Subject(s)
Academies and Institutes , Delivery of Health Care, Integrated/organization & administration , Heart Diseases/therapy , Quality Improvement/organization & administration , Telemedicine/organization & administration , Catchment Area, Health , Cost-Benefit Analysis , Delivery of Health Care, Integrated/economics , Health Care Costs , Heart Diseases/diagnosis , Heart Diseases/economics , Heart Diseases/physiopathology , Humans , Minnesota , Models, Organizational , Patient Care Team/organization & administration , Program Development , Program Evaluation , Quality Improvement/economics , Rural Health Services/organization & administration , Telemedicine/economics , Time-to-Treatment/organization & administration , Treatment Outcome , Waiting Lists , Wisconsin , WorkflowABSTRACT
BACKGROUND: Motion Picture Experts Group-2 (MPEG2) is a broadcast industry standard that allows high-level compression of echocardiographic data. Validation of MPEG2 digital images compared with super VHS videotape has not been previously reported. METHODS: Simultaneous super VHS videotape and MPEG2 digital images were acquired. In all, 4 experienced echocardiographers completed detailed reporting forms evaluating chamber size, ventricular function, regional wall-motion abnormalities, and measures of valvular regurgitation and stenosis in a blinded fashion. Comparisons between the 2 interpretations were then performed and intraobserver concordance was calculated for the various categories. RESULTS: A total of 80 paired comparisons were made. The overall concordance rate was 93.6% with most of the discrepancies being minor (4.1%). Concordance was 92.4% for left ventricle, 93.2% for right ventricle, 95.2% for regional wall-motion abnormalities, and 97.8% for valve stenosis. The mean grade of valvular regurgitation was similar for the 2 techniques. CONCLUSIONS: MPEG2 digital imaging offers excellent concordance compared with super VHS videotape.
Subject(s)
Echocardiography, Doppler, Color , Image Interpretation, Computer-Assisted , Motion Pictures , Signal Processing, Computer-Assisted , Videotape Recording , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/epidemiology , Artificial Intelligence , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Humans , Image Processing, Computer-Assisted , Minnesota , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/epidemiology , Observer Variation , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/epidemiologyABSTRACT
Left ventricular (LV) wall thickening is the most consistent clinical marker of hypertrophic cardiomyopathy (HC), and characteristically increases substantially during adolescence. In this study, we used 2-dimensional echocardiography to develop a cross-sectional profile of LV wall thicknesses in adult patients with HC. We studied a regional community-based cohort of 239 consecutively enrolled patients (aged 18 to 91 years). On average, maximum LV wall thickness decreased relative to increasing age (p = 0.007) within 4 age groups: 22.8 +/- 5.1 mm (18 to 39 years) to 22.1 +/- 5.1 mm (40 to 59 years) to 21.1 +/- 3.7 mm (60 to 74 years) to 20.8 +/- 3.6 mm (>or=75 years). The LV thickness index (summation of wall thicknesses in all 4 segments) also decreased with age (p = 0.017): 63.0 +/- 12.2 mm to 59.8 +/- 11.9 mm to 58.3 +/- 10.4 mm to 57.9 +/- 9.8 mm. Decreasing magnitude of LV hypertrophy was independently associated with increasing age, but not with other relevant disease variables, such as symptoms and outflow obstruction. However, when separated by gender, this inverse relation between age and LV wall thickness was statistically significant only for women (p = 0.007). In conclusion, in an unselected HC cohort, cross-sectional analysis showed a modest but statistically significant inverse relation between age and LV hypertrophy that was largely gender-specific for women. This association constitutes another facet of the natural history of this complex and heterogenous disease and may reflect disproportionate occurrence of premature death in young patients with HC with marked hypertrophy or possibly gradual LV remodeling.
Subject(s)
Cardiomyopathy, Hypertrophic/diagnostic imaging , Hypertrophy, Left Ventricular/diagnostic imaging , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Blood Flow Velocity , Cardiomyopathy, Hypertrophic/epidemiology , Cardiomyopathy, Hypertrophic/physiopathology , Cross-Sectional Studies , Echocardiography, Doppler , Female , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Humans , Hypertrophy, Left Ventricular/epidemiology , Hypertrophy, Left Ventricular/physiopathology , Male , Middle Aged , Multivariate Analysis , Regression Analysis , Sex FactorsABSTRACT
Because pulmonary venous pressure has never been measured, it is unclear whether pulmonary wedge pressure measures left atrial pressure, as commonly assumed, or pressure more upstream in the pulmonary venous or capillary beds. Fluid-filled mean pulmonary artery and pulmonary wedge pressure were compared with pulmonary venous and left atrial pressure obtained with high-fidelity micromanometer catheters in eight lightly sedated dogs over a physiologic range of filling pressures. In all conditions, mean pulmonary wedge pressure was virtually identical (r = 0.99) to mean left atrial pressure (slope = 0.99; intercept = -0.46 mm Hg). At the same time, mean pulmonary venous pressure (17.1 +/- 6.5 mm Hg) was intermediate between mean pulmonary artery pressure (20.2 +/- 6.2 mm Hg) and mean pulmonary wedge pressure (13.3 +/- 6.2 mm Hg; P < 0.0001) or mean left atrial pressure (13.4 +/- 6.3 mm Hg; P < 0.0001). These relationships were maintained over normal and increased pressure ranges. As measured by conventional flow-directed pulmonary catheters, mean pulmonary wedge pressure accurately reflects left atrial pressure in lightly sedated, spontaneously breathing normal dogs.
