Echocardiography In Women Research Articles

Transthoracic echocardiography in women with treated severe pre‐eclampsia

The aim of this study was to investigate cardiac function and haemodynamic indices using transthoracic echocardiography in women with severe pre-eclampsia who had already received treatment interventions. Fifteen women with treated severe pre-eclampsia were studied using transthoracic echocardiography. Mean (SD) cardiac output in women with treated disease was 5690 (1708) ml.min(-1). Systolic function was preserved in women with treated disease evidenced by mean (SD) fractional shortening 41 (9)%, fractional area change 62 (12)% and septal s' velocities 9.0 (2.1) cm.s(-1). Left ventricle end-diastolic diameters were within healthy reference ranges at 4.7 (0.3) cm and the left ventricle was not dilated. Diastolic function was reduced, with a mean (SD) mitral valve E/septal e' ratio of 12.6 (4.1). Left ventricular mass was increased at 182.0 (44.4) g. There was large variability in haemodynamics in women with treated severe pre-eclampsia. Transthoracic echocardiography is acceptable and applicable and enables quantification of cardiac function in women with severe pre-eclampsia.

O060 Clinical Significance of Dynamic Left Ventricular Outflow Tract Obstruction during Dobutamine Stress Echocardiography in Women with Chest Pain: Chest Pain in Korean Women’s Registry

Introduction: Although dobutamine stress echocardiography (DSE) is frequently associated with dynamic left ventricular outflow tract obstruction (LVOTO), its clinical significance in women with chest pain is little known. Objectives: We assessed provked clinical significance of dynamic left ventricular outflow tract obstruction (LVOTO) by dobutamine stress echocardiography (DSE) in women with chest pain. Methods: Of 880 women patients from chest pain in Korean women’s registry (which was a multicenter registry of Korean women who visited in clinic for chest pain, 102 patients (57 10 years) without DSE-provoked ischemia were included. LVOTO was defined by the presence of a systolic flow with dagger-shaped late peaking and peak LVOT pressure gradient equal to or greater than 30mmHg in the LVOT or the midventricular area, not present at baseline and that disappeared after the recovery phase. The presence of CAD was defined as any epicardial coronary artery stenosis 50%. Treadmill test was also performed in all patients and Duke treadmill score (DTS) was calculated. Results: Fifty of 102 patients had no provoked LVOTO (group 1) and 52 (51%) had provoked LVOTO (group 2). Group 2 were older than group 1 (p1⁄40.001). Group 2 had smaller LV diameter but had larger LV mass index and relative wall thickness (all p<0.05). LV diastolic parameters including A velocity, DT and the ratio of E velocity and early diastolic mitral annular velocity (E/e’) were worse in group 2 (all p<0.05). In addition, peak LVOT pressure gradient was mostly related to the LV relative wall thickness (r1⁄40.405, p<0.001) and DT (r1⁄40.328, p1⁄40.001) even with adjusted by age. Of 102 patients, 83 had no CAD and all these findings were consistent with those of all patients. There were no differences of peak LVOT pressure gradient (p1⁄40.24) and prevalence of LVOTO (p1⁄40.73) between patients with CAD and with no CAD, but patients with LVOTO had lower DTS (3.90 4.14 vs 6.32 3.99, p1⁄40.02).

Subclinical Left Ventricular Dysfunction in Preeclamptic Women With Preserved Left Ventricular Ejection Fraction

Background— Patients with preeclampsia are at risk for cardiovascular disease. Changes in cardiac function are subtle in preeclampsia and are difficult to quantify with conventional imaging. Strain measurements using speckle-tracking echocardiography have been used to sensitively quantify abnormalities in other disease settings. Methods and Results— We evaluated the feasibility and sensitivity of strain imaging using speckle-tracking echocardiography in women with preeclampsia. Forty-seven women were enrolled in this pilot study and 39 were analyzed: 11 with preeclampsia, 17 without a hypertensive disorder, and 11 with nonproteinuric hypertension. Echocardiographic ejection fraction and global peak longitudinal, radial, and circumferential strain were measured. Longitudinal strain was significantly worsened in women with preeclampsia compared with women without a hypertensive disorder ( P =0.0001). Similar results were observed for radial strain ( P =0.006) and circumferential strain ( P =0.03). Women with preeclampsia also had significantly worsened longitudinal ( P =0.04), radial ( P =0.01), and circumferential ( P =0.002) strain compared with women with nonproteinuric hypertension. Women with preeclampsia did not have a significantly different ejection fraction compared with women without a hypertensive disorder ( P =0.16) and women with nonproteinuric hypertension ( P =0.44). Conclusions— Myocardial strain imaging using speckle tracking is more sensitive than left ventricular ejection fraction to detect differences in left ventricular systolic function in women with and without preeclampsia.

