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1.
Int J Obes (Lond) ; 38(11): 1397-402, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24525960

ABSTRACT

OBJECTIVE: Fat accumulation around the heart and aorta may impact cardiovascular (CV) health. The purpose of this study was to conduct a systematic investigation to examine potential associations of these fat depots with risk factors for CV events, which has not been done before. METHODS: Pericardial fat, periaortic fat around the ascending aorta (AA), descending aorta (DA) and aortic arch, and abdominal subcutaneous and visceral fat were measured by MRI in older adults with (n = 385, 69 ± 8 years, 52% female) and without (n = 50, 69 ± 8 years, 58% female) risk factors for a CV event. RESULTS: Individuals with CV risk factors exhibited greater fat volumes across all fat depots compared with those without risk factors. In analysis of covariance accounting for age, gender, race/ethnicity, diabetes, hypertension, coronary artery disease, smoking and body mass index (BMI), individuals with risk factors possessed higher epicardial, pericardial, AA, DA and abdominal visceral fat (P < 0.05). When matched one-to-one on age, gender, race/ethnicity and BMI, AA and DA fat were higher in those with versus without CV risk factors (P < 0.01). CONCLUSIONS: Older adults with a high risk for CV events have greater periaortic fat than low-risk adults, even after accounting for BMI. More studies are needed to determine whether greater periaortic fat predicts future CV events.


Subject(s)
Adipose Tissue/pathology , Aorta , Heart Failure/etiology , Intra-Abdominal Fat/pathology , Obesity, Abdominal/complications , Pericardium , Pulmonary Edema/etiology , Subcutaneous Fat/pathology , Aged , Aged, 80 and over , Aorta, Abdominal , Aorta, Thoracic , Body Mass Index , Case-Control Studies , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Obesity, Abdominal/pathology , Predictive Value of Tests , Prospective Studies , Risk Factors
3.
Am J Cardiol ; 88(10): 1163-8, 2001 Nov 15.
Article in English | MEDLINE | ID: mdl-11703964

ABSTRACT

The impact of different methods of indexation of left ventricular (LV) mass and systemic hemodynamic variables on prevalences and correlates of cardiovascular abnormalities in relation to level of obesity in populations remains unclear. We evaluated 1,672 participants in the Hypertension Genetic Epidemiology Network Study to investigate the relations of overweight and level of obesity to LV mass and prevalences of LV hypertrophy, abnormal cardiac output, and peripheral resistance detected using different indexations for body size. In our study population, 1,577 subjects were clinically healthy nondiabetic hypertensive and 95 were normotensive normal-weight nondiabetic reference subjects. Fat-free mass (FFM) did not differ between the reference group and the normal-weight hypertensive subjects, and increased with overweight. In hypertensive subjects, LV mass and cardiac output increased and total peripheral resistance decreased with overweight. Indexation of LV mass for FFM or body surface area (BSA) resulted in no difference or even lower prevalence of LV hypertrophy in severely obese compared with normal-weight hypertensive subjects. In contrast, indexation of LV mass for height(2.7) identified an increased prevalence of LV hypertrophy with overweight and obesity. Absolute cardiac output increased and total peripheral resistance decreased with overweight. Prevalence of elevated cardiac output indexed for height(1.83) increased and for elevated total peripheral resistance-height(1.83) index decreased with greater overweight, whereas opposite trends were seen when cardiac output and total peripheral resistance were indexed for BSA or FFM. Thus, in hypertensive subjects, FFM increases with overweight and is directly related to LV mass, stroke volume, and cardiac output, and inversely related to total peripheral resistance. Indexations of LV mass and systemic hemodynamics for FFM or BSA obscured associations of LV hypertrophy and abnormal cardiac and total peripheral resistance indexes with overweight, whereas LV mass/height(2,7), cardiac output/height(1.83), and total peripheral resistance-height(1.83) detected significant preclinical cardiovascular abnormalities with obesity.


