ABSTRACT
Background: Cardiac resynchronization therapy (CRT) had shown great promise in improving hospitalization and mortality of the patients suffering from refractory heart failure (HF) inspite of optimal medical management. The goal of CRT is to reduce cardiac mechanical dyssynchrony, thereby enabling the heart to contract more efficiently. Mechanical ventricular dyssynchrony as estimated by electrical dyssynchrony, is assessed with the QRS duration. But electrical and mechanical dyssynchrony are not well correlated in all HF patients. The dyssynchrony might have been related to the underlying etiology of HF. Objective: To compare the concordance of mechanical and electrical dyssynchrony in both ischemic and nonischemic cardiomyopathy patients. Methods: Doppler echocardiography and strain echocardiography was performed in 76 patients presenting with heart failure due to ischemic cardiomyopathy (n=40) or nonischemic cardiomyopathy (n=36) with left ventricular ejection fraction<35% & New York Heart Association class III–IV, regardless of their QRS duration. Interventricular dyssynchrony was assessed by the time interval between preaortic and prepulmonary ejection times. Intra-ventricular dyssynchrony was assessed by using conventional Doppler and strain echocardiograpy. Obtained from the three standard apical view (TMinMax) and (2) the standard deviation of the averaged time-to-peak strain (TPS-SD, ms) and (3) time to peak myocardial systolic velocity (Ts-SD) of same segments. Result: The correlation coefficient between QRS duration and mechanical interventricular dyssynchrony was significant (r=0.57, P=0.001) in patients with non-ischemic cardiomyopathy and insignificant (r=0.175, p=0.281) in patients with ischemic cardiomyoparhy. The correlation coefficient between QRS duration and mechanical intraventricular dyssynchrony was significant in patients with nonischemic cardiomyopathy (r= 0.69, P = 0.001 for TMin Max; r=0.57, P= 0.001 for TPS-SD; r=0.48, p=0.003 for TS-SD) and insignificant in patients with ischemic cardiomyopathy (r=0.153; p=0.345 for TMin Max; r=0.178; p=0.273 for TPS-SD r=0.139; p=0.392 for TS-SD). Conclusion: This study showed that the relationship between electrical and mechanical dyssynchrony is dependent on the underlying etiology of heart failure.
ABSTRACT
Echocardiographic measurement of left ventricular mass (LVM) is being used for the diagnosis of left ventricular hypertrophy in children with various cardiovascular diseases. The purposes of this study was to establish normal values of LVM according to weight, height and body surface area (BSA) in children and to determine the sex differences. We evaluated 208 children (143 males and 65 females), aged 1 day to 14 years who had no cardiovascular disease. The end-diastolic left ventricular internal dimension (LVIDd), end-diastolic left ventricular posterior wall thickness (LVPWd) and end-diastolic interventricular septum (IVSd) values were determined by M-mode echocardiographic examination. By using these values, left ventricular mass was calculated. The difference between LVIDd, LVPWd and LVM values of boys and girls were not statistically significant . We observed statistically significant differences between the sexes relative to IVSd and LVM/BSA values. The left ventricular mass and its components presented a good correlation with age, weight, height and BSA. The study let us know the lower and upper limits of cardiac dimensions and LVM obtained by echocardiography in normal Turkish children according to BSA. Also, as the LVM/BSA values show gender difference in children, sex should be taken in consideration while evaluating the left ventricular hypertrophy.
La medición ecocardiográfica de la masa ventricular izquierda (LVM) se utiliza para el diagnóstico de la hipertrofia ventricular izquierda en los niños con diversas enfermedades cardiovasculares. Los objetivos de este estudio fueron establecer los valores normales de MVI en función del peso, altura y área de superficie corporal (BSA) en niños y determinar las diferencias entre sexos. Se evaluaron 208 niños (143 varones y 65 mujeres), con edades entre 1 día a 14 años de edad que presentaban enfermedades cardiovasculares. Se determinaron los valores interno al final del diástole ventricular izquierdo (LVIDd), el espesor de la pared posterior (LVPWd) y el tabique interventricular (IVSd) mediante el examen ecocardiográfico en modo M. Utilizando estos valores, fue calculada la masa ventricular izquierda. Las diferencias de los valores LVIDd, LVPWd LVM entre niños y niñas no fueron estadísticamente significativas. Observamos diferencias estadísticamente significativas entre los sexos en relación con los valores IVSd y LVM/BSA. La masa ventricular izquierda y sus componentes presentaron una buena correlación con la edad, peso, altura y BSA. Este estudio nos permitió conocer los límites superior e inferior de las dimensiones cardíacas, junto a la LVM obtenidas mediante ecocardiografía en niños turcos normales de acuerdo con el BSA. Además, como los valores LVM/BSA muestran diferencias entre sexos en los niños, el sexo se debería tomar en consideración al evaluar la hipertrofia ventricular izquierda.
