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1.
Echocardiography ; 39(1): 46-53, 2022 01.
Article in English | MEDLINE | ID: mdl-34904277

ABSTRACT

BACKGROUND: The left ventricle (LV) journey in their transition from hypertrophy to heart failure is marked by many subcellular events partially understood yet. The moment in which the structural abnormalities reach the umbral to induce myocardial dysfunction remains elusive. AIMS: To evaluate the anatomic-functional relationship between LV wall thickness and longitudinal systolic dysfunction. MATERIAL AND METHODS: We prospectively performed clinical assessment and transthoracic echocardiogram on healthy individuals and hypertensive patients with left ventricle ejection fraction (LVEF) ≥50% and absence of heart failure symptoms. RESULTS: A total of 226 patients and 101 healthy individuals were recruited. The distribution for sex was similar between groups. The mean age was 67±13 years old in the patients, and 44% had concentric LV hypertrophy. LVEF was identical in both groups (63±6%); in contrast, global longitudinal strain (GLS) (-18.8±2.5% vs -20.4±2%) and mitral annulus plane systolic excursion (MAPSE) (13.8±2.8 vs 15.5±2 mm) were lower. ROC curve optimally classified decreased GLS with LV septum thickness ≥13 mm and decreased MAPSE with thickness ≥14 mm. Multivariable logistic regression found that LV septum thickness is the only variable associated with longitudinal systolic dysfunction (OR = 1.1, CI95%  =  1.05 - 1.15, P = 0.001, R squared = .38). DISCUSSION: A progressive increase in LV wall thickness due to myocyte hypertrophy and interstitial expansion is associated with LV systolic longitudinal dysfunction. CONCLUSIONS: Patients with moderate or severe ventricular hypertrophy (septum ≥13 mm) had longitudinal systolic dysfunction, GLS decreases with minor structural change than MAPSE, and LVEF is insensitive in detecting longitudinal myocardial dysfunction in patients with hypertension.


Subject(s)
Cardiomyopathies , Hypertension , Ventricular Dysfunction, Left , Aged , Aged, 80 and over , Cardiomyopathies/complications , Cardiomyopathies/diagnostic imaging , Humans , Hypertension/complications , Hypertension/diagnostic imaging , Middle Aged , Stroke Volume , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Function, Left
2.
Echocardiography ; 36(12): 2195-2201, 2019 12.
Article in English | MEDLINE | ID: mdl-31755581

ABSTRACT

BACKGROUND: The left atrium reservoir function has an important role in the global cardiac performance and is determined by multiple cardiac and extra-cardiac factors. A new parameter is introduced, the independent strain, which quantifies left atrium reservoir phase deformation during isovolumetric relaxation. AIMS: Is evaluated whether independent strain can identify intrinsic atrial myocardial damage in hypertension. MATERIAL AND METHODS: Prospective observational study in which echocardiography was done to 50 hypertensive patients and 80 healthy volunteers. Myocardial deformation was evaluated with two-dimensional speckle tracking and left atrium volumes were calculated whit 3D-echocardiography. RESULTS: In hypertensive patients, the indexed left atrium volume was greater than in the control group (34 ± 7.8 vs 24 ± 4.9 mL/m2 ); strain of pump (-5.7 ± 2.4% vs -17±3.5%) and reservoir phases (34 ± 9% vs 48 ± 10%) were worst. The minimum left atrium volume was higher (26 ± 10 vs 15 ± 8 mL) and left atrium independent strain was lower in hypertensive patients (4.0% vs 6.5%, P = .001). Left atrium independent strain only correlated with minimum left atrium volume (r = -.31, P = .048). DISCUSSION: The left ventricle longitudinal performance has an important contributing role in the left atrium reservoir function; despite this finding, the independent strain was unrelated to left ventricle longitudinal function. CONCLUSION: Independent strain can identify atrial myocyte contractile dysfunction in hypertension given the relative absence of hemodynamic loads during this period. Additionally, quantification of left atrium minimum volume suggests indirectly the presence of atrial myocyte contractile dysfunction.


Subject(s)
Atrial Function, Left/physiology , Heart Atria/diagnostic imaging , Heart Diseases/physiopathology , Heart Ventricles/diagnostic imaging , Hypertension/complications , Stroke Volume/physiology , Ventricular Function, Left/physiology , Adult , Echocardiography/methods , Female , Follow-Up Studies , Heart Atria/physiopathology , Heart Diseases/diagnosis , Heart Diseases/etiology , Heart Ventricles/physiopathology , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Male , Middle Aged , Prospective Studies
3.
Arch Cardiol Mex ; 81(2): 126-36, 2011.
Article in Spanish | MEDLINE | ID: mdl-21775246

ABSTRACT

Pulmonary embolism (PE) is an important disease entity in clinical medicine. It consists of obstruction of pulmonary arterial blood flow of a clot embolism from distant sites of the vasculature. Its incidence is variable depending on the source analyzed and most existing data is in hospitalized patients. The clinical presentation is a broad spectrum, from asymptomatic to cardiogenic shock with sudden death due to acute right heart failure. Recently it has been used to D-dimer as a useful laboratory test and a large negative predictive value in the diagnosis of PE. The current classification schemes recommended guided in clinical, laboratory and image. Chest angiotomography is currently the most commonly used diagnostic method for confirmation of pulmonary embolism, but the standard remains arteriography.


Subject(s)
Pulmonary Embolism/diagnosis , Algorithms , Humans , Tomography, X-Ray Computed
4.
Arch. cardiol. Méx ; 81(2): 126-136, abr.-jun. 2011. ilus, tab
Article in Spanish | LILACS | ID: lil-632031

ABSTRACT

La tromboembolia pulmonar (TEP) es una entidad patológica de importancia en la medicina clínica. Consiste en la obstrucción del flujo sanguíneo arterial pulmonar por embolismo de un coágulo desde sitios distantes de la vasculatura. Su incidencia es variable dependiendo de la fuente analizada, la mayoría de los datos existentes son de pacientes hospitalizados. La presentación clínica tiene un espectro amplio, desde asintomática hasta el choque cardiogénico con muerte súbita debido a falla ventricular derecha aguda. En forma reciente se ha empleado al dímero D como un ensayo de laboratorio útil y con un gran valor predictivo negativo en el diagnóstico de TEP. Los esquemas de clasificación actuales recomiendan guiarse en parámetros clínicos, de laboratorio e imagen. La angiotomografía de tórax actualmente es el método diagnóstico más empleado para la confirmación de TEP, sin embargo, el estándar sigue siendo la arteriografía.


Pulmonary embolism (PE) is an important disease entity in clinical medicine. It consists of obstruction of pulmonary arterial blood flow of a clot embolism from distant sites of the vasculature. Its incidence is variable depending on the source analyzed and most existing data is in hospitalized patients. The clinical presentation is a broad spectrum, from asymptomatic to cardiogenic shock with sudden death due to acute right heart failure. Recently it has been used to D-dimer as a useful laboratory test and a large negative predictive value in the diagnosis of PE. The current classification schemes recommended guided in clinical, laboratory and image. Chest angiotomography is currently the most commonly used diagnostic method for confirmation of pulmonary embolism, but the standard remains arteriography.


Subject(s)
Humans , Pulmonary Embolism/diagnosis , Algorithms , Tomography, X-Ray Computed
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