Subject(s)
Body Mass Index , Hemodynamics , Hypertension/complications , Hypertrophy, Left Ventricular/complications , Obesity/complications , Female , Humans , Hypertension/epidemiology , Hypertrophy, Left Ventricular/epidemiology , Male , Middle Aged , Obesity/epidemiology , Prevalence , United States/epidemiology
5.
Am J Obstet Gynecol ; 185(4): 822-7, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11641659

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the effects of pregnancy and of maximal exercise on left ventricular diastolic filling response. STUDY DESIGN: Transmitral pulsed Doppler echocardiography was obtained in 10 healthy women during each trimester of pregnancy and at 12 weeks after delivery. Doppler studies were performed at rest and at each exercise workload. The P-R interval, the early and atrial peak flow velocities, the mitral early deceleration time, and the isovolumetric relaxation time were analyzed. Data are expressed as the mean and standard deviation of the mean. Values obtained during the last trimester of pregnancy were used as the pregnant value; values at the 12 weeks after delivery were used as the nonpregnant value. Paired t -test, analysis of variance, and mixed models were used to determine significance with a probability value of <.05. RESULTS: Pregnancy significantly increased the early and atrial peak flow velocities. Pregnancy decreased the P-R interval, the early deceleration time, and the isovolumetric relaxation time. Exercise significantly decreased these diastolic functions; but pregnancy, in any of the 3 trimesters, did not significantly affect this response. CONCLUSION: Pregnancy increased left ventricular diastolic camber stiffness at rest and shifted left ventricular diastolic filling during exercise from predominantly early to atrial filling. This finding suggests that there is an increase in left ventricular chamber stiffness during maximal upright bicycle exercise in pregnancy.


Subject(s)
Exercise Test , Exercise/physiology , Pregnancy/physiology , Ventricular Function, Left/physiology , Adult , Analysis of Variance , Cardiac Output , Diastole/physiology , Echocardiography, Doppler , Female , Heart Function Tests , Humans , Postpartum Period , Pregnancy Trimester, Third , Probability , Reference Values , Sensitivity and Specificity
7.
Hypertension ; 38(3): 417-23, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11566915

ABSTRACT

To determine the prevalence and correlates of left ventricular systolic dysfunction in hypertensive patients in a biracial population-based sample, clinical evaluation and echocardiography were performed in 2086 participants in the Hypertension Genetic Epidemiology Network (HyperGEN) examination; 86% had normal ejection fraction (>54%), 10% had mild ventricular dysfunction (ejection fraction 41% to 54%), and 4% had severe ventricular dysfunction (ejection fraction

Subject(s)
Black People , Hypertension/physiopathology , Ventricular Dysfunction, Left/physiopathology , White People , Adult , Aged , Aged, 80 and over , Blood Pressure/physiology , Echocardiography , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Predictive Value of Tests , Systole
8.
Hypertension ; 38(3): 424-8, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11566916

ABSTRACT

The relation of impaired left ventricular relaxation, as measured by prolonged isovolumic relaxation time, to ventricular systolic function in hypertension remains uncertain in population-based samples. In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, echocardiograms were analyzed in 1457 hypertensive participants without diabetes, >/=2+ valvular regurgitation, or coronary disease. Impaired relaxation (isovolumic relaxation time >100 ms) was present in 219 (15%) of the participants; they were older and had higher arterial pressure than did those with normal relaxation. Ventricular chamber size, wall thicknesses, mass, and relative wall thickness were greater, and stress-corrected midwall shortening and end-systolic stress/end-systolic volume index were lower with impaired relaxation than with normal relaxation time. Fractional shortening and ejection fraction did not differ between the groups. In logistic regression, the likelihood of prolonged isovolumic relaxation time decreased with higher stress-corrected midwall shortening (odds ratio, 0.97%; 95% confidence interval, 0.96 to 0.99), independently of age, heart rate, and ventricular mass. Neither ejection fraction nor the end-systolic stress/end-systolic volume index was independently related to isovolumic relaxation time. In hypertension, impaired left ventricular relaxation parallels ventricular midwall dysfunction but not systolic chamber function. Whether combined diastolic and systolic dysfunction identifies hypertensive patients at especially high risk of cardiovascular events requires further study.


