[Non-invasive estimation of dP/dt of the left ventricle: is the measurement taken during the isovolumetric contraction?]. / Estimación no invasiva de la dP/dt del ventrículo izquierdo: la medición se efectúa durante la contracción isovolumétrica?

UNLABELLED: Left ventricular dP/dt is estimated from mitral regurgitation (MR) jet as the rate of pressure rise (RPR) from 1 to 3 m/sec. In order to establish if this measure is made during the isovolumetric contraction (IC), we with MR studied 38 patients (age average 51 +/- 8 years) of different etiology. IC was estimated as pre-ejection time minus Q-first sound (S1). Velocity of the MR was measured at the onset and at the end of IC to estimate RPR during IC and time from 1 m/s to S1 (T1-S1) to indicate the mismatch between the two methods. RESULTS: There was not difference between RPR 1 to 3 m/s and RPR (IC). T 1-S1 was 26 +/- 24 ms indicating that the measure of RPR 1 to 3 m/s was made prior to the onset of IC. CONCLUSION: Noninvasive assessment of left ventricular dP/dt from 1 to 3 m/s is made prior to the onset of IC.

[Ventricular diastolic function: a correlation between phonomechanocardiography and echo-Doppler]. / Función diastólica ventricular: correlación entre fonomecanocardiografía y eco Doppler.

With the purpose to compare phonomechanocardiography and echo Doppler in the assessment of diastolic function of the left ventricle, we study 45 patients (30 male and 15 female) average age 50 +/- 9 years. We performed phonomechanocardiogram, echo-M, 2-D and Doppler transmitral. They were classified in four group according to mitral flow pattern: normal 14 patients; pattern I by Appleton (PI) 14 patients, 11 with aortic stenosis and 3 with hypertrophic cardiomyopathy; pattern II (PII) 12 patients with dilated cardiomyopathy grade III-IV and the last group of 5 patients with myocardial infarction with normal mitral flow but with impaired diastolic function by phonomechanocardiography. The phonomechanocardiographic index of ventricular relaxation (A2-O, ITRAT), compliance (a/D) and global diastolic function (ITAD) correlated with Doppler index (A2-D, E/A, atrial filling fraction, E-F slope and deceleration time) in N + PI group. The correlation was not significant when N + PI + PII or PI + PII groups were considered. The ITAD and E/A had r = 0.713 (p < 0.001) in N + PI, r = 0.12 (NS) in N + PI + PII and r = -0.308 (NS) in PI + PII. There was a dissociation between increased "a" wave in apexcardiogram and little "A" wave in PII patients suggesting "atrial failure". The patients with myocardial infarction received isosorbide dinitrate 5 mg showing changes of "pseudonormalizated" pattern in PI with normalized ITAD. This findings suggest that assessment of diastolic function by Doppler is dependent of loading conditions (specially preload), and cannot evaluate relaxation in PII but this is possible by phonomechanocardiography. It is advised the combination of the two technics for better assessment of diastolic function.

[Differences between patients with right bundle branch block and left anterior hemiblock in Chagas myocardiopathy]. / Diferencias entre pacientes con bloqueo de rama derecha y hemibloqueo anterior izquierdo en la miocardiopatía chagásica.

In order to establish whether different kinds of conduction disturbances like complete right branch block (CRBB) and left anterior hemiblock (LAH) are associated with different degrees of myocardial damage in Chagas disease (Chd), we studied 25 patients (p), 15 males and 10 women (41 +/- 5 years old) who were divided into five groups: normal EKG 5 p, incomplete right branch block 5 p, CRBB-LAH 5 p. We performed EKG, phonocardiogram, echo-M, 2-D and Doppler. The systolic function was evaluated with velocity of circumferential shortening and Weissler index; parietal motility with score of motility; dilatation with diastolic diameter of left ventricle and diastolic function with isovolumetric relaxation time and E/A ratio mitral and tricuspid. The patients who did not present basal severe arrhythmias were submitted to stress testing. We found that in LAH there were great systolic and diastolic dysfunctions, parietal motility alterations and malignant arrhythmias as compared with CRBB. There was no significant difference between LAH and CRBB-LAH. In Chagas disease, the presence of LAH showed much more myocardial damage than in CRBB.

