlations with mean pressure gradient and peak transaortic velocity, and the coefficients were higher in EOAEcho than in GOACT. EOAEcho of 1.05 cm2 and GOACT of 1.25 cm2 corresponds to hemodynamic cutoff values for diagnosing severe AS. EOAEcho was well correlated with the patient symptom scale and log NT-pro BNP, but GOACT was not. In addition, EOAEcho had a higher correlation coefficient with estimated LV filling pressure and LV global longitudinal strain than GOACT. GOACT can be used to evaluate the severity of bicuspid AS. The threshold for GOACT for diagnosing severe AS should be higher than that for EOAEcho. However, EOAEcho is still the method of choice because EOAEcho showed better correlations with clinical and functional variables than GOACT.

Cyclic Change in Right and Left Ventricular Systolic and Diastolic Function in Patients with Neuromuscular Disorders on Permanent Mechanical Ventilation.

Home mechanical ventilation is classically used to treat neuromuscular patients with chronic respiratory insufficiency. Since the heart and lungs are localized in the thorax, intrathoracic pressure may directly affect heart function. Here, we report the direct cyclic effects of mechanical ventilation on the right and left ventricular systolic and diastolic function in serial cases. These cases highlight the importance of performing Doppler echocardiography in patients with neuromuscular disorders, focusing on the right and left ventricular systolic and diastolic functions in the context of ventilation setting modifications or introduction.

Streamline-based three-dimensional peak-velocity tracing of transvalvular flow using four-dimensional flow cardiac magnetic resonance imaging for left ventricular diastolic assessment in aortic regurgitation: a case report

BackgroundDoppler transthoracic echocardiography is routinely performed to measure peak mitral inflow velocities in the assessment of left ventricular diastolic function. The limitations of echocardiography are well documented, but its accuracy in the measurement of transmitral peak velocity in the presence of aortic valve regurgitation has not yet been compared with four-dimensional flow cardiac magnetic resonance imaging. Four-dimensional flow cardiac magnetic resonance imaging offers time-resolved cross-sectional velocity information that can be used to investigate mitral inflow peak velocity. We present a case report demonstrating the potential superior capabilities of four-dimensional flow cardiac magnetic resonance imaging in accurately detecting mitral inflow velocities over Doppler echocardiography in patients with aortic regurgitation.Case presentationA 67-year-old Caucasian female presented to our outpatient cardiology clinic with exertional dyspnea. Doppler transthoracic echocardiography identified moderate to severe aortic regurgitation. Mapping of mitral inflow peak velocities proved challenging with Doppler echocardiography. Additionally, four-dimensional flow cardiac magnetic resonance imaging with automated three-dimensional flow streamlines was performed, which allowed for more accurate detection of mitral inflow peak velocities.ConclusionsDoppler echocardiography has a limited role in mitral inflow assessment where aortic regurgitation is present. In such cases, four-dimensional flow cardiac magnetic resonance imaging is an alternative imaging technique that may circumvent this issue and allow mitral inflow assessment.

Left Ventricular Ejection Fraction Correlation With Stroke Volume as Estimated by Doppler Echocardiography in Cardiogenic Shock: A Retrospective Observational Study