OS094. Subclinical left ventricular dysfunction in preeclamptic women with preserved left ventricular ejection fraction: A 2D speckle tracking imaging study

Patients with preeclampsia are at risk for cardiovascular disease [1,2]. Changes in cardiac function are subtle in preeclampsia and are quantitatively difficult with conventional imaging. Strain measurements using speckle-tracking echocardiography have been used to sensitively quantifyabnormalities in other disease settings [3]. The objective of this study was to evaluate changes in myocardial strain using speckle tracking echocardiography in women with and without preeclampsia. We hypothesized that global left systolic strain measures would prove more sensitive than conventional left ventricular ejection fraction in detecting early changes in systolic LV function manifesting as subclinical disease prior to overt progression. We evaluated the feasibility and sensitivity of strain imaging using speckle tracking echocardiography. Thirty-six women were enrolled in this pilot study; 28 were analyzed: 11 with preeclampsia and 17 without preeclampsia. Echocardiographic Ejection fraction and global peak longitudinal ,radial and circumferential strain were measured. Global Median longitudinal strain was significantly worsened in women with preeclampsia compared to women without preeclampsia (P<0.0001). Similar results were observed for global radial strain (P=0.006) and circumferential strain (P=0.03). There was no significant difference in ejection fraction between the groups (P=0.52) (Table 1). Data are presented as median (interquartile range). Myocardial strain imaging using speckle tracking is more sensitive than left ventricular ejection fraction to detect differences in left ventricular systolic function in women with and without preeclampsia.

Characterization of fetal cardiac structure and function detected by echocardiography in women with normal pregnancy and gestational diabetes mellitus

To assess fetal cardiac structure and function in normal pregnancy and in the presence of gestational diabetes mellitus (GDM) using echocardiography measurements. We studied fetal cardiac structure and function in 169 uncomplicated singleton pregnancies and in 92 complicated by GDM. Maternal glycemic control was deemed adequate in 75 women and inadequate in 17. Fetal two-dimensional ultrasound, pulsed wave Doppler and tissue Doppler imaging (TDI) were used to assess cardiac walls thickness and cardiac function, both systolic [with ejection fraction (EF)] and diastolic [using early diastolic peak flow velocity (E)/late peak of diastolic velocity (A) and early diastolic peak velocity at the annulus (Ea)/late diastolic peak velocity at the annulus (Aa) ratios]. In normal pregnancies, fetal ventricular walls and interventricular septum thickness increased progressively with advancing gestation and were significantly thicker in the presence of GDM (P < 0.001) independently of maternal glycemic control. Fetal cardiac systolic function indicated by EF did not change during normal pregnancy, but was significantly increased (P < 0.001) in the presence of GDM independently of maternal glycemic control. Both pulsed wave Doppler and TDI indicators of fetal diastolic cardiac function increased during normal pregnancy, reaching a maximum at 36 to 40 weeks of gestation (P < 0.001). The presence of GDM did not affect pulsed wave Doppler indicators of diastolic function [ratio of early/late diastolic peak flow velocity (E/A ratio)], whereas TDI indices [ratio of early/late diastolic peak velocity at the annulus (Ea/Aa ratio)] were significantly lower after adjustment for gestational age and estimated fetal weight (EFW); and such changes were independent of maternal diabetic control (P < 0.001). Fetal cardiac wall thickness, cardiac systolic and diastolic functions are affected by GDM independently of glycemic control.

The Evaluation of Diastolic Dysfunction with Tissue Doppler Echocardiography in Women with Subclinical Hypothyroidism and the Effect of L-Thyroxine Treatment on Diastolic Dysfunction: A Pilot Study