Subject(s)
Heart Ventricles/physiopathology , Hypertension/physiopathology , Systole/physiology , Ventricular Function, Left/physiology , Adult , Diastole/physiology , Echocardiography , Female , Heart Ventricles/pathology , Humans , Male , Middle Aged , Predictive Value of Tests , Stroke Volume/physiology
9.
J Am Coll Cardiol ; 38(3): 796-802, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11527636

ABSTRACT

OBJECTIVES: The goal of this study was to determine if cardiac cycle-dependent changes in proximal thoracic aortic area and distensibility are associated with exercise intolerance in elderly patients with diastolic heart failure (DHF). BACKGROUND: Aortic compliance declines substantially with age. We hypothesized that a reduction in cardiac cycle-dependent changes in thoracic aortic area and distensibility (above that which occurs with aging) could be associated with the exercise intolerance that is prominent in elderly diastolic heart failure patients. METHODS: Thirty subjects (20 healthy individuals [10 < 30 years of age and 10 > 60 years of age] and 10 individuals > the age of 60 years with DHF) underwent a magnetic resonance imaging (MRI) study of the heart and proximal thoracic aorta followed within 48 h by maximal exercise ergometry with expired gas analysis. RESULTS: The patients with DHF had higher resting brachial pulse and systolic blood pressure, left ventricular mass, aortic wall thickness and mean aortic flow velocity, and, compared with healthy older subjects, they had a significant reduction in MRI-assessed cardiac cycle-dependent change in aortic area and distensibility (p < 0.0001) that correlated with diminished peak exercise oxygen consumption (r = 0.79). After controlling for age and gender in a multivariate analysis, thoracic aortic distensibility was a significant predictor of peak exercise oxygen consumption (p < 0.04). CONCLUSIONS: Older patients with isolated DHF have reduced cardiac cycle-dependent changes in proximal thoracic aortic area and distensibility (beyond that which occurs with normal aging), and this correlates with and may contribute to their severe exercise intolerance.


Subject(s)
Aorta, Thoracic/pathology , Exercise Tolerance , Heart Failure/pathology , Ventricular Dysfunction, Left/pathology , Adult , Elasticity , Exercise Test , Female , Heart Failure/physiopathology , Humans , Magnetic Resonance Imaging , Male , Oxygen Consumption , Ventricular Dysfunction, Left/physiopathology
10.
Hypertension ; 37(5): 1229-35, 2001 May.
Article in English | MEDLINE | ID: mdl-11358933

ABSTRACT

The association of sinuses of Valsalva dilatation and aortic regurgitation with hypertension is disputed, and few data are available in population-based samples. We explored the relations of sinuses of Valsalva dilatation and aortic regurgitation to hypertension and additional clinical and echocardiographic data in 2096 hypertensive and 361 normotensive participants in the Hypertension Genetic Epidemiology Network study. Age and body surface area were used to predict aortic root diameter using published equations developed from a separated reference population. Aortic dilatation was defined as measured sinuses of Valsalva diameter exceeding the 97.5th percentile of the confidence interval of predicted diameter for age and body size. Aortic dilatation was present in 4.6% of the population. After adjustment for age and body surface area, mean aortic root diameter was larger in hypertensives with suboptimal blood pressure control than normotensives or hypertensives with optimal blood pressure control. In multivariate models, sinuses of Valsalva diameter was weakly positively related to diastolic blood pressure and to left ventricular mass independent of aortic regurgitation. Subjects with aortic dilatation were slightly older, were more frequently men, had higher left ventricular mass, and had lower left ventricular systolic chamber function independent of covariates. Sinuses of Valsalva dilatation was independently related to male gender, aortic valve fibrocalcification, and echocardiographic wall motion abnormalities but not to diastolic blood pressure (or history of hypertension in a separate model). The likelihood of aortic regurgitation increased with larger aortic root diameter, older age, female gender, presence of aortic valve fibrocalcification, and lower body mass index but not hypertension or diabetes. In a subsequent model, diastolic blood pressure was negatively related to aortic regurgitation independent of covariates. In a large population-based sample, sinuses of Valsalva diameter was only mildly larger in subjects with suboptimally controlled hypertension than in normotensives or well-controlled hypertensives, which did not result in differences in prevalence of aortic regurgitation among groups. Sinuses of Valsalva dilatation was associated with higher left ventricular mass and lower systolic function, which may contribute to higher cardiovascular risk in subjects with aortic root dilatation.


