Association between latest activated sites in the left ventricle and akinetic segments in patients with ischemic cardiomyopathy

Background: It is not clear whether the latest activation sites in the left ventricle [LV] are matched with infracted regions in patients with ischemic cardiomyopathy [ICM]. We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM

Methods: Data were analyzed in 106 patients [age = 60.5 +/- 12.1 y, male = 88.7%] with ICM [ejection fraction 120 ms

Results: A total of 1 272 segments were studied. The latest activation sites [with longest Ts] were most frequently located in the mid-anterior [n = 32, 30.2%] and basal-anterior segments [n = 29, 27.4%], while the most common sites of akinesia were the mid-anteroseptal [n = 65, 61.3%] and mid-septal [n = 51, 48.1%] segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration

Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM

Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result

The current study aims to identify demographic, clinical characteristics, echocardiographic and/or mitral valve morphological parameters that may predict the successful result of percutaneous transvenous mitral commissurotomy [PTMC]. The medical records of 196 patients [48 males, mean age: 42.7 +/- 11.5 years] who underwent PTMC were reviewed. Prior to PTMC, a combination of transthoracic and transesophageal echocardiography were used to investigate substantial mitral valve morphological subcomponents [thickening, mobility, calcification, and subvalvular thickness] and suitability for PTMC. The second transthoracic echocardiographic assessment was performed within six weeks after PTMC. Patients were divided into two categories of successful or unsuccessful according to PTMC results. Successful PTMC was defined as: final mitral valve area [MVA] >/= 1.5 cm[2] without a post-procedure mitral regurgitation [MR] grade >2. The significant predictor of the result was identified by comparing demographic data, initial echocardiographic assessment and mitral valve morphological scores within both groups. The mean MVA increased from 1.0 +/- 0.2 cm[2] to 1.7 +/- 0.4 cm[2], and mitral valve mean gradient [MVMG] decreased from 11.5 +/- 5.2 to 5.2 +/- 3.3 mmHg [P < 0.001 for both]. Successful results were obtained in 139 [70.9%] patients compared to unsuccessful results in 57 [29.1%]. Unsuccessful results were due to suboptimal secondary MVA < 1.5 cm[2] in 50 [25.5%] patients and post-procedure MR grade >2 in 7 [3.6%]. Multiple logistic regression analysis indicated that young age, lower size of the left atrium [LA], and smaller degree of mitral valve thickness were the predictors of successful result. Pre-procedure echocardiographic assessment appears to be helpful in predicting PTMC results. Successful PTMC is influenced by the patients' age, LA size, and mitral valve thickness

Assessment of left ventricular dyssynchrony in heart failure patients regarding underlying etiology and QRS duration

Left ventricular [LV] dyssynchrony is a prevalent feature in heart failure [HF] patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology. The available data on the tissue Doppler imaging [TDI] of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration < 120 ms; 120-150 ms; and >/= 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy [ICM] or dilated cardiomyopathy [DCM]. The time-to-peak myocardial sustained systolic velocity [Ts] in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay >/= 40 ms and tissue Doppler velocity all segments delay >/= 105 ms; standard deviation [SD] of all segments >/= 34.4 ms; basal segments delay >/= 78 ms; SD of basal segments >/= 34.5 ms; and opposing wall delay >/= 65 ms. After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration >/= 150 ms than in those with QRS duration 120-150 ms and < 120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration >/= 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration < 120 ms, while etiology did not influence the frequency of these indices in each QRS group. The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices

rey auditory verbal learning test: alternate forms equivalency and reliability for the Iranian adult population [Persian version]

Increasing demand for memory assessment in clinical settings in Iran, as well as the absence of a comprehensive and standardized task based upon the Persian culture and language, requires an appropriate culture- and language-specific version of the commonly used neuropsychological measure of verbal learning and memory, the Rey Auditory Verbal Learning Test [RAVLT]. The Persian adapted version of the original RAVLT and two other alternate word lists were generated based upon criteria previously set for developing new word lists. A total of 90 subjects [three groups of 30 persons], aged 29.7 +/- 7.10 years, volunteered to participate in our study and were tested using the original word list. The practice effect was assessed by retesting the first and second groups using the same list after 30 and 60 days, respectively. The test-retest reliability was evaluated by retesting the third group of participants twice using two new alternate word lists with an interval of 30 days. The re-administration of the same list after one or even two months led to significant practice effects. However, the use of alternate forms after a one-month delay yielded no significant difference across the forms. The first and second trials, as well as the total, immediate, and delayed recall scores showed the best reliability in retesting by the alternate list. The difference between the generated forms was minor, and it seems that the Persian version of the RAVLT is a reliable instrument for repeated neuropsychological testing as long as alternate forms are used and scores are carefully chosen

Association between androgenic hormone levels and left ventricular ejection fraction

Androgens have been shown to have diverse effects on the cardiovascular system. The aim of this study was to compare androgenic hormone levels in patients with different left ventricular ejection fractions [EF]. The study population consisted of 515 consecutive men who were referred for angiographic studies and whose results of echocardiography and coronary angiography were available. The patients were classified into four groups: EF < 35%, EF=35-45%, EF=45-54%, and EF >/= 55% to evaluate the trends of baseline characteristics and serum androgens, including free testosterone [fT], total testosterone [tT], and dehydroepiandrosterone sulfate [DHEAS]. To better elucidate the difference in the patients with severe heart failure, the patients were divided into two groups according to their EF level, and comparisons were repeated between those with EF < 35% and the ones with EF >/= 35%. There were statistically significant trends in some characteristics in the patients with different levels of EF. The subjects with higher EF levels were less likely to have diabetes [p value < 0.001], coronary artery lesion [p value < 0.001], or high levels of C-reactive protein [CRP] [p value < 0.001]. As regards the patients with severe heart failure, our regression analysis revealed that the fT level was significantly lower in those with EF < 35% than in the ones with EF >/= 35% [5.82 +/- 2.73 pg/mL vs. 6.88 +/- 3.34 pg/mL, p value < 0.05]. A significant association was found between the level of fT and EF < 35%. There is a need for further controlled prospective studies to delineate any possible causal relationship accurately

Transcatheter closure of patent ductus arteriosus: initial study on echocardiographic estimation of device size

Transcatheter occlusion of the patent ductus arteriosus [PDA] is a minimally invasive treatment. The appropriate device size is chosen based on the angiographic measurement of the PDA. The current study aimed to assess the relationship between the transthoracic echocardiographic [TTE] measurements of the PDA prior to the occlusion procedure and the actual size of the deployed device. We reviewed the available records of 7 patients [2 male] who underwent the procedure at our institution [mean age: 21 +/- 12.7years, range: 7 to 46years]. PDA closure was performed successfully using the Amplatzer Duct Occluder [n = 5] and its Chinese copycat, Cardi-O-Fix Occluder [n =2]. The TTE measurement of the aortic end diameter of the PDA showed a good linear regression correlation with the size of the implanted duct occluder [duct occluder size = 0.543 + [0.941 x TTE measured diameter], R = 0.907; p value