Myocardial velocities of the normal left ventricle using pulsed-wave tissue doppler echocardiography

The present study was designed to investigate the velocities of longitudinal movement of the human left ventricle by pulsed-wave tissue Doppler [PWTD] Echocardiography. In thirty normal subjects [Age 19-42 years], PWTD peak values of longitudinal systolic and diastolic velocities were measured for 18 left ventricular segments visualized from the apical window. Apical segments Doppler spectra were of suboptimal quality in 28%. The PWTD of each myocardial segment resulted in a triphasic velocity curve during each cardiac cycle: a systolic velocity wave S and an early diastolic [E] and a late diastolic [A] velocity waves. A heterogenous pattern of systolic and diastolic myocardial velocities was observed between individual wall segments as well as for the basal, mid-wall and apical segments of each myocardial wall. In general, lower velocity values were found in the septum and higher velocity values in the anterior wall. Substantial hetergencity of velocities exists within individual myocardial segments and must be taken into account in any clinical application

Post-myocardial infarction left ventricular aneurysm

Left ventricular aneurysm is not uncommon complication of myocardial infarction. We evaluated the clinical presentation, diagnostic accuracy of imaging modalities and results of therapy of 12 patients with true left ventricular aneurysm and one pseudoaneurysm. Most cases were related to anterior-Q-wave myocardial infarction, and apical location of the aneurysm was more frequent. Congestive heart failure and chest pain were the most frequently reported symptoms. All patients had ECG abnormality, but ST-segment elevation was not recorded in all patients. Most of our patients were controlled on medical treatment. [66.6%] Echocardiography was very accurate in diagnosis of left ventricular Aneurysm

Non invasive measurement of right atrial pressure

The aim of this study was to evaluate the correlation between right atrial pressure [RAP] and tricuspid Doppler variables. Tricuspid Doppler profile was recorded immediately before hemodynamic RAP estimation in 30 consecutive patients undergoing right-side catheterization. The diastolic tricuspid flow was obtained from standard apical 4-chamber view at a speed 100 mm/s. mean age of the study population 48 +/- 12 years. 15 patients were in sinus rhythm and 15 had atrial fibrillation. There was no significant difference between both groups in their Doppler variables. Mean RAP 6 +/- 4.2 [range 2-20 mmHg]. Significant relation was found between RAP and several tricuspid flow parameters in all patients. However, by stepwise multivariate analysis acceleration rate of early tricuspid flow emerged as the sole independent predictor of RAP [r = 0.985 F = 592, P <0.0001]. The analysis led to the following equation: RAP = [0.017 x acceleration rate] - 1.03. Doppler-derived tricuspid flow is a simple, bedside means for estimating right atrial pressure

Mechanism of angina in patients with systemic hypertension and normal coronary angiogram

the purpose of this study was to investigate the changes in the coronary flow reserve in hypertensive patients with angina and normal coronary arteries, and its relation with coronary vasomotor response. the study population consisted of thirty hypertensive patients with angina and normal coronary angiogram [group I [non-LVH] n = 15 without left ventricular hypertrophy, group II [LVH] n = 15 with left ventricular hypertrophy and a matched healthy control group [group III n = 10]. Coronary velocity was monitored by means of transesophageal Doppler echocardiography basely and during infusion of [0.56 mg/kg per 4-minute] dipyridamole. Coronary flow reserve [CFR] was assessed as the ratio of mean diastolic velocity after dipyridamole and basal diastolic velocity. Coronary vasomotion was assessed by means of coronary catheterization as the changes in arterial caliber by acetylcholine and papaverine. Left ventricular mass, dimensions and function were measured by transthoracic echocardiography, Electrocardiography [ECG] changes were recorded by resting and exercise stress ECG. compared with the control group, CFR was decreased in both hypertensive groups [non-LVH = 1.56 +/- 0.22, LVH = 1.46 +/- 0.14, control = 3.49 +/- 0.60, P < 0.001]. The reduction in CFR depends on both an increase in resting coronary flow, and an impaired in maximal vasodilator capacity. Hypertensive patients who showed a positive exercise test have significant high resting mean diastolic coronary flow velocity [p < 0.01], and CFR showed positive correlation with exercise duration and rate-pressure product. Left ventricular mass had no effect on CFR, and wall stress was the major discriminating variable between non-LVH and LVH groups. imparied coronary flow reserve in hypertensive patients is the mechanism for the clinical syndrome of angina pectoris, abnormal electrocardigram but normal coronary arteries

Thallium201 perfusion imaging in mitral valve prolapse

The clinical significance of chest pain in patients [pts.] with mitral valve prolaspe [MVP] has been difficult to assess. The characteristic pain is usually atypical of angina pectoris, however, some patients may have typical anginal pain in the absence of coronary artery disease [CAD]. The aim of this study was to assess stress thallium201 myocardial perfusion imaging in pts. With MVP without CAD. The study included 24 pts. With MVP with a mean age of 23 years; 12 males and 12 females were submitted for resting 12-lead ECG, Echo-cardiography and Doppler study as well as an exercise thallum201 SPECT study. Patients with positive perfusion studies were submitted for coronary angiography. Nineteen pts. [79.16%] had chest pain; 7/24 [29.16%] typical of angina and 12/24 [50%] atypical. Resting ECG was abnormal in five pts. [20.8%] and exercise stress ECG was abnormal in 3/24 [12.5%] and inconclusive in 1/24 [4.16%]. The echocardiographic examination revealed prolapse of both leaflets in 12/24 [50%], posterior in eight [33.3%] and anterior leaflet in 4/24 [16.6%]. Trivial mitral regurgitation in 18/24 [75%]. Thallium SPECT revealed reversible perfusion defects in 6/24 [25%]. Their coronary angiography was found to be normal. All of them had chest pain 6/19 [31.6%]; four with typical angina. The perfusion defects were inferior in four and combined anterior and inferior in on study and anterior only in another one regardless the site of leaflet prolapse. We conclude that despite potential myocardial ischemia in pts. With MVP, objective evidence with exercise-T1201 SPECT studies is present in only about one third of pts. presented with chest pain in absence of CAD and the majority of such pts. have normal scan

Beta endorphin in myocardial ischemia

This study was carried out on 30 patients with coronary artery disease. Fifteen patients had silent ischemia [group A] and 15 patients had angina pectoris [group B]; 10 normal volunteers served as control [group C]. Clinical variables related to history and physical examination were recorded. Forearm ischemic pain threshold and tolerance values were measured by modified submaximal effort tourniquet test. All subjects underwent a symptom limited treadmill exercise stress test and ambulatory 24-hour ECG recording. Silent ischemia was diagnosed when S-T segment depression occurred during exercise stress testing without anginal pains and when 90% or more of the episodes associated with S-T depression during ambulatory 24-hour ECG recording were not associated with pain. Plasma beta endorphin, cortisol and ACTH levels were measured by radio- immunoassay before, immediately post-exercise and 30 minutes after exercise in all subjects. This study revealed that there was no statistical significant difference between the silent and symptomatic groups regarding clinical variables, except history of prior myocardial infarction which was higher in the silent group