ABSTRACT
To analyze right-ventricular size and function and their relationship to left-ventricular dimensions in patients with dilated cardiomyopathy (DCM), biplane cineventriculography was performed in 57 patients. The results were compared to 15 normals (N). In patients dilatation of the right ventricle (RVEDVI: DCM: 126.5 +/- 41.4 ml/m2, N: 90.5 +/- 9.2 ml/m2, 2 p < 0.05) was less pronounced than dilatation of the left ventricle (LVEDVI: DCM: 136.0 +/- 45.8 ml/m2, N: 76.7 +/- 7.9 ml/m2, 2 p < 0.05). Left-ventricular ejection fraction (LVEF: DCM: 36.1 +/- 10.2%, N: 64.4 +/- 3.8%, 2 p < 0.05) was more reduced than right-ventricular ejection fraction (RVEF: DCM: 39.7 +/- 11.5%, N: 58.3 +/- 3.3%, 2 p < 0.05). Concerning the individual patient, a good correlation was found between right- and left-ventricular stroke volume (r = 0.74), whereas ejection fraction (r = 0.58), enddiastolic (r = 0.52) and endsystolic volume (r = 0.55) of the left and right ventricle correlated only moderately. Twenty-three of the 57 patients showed pronounced differences between right- and left-ventricular ejection fraction. The difference RVEF-LVEF was < = -10% in six patients, i.e., right-ventricular ejection fraction was markedly more reduced than left-ventricular ejection fraction. Right-ventricular myocardial biopsy was performed in five of these six patients with histologic evidence of dilated cardiomyopathy and, also, no signs of right-ventricular dysplasia (no lipomatous tissue replacement).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Cardiomyopathy, Dilated/physiopathology , Hemodynamics/physiology , Ventricular Function, Right/physiology , Adult , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Cardiac Catheterization , Cardiac Output, Low/diagnosis , Cardiac Output, Low/drug therapy , Cardiac Output, Low/physiopathology , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/drug therapy , Diuretics/therapeutic use , Drug Therapy, Combination , Female , Hemodynamics/drug effects , Humans , Male , Middle Aged , Pulmonary Circulation/drug effects , Pulmonary Circulation/physiology , Pulmonary Wedge Pressure/drug effects , Pulmonary Wedge Pressure/physiology , Vascular Resistance/drug effects , Vascular Resistance/physiology , Ventricular Function, Right/drug effectsABSTRACT
This study was undertaken to analyze the diagnostic value of Doppler echocardiographic determination of pressure gradient and valve orifice area for the evaluation of balloon valvuloplasty in mitral stenosis as well as the echocardiographic assessment of calcification, leaflet motion and the subvalvular apparatus for characterization of the most favorable morphologic prerequisites for this procedure. Doppler echocardiographic studies were performed in 24 patients with mitral stenosis, 21 women and three men, age range from 29 to 79 years, mean age 55 years, one day before and after balloon valvuloplasty and the results were compared with invasively-determined hemodynamic measurements. The Doppler echocardiographic determination of the mean pressure gradient before and after balloon valvuloplasty was carried out with the modified Bernoulli equation from the velocity profile of the stenotic jet and calculation of the mitral valve orifice area using the pressure half-time method. Echocardiographic assessment of valve morphology and motion was based on two-dimensional echocardiographic cross-sectional images. Calcification, as observed in the parasternal cross-sectional image, was classified as absent (grade 0), slight to moderate (grade 1) or severe (grade 2). Motion of the valve leaflets, as judged from the apical four- and two-chamber views, was assigned one of five grades taking into consideration the motion of the bodies of both leaflets from the systolic baseline position as less than 10 degrees, between 10 and 45 degrees and more than 45 degrees. The subvalvular apparatus, that is the chordae and the papillary muscles, were graded as unremarkable (grade 0), slightly altered (grade 1) and markedly altered (grade 2). Using a score derived by adding the grade of these three criteria, a formal value between 0 and 8 was calculated. Hemodynamic measurements were carried out with standard techniques employing simultaneous registrations of left atrial and left ventricular pressure for evaluation of the mean diastolic pressure gradient. Determination of the stroke volume was based on biplane left ventriculograms using Simpson's rule. The valve orifice area was calculated according to the Gorlin formula. Dilatation was carried out with a Bifoil (12F, balloon diameter 2 X 19 mm) or Trefoil (10F, 3 X 12 mm) valvuloplasty catheter. After PTVP, on comparison of the Doppler-echocardiographically determined pressure gradient (5.7 +/- 1.9 mm Hg) with that determined invasively (6.4 +/- 3.2 mm Hg) there was a moderate correlation (n = 19, r = 0.74, SEE = 1.3 mm Hg) where the noninvasively-determined values, in general, were smaller.(ABSTRACT TRUNCATED AT 400 WORDS)
Subject(s)
Catheterization , Echocardiography , Mitral Valve Stenosis/therapy , Adult , Aged , Evaluation Studies as Topic , Female , Hemodynamics , Humans , Male , Middle Aged , Mitral Valve Stenosis/physiopathologyABSTRACT