Background. Subclinical hypothyroidism (SH) predominantly affects women. The necessity of treatment in SH is controversial. Objective. We aimed to investigate the response of diastolic dysfunction to thyroid hormone replacement therapy (THRT) in women. Methods and Results. Twenty-two female subjects with SH and 20 euthyroid female controls were enrolled. Baseline and follow-up biochemical, hormonal, and echocardiographic evaluations were performed. Repeat echocardiograms were performed three months after the achievement of a euthyroid status with THRT. Mean baseline myocardial performance index (MPI) was 0.27 ± 0.08 in the SH group, and 0.22 ± 0.06 in the control group (P = 0.03). MPI did not change significantly after THRT. Pulsed-wave Doppler findings were not different among the groups. However, tissue Doppler-derived mitral annular E' velocities were significantly lower in the SH group. A moderate but significant improvement was observed in E' velocities after THRT (13.2 ± 3.87 versus 14.53 ± 2.75, P = 0.04). We also observed left ventricular concentric remodeling in SH patients which was reversible with THRT. Conclusions. Tissue Doppler echocardiography may be a useful tool for monitoring the response of diastolic dysfunction to thyroid hormone replacement therapy in patients with SH. Our findings suggest that THRT may reverse diastolic dysfunction in women with SH.

Age-Related Changes in Heart Function by Serial Echocardiography in Women Aged 40–80 Years

To determine if a defined set of echocardiographic parameters at entry and exit of a longitudinal study over 5 years showed changes with aging. The cohort consisted of 484 randomly recruited women aged 40-80. They were examined by two echocardiography cardiologists, independent of the medical information for these women. Across the age decades (40-49, 50-59, 60-69, 70-79 years), body weight and body surface area (BSA) did not vary, and diastolic blood pressure (DBP) was stable; systolic blood pressure (SBP) progressively increased. There was gradual decline in left ventricular (LV) diastolic function, increase in LV muscle mass, and decrease in LV end-diastolic volume (LVEDV). The serial decrease in rate of change over 5 years in ejection fraction (ET) was small but significant across the four age decades. As expected, there were age-related changes in cardiac structure and function over time in women who showed no apparent cardiovascular disease (CVD) at entry to the study. The direction of these serial changes was toward the development of LV stiffness and likelihood of subsequent heart failure. The clinical significance of the decrease in rate of change in EF remains unclear.

How to improve noninvasive coronary artery disease diagnostics in premenopausal women?: The influence of menstrual cycle on ST depression, left ventricle contractility, and chest pain observed during exercise echocardiography in women with angina and normal coronary angiogram

How to improve noninvasive coronary artery disease diagnostics in premenopausal women?: The influence of menstrual cycle on ST depression, left ventricle contractility, and chest pain observed during exercise echocardiography in women with angina and normal coronary angiogram

How to improve noninvasive coronary artery disease diagnostics in premenopausal women?: The influence of menstrual cycle on ST depression, left ventricle contractility, and chest pain observed during exercise echocardiography in women with angina and normal coronary angiogram

The aim was to assess the influence of menstrual cycle on results of exercise echocardiography and electrocardiography. Premenopausal women (n=28) with regular monthly menses, presented typical angina, positive electrocardiogram (ECG) exercise stress test, and normal coronary angiogram were recruited. Exercise supine bicycle echocardiography with simultaneous recording of 12-lead ECG was performed once a week for 4 consecutive weeks. Occurrence of angina, time to angina, time to significant ST deviation, and segmental myocardial contractility were analyzed. Blood samples were drawn to estimate follicle-stimulating hormone, luteinizing hormone, beta-estradiol, progesterone concentration and confirm the position in menstrual cycle. In correlation analysis, linear and logistic regression were used as appropriate. Qualitative variables were categorized into quartiles in logistic regression analysis. Exercise ST depression was more frequently observed in both luteal phases (early luteal 78%, late luteal 86%) compared to the late follicular phase (50%, P<.05). Time to ST depression was significantly longer in late follicular phase compared to other phases. The rate of segmental exercise left ventricular hypokinesis was low and not significantly related to menstrual cycle. Using linear regression, significant positive correlation was found between estradiol-progesterone ratio and time to ST depression. Using multiple logistic regression, we confirmed that progesterone level is independent factor influencing the presence of ST depression. In women with typical angina and normal coronary angiogram, the position in menstrual cycle influences the ST depression but not myocardial contractility during exercise echocardiography.

