2D Echocardiographic Findings, NT-ProBNP Levels, and Outcomes in Dyspnoeic Patients: Results from the Pro-BNP Investigation of Dyspnoea in the Emergency Department- a Single Centre Experience

Background: Dyspnoeic in the emergency department with multiple co-morbidities is a diagnostic challenge. Approximately 15-20% of acute dyspneic in the Emergency Department due to ADHF (acute decompensated heart failure) are misdiagnosed. B-type peptide (BNP) and its amino-terminal fragment (NT-proBNP) accurately identify HF in dyspnoeic patients. In the general population with dyspnoea, plasma pro-BNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction but are unaffected by pulmonary dysfunction. Aims and Objectives: To study the relation between NT pro-BNP & echocardiographic findings in acute dyspnoeic patients, and the relation between NT pro-BNP and In-hospital Mortality. Materials and Methods: Source of data- Patients admitted to the Emergency Room or cardiac intensive care unit with a history of acute dyspnea in a tertiary cardiac care center in south India, meeting inclusion & exclusion criteria, were studied. Results: The study population is predominantly constituted of the elderly population. The most common co-morbid condition was hypertension. The present study uses an NT pro BNP level of 900pg/ml as the cut-off level. 78 patients were positive for the test. Echocardiography showed that 58% had LV systolic dysfunction, 60% had diastolic dysfunction. 42 patients had EF >55%, 10 patients between 55-45%, 33 patients between 44-30% and 15 patients had EF < 30%. Mortality rate was 6% in the whole study population. However, Mortality was seen in only NT pro-BNP positive group it was not statistically significant (p=0.46). Conclusions: NT pro-BNP correlates well with the worsening of LV systolic function; as the EF decreases, NT pro-BNP increases. Increase in NT pro-BNP levels has to be interpreted in the clinical context, and it is not a substitute for echocardiography for assessing cardiac abnormalities and dysfunction.

Left ventricular global longitudinal strain imaging in identifying subclinical myocardial dysfunction among covid-19 survivors

Background: Covid-19 is multi-system viral infection caused by SARS-CoV-2 virus. Apart from having acute severe respiratory illness causing high mortality, the disease also has a variety of cardiovascular manifestations contributing to morbidity as well as mortality. Cardiac dysfunction and myocarditis are well established complications of Covid-19 as evident in multiple studies after the Covid-19 pandemic. However it is not sufficiently studied in Indian patients either by Echocardiography or by any other imaging modalities like cardiac magnetic resonance imaging (MRI). Methodology: In this study, we analysed the severity of Left ventricular(LV) dysfunction in Covid-19 survivors. A total of 100 consecutive patients of Covid-19 after one month of discharge who had no underlying cardiovascular diseases underwent echocardiography and global longitudinal strain (GLS) imaging. This study cohort included patients with mild 42 (42%),moderate 46(46%) and severe 12(12%) Covid-19 disease as defined by computerised tomography (CT) severity score. Result: We observed that total 36(36%) patients had reduced ejection fraction(EF) which included 11 patients having EF <40% and remaining 25(25%) having EF 40e50% (p<0.002). Also 22 (22%) patients had abnormal global longitudinal strain (GLS) values with normal ejection fraction which is suggestive of subclinical myocarditis. We observed LV dysfunction in 7(19.5%) patients who had severe Covid-19 while mild to moderate LV dysfunction observed in 29(80.5%) non critical patients. Conclusion: In conclusion our study demonstrates that myocardial dysfunction is common in covid-19 regardless of disease severity. 2D-echocardiography with GLS is likely to detect early LV dysfunction among these patients.

