Measurements Of Left Ventricular Dimensions Research Articles

Echocardiographic measurements of left ventricular dimensions and function in newborns with omphalocele and pulmonary

PurposeThe purpose of this study was to explore echocardiographic parameters of the left ventricle (LV) in relation to the outcomes of omphalocele neonates with pulmonary hypertension (PH).MethodsThis retrospective study was conducted among omphalocele patients with PH born from 2019 to 2020. Patients in this study did not have additional severe malformations or chromosomal aberrations. Patients who died under palliative care were excluded. The echocardiographic parameters of LV were obtained within 24 h after birth. Clinical and outcomes data were recorded, echocardiograms evaluated for left ventricular internal dimension in end-diastole (LVIDd), end-diastolic volume (EDV), stroke volume (SV) and cardiac output index (CI), among others.ResultsThere were 18 omphalocele newborns with PH, of whom 14 survived and 4 died. Both groups were comparable in the baseline characteristics. Non-survival was associated with a smaller LV [LVIDd (12.2 mm versus15.7 mm, p < 0.05), EDV (3.5 ml versus 6.8 ml, p < 0.05)] and with worse systolic function [SV (2.3 ml versus 4.2 ml, p < 0.05), and CI (1.7 L/min/m2 versus 2.9 L/min/m2, p < 0.01)].ConclusionIn the cohort of omphalocele patients with PH, lower LVIDd, EDV, SV and CI were associated with mortality.Level of evidenceLevel III.

Assessment of echocardiographic left ventricular dimensions with several clinical findings among healthy people

Background: The echocardiographic measurement of left ventricular dimensions and the changes of left ventricular dimensions may be important to assess cardiac as well as the cardiovascular conditions of patients. On the other hand, the QRS duration signifies the time for ventricular depolarization. Aim of the study: The aim of this study was to assess the echocardiographic left ventricular dimensions with several clinical findings among healthy people. Methods: This was an observational cross-sectional study which was conducted in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka over a period of 2 years from July 2008 to June 2010. In total 92 apparently healthy people without heart failure (HF) or myocardial infarction (MI) were included as the study population. Among them, 22 were in Referent (QRS duration &lt;100 ms), 40 in Incomplete BBB (QRS duration 100 – 119), and 30 in Complete BBB (≥ 120 ms) groups. Proper written consent was taken from all the participants and this study was approved by the ethical committee of the mentioned university. All data were processed, analyzed, and disseminated by MS Office and SPSS version as per need. Results: In this study, the left ventricular (LV) mass, left ventricular diastolic dimension, septal wall thickness, posterior wall thickness and left atrial size were significantly higher in complete BBB group than those in referent and incomplete BBB group (143.0 ± 30.2 vs. 182.6 ± 37.9 vs. 222.0 ± 61.0, p &lt; 0.001; 4.6 ± 0.3 vs. 4.9 ± 0.3 vs. 5.2±0.4, p&lt; 0.001; 0.9±0.1 vs. 1.0 ± 0.1 vs. 1.1± 0.1, p&lt;0.001; 0.9 ± 0.1 vs. 1.0 ± 0.1 vs. 1.1± 0.1, p&lt;0.001; and 3.3 ± 0.3 vs. 3.6±0.3 vs. 3.7±0.3, p&lt;0.001 respectively). However, fractional shortening and left ventricular ejection fraction were found to decrease significantly with the increase in QRS duration (p &lt; 0.001 and p &lt; 0.001 respectively). In this study the QRS duration was observed to be linearly correlated with LV mass, LV diastolic dimension, septal wall thickness, posterior wall thickness and left atrial size (r=0.577, p&lt;0.001; r=0.480, p&lt;0.001; r=0.583, p&lt;0.001; r=0.521, p&lt; 0.001 and r= 0.418, p&lt;0.001 respectively).&nbsp; However, QRS duration was found to maintain a negative correlation with fractional shortening and LVEF (r =- 0.637, p&lt;0.001 and r =- 0.701, p&lt;0.001 respectively). Conclusion: The present study revealed that longer electrocardiographic QRS duration was correlated with the increase in LV mass, LV diastolic dimensions, septal wall thickness, posterior wall thickness, and left atrial size. The association was most striking in individuals with complete BBB compared with a normal QRS duration. Meanwhile, the presence of prolonged QRS in a patient’s ECG can serve as a bedside clue to the presence of decreased fractional shortening and left ventricular ejection fraction.