Value and limitations of dobutamine stress echocardiography in women with suspected coronary artery disease

The accuracy of exercise electrocardiography (ECG) for detecting coronary artery disease (CAD) in women is limited. Dobutamine stress echocardiography (DSE) is an alternative. Limited and conflicting data exist on the utility of DSE. This prospective study determines value and limitations of DSE compared with exercise ECG in women with suspected CAD. A total of 114 consecutive women without previous myocardial infarction underwent standard exercise ECG and DSE prior to coronary angiography performed within 5±2 days. Pretest probability of CAD was calculated from clinical parameters and significant CAD was defined as ≥50% coronary artery luminal narrowing. Prevalence of CAD was 39.5% with multivessel disease in 49%. Most patients had a low or intermediate pretest probability of CAD (75%). Exercise ECG recordings were diagnostic in 71% and DSE in 90% of women. Overall sensitivity, specificity and accuracy for DSE were superior to exercise ECG (80%, 81%, and 80%, respectively, versus 65%, 55%, and 59%, respectively; p<0.05). Accuracy of DSE was increased in multivessel disease (85%), good echocardiographic image quality (86%) compared to single vessel disease (73%) and moderate image quality (69%). Accuracy of DSE demonstrated little differences in subgroups of pretest probability (78–85%), whereas accuracy of exercise ECG ranged from 44% to 71%. DSE is superior to exercise ECG in the evaluation of suspected CAD in women. Accuracy of ST-segment analysis in exercise ECG remains questionable for the investigation of myocardial ischemia in women and may be supplemented or substituted by DSE.

The diagnostic role of stress echocardiography in women with coronary artery disease: evidence based review

1) Coronary artery disease in women differs from men in several ways, including their response to many diagnostic tests.2) Strong comparative data on stress echocardiography for detecting coronary artery disease in women are lacking, but existing data consistently show sensitivity comparable with other high-sensitivity tests and superior specificity, increasing its diagnostic accuracy.3) Pharmacological stress echocardiography appears to provide superior specificity to exercise stress echocardiography due to difficulties in test execution with the latter that increase the number of false positive results.4) Current evidence suggests that stress echocardiography should be the first-line diagnostic tool for detecting coronary artery disease in women with chest pain, but other noninvasive imaging tests may be valuable in some patient subgroups.

President's messageThe year ahead

President's messageThe year ahead

Dobutamine stress echocardiography in women with systemic lupus erythematosus: increased occurrence of left ventricular outflow gradient.

Dobutamine stress echocardiography (DSE) is an accurate noninvasive test used for the diagnosis and evaluation of patients with known or suspected coronary artery disease (CAD). The aim of this study was to determine the rate of positive findings in DSE, to define the echocardiographic and clinical characteristics of women with systemic lupus erythematosus (SLE) and to evaluate the safety of DSE in SLE patients. Thirty consecutive SLE patients were enrolled in the study and underwent DSE study. The mean age of patients was 44 years (range 20-76). Mean duration of SLE was 8.1 years and mean SLEDAI was 5.5. None of the DSE tests performed were positive for myocardial ischaemia. A left ventricular outflow gradient (LVOG) was found in 15/28 (54%) patients who completed the test, a result higher than the reported 20% prevalence of this finding in the literature. There were no significant differences in baseline characteristics between patients who developed a gradient and patients in whom a gradient was not found. There were no significant adverse effects during the study. In the general population, LVOG has been reported to be associated with an increased rate of chest discomfort and with a significantly lower prevalence of CAD. Whether this is true for SLE patients requires further study.

Predictors of negative exercise echocardiography in women with positive exercise electrocardiograms

Predictors of negative exercise echocardiography in women with positive exercise electrocardiograms

The teratogenic effect of carbamazepine: a meta-analysis of 1255 exposures

Maternal use of antiepileptic drugs during pregnancy has been associated with an increased risk of major congenital abnormalities in the fetus. Carbamazepine (CBZ) is an antiepileptic drug that was developed and marketed mainly for the treatment of epileptic seizures. Some investigators described an increased rate of major congenital anomalies following treatment with CBZ during pregnancy while others found no such increase. In order to quantify better the risks of exposure to CBZ during pregnancy, we pooled data from prospective studies known to us. We found in prospective studies involving 1255 cases of exposure that CBZ therapy increased the rate of congenital anomalies, mainly neural tube defects, cardiovascular and urinary tract anomalies, and cleft palate. CBZ may also induce a pattern of minor congenital anomalies and developmental retardation, but our study did not address these endpoints. CBZ also appears to reduce gestational age at delivery. A combination of CBZ with other antiepileptic drugs is more teratogenic than CBZ monotherapy. Children born to untreated epileptic women do not appear to have an increased rate of major birth defects. In light of these results, we recommend performing a level 2 ultrasound and fetal echocardiography in women treated with CBZ during pregnancy.

Prognostic value of stress echocardiography in women with high (⩾80%) probability of coronary artery disease

OBJECTIVETo assess the prognostic significance of stress echocardiography in women with a high probability of coronary artery disease (CAD).SETTINGSecondary and tertiary cardiology unit at a university teaching hospital.PARTICIPANTSA total of...