Unusual presentation of scrub typhus in pregnancy with postpartum dilated cardiomyopathy: a case report

Though scrub typhus is one of the uncommon causes of fever in peripartum period it must be kept in differential diagnosis of any febrile illness particularly when the signs and symptoms points towards rickettsial etiology. Weil-Felix test can be used for diagnosis. Uncommon complications such as cardiomyopathy must be suspected in cases who present with undue dyspnea and signs of congestive heart failure. Patients with cardiomyopathy needs appropriate management in intensive care units. ECG and 2D echocardiography (2D echo) needs to be done in these patients which may show arrhythmias and ventricular hypokinesia and decreased ejection fraction respectively. A 21 years aged first gravida female at 34 weeks of gestational age was admitted with complaints of high-grade fever since 4-5 days with no previous antenatal visits. A diagnosis of rickettsial fever was suspected on the basis of presenting complaints and clinical examination. Weil-Felix test turned out to be positive with OX19 titre of 1:160. She underwent LSCS in view of fetal distress and delivered a healthy male child. In immediate postpartum period she developed respiratory distress. Her 2D echo showed features suggestive of dilated cardiomyopathy. She was managed in medical intensive care unit and was eventually discharged. Though uncommon rickettsial diseases should be kept in the differential diagnosis of any febrile illness particularly when presenting with characteristic rash. Serious complications such as cardiomyopathy must be diagnosed early and treated appropriately in these patients to prevent mortality.

Left ventricular dysfunction in patients with type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is on the increase globally. Cardiovascular complications, such as left ventricular dysfunction is a major cause of death in patients with type II DM. Prior to the development of symptomatic heart failure, subclinical left ventricular dysfunction (systolic and diastolic) may exist for some time. Aim of this study is to find out abnormalities in left ventricular function in patients of type 2 diabetes mellitus with help of 2D Colour Doppler Echocardiography. To find its correlation with glycemic control on the basis of glycosylated haemoglobin (Hba1c).Methods: Total 100 Patients of type 2 Diabetes Mellitus of duration more than 10 years of both sexes were included in the cross-sectional study conducted from Jan 2018 to Aug 2019.All the patients were assessed through clinical examination and 2-D echocardiography and control of diabetes determined on the basis of HbA1c.Results: Study consisted of 100 patients with type 2 DM, 55(55%) were females and 45(45%) males. Majority of patients were in the age group of 4th to 6th decade of life. Diastolic dysfunction was present in 81(81%) patients. systolic dysfunction was present in 14(14%) patients. There was a linear increase in prevalence of diastolic dysfunction with increasing age, increased FPG, increased BMI. There was also significant correlation between LV diastolic dysfunction (LVDD) and LA size. While no statistical correlation found between gender, duration of diabetes, HbA1c with diastolic and systolic dysfunction.Conclusions: LV diastolic dysfunction is an early manifestation of diabetic cardiomyopathy. LVDD contributes significantly to morbidity of congestive heart failure in diabetic patients. Echocardiography is a very useful non-invasive tool in detecting LVDD and systolic dysfunction in type 2 DM patients.

Evaluation of cardiac performance among asymptomatic obese subjects in comparison with normal individual

Background: Obesity constitutes a major health issue in the modern world. The purpose of this prospective study was to assess the effect of obesity on ventricular function by conventional 2D echocardiography and echocardiogram for assessment of early cardiac changes.Methods: In the present study, 50 asymptomatic obese subjects having BMI >30 were compared with 50 normal individuals having BMI in the range 20-24.9 to assess cardiac performance. The study was conducted over a period of 2 years, from 2009 to 2011.Results: There were 20(40%) males and 30(60%) females in both the groups. The ejection fraction was not significantly affected in obese subjects (60.86�34%) than normal individual (60.42�18%) which was found to be statistically not significant. So, in this study systolic function was not affected. The thickness of left ventricle was significantly increased in obese subjects (1.016�113 cm) than normal individual (0.77+0.073 cm) which was found to be statistically significant.Conclusions: The current study revealed increased wall thickness and mass of Left Ventricle (LV), significantly increased risk of LV diastolic dysfunction, evidence of Left Atrial (LA) enlargement associated with diastolic dysfunction, evidence of subclinical LV systolic dysfunction and Right Ventricular (RV) dysfunction among obese subjects in comparison with normal individuals.