Impact of Physiologic Pacing Versus Right Ventricular Pacing Among Patients With Left Ventricular Ejection Fraction Greater Than 35%: A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

It is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP). Our analysis sought to review existing literature to determine if BiVP and/or HisBP might prevent adverse remodeling and be associated with structural, functional, and clinical advantages compared with RVP among patients without severe left ventricular dysfunction (>35%) who required permanent pacing because of heart block. A literature search was conducted using MEDLINE (through PubMed) and Embase to identify randomized trials and observational studies comparing the effects of BiVP or HisBP versus RVP on measurements of left ventricular dimensions, left ventricular ejection fraction (LVEF), heart failure functional classification, quality of life, 6-minute walk, hospitalizations, and mortality. Data from studies that met the appropriate population, intervention, comparator, and outcomes of interest were abstracted for meta-analysis. Studies that reported pooled outcomes among patients with LVEF both above and below 35% could not be included in the meta-analysis because of strict relationships with industry procedures that preclude retrieval of industry-retained unpublished data on the subset of patients with preserved left ventricular function. Evidence from 8 studies, including a total of 679 patients meeting the prespecified criteria for inclusion, was identified. Results were compared for BiVP versus RVP, HisBP versus RVP, and BiVP+HisBP versus RVP. Among patients who received physiologic pacing with either BiVP or HisBP, the LV end-diastolic and end-systolic volumes were significantly lower (mean duration of follow-up: 1.64 years; -2.77 mL [95% CI -4.37 to -1.1 mL]; P=0.001; and -7.09 mL [95% CI -11.27 to -2.91; P=0.0009) and LVEF remained preserved or increased (mean duration of follow-up: 1.57 years; 5.328% [95% CI: 2.86%-7.8%; P<0.0001). Data on clinical impact such as functional status and quality of life were not definitive. Data on hospitalizations were unavailable. There was no effect on mortality. Several studies stratified results by LVEF and found that patients with LVEF >35% but ≤52% were more likely to receive benefit from physiologic pacing. Patients with chronic atrial fibrillation who underwent atrioventricular node ablation and pacemaker implant demonstrated clear improvement in LVEF with BiVP or HisBP versus RVP. Among patients with LVEF >35%, the LVEF remained preserved or increased with either BiVP or HisBP compared with RVP. However, patient-centered clinical outcome improvement appears to be limited primarily to patients who have chronic atrial fibrillation with rapid ventricular response rates and have undergone atrioventricular node ablation.

Right Heart Pressure Transients and Pulmonary Venous Pressure

tricular (RV) ejection phase indices were limited in part because the complex shape and geometry of the right ventricle limited any reasonable calculation of volume and wall stress. Likewise, methods to assess the RV ejection fraction were in their infancy. By contrast, RV and pulmonary artery (PA) pressure measurements were relatively easy to obtain and it was thought that RV pressure transients and the isovolumic indices of contractility might be applied to the assessment of RV and perhaps even global cardiac contractility. This idea matured during deliberations about the independent function of the right ventricle and the fact that RV failure occurring secondary to LV failure was not easily explained on the basis of the relatively small pressure load imposed by elevated pulmonary venous pressures. Recognizing the distinct architectural and anatomic differences between the right and left ventricles, further discussions led to considerations of ventricular interaction and the possibility that the normal left ventricle directly assists the right ventricle in its pumping function while the dysfunctional left ventricle was limited in this regard. In the early 1970s, cardiologists exhibited a considerable interest in the relative merits of the isovolumic and ejection phase indices of left ventricular (LV) contractility. The isovolumic indices were derived from high-fidelity measurements of LV pressure prior to aortic valve opening; thus, LV pressure and the time derivative of pressure (dP/dt) were used to calculate ‘contractile element’ velocity during the early systole when ventricular volume was nearly constant. Because the pressure transients occurred prior to aortic valve opening, the isovolumic indices were considered to be independent of changes in aortic pressure and LV afterload. The ejection phase indices were derived from measurements of LV dimensions or volume during ejection; thus, dimension or volume strain (ejection fraction) and strain rates were determined. With the incorporation of pressure data, wall stresses were calculated, myocardial length-force-shortening relations were plotted, and afterload-ejection fraction assessed [1–4] . During this period, interest in the right ventricle was limited, mainly due to technical reasons. The right venReceived: April 28, 2016 Accepted after revision: May 9, 2016 Published online: June 10, 2016

Impact of Left Ventricular Hypertrophy on Survival in Chronic Obstructive Pulmonary Disease.

