Pre-operative transthoracic real-time three-dimensional echocardiography for a better surgical strategy.

UNLABELLED: In this study we aimed to evaluate the three-dimensional (3D) transthoracic echocardiography (TTE) in the assessment of cardiac valve morphology. METHODS: Bidimensional (2D) and real-time 3D TTE was performed in 104 patients consecutive with cardiac catheterisation, prior to valve surgery. Using surgical findings as the gold standard, 2D and 3D TTE were compared for adequate recognition and accurate detection of morphology. A scoring protocol was used for recognition of the valvular segments (0= inadequate, 1 = adequate). RESULTS: Adequate echographic visualization of the valve segments was more frequently obtained by 3D than 2D TTE imaging (731/770 by 3D TTE vs. 693/770 by 2D TTE, p < 0.01). The valve leaflets segments were more clearly identified by 3D TTE rather than by 2D TTE (502/531 vs. 471/531, p <0.01). The assessment of commissures was similar by both methods (229/239 vs. 222/239, p=0.09). Total 3D TTE scores for mitral and aortic valves were significantly better than 2D ITE scores (mean score 12.91+/-1.62 by 3D vs 11.58+/-1.02 by 2D, p=0.02). This superiority of 3D TTE was irrespective of rhythm (p <0.05 for both sinus rhythm and atrial fibrillation). Using surgical classification of valvular disease as gold standard, the sensibility and specificity were 91% and 84 % for 3D TTE, and 85% and 77% for 2D TTE, respectively. CONCLUSIONS: Real-time 3D was superior to 2D TTE forthe accurate localization and identification of valvular pathology, irrespective of heart rhythm.

Secondary pathologic fractures in osteosarcoma: prognosis and evolution.

Secondary or pathologic fractures, associated with osteosarcoma, have been considered for a long time to be a negative prognosis regarding its evolution in the patients. The aim of this study was to evaluate the prognostic importance of such pathologic fractures in osteosarcoma patients receiving new therapies as well as the best conditions for surgery aiming at "limbs salvage". On a total of 22 patients affected by osteosarcoma, we performed a retrospective study with 12 patients showing pathologic fractures caused by osteosarcoma and 10 patients without any pathologic fracture. The patients enrolled into Timisoara University Hospital have been followed up along 5 years or until a reappearance of either the disease or metastases, distant or local.

Effects on rat sexual behaviour of acute MDMA (ecstasy) alone or in combination with loud music.

The effects on sexual behaviour of acute low doses of methylendioxymethamphetamine (MDMA) (0.3, 1, 3 mg/kg/i.p.), alone or in combination with exposure to loud music (1 h stimulation), were investigated in Wistar rats. Results indicate that acute MDMA, at dose of 3 mg/kg, notably impaired copulatory behavior of sexually experienced male rats. In particular, MDMA-exposed animals exhibited a significant increase in intromission and ejaculation latencies as well as a significant decrease in percentage of rats displaying copulatory activity (one intromission at least). Surprisingly, one hour exposure to loud music, which per se resulted ineffective, antagonized the suppressive effect of MDMA by increasing the percent of animals displaying sexual activity. However, combined treatment of MDMA and music stimulation did not fully restore normal sexual behavior as the animals reaching ejaculation still showed a marked reduction of copulatory efficiency. These findings demonstrate that the systemic administration of a single low dose of MDMA, alone or in combination with loud music, which is commonly present in certain environments such as rave parties, notably impairs copulatory activity of male rats.

Our experience in Helicobacter pylori infection and gastric MALToma.

OBJECTIVE: A number of recent studies have expanded our understanding of Helicobacter pylori (Hp) infection and of the pathogenesis of MALT lymphoma. The purpose of this paper is to perform a retrospective analysis of the clinical characteristics of gastric MALT lymphoma and its relationship with H. pylori infection in authors' experience. MATERIALS AND METHODS: We report nineteen patients observed during 10 years, presenting with gastric MALTomas at any stage. The staging classification and the presence of H. pylori infection have been assessed, and the chosen therapy also. RESULTS: The most part of our patients underwent surgery, still now resulting the most effective therapy. None of the patients had eradicating therapy due to their poor compliance and because the most part of cases were observed before the time of clinical validation of such treatment. CONCLUSIONS: In our series, surgery was effective for treatment of gastric MALT lymphomas. Surgery and chemotherapy remain, in accord with literature data, the best treatment for gastric MALTomas. Hence, because Hp may play a role in the development of such pathology in certain patients, antibiotic treatment for Hp eradication should not be discouraged in these patients, especially in them with low grade gastric MALT lymphomas. In fact, the failure of this therapy will not modify either survival or later recourse to surgical and/or radio- and chemotherapy.