Impairment of left and right ventricular longitudinal strain in asymptomatic children with type 1 diabetes

Aim The relationship between type 1 diabetes (T1DM) and cardiac function in children is not well established. The purpose of this study was to investigate whether children and adolescents with T1DM present early asymptomatic abnormalities of left ventricular (LV) and right ventricular (RV) function. In addition, we evaluated the relationship of any such abnormalities with glycemic control and diabetes duration. Methods This was a prospective study. Standard echocardiography, tissue Doppler imaging, and two-dimensional strain analysis were performed prospectively in 52 children with T1DM. The results were compared with those from 52 healthy children matched for age and sex. Results There were no significant differences between the two groups in LV ejection fraction or RV systolic function. There was a difference between the two study groups in transtricuspid flow: the E-wave and A-wave velocities were significantly higher in the diabetic group. Left ventricular global longitudinal strain (LV GLS) was significantly lower in children with T1DM (−20.01 ± 1.86% vs. −22.99 ± 0.98%, respectively; P < .001), as was RV free-wall longitudinal strain (RV FWLS) (−29.13 ± 1.85% vs. −30.22 ± 1.53%, respectively; P = .002). LV GLS was correlated with diabetes duration (r = 0.444, P < .001) and glycated hemoglobin (HbA1c) (r = 0.683, P < .001); however, no correlation was found between RV FWLS and HbA1c or diabetes duration. Conclusions Our findings suggest that LV GLS and RV FWLS are impaired in children with T1DM and that the decrease in LV GLS is correlated with diabetes duration and HbA1c levels.

A study on the left ventricular hypertrophy among the patients of chronic kidney disease stage third to five

Background: In Chronic kidney Disease (CKD) a significant risk factor for mortality is Cardiovascular disease (CVD) and the most prevalent cardiovascular risk factor is left ventricular hypertrophy (LVH). Anemia, hypertension and volume overload are risk factors for LVH in CKD. So, the present was aimed at comparing the risk factors between CKD with and without LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh. A total of 120 patients are included in this study and divided in to CKD stage III to V based on estimated GFR. Based on 2D echocardiography data CKD cases are further divided in to CKD with LVH and CKD without LVH.Results: The Left ventricular mass index was significant higher in CKD with LVH (128.89±19.28) when compared with CKD without LVH (108.20±10.28). The left ventricular mass index was noted in more number in stage V of CKD. It is also observed that the left ventricular mass index was negatively correlated with haemoglobin and eGFR and was positively correlated with systolic blood pressure and serum NT-proBNP.Conclusions: Present study finding suggested that the incidence of LVH is higher in CKD patients. LVH was positively correlated with hypertension and NT-proBNP and negatively correlated with anemia and estimated GFR.

Demographic and Clinical Features of Left Atrial Tumors in South Indian Population: A Case Series

Myxomas are the most common type of primary cardiac tumor. They cause a variety of clinical manifestations depending on size and anatomical location. Sometimes, manifestations are atypical challenging differential diagnosis and the therapeutic approach. Left atrial myxomas are commonly missed clinically and often lead to grave consequences. We present here a series of 6 cases of left atrial myxomas with demographic and clinical characterization of the patients that were managed successfully.

A prospective study of electrocardiographic and echocardiographic changes in patients with cerebrovascular accidents

Background: Cerebrovascular accident also called as stroke is defined as the sudden onset of neurological deficit that can be attributable to a focal vascular cause. Many studies in the past have demonstrated the fact that neurological abnormalities produce Electrocardiographic changes without any underlying cardiac lesions. Present study is done to analyze different changes in Electrocardiogram and echocardiographic patterns in the cases of cerebrovascular accidents and to assess whether these different changes have got any prognostic significance in these patients.Methods: In this study 100 patients of acute stroke admitted between May 2011 to August 2012 in Vydehi institute of medical sciences and research centre were considered and subjected to CT scan of brain, Electrocardiogram and 2D echocardiography within 24 hours of admission. Follow-up was done within the hospital to know the prognosis of all the patients.Results: Out of 100 patients majority of them had ischemic stroke accounting for 80% and remaining 20% of patients had haemorrhagic stroke. Abnormal Electrocardiographic changes were seen in 64% patients and 58% patients showed abnormal Echocardiography. ECG changes seen are Tachycardia, QTc prolongation, T wave inversion, ST depression, U waves and Bradycardia. Commonly seen echocardiographic changes were LV dysfunction, mitral valve abnormality, aortic valve abnormality. Overall mortality in patients with abnormal ECG was 28.12% compared to 11.11% in patients with normal ECG and it was statistically not significant. Overall mortality in patients with abnormal 2D echocardiography was 31.03% compared to patients with normal 2D Echocardiography which was 4.76% and it was statistically significant.Conclusions: From this study we conclude that ECG abnormalities in stroke patients do not have any prognostic significance. But LV dysfunction has prognostic significance in predicting mortality in cerebrovascular accident.