Left ventricular hypertrophy (LVH) is a significant cardiac risk factor, associated with increased mortality. The impact of LVH on mortality in chronic obstructive pulmonary disease (COPD) is unknown. We evaluated the impact of LVH on mortality in COPD patients by measurement of left ventricular dimensions by echocardiography. Retrospective cohort study utilizing a NHS database of COPD patients (TARDIS), in Tayside, Scotland (2001-2010), linked with databases regarding echocardiograms, pharmacy prescription, and the General Register Office for Scotland death registry. Cox proportional hazard regression was used to determine hazard ratios for mortality and hospital admissions based upon left ventricular mass index (LVMI) and left ventricular internal diastolic diameter after correction for all available influential covariates. Increased LVIDd was defined as >5.3 cm (female) and >5.9 cm (male). LVH was defined as an LVMI of >95 g/m(2) (female) and >115 g/m(2) (male). 617 patients were included for analysis. Mean (SD) age at diagnosis, 70 (9); mean FEV1 % (SD), 60.6 (19.3); mean resting SaO2 % (SD), 92.7 (10). Mean follow-up 4.5 years. Increased LVIDd was not associated with increased mortality, χ (2)= 0.767, p = 0.381. Increased LVMI was associated with a significant increased risk of mortality, χ (2) = 5.447, p = 0.02 with an adjusted HR (95 % CI) of 1.542 (1.068-2.228), p = 0.021. The presence of LVH, demonstrated by elevated left ventricular mass index is associated with a significantly increased risk of mortality in COPD patients. Therapeutic interventions are required to address this important modifiable risk factor in COPD patients.

P130 Impact of left ventricular hypertrophy on mortality in COPD

Introduction and ObjectivesLeft ventricular hypertrophy (LVH) is a significant risk factor of cardiovascular disease and is associated with increased mortality. Previous studies have shown an increased prevalence of LVH in...

Abstract 2819: Identification and Characterization of Super-Responders to Cardiac Resynchronization Therapy: An Echocardiographic Study

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)&gt;50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF &lt;50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p&lt;0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p&lt;0.01) and 53±7.4mm vs 63±8.4mm (p&lt;0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p&lt;0.02) and 123±43ml vs 163±69ml (p&lt;0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p&lt;0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p&lt;0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p&lt;0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p&lt;0.0001). In a large multicenter study, CRT super-responders (EF&gt;50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.

Measurement of left ventricular dimensions with contrast-enhanced three-dimensional cine imaging facilitated by k-t SENSE.

AimTo compare three-dimensional (3D) k-t sensitivity encoded (k-t SENSE) cine cardiovascular magnetic resonance (CMR), before and after contrast administration, against standard 2D imaging for the assessment of left ventricular volumes and mass.MethodTwenty-six subjects (14 volunteers, 12 patients) underwent multiple breathhold 2D balanced turbo-field echo cine CMR in addition to k-t SENSE accelerated 3D imaging (acceleration factor 5; 5× k-t SENSE), performed before and after administration of a high-relaxivity gadolinium-based contrast agent (Gadobutrolum). k-t acceleration factors of 7 and 10 were also assessed in six volunteers. Left ventricular end diastolic volume (EDV), end systolic volume (ESV), mass, and ejection fraction (EF) were calculated for each method.ResultsThere was at least moderate agreement between the EDV, ESV, mass and EF calculated by 2D and 3D 5× k-t SENSE methods before contrast (concordance coefficients 0.92, 0.95, 0.97, 0.92, respectively). Agreement improved following contrast (concordance coefficients 0.97, 0.99, 0.98, 0.93, respectively). The 3D method underestimated all parameters compared to 2D (mean bias pre-contrast 6.1 ml, 0.6 ml, 3.5 g, 2.0% respectively). 3D image quality scores were significantly poorer than 2D, showing a non-significant trend to improvement following contrast administration. Parameters derived with k-t acceleration factors of 7 and 10 showed poorer agreement with 2D values.ConclusionLeft ventricular volumes and mass are reliably assessed using 3D 5× k-t SENSE accelerated CMR. Contrast administration further improves agreement between 5× k-t SENSE and 2D-derived measurements. k-t acceleration factors greater than 5, though feasible, produce poorer agreement with 2D values.