Subject(s)
Aortic Valve Insufficiency/etiology , Hypertension/complications , Sinus of Valsalva/physiology , Aortic Valve Insufficiency/epidemiology , Blood Pressure , Body Composition/physiology , Calcinosis/etiology , Female , Humans , Male , Middle Aged , Prevalence , Sex Characteristics , Systole , Vasodilation , Ventricular Remodeling/physiology
11.
Am J Cardiol ; 87(4): 413-9, 2001 Feb 15.
Article in English | MEDLINE | ID: mdl-11179524

ABSTRACT

Although congestive heart failure (CHF) is a common syndrome among the elderly, there is a relative paucity of population-based data, particularly regarding CHF with normal systolic left ventricular function. A total of 4,842 independent living, community-dwelling subjects aged 66 to 103 years received questionnaires on medical history, family history, personal habits, physical activity, and socioeconomic status, confirmation of pre-existing cardiovascular and cerebrovascular disease, anthropometric measurements, casual seated random-zero blood pressure, forced vital capacity and expiratory volume in 1 second, 12-lead supine electrocardiogram, fasting glucose, creatinine, plasma lipids, carotid artery wall thickness by ultrasonography, and echocardiography-Doppler examinations. Participants with at least 1 confirmed episode of CHF by Cardiovascular Health Study criteria were considered prevalent for CHF. The prevalence of CHF was 8.8% and was associated with increased age, particularly for women, in whom it increased more than twofold from age 65 to 69 years (6.6%) to age > or = 85 years (14%). In multivariate analysis, subjects with CHF were more likely to be older (odds ratio [OR] 1.2 for 5-year difference, men OR 1.1), and more often had a history of myocardial infarction (OR 7.3), atrial fibrillation (OR 3.0), diabetes mellitus (OR 2.1), renal dysfunction (OR 2.0 for creatinine < or = 1.5 mg/ dl), and chronic pulmonary disease (OR 1.8; women only). The echocardiographic correlates of CHF were increased left atrial and ventricular dimensions. Importantly, 55% of subjects with CHF had normal left ventricular systolic function and 80% had either normal or only mildly reduced systolic function. Among subjects with CHF, women had normal systolic function more frequently than men (67% vs 42%; p < 0.001). Thus, CHF is common among community-dwelling elderly. It increases with age and is usually associated with normal systolic LV function, particularly among women. The finding that a large proportion of elderly with CHF have preserved LV systolic function is important because there is a paucity of data to guide management in this dominant subset.


Subject(s)
Heart Failure/physiopathology , Ventricular Function, Left/physiology , Aged , Aged, 80 and over , Analysis of Variance , Chi-Square Distribution , Echocardiography, Doppler , Female , Health Status , Heart Failure/diagnostic imaging , Heart Failure/epidemiology , Humans , Logistic Models , Longitudinal Studies , Male , Prevalence , Risk Factors , Surveys and Questionnaires , United States/epidemiology
12.
N Engl J Med ; 344(1): 17-22, 2001 Jan 04.
Article in English | MEDLINE | ID: mdl-11136955

ABSTRACT

BACKGROUND: Patients with acute pulmonary edema often have marked hypertension but, after reduction of the blood pressure, have a normal left ventricular ejection fraction (> or =0.50). However, the pulmonary edema may not have resulted from isolated diastolic dysfunction but, instead, may be due to transient systolic dysfunction, acute mitral regurgitation, or both. METHODS: We studied 38 patients (14 men and 24 women; mean [+/-SD] age, 67+/-13 years) with acute pulmonary edema and systolic blood pressure greater than 160 mm Hg. We evaluated the ejection fraction and regional function by two-dimensional Doppler echocardiography, both during the acute episode and one to three days after treatment. RESULTS: The mean systolic blood pressure was 200+/-26 mm Hg during the initial echocardiographic examination and was reduced to 139+/-17 mm Hg (P< 0.01) at the time of the follow-up examination. Despite the marked difference in blood pressure, the ejection fraction was similar during the acute episode (0.50+/-0.15) and after treatment (0.50+/-0.13). The left ventricular regional wall-motion index (the mean value for 16 segments) was also the same during the acute episode (1.6+/-0.6) and after treatment (1.6+/-0.6). No patient had severe mitral regurgitation during the acute episode. Eighteen patients had a normal ejection fraction (at least 0.50) after treatment. In 16 of these 18 patients, the ejection fraction was at least 0.50 during the acute episode. CONCLUSIONS: In patients with hypertensive pulmonary edema, a normal ejection fraction after treatment suggests that the edema was due to the exacerbation of diastolic dysfunction by hypertension--not to transient systolic dysfunction or mitral regurgitation.