Prevalence of pulmonary hypertension in COPD

Background: Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality in adults all over the world. Pulmonary hypertension (PH) is a severe disorder defined by a mean pulmonary artery pressure of ?25 mmHg at rest. Pulmonary hypertension can occur as an isolated disease or as a consequence of a number of underlying diseases and conditions, such as heart failure and chronic obstructive pulmonary disease (COPD). The aim of our study was to study the prevalence of pulmonary hypertension in COPD patients and to highlight the importance of early diagnosis of pulmonary hypertension to prevent further complications.Methods: This was a retrospective observational hospital based study conducted at Integral Institute of Medical Sciences and Research Lucknow U P, during 1st January to 31st December 2017. A total of 210 patients were evaluated for presence of pulmonary hypertension using chest X-ray, electrocardiogram, 2D echocardiography.Results: The present study finding reveals 38.02 % patients of various severity of COPD have findings of pulmonary hypertension, that is similar in prevalence of previous studies.Conclusions: The prevalence of PH in patients with COPD was 38.02%. As PH has an important role in the prognosis of COPD patients, it should be evaluated in as many COPD patients as possible.

Assessment of left atrial function in dogs with myxomatous mitral valve disease by biplane simpson's method / Avaliação da função atrial esquerda em cães com degeneração mixomatosa de valva mitral pelo método Simpson biplanar

The relationship between the diameter of the left atrium (LA) and aorta (Ao) is considered as a prognostic factor in chronic mitral valve disease. As the left atrium is a three-dimensional structure, methods based on measurement of the chamber volume can be more accurate than linear methods.The aim of this study was to assess the feasibility of measuring LA volume with 2D echocardiography using the biplane modified Simpson (SIMP) method in 33 dogs with various classes of myxomatous mitral valve disease (MMVD), as well as to present values of LA function using the atrial diastolic and systolic volume indices (ADVI and ASVI), cardiac index (ACI) and atrial ejection fraction (AEF). We observed agreement among the LA/Ao ratio and the atrial volume indices (ADVI and ASVI) and the ACI, suggesting that the values of the variables increase as the LA/Ao ratio increases due to atrial remodeling that accompanies MMVD progression. The data demonstrated a good assessment of atrial function, allowing a better understanding of LA's role in the pathophysiology of MMVD.(AU)

A relação entre o diâmetro átrio esquerdo (AE) e da aorta (Ao) é considerada como fator prognóstico na doença crônica de valva mitral. Como o átrio esquerdo é uma estrutura tridimensional, os métodos baseados na mensuração de volume da câmara podem ser mais precisos que os métodos lineares. O objetivo deste estudo foi avaliar a viabilidade da mensuração do volume do AE com a ecocardiografia bidimensional, sendo usado o método Simpson biplanar em 33 cães com diversas classes da degeneração mixomatosa de valva mitral (DMVM), bem como apresentar valores de função do AE utilizando-se os índices de volumes atriais diastólico e sistólico (iVdA e iVsA), o índice cardíaco atrial (iCA) e a fração de ejeção atrial (FEA). Observou-se uma concordância entre a relação AE/Ao e os índices de volume atrial (iVdA e iVsA) e o iCA, o que sugere que os valores das variáveis aumentam à medida que a relação AE/Ao aumenta, devido à remodelação atrial que acompanha a progressão da DMVM. Os dados demonstram uma boa avaliação da função atrial e permitem uma melhor compreensão do papel do AE na fisiopatologia da DMVM.(AU)