Balloon Angioplasty for Native Aortic Coarctation in Different Anatomic Variants

Balloon angioplasty for native coarctation of the aorta in infants and children is gaining acceptance as an alternative to surgery in discrete membranous obstruction. The aim of this study was to assess the immediate and intermediate-term effectiveness and safety of balloon angioplasty in infants and children with discrete membranous obstruction and mild complex arch anomalies. We performed a retrospective study evaluating the immediate and intermediate-term results of balloon angioplasty in 46 consecutive patients with native coarctation of the aorta done between March 1998 and June 2003. Isolated discrete fibromembranous obstruction occurred in 32 patients, and 14 patients had mild complex arch anomalies. Follow-up was obtained in 40 patients. There was no early mortality. The procedure was initially successful in 43 patients (93%). There were three immediate failures. Of the 40 patients who were followed, 32 (80%) had maintained a cuff pressure gradient of 20 mmHg across the dilated area. Four patients developed restenosis, which was successfully treated by repeated balloon angioplasty. The other four patients continued to have mild gradient (20-22 mmHg) with systolic hypertension and without angiographic evidence of restenosis but with isthmus hypoplasia; they received atenolol and captopril. Serial echocardiographic measurement of left ventricular dimension and function revealed significant improvement after balloon angioplasty of aortic coarctation in patients with the echocardiographic picture of hypertensive cardiomyopathy. Balloon angioplasty may be considered as a tool in the armamentarium of management of aortic coarctation in different anatomic variants, taking into consideration the clinical presentation and patient age.

Automated Short-Axis Cardiac Magnetic Resonance Image Acquisitions

This study investigates the use of an automated observer-independent planning system for short-axis cardiovascular magnetic resonance (MR) acquisitions in the clinical environment. The capacity of the automated method to produce accurate measurements of left ventricular dimensions and function was quantitatively assessed in normal subjects and patients. Fourteen healthy volunteers and 8 patients underwent cardiovascular MR (CMR) acquisitions for ventricular function assessment. Short-axis datasets of the left ventricle (LV) were acquired in 2 ways: manually planned and generated in an automatic fashion. End-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and left ventricular mass (LVM) were derived from the 2 datasets. The agreement between the manual and automatic planning methods was assessed. The mean differences between the manual and automated CMR planning methods for the normal subjects and patients were 5.89 mL and 1.93 mL (EDV), 1.14 mL and -0.41 mL (ESV), 0.81% and 0.89% (EF), and 4.35 g and 3.88 g (LVM), respectively. There was no significant difference in ESV and EF. LVM significantly differed in both groups, whereas EDV was significantly different in the normal subjects and insignificantly different in the patients. The variability coefficients were 2.8 and 3.59 (EDV), 3.3 and 5.03 (ESV), 1.79 and 2.65 (EF), and 4.36 and 2.27 (LVM) for the normal subjects and patients, respectively. The mean angular deviation of the LV axes turned out to be 8.58 +/- 5.76 degrees for the normal subjects and 8.35 +/- 5.15 degrees for the patients. Automated CMR planning method can provide accurate measurements of LV dimensions in normal subjects and patients, and therefore, can be used in the clinical environment for functional assessment of the human cardiovascular system.

Differences Between Echocardiographic Measurements of Left Ventricular Dimensions and Function by Local Investigators and a Core Laboratory in a 2-year Follow-up Study of Patients with an Acute Myocardial Infarction

To examine differences in measurements of left ventricular dimensions and function, and prognostic value between local investigators and a core laboratory in a multicentre serial echocardiographic study. Seven hundred and fifty-six patients with acute myocardial infarction and preserved left ventricular function were examined at baseline and after 3 months with measurements by the biplane Simpson's method, and followed prospectively from 3 to 24 months. At baseline and 3 months local investigators relative to the core laboratory measured lesser end-diastolic volume by 8 and 6 ml (P<0.001), end-systolic volume by 3 and 2 ml (P<0.01), and ejection fraction by 0.0 and 0.6% (P<0.01), respectively. Local investigators and the core laboratory measured an increase in left ventricular end-diastolic volume of 8.6 and 6.9 ml, and in left ventricular end-systolic volume of 5.2 and 4.3 ml, and a decrease in left ventricular ejection fraction of 0.6 and 0.0%. Using the Cox proportionate hazards model, the prognostic value for subsequent clinical endpoints was significant both for the 3-month values (P<0.05) and changes (P<0.005) measured by the core laboratory, but not by local investigators. Only measurements in the core laboratory had significant prognostic value for subsequent clinical endpoints. These results strongly support the use of a core laboratory in studies employing echocardiographic measurements.