Echocardiography is the main tool for cardiac assessment and helps to guide management in patients admitted to the intensive care unit (ICU) with cardiogenic shock (CS). Left ventricular ejection fraction (LVEF) is a commonly used echocardiographic surrogate for left ventricular (LV) systolic function. In this hypothesis-generating study, the authors investigated the correlation between LVEF and stroke volume (SV)/SV index (SVI) estimated by Doppler echocardiography in patients admitted to the ICU with CS and reduced LVEF. This retrospective analysis was performed in a single tertiary cardiac center in London, United Kingdom. Patients admitted to the ICU over a 34-month period with ST elevation myocardial infarction (STEMI) complicated by CS and LVEF <40%. Clinical and echocardiographic data were collected. LVEF (total, by visual estimate and by modified Simpson's method) was correlated with SV and SVI estimated by Doppler echocardiography. One-hundred patients were included. The mean age was 62.6 ± 12.7 years and 78% were male patients. The median LVEF was 29% (20-35) and the mean SV and SVI by Doppler echocardiography were 47 mL ± 16 and 25 mL ± 9, respectively. Analysis revealed a weak yet statistically significant correlation among LVEF and Doppler SV and SVI (r = 0.44, confidence interval [CI] 0.26-0.60, p < 0.0001, r = 0.47, CI 0.28-0.62, p < 0.001, respectively). Visually estimated LVEF (n=74) correlated weakly with Doppler SV and SVI yet better compared to LVEF by Simpson's method (n=25) (r = 0.48, CI 0.27-0.65, p < 0.0001 and r = 0.49, CI 0.28-0.66, p < 0.0001, respectively, v r = 0.36, CI 0.05-0.67, p = 0.08 and r = 0.37, CI -0.04-0.67, p 0.07, respectively). There is a weak correlation between LVEF and SV or SVI estimated by Doppler echocardiography in patients admitted to the ICU with STEMI complicated by CS and reduced LVEF. Visually estimated LVEF correlated slightly better with Doppler SV compared to modified Simpson's LVEF.

Mitral valve thickening in acute rheumatic fever as a predictor of late valvar dysfunction.

BackgroundRheumatic heart disease (RHD) complicating acute rheumatic fever (ARF) remains an important health problem in developing countries. No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established.ObjectiveTo investigate the prognostic value of DEC in patients with ARF as a predictor of chronic valve dysfunction.MethodsProspectively enrolled patients with clinical ARF had a DEC performed soon after diagnosis and repeated at 1, 3, 6 and 12 months and thereafter at every 1–2 years. We defined chronic valve dysfunction by ≥ 3 of the following: increased valve thickening, commissure fusion, subvalvular thickening, reduced leaflet mobility, non-trivial mitral and/or aortic regurgitation. We performed univariate analysis and developed multivariate logistic regression models to identify variables that may influence evolution to RHD. p <0.05 was considered significant.ResultsWe evaluated 70(57% men) patients, 10.8±5.6 years-old during the ARF episode and followed for 95±26 months. Chronic valve dysfunction was identified in 36(51.4%) which fulfilled criteria for RHD and 10(27.8%) of them died or underwent valve surgery. Univariate analysis showed that mitral valve thickening and presence of mitral regurgitation at baseline DEC, were associated with RHD(p<0.01). Multivariate logistic regression showed that only mitral valve thickness either as a continuous (Odds-Ratio:5.8;95%CI:1.7–19.7) or as a categorical variable (Odds-Ratio:4.04;95%CI:1.06–15.3) was an independent predictor of chronic valve dysfunction.ConclusionsMitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to RHD.

Characteristics of coronary flow velocity reserve on transthoracic Doppler echocardiography in patients with a history of Kawasaki disease.

The coronary flow velocity reserve of the left anterior descending artery was examined by transthoracic Doppler echocardiography in 189 patients (male 125, female 64) with a history of Kawasaki disease and 10 volunteers (control). Their ages ranged from 6 to 40 years (median 22 years). The patients were divided into nine groups based on the left anterior descending artery lesions. The coronary flow velocity reserve was measured by intravenous administration of adenosine triphosphate (0.15 mg/kg/minute) while fasting. The coronary flow velocity reserve was calculated as the ratio of hyperaemic to basal mean diastolic flow velocities. The respective groups were as follows: control, no coronary artery lesions (n = 39), no coronary artery lesions in the right coronary artery (n = 29), regression (n = 11), aneurysm at the bifurcation of the left coronary artery (n = 26), aneurysm of the left anterior descending artery (n = 15), localised stenosis <75% (n = 12), localised stenosis ≥75% (n = 17), segmental stenosis (n = 5) and coronary artery bypass grafting (n = 36). One-factor ANOVA followed by Tukey's test was used to compare the coronary flow velocity reserve among the groups. The coronary flow velocity reserve was significantly lower in the localised stenosis ≥75%, segmental stenosis and coronary artery grafting groups than in the other groups (p < 0.05). The endothelial function in the epicoronary artery was preserved in patients with a history of Kawasaki disease and dilated coronary artery lesions.