Subject(s)
Humans , Male , Female , Child , Sex Differentiation/physiology , Hypertrophy, Left Ventricular/diagnosis , Body Weights and Measures/methods , Echocardiography/methods , Reference ValuesABSTRACT
Objective To assess the application of echocardiography in mini-invasive surgical device closure of ventricular septal defect (VSD). Methods 73 VSD patients including 35 with aneurysm formation and among them 21 with multi-defects in the aneurysm were treated by mini-invasive device closure. A closure device was positioned to the defect through parastemal mini-incision in all patients. TEE was used to monitor the whole procedure, to guide the device positioning and to evaluate the curative effect instantly after operation. All patients were evaluated by TTE one year postoperatively. Results All patients were successfully positioned closure devices by TEE guiding. 9 cases were found with trace to small amount residual shunt instantly after operation. 7 cases still had small amount residual shunt at the time of 48 hours after the operation. In the one year follow-up, 4 cases had residual shunt, but the size and volume of left ventricle were significantly reduced than those before operation, and the pulmonary artery systolic pressure was also reduced. Conclusion Echocardiography possesses an important role in preoperative indication screening, intraoperation monitoring and evaluating the curative effect postoperatively.
ABSTRACT
Vegetative electrode infection after implantation of permanent pacemaker or defibrillator is an uncommon but a serious complication. Diagnosis of the lead infection is particularly important since surgical manipulation is usually required for its treatment. We present 3 cases of electrodes related infective endocarditis among the 154 patients who implanted pacemaker or defibrillator between 2001 and 2004 in Korea university hospital. These complications were difficult to diagnose because of ambiguous clinical manifestations and indeterminate transthoracic echocardiographic (TTE) findings and were finally confirmed by transesophageal echocardiography (TEE).
Subject(s)
Humans , Defibrillators , Diagnosis , Echocardiography , Echocardiography, Transesophageal , Electrodes , Endocarditis , Korea , Pacemaker, ArtificialABSTRACT
BACKGROUND: The assessment of coronary blood flow reserve measured by intracoronary Dopper syudy is a useful method for evaluation of functional impairment of coronary artery disease irrespective of significant anatomic stenosis. To validate the usefullness of myocardial contrast echocardiography in clinical assessment of coronary blood flow reserve, several variables analysed by myocardial contrast echocardiography were compared with coronary flow reserve measured by Dopper catheter study. METHODS: During the coronary angiography, coronary flow reserve was measured by intracoronary Dopper-tipped guidewire with coronary blood flow velocity ratio in 16 patients without angiographically significant coronary artery disease. For the measurement of coronary flow reserve, we analyzed the time-video intensity curve of short axis image of the left ventricle follwing infusion of sonicated hexabrix before and after intracoronary administration of adenosine. RESULTS: 1) There was no significiant difference or correlation between peak intensity, peak intensity ratio, washout time, half time of washout, and washout time ratio analysed by contrast echocardiography and coronary blood flow reserve measured by intracoronary Doppler study(p>0.05). But inverse correlation was observed between half time ratio of contrast washout and coronary flow reserve(r=0.63,p<0.05). 2) There was no significiant difference between non myocardial infarction group and myocardial infartion group in coronary flow reserve and half time ratio of contrast washout. 3) No significant difference was observed before and after administrantion of sonicated hexabrix in hemodynamic variables. CONCLUSION: Among several variables of myocardial contrast echocardiography analysis half time ratio of washout was significantly correlated with coronary flow reserve. Thus assesssment of coronary flow reserve with myocardial contrast echocardiography is promising method in the evaluation of dymamic coronary perfusion and myocardial viability.