Differences Between Echocardiographic Measurements of Left Ventricular Dimensions and Function by Local Investigators and a Core Laboratory in a 2-year Follow-up Study of Patients with an Acute Myocardial Infarction

Differences Between Echocardiographic Measurements of Left Ventricular Dimensions and Function by Local Investigators and a Core Laboratory in a 2-year Follow-up Study of Patients with an Acute Myocardial Infarction

Differences Between Echocardiographic Measurements of Left Ventricular Dimensions and Function by Local Investigators and a Core Laboratory in a 2-year Follow-up Study of Patients with an Acute Myocardial Infarction

Differences Between Echocardiographic Measurements of Left Ventricular Dimensions and Function by Local Investigators and a Core Laboratory in a 2-year Follow-up Study of Patients with an Acute Myocardial Infarction

Intra- and inter-observer reproducibility of transthoracic pulmonary venous Doppler flow indices after acute myocardial infarction.

To examine the intra- and inter-observer reproducibility of pulmonary venous flow indices in patients with acute myocardial infarction. Two investigators, blinded to the results of the other examination, each examined 28 clinically stable post infarction patients in sinus rhythm. The two stored digital Doppler recordings from each patient were analysed in a blinded manner by both investigators to obtain the intra- and inter-observer reproducibility including both a new recording and new measurements. The intra- and inter-observer coefficients of variation for the different variables ranged between 5-15% and 8-23% respectively. For some of the indices there was a difference in means between the observers, and the indices were influenced in different degree by a new measurement and new recording. The degree of variability found in this study indicates wide relative limits of agreement, ranging from +/-10% to +/-45%. The reproducibility of pulmonary venous flow indices was only moderate with relatively wide limits of agreement. The reproducibility was, however, comparable to other echocardiographic measurements of left ventricular dimensions and function.

Measurements of left ventricular dimensions using real-time acquisition in cardiac magnetic resonance imaging: comparison with conventional gradient echo imaging

Measurements of left ventricular dimensions using real-time acquisition in cardiac magnetic resonance imaging: comparison with conventional gradient echo imaging

Cardiac abnormalities and skeletal muscle weakness in carriers of Duchenne and Becker muscular dystrophies and controls.

Cardiac abnormalities, cardiomyopathy and skeletal muscle weakness have been described in female carriers of the Xp21 (Duchenne and Becker) muscular dystrophies (J Neurol 1975;209(4):279-285; Br Med J 1969;2:418-420; J AmMed Assoc 1996;275(17):1335-1338; Neurology 1980;30(5):497-501; Neuromusc Disord 1999;9:347-351; Arch Neurol 1989;46:673-675). We have screened volunteers from our Xp21 genetics register and found the prevalence of previously unrecognized, clinically relevant, abnormalities in this group to be less than previously reported. We studied 91 women (56 carriers and 35 controls), aged between 18 and 69 years, from our local population known to the Oxford Regional Genetics Register. Our study included controls, with the investigators being blind to the subject's genetic status. The prevalence of previously unrecognised cardiac abnormalities on echocardiogram and ECG was 18% (10/56). Seven percent (4/56) of carriers had cardiomyopathy, defined by significant LV dilatation and decreased shortening fraction. In most cases, subjects with abnormal cardiac findings were asymptomatic. Echocardiography was more frequently abnormal than electrocardiography, but in many subjects the measurements of left ventricular dimensions were only just outside the normal ranges. The prevalence of skeletal muscle weakness was 12% (7/56). It was usually recognized by the individual, although not previously volunteered, but was mild and did not substantially affect activities of daily living.

Cardiac responses to progressive exercise in normal children: a synthesis.

The cardiac responses to exercise are influenced by a complex interplay of changes in diastolic filling, intrinsic myocardial contractility, heart rate, and ventricular afterload. To characterize these responses in children, findings are reported from two studies utilizing Doppler echocardiographic assessment of stroke volume and cardiac output during maximal upright and semisupine cycle exercise. In study 1, stroke volume, heart rate, and peak aortic velocity were assessed during upright cycle exercise to exhaustion in 39 sixth-grade boys. In study 2, similar methods were used to examine cardiac responses to semisupine exercise with measurement of left ventricular dimensions by two-dimensional echocardiography. The findings support patterns similar to that previously described in adults, with an initial rise in stroke volume reaching a plateau at mild-moderate exercise intensities. The observations in these two studies also suggest 1) peripheral vasodilatation plays an important role in the early rise in stroke volume, 2) increasing heart rate acts to maintain a stable stroke volume and left ventricular diastolic dimension at high workloads, and 3) improvements in contractility serve to maintain stroke volume as the systolic ejection period shortens.

