Echocardiographic assessment of right ventricle adaptation to endurance training in young rowers - speckle tracking echocardiography.

The aim of this study was to determine the relationship between the degree of cardiorespiratory fitness and the function of the right ventricle (RV). 117 rowers, age 17.5±1.5 years. All subjects underwent cardiopulmonary exercise. Standard echocardiography and 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal - RVLS-B; mid - RVLS-M, apical - RVLS-A) and global RV free-wall strain (RVLS-G) were performed. RVLS-B values were lower compared to the RVLS-M (-25.8±4.4 vs -29.3±3.5; p<0.001) and RVLS-A values (-25.8±4.4 vs -26.2±3.4; p=0.85). Correlations between VO2max and RVLS were observed in men: RVLS-G strain (r = 0.43; p <0.001); RVLS-B (r = 0.30; p = 0.02); RVLS-M (r = 0.38; p = 0.02). A similar relationship was not observed in the group of women. The strongest predictors corresponding to a change in global and basal strain were VO2max and training time: RVLS-G (VO2max: ß = 0.18, p = 0.003; training time: ß = -0.39; p = 0.02) and RVLS-B (VO2max: ß = 0.23; p = 0.0001 training time: ß = -1.16; p = 0.0001). The global and regional reduction of RV systolic function positively correlates with the level of fitness, and this relationship is observed already in young athletes. The character of the relationship between RV deformation parameters and the variables that determine the physical performance depend on gender. The dependencies apply to the proximal fragment of the RV inflow tract, which may be a response to the type of flow during exercise in endurance athletes.

[Efficacy of mononitrate retard therapy in patients with advanced congestive heart failure]. / Skutecznosc monoazotanu retard u chorych z zaawansowana niewydolnoscia krazenia.

To determine the efficacy of mononitrate retard therapy in congestive heart failure 54 pts (42 males and 12 females, aged 67.2 +/- 8.7 yrs.) with NYHA functional class 1-3 and left ventricular ejection fraction less than 40% were investigated. Clinical examination, exercise treadmill test (ETT), ecg holter monitoring and echocardiography (echo-2D) were performed before and after 4 weeks of therapy with Olicard 40 mg Retard. 4 weeks treatment with mononitrate improved clinical parameters. The shift to lower functional NYHA class was observed in 12 cases (p < 0.01). Number of anginal pains per week was reduced from average 3.15 to 1.55 (p < 0.01). Mononitrate therapy improved exercise tolerance during ETT. Exercise time increased from 424 +/- 168 to 568 +/- 143 sec. (p < 0.001) as well as total workload in METS (3.6 +/- 1.4 vs. 4.9 +/- 1.9, p < 0.001). The time to 0.1 mV ischemic ST segment depression was extended from 215 +/- 149 to 357 +/- 173 sec. (p < 0.01). Holter monitoring revealed moderate increase in heart rate and significant reduction of ventricular arrhythmia (p < 0.05). No changes in systolic and diastolic echo-2D parameters were observed.

[Multi-plane transesophageal echocardiography--the next step to 3 dimensional imaging of the heart]. / Wieloplaszczyznowa echokardiografia przezprzelykowa--kolejny krok do trojwymiarowej oceny serca.

The multiplane transesophageal echocardiography (MTEE) is a new method making the precise imaging of the heart and great vessels possible. That technique allows to obtain the images of cardiovascular structures in two perpendicular investigation planes ("biplane" operation): transverse (examination angle is equal to 90 degrees--in relation to long axis of esophagus) and longitudinal = sagittal (examination angle is equal to 0 degree--in relation to long axis of esophagus) and, as well, in all medial planes enclosed from 0 degree to 90 degrees examination angle. During the investigation planes were being rotated mechanically or manually by rotation wheel. Passing from one plane to another is fluent, due to that the heart and main vessels can be observed continuously. Sector angle variability is 180 degrees (from minus 90 degrees to plus 90 degrees). The investigation planes from 0 degrees to plus 90 degrees from so called "normal" visualization field, and planes from 90 degrees to 0 degree make a "mirror" reflection of the "normal" field (mirror field). In our investigations the Vingmed-Sonotron echocardiograph connected with 5 MHz annular phased--array transducer, placed at the end of flexible endoscope was used. The multiplanar transducers have a full Doppler option (pulsed and continuous waves) with the possibility of colour flow imaging. The initial experience with the new method is presented in this report. The MTEE enables precise assessment of atrial septal defects. The multiplane imaging allows complete evaluation of heart muscle thickness and left ventricular contractility. This technique gives a better visualization of coronary artery. MTEE permits for planimetric assessment of aortic valve.(ABSTRACT TRUNCATED AT 250 WORDS)

[Localization of myocardial infarction with the help of EKG and two-dimensional echocardiography. Controversies]. / Lokalizacja zawalu serca za pomoca ekg i echokardiografii dwuwymiarowej. Kontrowersje.