Subject(s)
Hypertension/complications , Pulmonary Edema/etiology , Ventricular Dysfunction, Left/complications , Acute Disease , Aged , Antihypertensive Agents/therapeutic use , Diastole , Diuretics/therapeutic use , Echocardiography, Doppler , Female , Follow-Up Studies , Heart Failure/etiology , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Male , Mitral Valve Insufficiency/complications , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/drug therapy , Radiography , Stroke Volume , Vasodilator Agents/therapeutic use , Ventricular Function, Left
13.
Circulation ; 103(1): 102-7, 2001 Jan 02.
Article in English | MEDLINE | ID: mdl-11136693

ABSTRACT

BACKGROUND: Type 2 diabetes is a cardiovascular risk factor. It remains to be elucidated in a large, population-based sample whether diabetes is associated with changes in left ventricular (LV) structure and systolic function independent of obesity and systolic blood pressure (BP). METHODS AND RESULTS: Among 1950 hypertensive participants in the HyperGEN Study without overt coronary heart disease or significant valve disease, 20% (n=386) had diabetes. Diabetics were more likely to be women, black, older, and have higher BMI and waist/hip ratio than were nondiabetics. After adjustment for age and sex, diabetics had higher systolic BP, pulse pressure, and heart rate; lower diastolic BP; and longer duration of hypertension than nondiabetics. LV mass and relative wall thickness were higher in diabetic than nondiabetic subjects independent of covariates. Compared with nondiabetic hypertensives, diabetics had lower stress-corrected midwall shortening, independent of covariates, without difference in LV EF. Insulin levels and insulin resistance were higher in non-insulin-treated diabetics (n=195) than nondiabetic (n=1439) subjects (both P:<0.01). Insulin resistance positively but weakly related to LV mass and relative wall thickness. CONCLUSIONS: In a relatively healthy, population-based sample of hypertensive adults, type 2 diabetes was associated with higher LV mass, more concentric LV geometry, and lower myocardial function, independent of age, sex, body size, and arterial BP. structural and functional abnormalities in addition to, and independent of, atherosclerosis.(13) (14) In the Framingham cohort, diabetes was associated with higher LV mass in women but not men.(15) High blood pressure (BP), obesity, and abnormal lipid profile, which often coexist with diabetes, tend to be associated with preclinical cardiovascular abnormalities(16) and may contribute to the association of diabetes with cardiovascular events. Cardiac features of diabetic and nondiabetic hypertensive subjects remain incompletely described in population-based samples. Therefore, we compared clinical and metabolic characteristics, LV geometry, and systolic function between diabetic and nondiabetic hypertensive participants in the Hypertension Genetic Epidemiology Network (HyperGEN) Study.


Subject(s)
Diabetes Mellitus, Type 2/physiopathology , Hypertension/physiopathology , Ventricular Function, Left , Ventricular Remodeling , Adult , Age Distribution , Black People/genetics , Blood Glucose , Blood Pressure , Body Constitution , Body Mass Index , Cholesterol/blood , Cholesterol, HDL/blood , Comorbidity , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/epidemiology , Female , Heart Function Tests , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Hypertension/blood , Hypertension/epidemiology , Hypertension/genetics , Male , Middle Aged , Organ Size , Sex Distribution , Systole , Triglycerides/blood , Ultrasonography , White People/genetics
14.
Am J Hypertens ; 14(12): 1226-30, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11775131

ABSTRACT

BACKGROUND: Evidence suggests that left ventricular (LV) mass is under genetic control, independently of risk factors known to influence LV size and geometry. METHODS: As part of the HyperGEN study, four field centers recruited African American and white hypertensive siblings (n = 1,664), aged 23 to 87 years. Two-dimensionally guided M-mode echocardiography was performed, and LV mass and relative wall thickness (RWT) were measured at a central reading center. Familial correlations were calculated separately for each ethnic group using maximum likelihood methods, adjusted for the potential confounding influences of age, gender, systolic blood pressure, and obesity. RESULTS: In African Americans, brother-sister, brother-brother, and sister-sister correlation coefficients and standard errors for LV mass were 0.29 (0.08), 0.44 (0.10), and 0.33 (0.05). In whites, the corresponding correlations were lower than in African Americans at 0.05 (0.08), 0.12 (0.11), and 0.22 (0.09), respectively. Sibling correlation of LV geometry, assessed by RWT, was less in African Americans than in whites: brother-sister, 0.04 (0.10) v 0.21 (0.10), brother-brother, 0.12 (0.22) v 0.28 (0.09), and sister-sister, 0.11 (0.07) v 0.19 (0.11). CONCLUSIONS: LV mass is strongly correlated in hypertensive African American siblings, and modestly correlated in their white counterparts, whereas RWT has stronger sibling correlation in whites. The patterns of familial correlation of echocardiographic LV mass and RWT suggest that the genetic underpinnings of LV hypertrophy and geometric remodeling may differ among ethnic groups.