Studying the mechanics of left ventricular contraction.

Several interesting aspects of the ESPVR have been discussed in this study, including: a) A possibility to introduce, in an explicit manner, the active force of the myocardium in the formalism describing the PVR of the left ventricle. b) A possibility to express the ventriculo-arterial coupling by using the ratio Emax/eam in a way to distinguish between the normal physiological state and the mildly or severely depressed state of the heart. The possibility of also expressing this coupling by using directly different areas under ESPVR has been indicated. A third method, not discussed here, is to use the windkessel model (see [27, 53]). c) The relationship between oxygen consumption and all the areas under ESPVR. d) A possible mechanism of adaptation to short- or long-term variation in load condition by changing ESPVR in a way to create an SWR (see Fig. 4 and Table 2). e) A possibility to use different areas under ESPVR for clinical diagnostic purposes (see [20]); an example for SWR and SWR/SW is given in Table. 2. f) A possibility of noninvasive clinical application of various results of this study. Item (f) depends on the possibility of noninvasive measurement of the left ventricular pressure, which has been reported by Bourguignon and Wagner [61], and Sato, et al. [62]. Noninvasive measurement of left ventricular dimensions has been discussed by Teichholz, et al. [63], Grassman, et al. [64], Dumesnil et al [65], Dumesnil and Shoucri [66, 67]. Measurement of ESPVR from one loop of the contraction cycle has also been discussed by Takeuchi, et al. [68] and Nakamoto, et al. [69]. Further readings can be found in [70] and [71]. The list of references is not exhaustive, but has been chosen to illustrate various related aspects of the topics discussed.

Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients.

Some patients with hypertrophic obstructive cardiomyopathy may gain symptomatic relief from a reduction in the extent of obstruction to left ventricular outflow. We present the outcome of the first series of patients treated with an alternative method of gradient reduction using catheter techniques. Eighteen patients were treated with selective intracoronary alcohol injection to induce localized septal infarction. Patients underwent echocardiographic measurement of left ventricular dimensions and Doppler echocardiographic evaluation of left ventricular outflow tract gradients before the procedure, on the first postoperative day, and at a median follow-up of 3 months after the procedure. In addition, patients underwent exercise testing and symptom evaluation before and 3 months after nonsurgical septal reduction. There was a significant reduction in left ventricular outflow tract obstruction after the procedure (preprocedure, 67 mm Hg [95% CI, 48 to 87 mm Hg]; postprocedure, 25 mm Hg [95% CI, 16 to 34 mm Hg]; P=.0006), which persisted at 3-month follow-up (22 mm Hg [95% CI, 12 to 32 mm Hg]; P=.001). This was associated with a significant improvement in symptoms. There was a small but not significant increase in exercise capacity (n=10; preprocedure, 418 seconds [95% CI, 273 to 563 seconds]; postprocedure, 452 seconds [95% CI, 283 to 621 seconds). Left ventricular dimensions were not significantly altered by nonsurgical septal reduction. Nonsurgical septal reduction significantly reduces left ventricular outflow tract obstruction and improves symptoms in some patients with hypertrophic obstructive cardiomyopathy. The technique may provide an alternative to surgical myomectomy in selected patients.

Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function

To investigate sources of variability in serial echocardiographic recordings in a core laboratory we assessed the impact of repeated echo recordings, repeated video measurements and measurements made by different investigators. Two investigators each recorded and analysed two-dimensional echos in 12 individuals (n = 24 in total) three times at one week intervals. Left ventricular end-diastolic and end-systolic volumes were measured using the biplane modified Simpson's rule. Ejection fraction was derived from these volumes and left ventricular mass estimated using the area-length method. The left ventricular spherity index was expressed as the ratio of the short axis area and the long axis area at end-diastole. A video recording from each examination was reexamined twice by both investigators. Deviations between repeated echo recordings and repeated video measurements ranged from -5 to +5% between investigators. A three-way repeated analysis of variance indicated a small, but systematic difference between investigators. Reproducibility, measured by coefficients of variation, ranged from 3-9% for different investigators, 3-6% for repeated video measurements and 7-19% for repeated echo recordings across the different variables. The total variability of all three factors should be considered when the smallest detectable significant change in a variable is assessed. These ranged from 16-28% across the five variables studied, when a 10% error of classification was accepted for a one-sided change in a variable. Repeated echo recordings were the dominant component of variation. Two-dimensional echo measurements are reproducible and accurate, but the same investigator should follow the same patients.