Effect of balloon dilatation angioplasty for native coarctation on left ventricular function echo-doppler study

The following Echocardiographic indices were measured in conjunction with cardiac catheterization in 14 adult patients with coarctation of the aorta [CoA] immediately before and 6 months after balloon dilatation angioplasty [BDA]: LV enddiastolic volume index [EDVI], left ventricular end-systolic volume index [ESVI], LV ejection fraction [EF], LV mass [LVM], and LV end systolic wall stress [ESS]. Results [mean +/- SD] showed striking reduction of peak systolic pressure gradient [from 69 +/- 23 to 8 +/- 13 immediately after BDA to 6 +/- 12 mmHg. 6 months later, P], ESS [from 574 +/- 447 to 364 293 10. dynes. cm2; P], LVM [from 330 +/- 263 to 249 +/- 197 g/m2; P], EDVI [from 187 +/- 116 to 137 +/- 108 ml/M2; P] and ESVI [from 40 +/- 32 to 30 +/- 24 ml/M2; P]. LVEF showed significant increase [from 75 +/- 7 to 78 +/- 5%, P]. The percent reduction in ESS correlated significantly with the degree of regression of LVM [r = 0.94, P] and of EDVI [r = 0.9, P]. Thus on short-term, there is significant regression of left ventricular hypertrophy associated with improvement in LV systolic function after BDA for adult native CoA

Electrocardiographic and echo-doppler study in Duchenne muscular dystrophy

Twenty six patients with Duchenne muscular dystrophy [DMD] [4-18 years] and 16 controls [4-18 years] were subjected to cardiac and neurological examination. Patients were divided into gp I [early Duchenne 17 patients] and gp II [late Duchenne, 7 patients]. The electrocardiogram showed sinus tachycardia [77%], sinus arrhy thmias [69%] P wave abnormalities [19%], tall R in v 1 and V 2 [35%]. RSr [31%]. R/S >1 [54%], deep Q [42%] and ST-T changes in [58%]. Six cases [23%] had mitral valve prolapse by echocardiography. Ejection fraction [EF%] and fractional shortening [FS%] were significantly less in Duchenne patients compared to controls [p < 0.01]. EF and FS were significantly less in gp II [late Duchenne] compared to gp I [early Duchenne] [p < 0.01]. Significant impairement was also reported in peak velocity of early diastolic inflow [PE] [p < .05] and PE/peak velocity of late diastolic inflow PE/PA [p < 0.01] in the total gp and gp I compared to controls. PE/PA was significantly less in gp II compared to controls [p < 0.01] and compared to gp I [p < 0.01]. In 14 of the 26 patients we found significant impairment in atrial filling rat [p < 0.01] and rapid filling index [p < 0.05] as compared to controls. In other 10 patients impairement was reported in maximal diastolic posterior wall endocardial velocity [p < 0.001] and deceleration of early diastolic filling [p < 0.05]. We concluded that ECG is a sensetive tool in detecting cardiac involvement in DMD. Both systolic and diastolic functions are affected by myocardial dystrophy, such impairement is progressive throughout the course of the disease

Influence of left ventricular geometry on diastolic filling pattern in patients with chronic ischaemic heart disease

Left ventricular [LV] shape changes are characteristic features of many cardiac diseases and have been related to systolic function but has not been related to LV diastolic filling pattern. In this work M-mode and 2-D echocardiography has been used to characterize LV cavity shape at end diastole in 56 patients with significant chronic ischaemic heart disease and relate it to LV filling pattern as assessed by Doppler echocardiography. The following were measured: LV mean wall thickness [MWT], end diastolic volume [EDV], end systolic volume [ESV], ejection fraction [EF], minor to long axis ratio [D/L], peak early [E] and late [A] mitral inflow filling velocities and their ratio [A/E], isovolumetric relaxation time [IVRT] and posterior wall endocardial velocity [PEV]. Patients were classified into two groups based on D/L ratio; group [A] > 0.60 and group [B] < 0.60. Results showed that D/L ratio correlated with Al WT [r 0.32, p < 0.01], and inversely with PEV[r = -0.3, p < 0,0.01], EDV[r = -0.25, p < 0.05], and ESV [r = 0.27, p < 0. 04]. Group A had lower values than group B in relation to PEV [p < 0.05], E [p <0.05], and A [p < 0.03] and a higher value for MWT [p < 0.007]. There was no significant differenee between both groups in relation to EDV, ESV. FE, IVRT or A/E ratio. Among other factors LV morphology at end diastole affects filling dynamics even in the absence of significant alteration of LV systolic function

Improvement of left ventricular filling after short term captopril therapy in hypertensive patients