Diferencias entre pacientes con bloqueo de rama derecha y hemibloqueo anterior izquierdo en la miocardiopatia chagasica / Differences between patients with right bundle branch block and left anterior hemiblock in Chagas myocardiopathy

Con el objetivo de establecer si destintos trastornos de conducción como el bloqueo completo de rama derecha (BCRD) y el hemibloqueo anterior izquierdo (HBA) se asocian con diferentes grados de daño miocárdio en la Enfermedad de Chagas (ECh) se estudiaron 25 pacientes (p), 15 hombres y 10 mujeres (edad promedio 41 ñ 5 años), los que fueron dividios en cinco grupos: ECG normal 5 p, BIRD 5 p, BCRD 5 p, HBAI 5 p y BCRD-HBAI 5 p. Se efectuó ECG fonocardiograma, eco-M, bidimensional y Doppler. La función sistólica se evaluó con la velocidad acortamiento circunferencial e índice de Weissler; la motilidad parietal con el score de motilidad; la dilatación ventricular con el diámetro diastólico del ventrículo y la función diastólica mediante el timepo de relajación isovolumétrica y la relación entre la velocidad de lleno rápido-velocidad de lleno auricular (E/A) mitral y tricuspídeo con eco-Doppler. Los p que no presentaron arritmias severas en el basal realizaron ergometría para ponerias en evidencia. El HBAI se asoció con mayor disfunción sistólica y diastólica, alternaciones de la motilidad parietal y arritmias malignas que el BCRD. No se observaron diferencias significativas entre los p con HBAI y BCRD-HBAI. En la ECh la presencia de HBAI expresa mayor daño miocárdico que el BCRD

Diferencias entre pacientes con bloqueo de rama derecha y hemibloqueo anterior izquierdo en la miocardiopatia chagasica / Differences between patients with right bundle branch block and left anterior hemiblock in Chagas myocardiopathy

Con el objetivo de establecer si destintos trastornos de conducción como el bloqueo completo de rama derecha (BCRD) y el hemibloqueo anterior izquierdo (HBA) se asocian con diferentes grados de daño miocárdio en la Enfermedad de Chagas (ECh) se estudiaron 25 pacientes (p), 15 hombres y 10 mujeres (edad promedio 41 ñ 5 años), los que fueron dividios en cinco grupos: ECG normal 5 p, BIRD 5 p, BCRD 5 p, HBAI 5 p y BCRD-HBAI 5 p. Se efectuó ECG fonocardiograma, eco-M, bidimensional y Doppler. La función sistólica se evaluó con la velocidad acortamiento circunferencial e índice de Weissler; la motilidad parietal con el score de motilidad; la dilatación ventricular con el diámetro diastólico del ventrículo y la función diastólica mediante el timepo de relajación isovolumétrica y la relación entre la velocidad de lleno rápido-velocidad de lleno auricular (E/A) mitral y tricuspídeo con eco-Doppler. Los p que no presentaron arritmias severas en el basal realizaron ergometría para ponerias en evidencia. El HBAI se asoció con mayor disfunción sistólica y diastólica, alternaciones de la motilidad parietal y arritmias malignas que el BCRD. No se observaron diferencias significativas entre los p con HBAI y BCRD-HBAI. En la ECh la presencia de HBAI expresa mayor daño miocárdico que el BCRD (AU)

Diferencias entre pacientes con bloqueo de rama derecha y hemibloqueo anterior izquierdo en la miocardiopatía chagásica. / [Differences between patients with right bundle branch block and left anterior hemiblock in Chagas myocardiopathy]