Spectrum of electrocardiographic and echocardiographic changes inacute stroke – Our experience

Background: Vascular diseases remains the chief cause of death and disability in industrialised countries. Clinical and experimental data suggest that some kind of neurologically mediated myocardial injury exists especially in subarachnoid hemorrhage but not as a manifestation of joint ischemic heart disease. Objectives: To study the spectrum of changes in ECG and echocardiographic patterns in the cases of cerebrovascular disease and to assess these different changes have got any prognostic significance. Materials and methods: 100 patients with acute stroke were considered, and ECG and the 2D echo of these patients were done within 24 hours of admission. In-hospital follow-up was done to know the prognosis of all the patients. Results: ST segment depression (53.1%) and U-waves (56.2%) followed by QTc prolongation (0.5±0.7 ms) were the most common abnormalities in haemorrhage group. Whereas in infarct type of stroke U-wave was the most common ECG finding (50.0%) among infarct group followed by QTc (0.45±0.08 ms) and T-wave inversion (29.4%). None of the ECG changes had much significance on mortality and was statistically insignificant (p>0.05) with either ischemic or hemorrhagic stroke. LV dysfunction, the most common abnormality was (29.4%) in infarct and haemorrhage (46.9%) stroke. LV dysfunction did not show significant impact on mortality in either of stroke subtypes (p>0.05). Conclusion: In our experience, both ECG and ECHO abnormalities in stroke patients do not have any prognostic significance predicting mortality in CVA

Correlation of 2D-Echocardiography Findings in Young Patients of Myocardial Infarction with Prevalence of Risk Factors

Background: The prevalence of Coronary Artery Disease (CAD) has progressively increased in India during the later half of the last century. Projection based on the Global Burden of Disease Study estimate that by the year 2020, the burden of atheroembolic cardiovascular disease in India would surpass that in any other region in the world. Objectives: To Correlation Of 2D-Echocardiography Findings In Young Patients Of Myocardial Infarction With Prevalence Of Risk Factors in Ghaziabad, Uttar Pradesh area, From May 2010 to April 2011. Materials and methods: 50 patients of aged 18 – 45 yrs with acute myocardial infarction were evaluated on the basis of age, sex, socioeconomic status, family history of coronary artery disease, smoking, obesity, history of hypertension, diabetes, dyslipidemia, ECG and Ejection Fraction on 2DECHO. Results: Mean age of study group was 36.2. Male were more affected than female. Prevalence of family history of coronary heart disease was 35%. 55% of patients were smokers. 20% of patients were obese. 75% patients had dyslipidemia. 25% had history of hypertension and 20% were diabetic. Goel A, Goel D, Yadav Y, Gupta SK. Correlation of 2D-Echocardiography Findings in Young Patients of Myocardial Infarction with Prevalence of Risk Factors. IAIM, 2016; 3(10): 221-227. Page 222 64% of patients in present study had anterior wall MI. Left Ventricle End Diastolic Diameter (LVEDD) mean 49.84 mm. Left Ventricle End Systolic Volume (LVESD), mean was 38.36 mm. Interventricular Septum thickness (IVS) mean was 9.86 mm. 56% had moderate LV dysfunction. MR mostly present in EF less than 40%. 12% cases had presence of pericardial effusion. 66.66% smokers have MR on 2D-Echocardiography. Conclusion: The Incidence of Myocardial Infarction is rising in young individuals owing to change in lifestyle pattern, eating habits, more stress and workload. Incidence remained highest in Males as compared to females. Highly associated risk factor in young myocardial infarction patients are dyslipidemia and smoking. Other traditional risk factors associated with myocardial infarction like diabetes, hypertension, obesity are also very much correlated and their incidence is also seems to be increasing. The role of 2D-Echocardiography in establishing the diagnosis, location, and extent of MI, in diagnosing mechanical complications of infarction, and in providing prognostic information that is important for risk stratification.