Acute Inspiratory Muscle Training Modifies Hemodynamic Indices in Patients with Heart Failure with Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF), a syndrome associated to decrease functional capacity, is quite difficult to manage. Inspiratory muscle training (IMT) has been used to treat symptoms and to improve functional capacity of patients with HFpEF. Thus, we aimed to evaluate the immediate effects and after 1 h of IMT on arterial pulsatile hemodynamics and on hemodynamic indices of left ventricular filling derived from Doppler echocardiography in patients with HFpEF. Methods: Eighteen patients with HFpEF who [...]

Diastolic function of left ventricle and importance of tissue doppler echocardiography in patients with coronary artery disease and type 2 diabetes mellitus after coronary artery bypass grafting

Objective. To analyze the influence of coronary artery bypass grafting CABG) on the diastolic function DF) in patients with coronary artery disease and type 2 diabetes mellitus with the preserved systolic function of the left ventricle LV) using tissue myocardial Doppler echocardiography TMD). The increase in the number of patients with type 2 diabetes mellitus type 2 DM) is one of the causes of a constant growth of the quantity of patients with coronary artery disease CAD). Taking into account the character of vascular bed lesion in patients with type 2 DM, revascularization of myocardium is significant for CAD treatment in this group of patients.&#x0D; Materials and methods. The study included 122 patients diagnosed coronary artery disease mean age 58.8 0.7 years, men 81.1 %), who underwent coronary artery bypass grafting. The patients were divided into two groups: group 152 patients with CAD without type 2 DM; group 270 patients with CAD and type 2 DM. To assesss the diastolic function using pulse-wave Dollper PWD), there were estimated the velocity and time characteristics of the transmitral blood flow by means of TMD myocardium movement velocity at the level of the mitral valve fibrous ring.&#x0D; Results. The quantity of the detected patients with diastolic dysfunction DD) when using both PWD and TMD with type 2 DM 85.7 %, without type 2 DM 65.3 %) in both groups was higher compared with PWD applied alone with type 2 DM 77.3 %, without type 2 DM 59.6 %) p 0.001).&#x0D; Conclusions. Among CAD patients with preserved systolic function of the left ventricle, who underwent CABG and have type 2 DM, the use of both PWD and TMD is more preferable for revealing DD and dynamic postoperative observation.

Noninvasive Evaluation of Coronary Perfusion by Transthoracic Doppler Echocardiography in Patients with Anterior Myocardial Infarction before Coronary Intervention

Background: Transthoracic Doppler Echocardiography (TTDE) has made a breakthrough in noninvasive evaluation of coronary artery flow, especially in the distal left anterior descending coronary artery (LAD). The present study was intended to test the hypothesis whether TTDE can differentiate coronary perfusion with Thrombolysis in Myocardial Infarction (TIMI) grade 3 from TIMI grade ≤2 in patients with anterior myocardial infarction (AMI). Methods: A total of 30 consecutive patients suggestive of anterior MI including those who received thrombolysis with the potential need for Percutaneus Coronary Intervention (PCI) were enrolled in the study. The coronary perfusion was evaluated by antegrade flow visualization in distal LAD by Colour TTDE and antegrade flow velocity measured by pulsed TTDE followed by coronary angiogram for TIMI grade flow in culprit artery. The sensitivity, specificity and diagnostic accuracy were determined by comparing TTDE parameters with angiographic TIMI flow grade. Results: The antegrade distal LAD flow visualization by Color TTDE enabled differentiation of TIMI 3 from TIMI ≤2 with a sensitivity, specificity, PPV, NPV and diagnostic accuracy of 100%, 62.5%, 40%, 100% and 70% respectively. The Receiver Operating Characteristic (ROC) curve constructed to find the cut-off value for antegrade flow velocity in distal LAD in differentiating TIMI 3 from TIMI 0-2 was found to be 30.5 cm/ s with an area under the curve being 0.893, p =0.011. The antegrade flow velocity in distal LAD e” 30.5 cm/s by pulsed TTDE had a fair sensitivity (66.7%) , but had high specificity (100%) and overall diagnostic accuracy (86.7%). Conclusion: The study concluded that antegrade distal LAD flow visualization by Color TTDE can fairly differentiate TIMI 3 from TIMI ≤2 with high sensitivity, and moderate specificity and diagnostic accuracy. Additionally, the antegrade flow velocity in distal LAD by pulsed TTDE has a moderate sensitivity and high specificity to predict the angiographic TIMI flow grade. Thus, TTDE enables noninvasive differentiation of coronary perfusion in patients with anterior MI before coronary intervention.&#x0D; University Heart Journal Vol. 15, No. 1, Jan 2019; 22-27