In order to establish whether different kinds of conduction disturbances like complete right branch block (CRBB) and left anterior hemiblock (LAH) are associated with different degrees of myocardial damage in Chagas disease (Chd), we studied 25 patients (p), 15 males and 10 women (41 +/- 5 years old) who were divided into five groups: normal EKG 5 p, incomplete right branch block 5 p, CRBB-LAH 5 p. We performed EKG, phonocardiogram, echo-M, 2-D and Doppler. The systolic function was evaluated with velocity of circumferential shortening and Weissler index; parietal motility with score of motility; dilatation with diastolic diameter of left ventricle and diastolic function with isovolumetric relaxation time and E/A ratio mitral and tricuspid. The patients who did not present basal severe arrhythmias were submitted to stress testing. We found that in LAH there were great systolic and diastolic dysfunctions, parietal motility alterations and malignant arrhythmias as compared with CRBB. There was no significant difference between LAH and CRBB-LAH. In Chagas disease, the presence of LAH showed much more myocardial damage than in CRBB.

Diferencias entre pacientes con bloqueo de rama derecha y hemibloqueo anterior izquierdo en la miocardiopatía chagásica. / [Differences between patients with right bundle branch block and left anterior hemiblock in Chagas myocardiopathy]

In order to establish whether different kinds of conduction disturbances like complete right branch block (CRBB) and left anterior hemiblock (LAH) are associated with different degrees of myocardial damage in Chagas disease (Chd), we studied 25 patients (p), 15 males and 10 women (41 +/- 5 years old) who were divided into five groups: normal EKG 5 p, incomplete right branch block 5 p, CRBB-LAH 5 p. We performed EKG, phonocardiogram, echo-M, 2-D and Doppler. The systolic function was evaluated with velocity of circumferential shortening and Weissler index; parietal motility with score of motility; dilatation with diastolic diameter of left ventricle and diastolic function with isovolumetric relaxation time and E/A ratio mitral and tricuspid. The patients who did not present basal severe arrhythmias were submitted to stress testing. We found that in LAH there were great systolic and diastolic dysfunctions, parietal motility alterations and malignant arrhythmias as compared with CRBB. There was no significant difference between LAH and CRBB-LAH. In Chagas disease, the presence of LAH showed much more myocardial damage than in CRBB.

Función diastólica en la enfermedad de Chagas / Diastolic function in Chagas disease

Con el objetivo de analizar la función diastólica (FD) en la enfermedad de Chagas (ECh), se estudiaron 42 pacientes (p): 31 hombres (33 + o - 9 años), 22 de los cuales tenían serología poositiva para ECh y 9 serologia negativa; 11 mujeres (36 + o - 12 años), 10 con serología positiva y 1 con serología negativa. A todos los p se les realizó ECG 2 - D y registro simultáneo de ECG, fonocardiograma, apexcardiograma y ECO-M a 100 mm/seg. Se midió el tiempo A2 - D, A2 - 0 (relajación apexocardiográfica total - RAT), a/D (amplitud diastólica de la onda "a"), ITRAT = A2 - C / RAT, DDVI, DSVI, fracción de acortamiento (FA) y procentaje de variación de dimensión. Los p fueron divididos en 4 grupos: G - A (n = 10) normales, G - B (n = 15) serologiía positiva (S+), ECG, Rx y FA normal; G - C (n = 10) S+, ECG anormal, Rx y FA normal y G - D (n = 7) S+, ECG anormal, Rx con cardiomegalia leve y FA disminuida. Los p del G - B presentaron alteraciones significativas del 46% (7/15) de los índices de FD y los del G D del 70% (5/7), indicando contracción y relajación incoordinada. Se observó un progresivo deterioro de la FD del G - B al G - D, alcanzando en este último valores de significación estadística. En la ECh las alteraciones de la FD preceden a las sistólicas consideradas, permitiendo detectar daño miocárdico precoz mediante técnicas no invasivas

Función diastólica en la enfermedad de Chagas / Diastolic function in Chagas disease