Sequential functional analysis of left ventricle from 2D-echocardiography images.

The sequential changes in shape of left ventricle (LV), which are the result of cellular interactions and their levels of organizational complexity, in its long axis view during one cardiac cycle are obtained. The changes are presented in terms of shape descriptors by processing of images obtained from a normal subject and two patients with dilated left ventricular cardio-myopathy. These images are processed, frame by frame, by a semi-automatic algorithm developed by MATLAB. This is consisting of gray scale conversion, the LV contour extraction by application of median and SRAD filters, and morphological operations. By filling the identified region with pixels and number of pixels along its contour the area and perimeter are calculated, respectively. From these the changes in LV volume and shape index are calculated. Based on these the stroke volume (SV) and ejection fraction (EF) are calculated. The changes in LV area, perimeter, volume and shape index in cardiac patients are less than that of normal subject. The calculated SV and EF of normal subject are within the range as obtained by various imaging procedures.

Valsalva Aneurysm Filled with Thrombi Mimicking a Cardiac Tumor

A Valsalva aneurysm filled with thrombi can be difficult to diagnose, because it mimics a cardiac tumor. Both cardiac magnetic resonance imaging (MRI) and transesophageal echocardiogram (TEE) were performed on a patient who showed a low-echoic mass located between the atrial septum and the non-coronary sinus. Based on MRI findings allowing tissue characterization and the accurate location of the mass and the TEE findings of an irregular surface of the mass and a partial defect in the edge of the non-coronary sinus, we diagnosed the mass as a thrombosed Valsalva aneurysm that had perforated the inter-atrial septum. The operative findings coincided with the preoperative diagnosis. Both MRI and TEE are useful for diagnosing this condition.

Clinical Observations of Regurgitative Valvular Heart Disease in Elderly Patients Older Than 65 Years in Age

BACKGROUND: The regurgitative valvular heart diseases are important underlying diseases that result in congestive heart failure, and the prevalence increase with the increasing age. Early detection and management of the regurgitative valvular heart disease could decrease the morbidity and mortality rate of the elderly. METHODS: We reviewed medical records of 425 patients who visited KonKuk University Medical Center ChungJu Hospital for the echocardiography between April 1994 to September 2000. 281 out of 425 patients were diagnosed with regurgitative valvular heart disease, and they were analyzed according to their age, sex, underlying disease, and accompaniment of congestive heart failure. Also the relationships between the regurgitative valvular heart disease and fractional shortening(FS), and also with ejection fraction(EP) were analyzed. RESULTS: There were 281 patients diagnosed with regurgitative valvular heart disease. Greatest number of patients was diagnosed with MR, followed by AR, TR and PR, accordingly. The prevalence of regurgitative valvular heart disease increased as the age increased. The prevalence of regurgitative valvular heart disease in male patients were 74% and for female patients, 62%. For patients with hypertension, it was 59%, and for DM patients it was 60%. For patients with past history of ischemic heart disease, or congestive heart failure, the prevalences of regurgitative valvular heart disease were high. FS for the patients with regurgitative valvular heart disease was 28.91% compared 32.69% for the patients without regurgitative valvular heart disease. EF for the patients with regurgitative valvular heart disease was 54% compared to the 60% for without regurgitative valvular heart disease. The FS for patients with symptomatic regurgitative valvular heart disease was 23.86% compared to 27.7% for asymptomatic group. The EF for symptomatic regurgitative valvular heart disease was 46.2% compared to 52.3% for asymptomatic group. CONCLUSION: When 2D-echocardiography was performed on elderly patients who were older than 65 years of age, most of them featured degenerative structural changes in valves and deterioration of valvular functions resulting in regurgitative valvular heart disease. When patients had any symptoms or underlying diseases, the decrease in cardiac function and high prevalence of regurgitative valvular heart disease were apparent. Therefore in elderly patients, even if they are asymptomatic or without any underlying diseases, aggressive diagnostic approaches and early intervention may delay the progress of valvular heart disease.