Left atrial surface cut point to detect trapezoidal shape for characterisation of atrial anatomical remodeling.

BACKGROUND: Complete geometrical and shape characterization of left atrium has not been performed. Ellipse formula has been proved to underestimate the real LA volume. The aim of the study is to analyze the relation between LA area and shape in order to predict their value in the assessment of the severity of anatomical remodeling. METHODS: 216 consecutive patients (pts) aged 53 +/- 27 years were included. The following parameters were assessed: LA dimensions (LAd=M-mode, parasternal long axis, LAt and LA1 are the measurements of short- and long-axis in apical four chamber view), LA surface in apical four chamber view (LAs). A new measurement was introduced, the basal dimension of the LA (LAb) as the maximal transverse distance at the base of LA apical four chamber view. LA measurements were calculated at end-systole (maximal). Trapezoidal LA shape was defined if transverse dimension < basal dimension. RESULTS: LAs ranged 10.5-54.5 cm2. Trapezoidal LA was found in 149 pts. ROC curve for prediction trapezoidal LA showed a 0.89 area under the curve. The analysis demonstrates a cutoff value of 22.3 cm2 for LAs to detect trapezoidal shape with a sensitivity of 85% and specificity of 82.5%. The simple regression analysis demonstrated a statistically significant linear correlation between LAd and LAs (r2=0.63, p<0.0001) but LA1 was better correlated with LAs (r2=0.7, p<0.0001). Trapezoid LA with atrialization of the pulmonary veins and predominant dilatation of bazal atrium than annular side may explain underestimation of LA volume using ellipse formula. CONCLUSION: LAs is a reliable parameter and may be the best choice to estimate LA dilatation; LAs is related to shape remodeling; LA1 is a better parameter than LAd for estimating LA dilatation and complete characterization of LA remodeling should include shape definition and LAb.

Helicobacter pylori infection and gastric MALTomas: an up-to-date and therapy highlight.

During the last 20 years Helicobacter pylori (Hp) has been, undoubtly, the star of gastroenterology and microbiology, so much to deserve the "Nobel prize 2005" for biology and medicine to its discoverers. More recently, an increased interest arised on Hp and its linkages with other medical fi elds such as immunology, surgery and dentistry. The outcome of the pathologies due to such bacterium is dependent on many factors, including bacterial genotype, host physiology and genetics, and environmental factors such as diet. In spite of its clear involvement in some pathologies like acute and chronic gastritis, peptic ulcer and gastric cancer, very little is known about another pathology recently proved to be closely associated to the infection by Hp: the gastric MALToma, which account for 7% of all newly diagnosed non-Hodgkin's lymphoma. The chronic infection of the gastric mucosa from Helicobacter pylori primes a complex pathogenic process which could determine the onset of the gastric cancer through some intermediary steps. On these bases, in 1994, the International Agency for Cancer Research (IARC) defined this bacterium a "class I carcinogenic agent" for gastric cancer. The MALT lymphomas are the most frequent lymphoid neoplasms of the digestive tract; we can also observe other and more rare lymphomatous tumours with specific clinical patterns, like the T-lymphoma associated with lymphomatous polyposis and enteropathy. The development of gastric lymphomas is usually preceded by the acquisition of lymphatic tissue, after inflammatory stimuli and particularly after the infection from Hp, which organizes itself with the characteristics of the MALT. Recently, a number of papers have highlighted the remarkable efficacy of Hp eradicating therapy in patients with low-grade MALT lymphoma of the stomach without other modalities, e.g. surgery and systemic chemotherapy. The aim of this study is to be helpful for a comprehensive understanding the possible connections between Hp and gastric MALT lymphoma, evaluating the best therapy strategies, surgical and non surgical, actually available for its treatment.

Thromboembolic risk after knee endoprosthesis.