Con el objetivo de analizar la función diastólica (FD) en la enfermedad de Chagas (ECh), se estudiaron 42 pacientes (p): 31 hombres (33 + o - 9 años), 22 de los cuales tenían serología poositiva para ECh y 9 serologia negativa; 11 mujeres (36 + o - 12 años), 10 con serología positiva y 1 con serología negativa. A todos los p se les realizó ECG 2 - D y registro simultáneo de ECG, fonocardiograma, apexcardiograma y ECO-M a 100 mm/seg. Se midió el tiempo A2 - D, A2 - 0 (relajación apexocardiográfica total - RAT), a/D (amplitud diastólica de la onda "a"), ITRAT = A2 - C / RAT, DDVI, DSVI, fracción de acortamiento (FA) y procentaje de variación de dimensión. Los p fueron divididos en 4 grupos: G - A (n = 10) normales, G - B (n = 15) serologiía positiva (S+), ECG, Rx y FA normal; G - C (n = 10) S+, ECG anormal, Rx y FA normal y G - D (n = 7) S+, ECG anormal, Rx con cardiomegalia leve y FA disminuida. Los p del G - B presentaron alteraciones significativas del 46% (7/15) de los índices de FD y los del G D del 70% (5/7), indicando contracción y relajación incoordinada. Se observó un progresivo deterioro de la FD del G - B al G - D, alcanzando en este último valores de significación estadística. En la ECh las alteraciones de la FD preceden a las sistólicas consideradas, permitiendo detectar daño miocárdico precoz mediante técnicas no invasivas (AU)

[Diastolic function in Chagas disease]. / Función diastólica en la enfermedad de Chagas.

With the purpose of analyzing diastolic function in Chagas, disease (ECh), 42 patients were studied: 31 males (aged 33 +/- 9), 22 of them with positive serology for ECh and 9 with negative serology; 11 female patients (aged 36 +/- 12), 10 with positive serology and 1 with negative serology. In all patients 2 D-Echo and simultaneous EKG, phonocardiogram, apexcardiogram and M-mode Echo at 100 mm/sec were taken. The A2-D, A2-O (total apexcardiographic relaxation-RAT), a/D (diastolic amplitude of "a" wave), ITRAT = A2 - C/RAT, DDVI, DSVI, shortening fraction (FA) and percentage of dimension changes (D D%) were determined. The patients were divided into 4 groups: G - A (n = 10) normal; G - B (n = 15) positive serology, with EKG and Rx and FA normal; G - C (n = 10) positive serology, abnormal EKG, and normal Rx and FA; G - D (n = 7) positive serology, abnormal EKG, mild cardiomegalia and diminished FA. The patients from group B presented significative modification, 46& (7/15) of the FD indexes and those from group D with 70% (5/7), as well as of D D C - E and D D Dm-0 indicative of uncoordinated contraction and relaxation. A progressive worsening of the FD from G - D was observed, reaching in this last one statistically significant values. In the ECh the alterations in the FD precede the systolic, which allows for an early detection of myocardiac damage by noninvasive techniques.

Función diastólica en la enfermedad de Chagas. / [Diastolic function in Chagas disease]

With the purpose of analyzing diastolic function in Chagas, disease (ECh), 42 patients were studied: 31 males (aged 33 +/- 9), 22 of them with positive serology for ECh and 9 with negative serology; 11 female patients (aged 36 +/- 12), 10 with positive serology and 1 with negative serology. In all patients 2 D-Echo and simultaneous EKG, phonocardiogram, apexcardiogram and M-mode Echo at 100 mm/sec were taken. The A2-D, A2-O (total apexcardiographic relaxation-RAT), a/D (diastolic amplitude of [quot ]a[quot ] wave), ITRAT = A2 - C/RAT, DDVI, DSVI, shortening fraction (FA) and percentage of dimension changes (D D

) were determined. The patients were divided into 4 groups: G - A (n = 10) normal; G - B (n = 15) positive serology, with EKG and Rx and FA normal; G - C (n = 10) positive serology, abnormal EKG, and normal Rx and FA; G - D (n = 7) positive serology, abnormal EKG, mild cardiomegalia and diminished FA. The patients from group B presented significative modification, 46& (7/15) of the FD indexes and those from group D with 70

(5/7), as well as of D D C - E and D D Dm-0 indicative of uncoordinated contraction and relaxation. A progressive worsening of the FD from G - D was observed, reaching in this last one statistically significant values. In the ECh the alterations in the FD precede the systolic, which allows for an early detection of myocardiac damage by noninvasive techniques.