Left ventricular [LV] filling abnormalities were reported in hypertensives. To study the effect of treatment on these abnormalities we studied 12 untreated pts before [b] and after [a] short-term captopril therapy using echo-Doppler techniques. Results were compared to an age matched control group [c] of 10 individuals and are summarized in the following table: -HR [B/M]; 79 [5]; 77 [5]; 79 [5] - SBP MMHG; 126[10]; 157 [15]; 136 [10] - DBP [MMHG]; 83 [5]; 108 [12]; 83 [4] - MBP [MMHG]; 97 [6]; 125 [9]; 97 [6] - A/R RATIO; .59 [.11]; 1.1 [.21]; .59 [.11] - ACC CM-SEC2; 740 [160]; 562 [181]; 740 [161] - DEC CM-SEC2; 506 [121]; 309 [103]; 506 [121] - PFR M/SEC; 530 [134]; 437 [150]; 531 [134] - LVM GM; 205 [40]; 249 [64]; 205 [40]. R: early peak velocity. A.' late peak velocity, [A CC and DCC] acceleration and deceleration of early velocity wave, PFR: peak early filling rate computed as RX mitral annulus diameter. LVM = LV mass. Compared to CB showed a higher blood pressure, and LVM. [P < 01]. LV filling showed a higher A/R and a lower ACC and /DCC [p < 01]. After therapy there was improvement in A/R ratio and a drop in blood pressure. Other parameters did not change significantly. Drop in A/R ratio showed a correlation to the drop in DBP [6 = 0.55]. We conclude that captopril short term therapy has a potential for improving LV filling in hypertensive patients and that this improvement is related to the drop in DBP

Doppler pressure half-time and catheter pressure gradient half-time in the calculation of mitral valve area

The use of Doppler derived measurements in the assessment of mitral stenosis [MS.] was evaluated in 45 patients [pts] with rheumatic heart disease and the data were compared with that obtained by cardiac catheterization and direct measurement of the valve orifice area [MVA] at surgery. Results showed that Doppler derived measurements of MVA by pressure half-time method were of particular value in 24 pts in whom technically adequate cross-sectional images and MVA measurements were difficult to obtain.Eighteen of these cases [40%] had heavily calcified and disorganized valves and six pts [13%] had a poor acoustic window. The Doppler data were more accurate than standard two-dimensional measurements in 30 pts.[66%] with atrial fibrillation. The comparison with Gorlin's formula for catheter-derived MVA was poor, especially in the presence of mitral regurgitation or irregular rhythm. Excellent comparisons were obtained with a catheter-derived pressure half-time and surgical assessment of MVA. Thus, The Doppler examination proved to be an invaluable adjunct to a complete assessment of MVA and replaces the need for haemodynamic assessment in most pts with MS

Short term prognostic implication of right ventricular involvement in acute inferior myocardial infarction

Infarction of the right ventricular free [RVI] wall was drawing little attention till recent years. The incidence of right ventricular involvement in patients with inferior wall infarction varies from 25% to 50%. The importance of differentiating RVI as a separate entity is related not only to its characteristic diagnostic picture but also to its prognostic and therapeutic implications. The published data on the importance of right ventricular involvement-as an independant risk factor-for early morbidity and mortality in patients with acute inferior wall myocardial infarction has been few and inconsistent. In this work we examined 33 patients with acute inferior wall infarction 17 with clinical and/or ECG evidence of RV involvement and 16 without. We examine the incidence, extent and consequences of early-in hospital-complication in both groups in order to determine the short term prognostic implication of right ventricular involvement in patients suffering from acute inferior wall myocardial infarction. RVI group was found to be associated with a significantly higher incidence of inhospital early mortality, pulmonary embolism, complete heart block, atrial and ventricular arrhythmia, and a special form of pump failure that responded to inotropics and fluid therapy

Pressure-volume characteristics of the left atrium in children, adolescent, and adults with chronic rheumatic mitral incompetence

37 patients of different age groups with chrnoic rheumatic mitral incompetence and atrial fibrillation were studied by haemodynamic and angiocardiographic methods. The following parameters were measured in each patient: pulmonary capillary wedge pressure [PCWP]; left atrial [LA] wall tension at end ventricular systole, LA maximal volume [LAV max], and LA wall compliance. Results showed lower PCWP [p<0.007], large LAV max [p<0.03], and higher LA wall compliance [p<0.01] in the young age group [below 15 years]. Among other factors the LAV max seemed to depend on the magnitude of LA wall tension [p<0.0001] and compliance [p<0.0001]. PCWP was mainly found to be function of LA wall compliance [p<0.008] in all ages and at different values for LAV max. We conclude that young patients have larger LAV max and lower PCWP probably because their atria are more compliant