Thromboembolic complications are the most frequent associated pathologies after knee replacement. The secondary deep vein thrombosis in the knee arthroplasty is often low symptomatic or asymptomatic and, sometime, it could lead to fatal pulmonary embolism. This is the main purpose recommending an antithrombotic prophylaxis. In this study 214 patients operated for knee arthroplasty and receiving low molecular heparin therapy were enrolled. They were clinically and echo/radiologically monitored for thromboembolic and/or hemorrhagic complications on the 2nd, 7th, 14th and 45th day from surgery. Results showed that only 45% of the cases developed DVT (deep vein thrombosis) out of which 17% could be objectively verified by ultrasonography and phlebography. In only one case massive pulmonary embolism with fatal evolution was discovered. It was not found any major bleeding except in four cases in which local haematomas were discovered (most probably related to anticoagulant treatment). This study concluded that the administration of low molecular weight heparin after knee arthroplasty significantly reduces the risks of thromboembolism in conditions where the increase of hemorrhagic complications doesn't result statistically significant.

Time movement timing parameters validation using tissue Doppler imaging in patients with dilated cardiomyopathy.

UNLABELLED: The aim of the study was to compare similar time-movement (TM) and tissue Doppler (TDI) timing parameters and to predict their value in assessment of systolic asynchrony for biventricular pacing indication. METHODS: 41 patients (pts) aged 56.4 +/- 11.2 years with dilated cardiomyopathy were included. PARAMETERS: QRS duration (QRSd); septal (S), posterior (P), lateral (L) and posterolateral (PL) wall delays, as the time from QRS onset to maximal wall contraction (parasternal, 4 chamber view and subcostal incidence); left ventricular mechanical delays (LVD) time interval from maximal contraction between interventricular septum and posterior (LVDp), lateral (LVD1) and posterolateral (LVDp1) wall, both in TM and TDI; TDI measurements were performed using both color and pulsed TDI (from onset of QRS to the end of S wave); isovolumic relaxation time (IRT) in each wall using TDI; An error parameter (Er) was assessed for each measurement as the difference in similar timing parameters TM-TDI. RESULTS: LVDp = 111 +/- 69ms, LVD1 = 132 +/- 62ms, LVDp1 = 151 +/- 77ms; 26 pts presented QRSd > 120 ms (LBBB), 15 pts had QRSd < 120 ms. LVD > 100 ms was found in 32 pts; LVD were significantly higher in LBBB pts. There was no correlation between QRSd and echocardiographic parameters. Er ranged from 0-80 ms. Er > 30 ms were found in pts with fragmented wall motion and IRT > 30 ms. The most delayed wall was PL (42% pts), L (38%) and P (30%). CONCLUSION: Intraventricular asynchronized contraction occurs even in pts with normal QRS duration; these changes can be easily and accurately detected using simple TM timing parameters. The most delayed site to be stimulated can be found either using TDI or TM.

Dual renin angiotensin system blockade in patients with acute myocardial infarction and preserved left ventricular systolic function.

UNLABELLED: The activation of the renin-angiotensin system (RAS) is a major determinant of ventricular remodeling. We prospectively assessed whether the dual RAS blockade (angiotensin II AT 1-receptor blocker and angiotensin-converting enzyme inhibitor therapy) in patients with acute myocardial infarction (AMI) who were treated by primary percutaneous coronary intervention (PCI) and stenting provides benefit on the improvement of the left ventricle function. A secondary aim is to demonstrate that triple therapy with angiotensin-converting enzyme (ACE) inhibitors, angiotensin II AT 1-receptor blockers (ARBs) and beta blockers does not increase cardiovascular morbidity, cardiovascular mortality and all cause mortality. METHODS: We investigated 44 patients with AMI with ST elevation undergoing primary PCI and stenting. All patients received standard therapy including an ACE inhibitor and a beta blocker. We divided the patients into two groups, A and B. Valsartan was added to the standard therapy within the first 6 hours from the onset of AMI in group A. We assessed cardiovascular and all cause mortality, incidence of major acute coronary events (MACE), incidence of non-fatal AMI, the evolution of left ventricle ejection fraction (LVEF), wall motion score index (WMSI) and left ventricle end-systolic and end-diastolic diameters. The follow-up period was one year. RESULTS: There were no statistically significant differences between groups regarding cardiovascular and all cause mortality, incidence of MACE, incidence of non-fatal MI. LVEF significantly increased at 1 year in both groups. In both groups the reduction of end-systolic and end-diastolic diameters at 1 year was statistically significant. Echocardiographic findings demonstrated also a significant decrease of WMSI at 1 year in both groups. CONCLUSIONS: The dual renin-angiotensin system blockade (ARBs and ACE inhibitor) has proved its beneficial effect on the improvement of left ventricular function, without increasing cardiovascular mortality and incidence of non fatal myocardial infarction (MI) in patients with AMI treated by primary PCI and stenting within a 1 year follow-up period.