Prognostic Value of Preserved Coronary Flow Velocity Reserve by Noninvasive Transthoracic Doppler Echocardiography in Patients With Angiographically Intermediate Left Main Stenosis

The potential of angiography to evaluate the hemodynamic severity of a left main coronary artery (LM) stenosis is limited. Noninvasive transthoracic Doppler echocardiographic coronary flow velocity reserve (CFVR) evaluation of intermediate coronary stenosis has demonstrated remarkably high negative prognostic value. The aim of this study was to assess clinical outcomes in patients with angiographically intermediate LM stenosis and preserved CFVR (>2.0) as evaluated by transthoracic Doppler echocardiographic CFVR. The initial study population included 102 patients with intermediate coronary stenosis of the LM referred for transthoracic Doppler echocardiographic CFVR assessment. Peak diastolic CFVR measurements were performed in the distal segment of the left anterior descending coronary artery after intravenous adenosine (140μg/kg/min), and CFVR was calculated as the ratio between maximal hyperemic and baseline coronary flow velocity. Nineteen patients had impaired CFVR (≤2.0) and were excluded from further analysis, as well as two patients with poor acoustic windows. The final group consisted of 81 patients (mean age, 60±9years; 76 men) evaluated for adverse cardiac events including death, myocardial infarction, and revascularization. Mean follow-up duration was 62±26months. Mean CFVR was 2.4±0.4. Total event-free survival was 75 of 81 (92.6%), as six patients were referred for revascularization (five patients with coronary artery bypass grafting, one patient with percutaneous coronary intervention). There were no documented myocardial infarctions or cardiovascular deaths in the follow-up period. In patients with angiographically intermediate and equivocal LM stenosis and preserved CFVR values of >2.0, revascularization can be safely deferred.

Cardiac Iron Overload: Correlation between MRI T2* &amp; Two Dimensional Strain Echocardiography in Children with b-Thalassemia Major

AbstractBackground: b-thalassemia is a group of inherited blood disorders that causes iron overload in the heart. Development of overt heart failure is delayed till the second decade of life. Early detection of cardiac iron overload is necessary before development of heart failure.Aim of the Study: Was to evaluate cardiac function in children with b-thalassemia major having iron overload and to Compare MRI T2* and doppler echocardiography in dem-onstration of iron deposition in cardiac muscles in those patients.Patients and Methods: Fifty children with thalassemia major were subjected to history taking, clinical assessment, laboratory assessment, Doppler echocardiography and MRI for cardiac iron load assessment.Results: There is a negative correlation between cardiac MRI T2* with age, ferritin and serum iron level. As regard correltion between MRI and doppler echocardiography there is a positive correlation between MRI T2* and diastolic echocardiographic parameters Tei index in patients with thalassemia Major.Conclusion: There is a significant correlation between MRI T2* and Doppler echocardiography in patients with b thalassemia major.

Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma.

BackgroundMajority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group.ObjectiveIn this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI.MethodsThirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant.ResultsLeft ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups.ConclusionOur study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

Value of Brain Natriuretic Peptide Assay for the Etiologic Diagnosis and Its Correlation with Doppler Echocardiography in Patients of Acute Onset Dyspnoea

Value of Brain Natriuretic Peptide Assay for the Etiologic Diagnosis and Its Correlation with Doppler Echocardiography in Patients of Acute Onset Dyspnoea