Subject(s)
Black People/genetics , Hypertrophy, Left Ventricular/ethnology , Hypertrophy, Left Ventricular/pathology , White People/genetics , Adult , Aged , Aged, 80 and over , Echocardiography , Family Health , Female , Humans , Hypertrophy, Left Ventricular/genetics , Male , Middle Aged , Nuclear Family , Risk Factors , Sex Distribution , United States/epidemiology , Ventricular Remodeling/genetics
15.
Cardiol Clin ; 18(3): 597-617, x, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10986592

ABSTRACT

Diastolic left ventricular function is altered substantially with advancing age in healthy persons, and diastolic dysfunction impacts most cardiovascular disorders in the elderly. Older, healthy persons have a delayed relaxation Doppler filling pattern and their early deceleration time is similar to, or modestly lengthened, compared with younger, healthy persons. Two abnormal Doppler filling patterns, the pseudo-normal and the restricted, are discerned more easily, and are more specific in the elderly than the young, because they are the opposite (reverse) of the normal elderly pattern. Most heart failure in the elderly occurs in the presence of preserved systolic function (presumed diastolic heart failure). Elderly patients with diastolic heart failure tend to be women with hypertrophied, hyperdynamic left ventricles, and chronic hypertension. Prognosis may be somewhat better than in systolic heart failure, but the difference diminishes when adjusted for gender and in the very elderly. The pathophysiology of this disorder is not well characterized, diagnostic criteria have not been standardized, and there are no large, multicenter, randomized trials to guide therapy. Further research in this area should be a high priority.


Subject(s)
Cardiovascular Agents/therapeutic use , Diastole/drug effects , Ventricular Dysfunction, Left/drug therapy , Aged , Aged, 80 and over , Cardiovascular Agents/adverse effects , Diastole/physiology , Female , Hemodynamics/drug effects , Hemodynamics/physiology , Humans , Male , Randomized Controlled Trials as Topic , Survival Rate , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/mortality
16.
Am J Cardiol ; 86(6): 669-74, 2000 Sep 15.
Article in English | MEDLINE | ID: mdl-10980221

ABSTRACT

Suboptimal left ventricular (LV) cavity visualization and endocardial border delineation often compromise the clinical utility of echocardiography. This study examines the safety and efficacy of perflutren, a novel ultrasound contrast agent, for LV cavity opacification and endocardial border delineation in patients with suboptimal baseline echocardiograms. In a multicenter, randomized, placebo-controlled, double-blind trial, 211 patients with suspected cardiac disease and suboptimal baseline echocardiograms were enrolled at 17 sites. Two intravenous injections of either placebo (saline) or perflutren (5 or 10 microl/kg) were given approximately 30 minutes apart. Images of the apical 4- and 2-chamber views were acquired and scored. Perflutren opacified the LV cavity after both dosages (5 and 10 microl/kg dosages). Clinically useful contrast was observed in 89% of patients who received perflutren and in 0% of patients who received placebo (p < 0.01). Quantitative assessment of LV opacification with videodensitometry showed similar results. The mean duration of clinically useful contrast was 90 seconds. Improvement in endocardial border delineation was demonstrated in 91% of patients who received perflutren and in 12% of those who received placebo (p < 0.001). Following perflutren, an average of 4 more segments per patient were evaluable compared with baseline. Salvage of nondiagnostic baseline examinations by perflutren was demonstrated in 48% of eligible subjects. The safety profile of perflutren was similar to placebo. These data indicate that administration of perflutren to patients with suboptimal baseline images is well tolerated and provides substantial LV cavity opacification and improvement in endocardial border delineation.


Subject(s)
Contrast Media , Echocardiography/methods , Fluorocarbons , Heart Ventricles/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Densitometry , Diagnosis, Differential , Double-Blind Method , Female , Humans , Injections, Intravenous , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Safety , Video Recording
17.
Echocardiography ; 17(5): 447-9, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10979019

ABSTRACT

A patient with a large Zenker's diverticulum and narrow, angulated passageway successfully underwent transesophageal echocardiography using a pediatric endoscope, short esophageal overtube, and a pediatric transesophageal echocardiographic probe.