This study was undertaken to assess the diagnostic value of Doppler echocardiographic methods for determination of the mean pressure gradient and valve orifice area in the evaluation of the results of balloon valvuloplasty (PTVP) in aortic stenosis by comparison with invasively-determined measurements. In 16 patients with aortic valve stenosis, eight men and eight women, mean age 64 +/- 10 years, Doppler echocardiographic studies were performed one day before and after PTVP. The mean pressure gradient was calculated with the aid of the modified Bernoulli equation and the aortic valve orifice area with the continuity equation. After PTVP, on comparison of Doppler echocardiographic and invasively-determined pressure gradients, there was no significant correlation (n = 16, y = 0.3x + 18.7, r = 0.36, SEE = 9.3 mm Hg) (Figure 2). Prior to PTVP the two methods correlated reasonably well with each other (n = 16, y = 0.6x + 7.7, r = 0.54, SEE = 17.8 mm Hg) (Figure 2). On comparison of the Doppler echocardiographic and invasively-determined aortic valve orifice area, both after and before PTVP, there were significant linear correlations (n = 8, y = 0.41x + 0.41, r = 0.73, SEE = 0.12 cm2 and n = 14, y = 0.71x + 0.17, r = 0.86, SEE = 0.10 cm2, respectively) (Figure 4). Correspondingly, there was close agreement between the change in absolute aortic valve orifice areas determined invasively (0.18 +/- 0.15 cm2) and noninvasively (0.15 +/- 0.10 cm2, n = 8).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Aortic Valve Stenosis/therapy , Catheterization , Echocardiography , Aged , Aortic Valve Stenosis/physiopathology , Evaluation Studies as Topic , Female , Hemodynamics , Humans , Male , Middle AgedABSTRACT
Percutaneous transluminal valvuloplasty for mitral stenosis represents an alternative to surgical treatment. The reported increases in valve orifice area vary with values from 0.6 to 2.03 cm2 over a wide range. This study was undertaken to evaluate our own results and to determine if factors could be identified which may exert an influence on the outcome of the procedure. Additionally, to evaluate this new method of treatment, the pressure-flow relationship at rest and during exercise after valvuloplasty was compared with that observed after mitral valve commissurotomy or mitral valve replacement. In 25 patients with moderately-severe to severe mitral stenosis, mean age 56 +/- 11 years, mean valve orifice area 1.1 +/- 0.37 cm2, 52% with preexistent regurgitation, antegrade percutaneous, transvalvular valvuloplasty was carried out. Diagnostic catheterization was performed immediately prior to and after the procedure. Two concurrent groups of patients were analyzed for the purpose of comparison: 26 consecutive patients who underwent mitral valve commissurotomy with a comparable valve orifice area of 1.13 +/- 0.39 cm2 of whom 31% had a regurgitant component; and 37 consecutive patients who had valve replacement mostly with a Björk-Shiley prosthesis (M 29, 31, 33), mean age 52 +/- 8 years, comparable valve orifice area of 1.1 +/- 0.37 cm2 and a regurgitant component in 65%. Dilatation of the valve was carried out after transseptal catheterization with the use of an 8F Mullins sheath introducing a 7F balloon-tipped catheter (Critikon) via the left atrium, the left ventricle and into the descending aorta through which a 300 cm long 0.035" guidewire was advanced. By means of a retrieval catheter introduced via the femoral artery into the descending aorta, the guidewire was exteriorated via the femoral artery. After dilatation of the septum with a 9F dilatation catheter with a balloon of 8 mm diameter, a 10F or 12F dilatation catheter (Trefoil 3 X 12 mm or Bifoil 2 X 19 mm) (Schneider-Shiley) was advanced transseptally and the balloons positioned at the level of the mitral valve. The balloons were inflated with a pressure averaging 3.6 + 0.65 atmospheres (2-4.7 atm) and a mean duration of 27 +/- 8 s (16 to 45 s) on the average 3.9 +/- 1.6 times (1 to 9X) until disappearance or widening of the hour-glass waist of the balloon.(ABSTRACT TRUNCATED AT 400 WORDS)
Subject(s)
Catheterization , Mitral Valve Stenosis/therapy , Adult , Age Factors , Blood Pressure , Cardiac Output , Catheterization/methods , Female , Heart Rate , Heart Valve Prosthesis , Hemodynamics , Humans , Male , Middle Aged , Mitral Valve Insufficiency/physiopathology , Mitral Valve Stenosis/physiopathology , Mitral Valve Stenosis/surgery , Pulmonary Artery/physiologyABSTRACT
This study was undertaken to analyze change in stenosis caliber up to six months after PTCA with respect to regression or progression as well as to detect factors which possibly influencing the restenosis rate. A computer assisted system with high accuracy was used for two-dimensional quantitation of stenosis. A linear multivariate analysis was applied to quantitative and qualitative angiographic data as well as to clinical findings obtained before, immediately after and six months post-PTCA in 95 consecutive patients in whom 101 stenoses were dilatated. All patients were on a standard medical regimen of aspirin or coumadin and nifedipine. After six months, 56 patients showed a change in minimal stenosis area (mSA) of less than 1 mm2 (no progression), 33 patients showed a decrease in mSA of greater than 1 mm2 which rendered the stenosis with greater than 70% luminal reduction, and 12 patients showed a decrease in mSA of greater than 1 mm2 which did not, however, result in high-grade luminal narrowing. With regard to factors capable of affecting restenosis rate, there was no relationship between extent of dilatation achieved, local dissection, stenosis configuration or localization, calcification, patient age, sex, duration of symptoms, overweight, cholesterol, triglycerides, HDL, LDL, smoking, hypertension or diabetes. However, a relationship was found between the discontinuation of aspirin or coumadin as a result of GI side effects or bleeding (2% no progression; 20% progression). Thus, antiplatelet therapy appears to be important with respect to long-term results after PTCA.