A multicentre study of the localization of myocardial infarction (MI) using ECG and 2-dimensional echocardiography (Echo-2D) was performed on the 21st day of the onset of MI. The study population consisted of 650 pts (mean age 55.0 years), 553 males and 97 females. The purpose of the study was: 1) to compare the site of MI as diagnosed by ECG and Echo-2D, 2) to determine the controversies in the diagnosis between these two methods. Consistent results of both methods were obtained in 408 pts (62.8%) of the group. In 61 pts (9.4%) the diagnosis of MI by ECG and Echo-2D was undefined. In 181 pts (27.8%) the inconsistencies of ECG and Echo-2D evaluations were demonstrated; in 106 pts ECG changes were undefined, but evident Echo-2D changes were found; on the contrary, in 51 pts MI diagnosed by ECG was not confirmed by Echo-2D. In 24 pts entirely inconsistent results were shown. 209 pts (32%) with myocardial contractility disorders in the apical region of the heart diagnosed by Echo-2D showed different MI localisation as determined by ECG: 147 pts had anterior or antero-lateral MI, 28 pts--postero-inferior MI, 12 pts--apical MI and 22 pts--another one. By these findings it has been shown that ECG and Echo-2D are compatible methods but not replaceable ones.

[Two-dimensional transesophageal echocardiography (clinical value)]. / Dwuplaszczyznowa echokardiografia przezprzelykowa (wartosc kliniczna).

The introduction of two-dimensional echocardiography (echo 2D) complemented by doppler techniques has allowed to assess the dynamic function of the heart. However in 10-15% patients the standard transthoracic method (TEE) does not provide complete echocardiographic image due to obesity, emphysema and deformations of thorax. These difficulties have been later overcome by transesophageal probe, but it made the examination possible only in one plane-monoplane TEE (m-TEE). Transesophageal echocardiography the biplane probe (bi-TEE), introduced in late 80s has permitted the heart and aorta visualization in two perpendicular planes: transverse (T) and longitudinal (L). The purpose of our study was to establish the diagnostic value of biplane transesophageal echocardiography in comparison with hitherto existing monoplane echocardiography (transverse plane). The study group consists of 60 patients (aged 19-78 years) with various diseases of heart and aorta. We performed biplane transesophageal examinations with the use of Aloka SSD-870 echocardiograph connected with the biplane probe (45 patients) or new, prototypical matrix probe (15 patients). For the heart and aorta assessment the typical projections were used. The advantages of biplane TEE compared with monoplane TEE are as follows: 1) more favorable left ventricular examination, 2) better assessment of the heart apex, 3) the ability to investigate the right heart; tricuspid valve, right ventricular outflow tract, pulmonary valve, pulmonary trunk and right pulmonary artery, 4) precise imaging of both atrial' structures: cavities, intraatrial septum, foramen ovale, left atrial appendage, venae cavae and pulmonary veins, 5) possibility of thoracic aorta diagnostics, especially in ascending aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transesophageal and classical echocardiography in myocardial infarction and heart valve disease (comparison study)]. / Echokardiografia przezprzelykowa i klasyczna w zawale serca i wadach zastawkowych (badanie porównawcze).

In 85 patients (22 with myocardial infarct and 63 with valvular heart disease) echocardiographical examination simultaneously by classical and transesophageal methods was done. The transesophageal method was better in assessing the aortic valve and similar to the classical method in reference to the mitral valve. Heart contractility assessment was better with the classical method. Transesophageal echocardiography is the method of choice in patients in whom classical echocardiography cannot be done (obesity, emphysema, chest deformation).

[Transesophageal echocardiography--a method of evaluation of the aortic and mitral valves]. / Echokardiografia przezprzelykowa--metoda oceny zastawek: aortalnej i mitralnej.

Transoesophageal echocardiography (TEE) is a new diagnostic method introduced for clinical practice about 1985. The method is particularly useful for the evaluation of the aorta and mitral valves. Twenty-seven patients with pathological changes of the valves of the left side of the heart were studied. In all patients the result of transthoracic echocardiography--TTE was non-diagnostic due to obesity, emphysema, deformity of the chest. In TEE diagnostic findings in the structures of the chest were obtained, their morphology and function were assessed, the clinical diagnosis was confirmed or verified. TEE was found to be useful in the evaluation of the valves, making possible establishing of correct diagnosis, especially in cases in which TTE was insufficient for providing of adequate information.

[Transesophageal echocardiography--our preliminary experience]. / Echokardiografia przezprzelykowa--wstepne doswiadczenia wlasne.