Subject(s)
Echocardiography, Transesophageal/methods , Zenker Diverticulum , Echocardiography, Transesophageal/instrumentation , Esophagus , Female , Humans , Intubation/instrumentation , Intubation/methods , Middle Aged
18.
Am Heart J ; 140(2): E1-4, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10925321

ABSTRACT

BACKGROUND: Thromboembolism is an infrequent but serious complication in dilated cardiomyopathy (DCM), and the role of primary preventive antithrombotic or anticoagulation therapy is undetermined. High-intensity transient signals (HITS) by Doppler ultrasound representing microemboli have been described in various clinical settings associated with increased risk of stroke. This study assessed the feasibility, reproducibility, and prevalence of HITS in patients with DCM. METHODS: Thirty patients with severely reduced left ventricular ejection fraction (< or = 35%, mean 25%) and New York Heart Association class II to III who were not receiving antithrombotic or anticoagulant therapy and 20 age-matched normal subjects were prospectively examined. Patients with atrial fibrillation, significant cardiac valvular heart disease, a history of cerebrovascular disease, and those who otherwise required antithrombotic or anticoagulation therapy were excluded. One-hour pulsed-wave Doppler recordings over the common carotid artery (CCA) were performed on 3 separate days in each subject by a single, experienced, blinded sonographer with a 4-MHz probe (TC-2000, Nicolet/EME) with a specially designed probe holder. Studies were read in a blinded, random fashion by 2 independent, experienced HITS Doppler recording readers. RESULTS: HITS in the CCA were detected in 6 (20%) of 30 patients with DCM and in 3 (15%) of 20 volunteers. This difference was not statistically significant. Intrareader and interreader reproducibility were high (kappa = 0.91 and 0.84, respectively; P <.001), whereas intrasubject reproducibility over the 3 visits was moderate to low (kappa = 0.22). There was no significant difference between HITS characteristics, that is, intensity and duration, in patients versus controls. CONCLUSIONS: The prevalence of CCA HITS in patients with clinically stable heart failure who are not receiving anticoagulation/antithrombotic therapy and are not in atrial fibrillation is low and not significantly different from normal patients. These data suggest that HITS monitoring is not a viable surrogate marker for increased thromboembolic risk in such patients with DCM.


Subject(s)
Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/diagnostic imaging , Carotid Artery, Common/diagnostic imaging , Intracranial Embolism/diagnostic imaging , Intracranial Embolism/etiology , Ultrasonography, Doppler, Transcranial , Adult , Aged , Feasibility Studies , Humans , Intracranial Embolism/epidemiology , Middle Aged , Observer Variation , Prevalence , Prospective Studies , Reproducibility of Results
19.
Clin Geriatr Med ; 16(3): 489-512, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10918644

ABSTRACT

Contrary to popular belief, population studies indicate that most elderly patients with heart failure have preserved left ventricular systolic function (i.e., presumed diastolic heart failure). Several normal aging changes may predispose older individuals to diastolic heart failure, including increased hypertrophy and stiffness of the left ventricle, increased vascular stiffness, and decreased cardiovascular reserve. Progress in diastolic heart failure has been hindered by a lack of standard case definition; absence of a readily available, reliable test to quantitate diastolic function; poor understanding of the pathophysiology of heart failure; and lack of data from randomized, controlled, multicenter trials. Typical patients are older women with chronic hypertension, left ventricular hypertrophy, chronic exercise intolerance, and occasional acute exacerbations (pulmonary edema). Although heart failure is a clinical, bedside diagnosis, echocardiography is helpful in differentiating diastolic from systolic heart failure and in ruling out other disorders. Although optimal pharmacologic therapy has not been clarified, control of blood pressure; exercise conditioning; and a multidisciplinary, case management approach seem beneficial.


Subject(s)
Aging/physiology , Heart Failure/etiology , Heart Failure/physiopathology , Hemodynamics , Systole/physiology , Ventricular Function, Left/physiology , Age Factors , Aged , Aging/pathology , Causality , Diastole , Exercise Test , Female , Heart Failure/diagnosis , Heart Failure/therapy , Humans , Hypertension/complications , Hypertrophy, Left Ventricular/etiology , Male , Prognosis
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