Subject(s)
Angina Pectoris/therapy , Angioplasty, Balloon , Angina Pectoris/etiology , Angina Pectoris/pathology , Coronary Vessels/pathology , Female , Humans , Male , Middle Aged , Recurrence , Risk FactorsABSTRACT
This study was undertaken to assess whether various parameters of the extension of aortic regurgitation with color Doppler imaging are comparable with angiographic techniques for classification of severity. In 39 patients with aortic regurgitation, 14 women and 25 men, mean age 53 +/- 14 years, Doppler echocardiographic examinations were performed prospectively for determination of length, width and area of the maximal extension of regurgitant flow (Figure 1). Angiographic assessment of severity showed grade I regurgitation in nine, grade II in 14, grade III in twelve, and grade IV in four patients. The length of regurgitant flow in the color Doppler image showed an increasing tendency with increasing angiographic severity (r = 0.38, SEE = 13 mm), however, for various grades of severity, there was clear overlap. The area of regurgitation, similarly, due to substantial overlap, correlated only weakly with the angiographic data (r = 0.54, SEE = 196 mm2). To date, there is not theoretical basis for a correlation of the length and area of regurgitant flow with the severity and experimental studies have shown that there is no simple relationship. The best correlation was found for the width of the regurgitant flow (r = 0.63, SEE = 3 mm), however, here as well, there was clear overlap of data such that there was no statistically significant difference between grades II and III. Unequivocal differentiation of the values could only be achieved between grades I and IV. Based on a width of 7 mm, high-grade regurgitation could be detected with a sensitivity of 75% and a specificity of 74%.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Aortic Valve Insufficiency/diagnosis , Echocardiography/methods , Adolescent , Adult , Aged , Angiography/methods , Color , Female , Humans , Male , Middle AgedSubject(s)
Heart Valve Diseases/diagnosis , Heart Valve Prosthesis , Adult , Aortic Valve Insufficiency/diagnosis , Aortic Valve Stenosis/diagnosis , Exercise Test , Female , Heart Valve Diseases/surgery , Hemodynamics , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Mitral Valve Stenosis/diagnosisSubject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Bioprosthesis , Heart Valve Prosthesis , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/surgery , Myocardial Contraction , Adult , Aged , Aortic Valve Insufficiency/diagnosis , Aortic Valve Stenosis/diagnosis , Female , Hemodynamics , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Mitral Valve Stenosis/diagnosis , Physical Exertion , Postoperative Complications/diagnosisSubject(s)
Aortic Valve/surgery , Bioprosthesis , Heart Valve Prosthesis , Hemodynamics , Mitral Valve/surgery , Physical Exertion , Adult , Aged , Atrial Fibrillation/etiology , Blood Pressure , Female , Heart Rate , Humans , Male , Middle Aged , Postoperative Complications/etiology , Prosthesis DesignABSTRACT
Regional myocardial blood flow was measured by means of a computerized gamma-camera system in 30 patients with coronary artery disease (CAD) and in 14 healthy control subjects. Ventricular wall motion was quantitatively analyzed in 65 CAD-patients. Global and semiregional blood flow measurements yielded only limited information. In contrast, measurements of regional blood flow permitted detection of hypoperfused myocardium and the effects of pharmacologic intervention. The administration of 15 mg isosorbide dinitrate (ISDN) resulted in an increase in blood flow in post-stenotic hypoperfused myocardial regions of 20p.c. and a decrease in flow through normal myocardium of 14 p.c. These observations represent the adaption of flow to a newly-established level of metabolic demand. This increase in blood flow coupled with a reduction in afterload leads to improved ventricular wall motion in 65-75 p.c. of areas of hypokinetic myocardium and, to a markedly lesser degree, in only 20-25 p.c. of akinetic regions. Dyskinetic regions show no improvement. As compared with the 13ml/loog/min increase in blood flow seen after intracoronary administration of 0.45 mg ISDN in normal coronary vessels, the compromised dilatory capacity of diseased coronary vessels results in a relatively small increase in flow of 6 ml/100 g/min. The reduction of the extravascular component of coronary resistance, thus, appears to be the mechanism primarily responsible for the therapeutic effect of nitrates.