Prognostic value of exercise echocardiography in women in the community setting

Treadmill stress echocardiography was performed in 1,136 women with known or suspected coronary artery disease whose clinical course was then evaluated a mean of 33 months later (range 12 to 60). The strongest predictor of an adverse outcome was the presence of a resting or an exercise-induced wall motion abnormality.

474 Assessment of left ventricular filling pressures by transoesophageal Doppler echocardiography in women with severe aortic stenosis

474 Assessment of left ventricular filling pressures by transoesophageal Doppler echocardiography in women with severe aortic stenosis

Clinical relevance of chest pain during dobutamine stress echocardiography in women.

Dobutamine stress echocardiography (DSE) is commonly used for diagnosis and management of patients with known or suspected coronary artery disease. Chest pain occurring during DSE potentially provides additional diagnostic accuracy. Our experience suggests that chest pain occurs frequently in women undergoing DSE. It was the purpose of this study to determine the frequency with which chest pain occurs in women undergoing DSE and the relation to inducible ischemia or coronary artery stenosis. To determine the prevalence and clinical significance or chest pain during DSE, we reviewed the records of 154 consecutive women undergoing DSE in our laboratory. Of these, 59 patients (37.5%) also underwent coronary angiography. The presence or absence of chest pain was correlated with ECG changes, left ventricular wall motion abnormalities during DSE, and coronary stenosis by angiography. Forty-one women (26%) developed chest pain during DSE. Patients experiencing chest pain were older (58.5 +/- 9.3 vs. 54.9 +/- 12.6; p = 0.05), and had lower resting heart rates (71 +/- 12.2 vs. 77.9 +/- 14.9; p = 0.008), but received similar maximum doses of dobutamine and reached comparable peak heart rates (131.1 +/- 17.4 vs. 133.5 +/- 21.7; p = NS). Patients with chest pain more commonly exhibited ST-segment depression > or = 1 mm during dobutamine infusion (13/41, 32%, vs. 17/113, 15%; p = 0.02), but chest pain showed no statistically significant correlation with abnormal DSE or with coronary stenosis. In women undergoing DSE, chest pain occurs in 26% and does not appear to be related to inducible myocardial ischemia. Electrocardiographic changes occur more frequently in patients who experience chest pain, but are also often unrelated to inducible myocardial ischemia.

Dobutamine stress echocardiography in women with chest pain: Pilot phase data from the National Heart, Lung and Blood Institute Women’s Ischemia Syndrome Evaluation (WISE)

OBJECTIVESThe aim of this project was to assess the utility of dobutamine stress echocardiography (DSE) for evaluation of women with suspected ischemic heart disease.BACKGROUNDMost investigations addressing efficacy of diagnosis and treatment of coronary artery disease (CAD) have been performed in predominantly male populations. As part of the Women’s Ischemia Syndrome Evaluation (WISE) study, DSE was assessed in women participating at the University of Florida clinical site.METHODSWomen with chest pain or other symptoms suggestive of myocardial ischemia and clinically indicated coronary angiography were eligible for the WISE study. Enrolled subjects underwent DSE using a modified protocol. Coronary stenosis was assessed by core laboratory quantitative coronary angiography (QCA).RESULTSThe 92 women studied ranged in age from 34 to 82 years (mean 57.5). All women had ≥1 major risk for CAD, and most (89, 97%) had ≥2 risk factors. In 78 women (85%), left ventricular wall motion was normal at baseline and during peak infusion. The remaining 14 women had wall motion abnormalities during DSE. By QCA, 25 women (27%) had ≥50% coronary stenosis, including 10 with single-vessel obstruction. Dobutamine stress echocardiography was abnormal in 10 of these 25 women, yielding overall sensitivity of 40%, and 60% for multivessel stenosis. Exclusion of women with inadequate heart rate response yielded overall sensitivity of 50%, and 81.8% for multivessel stenosis. Dobutamine stress echocardiography was normal in 54 of the 67 women with <50% coronary narrowing, specificity 80.6%.CONCLUSIONSDobutamine stress echocardiography reliably detects multivessel stenosis in women with suspected CAD. However, DSE is usually negative in women with single-vessel stenosis, and in the larger subset without coronary stenosis. Ongoing protocols of the WISE study are expected to improve diagnostic accuracy in women with single-vessel disease, as well as provide important data in the substantial number of women with chest pain but without epicardial coronary artery stenosis.