This study presents the initial experience of our department with transesophageal echocardiography. Transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) were performed simultaneously in 31 clinical patients (16 to 76 years old). 13 pts with aortic (9) and mitral (4) valve disease, 10 pts with ischemic heart disease (including 7 AMI), 3 pts with congestive cardiomyopathy, 2 pts with aortic aneurysm and 3 pts with other heart diseases. The investigations were performed with use of Aloka SSD 650 machine and 7.5 MHz transesophageal convex transducer. The patients were prepared for the examination in the typical way by local anesthesia, administration of sedatives and heart monitoring. The following projections were used: basic short- and long-axis view, four chamber view, and transgastric view. These investigation confirmed the usefulness TEE for evaluation of aortic and mitral valves, especially their morphology, atrial septum and atrial cavities. Contractility and other heart structures were difficult to be evaluated by TEE. It seems to be possible to estimate the proximal sections of the coronary arteries. Only few complications were found: supraventricular (2) and ventricular extrasystoles (8), transient supraventricular tachycardia (3), and bradycardia (3). Late complications were not found.

[Cardiac arrhythmias in myocardial infarction as an extension of lesions to the myocardium and the state of circulatory efficiency]. / Zaburzenia rytmu w zawale serca a rozleglosc uszkodzenia miesnia sercowego i stan wydolnosci krazenia.

The study involved 55 patients with the acute myocardial infarction aged between 34 and 69 years (mean 53 years) in whom the relation of cardiac arrhythmias incidence to the extension of myocardial involvement and circulatory efficiency was assessed. All patients were examined clinically, a 24-hour ECG with Holter technique (in the first day, 21st day and 6th months after myocardial infarction) and echocardiographic (Echo-2D) tests were registered. Echocardiography was performed during hospital phase and 6 months after myocardial infarction. Cardiac arrhythmias were evaluated with classification into classes described by Lown. Close relation of serious cardiac arrhythmias with extension of myocardial involvement was noted especially in the acute phase of myocardial infarction. High risk arrhythmias--class IVA, IVB and V were noted in nearly 100% of patients in this phase with cardiac aneurysm, extensive akinesis of apex and anterior wall of the heart. Mean value of the ejection fraction was 31% in this group. Incidence of cardiac arrhythmias did not exceed 40%, ejection fraction was 56% in the group of patients with limited lesions to the heart, e.g. akinesis of the lower wall. Incidence of late cardiac arrhythmias (6 months) did not differ significantly in particular groups of patients. The value of ejection fraction remained, however, on the same level as in the hospital phase of the myocardial infarction.

[Ventricular arrhythmias and QT/QS2 index in patients with ischemic heart disease]. / Arytmie komorowe, a wskaznik QT/QS2 u chorych z choroba niedokrwienna serca.

This multicenter study comprised a group of 900 patients (207 females and 693 males, aged 23-68 years, mean 53) with ischaemic heart disease. Go medications other than nitrates, nifedipine and diuretics were administered at the time of study. In all patients a simultaneous standard 12-lead ecg and a phonocardiogram was registered. QT and QS2 intervals were then measured, and the QT/QS2 index calculated. QT/QS2 ratio 1.0 was considered as a normal one. A 24-h Holter ecg monitoring was performed in each patients, and ectopic ventricular activity was graded according to the Lown's classification. For patients with each class of arrhythmia the mean value of QT/QS2 was calculated. All means were similar, with values 1.0. Proportion of patients with abnormal values of QT/QS2 index was similar in patients showing different Lown classes of arrhythmia. Since a 24-hour monitoring does not give a full information about the arrhythmic events, patients with the history of VT/VF were analyzed separately. In this group an increase of QT/QS2 index was observed significantly more frequently than in other patients (37% vs 19%, p = 0.016). It is concluded that no close relationship exists between QT/QS2 index and the type of ventricular arrhythmia found on the Holter monitoring. However, pathologic QT/QS2 values seem to characterize the patients with increase risk of VT/VF.

[Palpitin--an anti-arrhythmic drug in ischemic heart disease]. / Palpitin--lek przeciwarytmiczny w chorobie niedokrwiennej serca.

The effectiveness was assessed of the antiarrhythmic treatment with Palpitin in 30 patients with ischaemic heart disease (IHD). The control group comprised 15 patients with IHD and arrhythmia, treated with propranolol. In all patients ECG recording by Holter's method was done before the treatment and after 14 days of the treatment. The effectiveness of Palpitin was expressed as improvement in 66% of cases (reduction of ectopic beats by 75%), and in 40% of cases complete regression of arrhythmia was achieved. These results were slightly better than in the group treated with propranolol (improvement in 60% of cases). Palpitin during the treatment caused no increase in the manifestations of cardiac failure and produced no disturbances of atrioventricular conduction. Fairly frequently the patients complained about mucosal dryness and sporadically about dyspeptic symptoms, but these symptoms were not disturbing the course of the treatment.