Value of echocardiography during acute exacerbations of chronic obstructive pulmonary diseas

This study was conducted in the general Intensive Care Unit [ICU], Faculty of Medicine El-Minya University Hospital, to evaluate the value of echocardiography in prediction of the need of mechanical ventilation during acute exacerbations of chronic obstructive pulmonary disease. It included sixty patients who were classified into two groups according to their outcome: Group [1]: included 34 patients, 22 males and 12 females, with a mean age +/- SD of 63 +/- 6.84 years, who required mechanical ventilation [MV] due to failure of conservative treatment Group [II]: included 26 patients, 24 males and 2 females, with a mean age +/- SD of 59.2 +/- 7.95 years, who did not need mechanical ventilation. Right ventricular [RV] end-diastolic and end-systolic dimensions were significantly higher, while E-wave velocity and E/A ratio of tricuspid Doppler flow signal were significantly lower in MV group than CT group. The following echocardiographic parameters had a strong diagnostic predictive value for the need of mechanical ventilation, as evidenced by the ROC curve analysis: RV end-diastolic and endsystolic dimensions, Pulmonary artery systolic pressure, and E/A ratio of Tricuspid Doppler flow signal. On the other hand, right ventricular ejection fraction, left ventricular dimensions and ejection fraction, and E/A ratio of mitral flow, did not have such diagnostic value. For RV end-diastolic dimension, a cut-off value of 27.35 mm had a sensitivity of 82.4% and a specificity of 70% for the diagnosis of the need of mechanical ventilation. For RV endsystolic dimension, a cut value of 21.75 mm had a sensitivity of 82.4% and a specificity of 62%. For pulmonary artery systolic pressure, a cut-off value of 36.6 mmHg had a sensitivity of 82.4% and a specificity of 70%. For E/A ratio of tricuspid flow, a cut value of 0.894 had a sensitivity of 94% and a specificity of 70%. We may conclude that, the following echocardiographic parameters have strong diagnostic predictive value and may be used for prediction of the need of mechanical ventilation during acute exacerbations of COPD: Right ventricular end diastolic and end systolic dimensions, E/A ratio of tricuspid Doppler flow signal and pulmonary artery systolic pressure

Hemodynamic exercise response in rheumatic mitral stenosis: an echo-doppler study

The effects of exercise on patients with rheumatic mitral stenosis were investigated using echocardiography. Twenty-five patients in sinus rhythm with no contraindication to exercise were subjected to sub-maximal treadmill exercise according to modified Bruce protocol. A heterogeneous response depending mainly on the degree of mitral valve destruction was noticed. Patients with the same valve areas at rest did not have the same response to exercise. This might explain the difference in severity of symptoms in patients with the same valve areas at rest. It has been concluded that hemodynamic exercise response in patients with mitral stenosis evaluated by Doppler echocardiography immediately after sub-maximal exercise treadmill test is a useful method for evaluation of these patients and gives a better insight of the disease