Quantification of Large Pericardial Effusion by Two-Dimensional Echocardiography

BACKGROUND: The accurate information about the volume of pericardial effusion can assist in clinical decisions and has impartant prognostic value. In addition, accurate quantification of serial change in effusion volume is necessary in assessing pericardial disease and making a decision of immediate drainage. This study was performed to evaluate the efficacy of 2-D echocardiographic quantification of pericardial effusion. METHOD: The study populations are 22 patients with large pericardial effusion whose volume of effusion is confirmed by paracentesis or surgical drainage. Through the echocardiographic reviw, the volume of pericardial sac and heart was calculated by method of D'cruz and then, the effusion volume was derived as the difference of two volumes. Each echocardiographically calculated volume of pericardial effusion was compared with the measured volume drained percutaneously or surgically. RESULTS: The volume of pericardial effusion calculated echocardiographically was excellently correlated with the drained volume(r=0.90, p < 0.01). The echo-free space was well correlated with the volume of pericardial effusion in the anterior aspect of the heart(r=0.71, p < 0.01), but not in the posterior aspect. CONCLUSION: 2-D echocardiographic Quantification of pericardial effusion is simple and reliable method, and its clinical efficacy may be great.

The value of 2-D echocardiography in diagnosis of CHD

No abstract available.

Computerized Quantitative Analysis of Left Ventricular Wall Motion by 2-Dimensional Echocardiography

We present the methods of analysis of left ventricular wall motion by 2-dimensional echocardiography using computerized system. Quantiative analysis of left ventricular wall motion abnormalities depents on the used reference method, because the heart shifts and rotates within thorax during the cardiac cycle. To access left ventricular wall motion abnormalities, we studied 60 subjects(normal; 30 subjects, abnormal; 30 subjects)with 5 different floating reference methods correcting for traslation and/or rotation in two echocardiographic views. (apical 4-chamber view and apical 2-chamber view) In the first the endocardial tracings of enddiastole and endsystole in 30 normal subjects were stored in VAX-11-780 main computer and the data of these 30 normal subjects were plotted to obtain a 95% confidence interval for measured normal fractional change every five degree according to 5 reference methods. In the second, 30 patients with abnormal left ventricular wall motion analyzed and the results were compared with a 95% confidence interval. We assessed that left ventricular wall motion by visual and computerized quantitative anlysis were in close relationship according to optimal reference method. We suggested that computerized quantitative analysis of left ventricular wall motion by 2-dimensional echocardiography was clinically useful method and translation of the midpoint of mitral anulus with rotation according to center of mass was the most specific and sensitive new method of evaluating left ventricular wall motion abnormalities.

Noninvasive Evaluation of Rheumatic Tricuspid Stenosis with Doppler and 2 Dimensional Echocardiography

In order to determine the meaning of tricuspid stenosis(TS) in rhematic valvular heart disease(RVHD), 310 consecutive patients with RVHD were assessed by Doppler and 2-dimensional(2D) echocardiography. The frequency of 2D echocardiographic TS(diastolic doming of anterior tricuspid leaflet and thickened tricuspid leaflets) was 8.4%, and all patients with 2D echocardiographic TS had the mean tricuspid pressure gradient(MTPG) of 1mmHg or more compared to normal control of less than 1mmHg with Doppler echocardiography. The frequency of clinically significant hemodynamic TS(MTPG>2mmHg) and of servere hemodynamic TS(MTPG>5mmHg) in RVHD were 3.5% and 0.6% respectively. Rheumatic TS was accompanied by tricuspid regurgitation in the frequency of 92.3% and did not occurs in pure mitral regurgitation. Rhematic TS occurs with high frequency in advanced rheumatic valvular stenosis, and the frequency of rheumatic TS in severe rheumatic mitral stenosis and mitral stenosis coexing with aortic stenosis were 20.8% and 23.9% respectively. The results indicates that TS in RVHD is little practical meaning but is unable to disregard especially in the cases of advanced rhematic valvular stenosis, and there is need to recognize of TS in RVHD.