Is age correlated with dynamic atrial decremental conduction properties?

UNLABELLED: Atrial fibrillation (AF) has been associated with premature beats and decreased atrial conduction velocities. On the other hand, prevalence of AF is increased in the elderly. The aim is to evaluate and analyze the relation between age, atrial size and a new index of dynamic interatrial conduction time (iaCT) in a homogeneous population of patients (pts) with structurally normal heart without AF. METHODS: 45 patients (pts) without structural heart disease aged 53 +/- 20 years referred for electrophysiologic study were analyzed. To examine the atrial electrophysiologic characteristics we studied interatrial conduction time (iaCT), double potentials and fragmented atrial activity during premature stimulation of high right atrium; prior to investigation, all antiarrhythmic drugs were withdrawn for an appropriate period of time. The following parameters were assessed: baseline iaCT (iaCTb) between high right atrium (HRA) and distal coronary sinus (CS), iaCT during HRA pacing S1S1 600ms (iaCTS1), maximum prolongation of iaCT during S2 and S3 delivery (iaCTS2, iaCTS3). We calculated a derived parameter: maximum prolongation iaCT/decremental index (DI)= iaCT S3-ia CTS1/iaCTS1%. The following echocardiograhic parameters were assessed: left atrial dimensions and surface (LAs), right atrial dimension and surface (RAs), total atrial surface (TAs=LAs+RAs) and left atrial volume (LAv) calculated using ellipse formula. RESULTS: iaCT ranged from 42 to 87ms; DI ranged from 16 to 52%. Simple regression analysis demonstrated a statistically significant linear correlation between the age of pts and HRA DI (r = 0.76, r2 = 0.55, p <0.0001). A trend toward a significant correlation was found between TAs and DI (r=0.64, r2=0.41, p<0.0001) LAv and DI (r=0.59, r2=0.35, p<0.0001). No significant correlation was found in this group between age and iaCT. Atrial double potentials and fragmentated electrograms were recorded using HRA stimulation in CS leads in 7 pts (15%) all aged >35 years. Pts were divided into two groups: 17 pts with normal electrophysiologic findings and 28 pts with junctional reentrant tachycardia. There were no significant differences between subgroups concerning the main studied parameters. CONCLUSIONS: This study shows a direct better correlation for age than atrial size in the relation with the dynamic behaviour interatrial conduction, suggesting that higher incidence in AF in the elderly might be also a consequence of the higher incidence of atrial conduction disturbances.

Inflammatory response after dexamethasone eluting coronary stent implantation.

UNLABELLED: C-reactive protein (CRP) elevation after coronary stent implantation is a predictor for recurrence. We prospectively evaluated the inflammatory response after dexamethasone eluting stent implantation in a native coronary artery by serial measurement of plasma level C-reactive protein. METHODS: We investigated patients undergoing primary successful implantation of a single dexamethasone stent (Dexamet, Abbott Vascular Devices, Redwood City, CA, USA) in a native coronary artery. We analyzed plasma concentrations of CRP by immunoturbidimetric assay before stent implantation and 12, 24, 48 and 72 hours after the procedure. Patients on anti-inflammatory drugs or with evidences of inflammatory conditions were excluded. RESULTS: Seventeen patients (mean age 62+/-9 years, 12 males) were enrolled. The presentation was unstable angina in 13 patients and stable angina in 4 patients. Eighteen stents were implanted as follows: 16 type B lesions (88%), 1 type C lesions (6%) and 1 type A lesion (6%), located in LM in 2 patients (11%), LAD in 8 (44%), LCX/OM in 7 (39%), and RCA in 1 patient (6%). The mean CRP increased from 5.6+/-2.2 mg/l at baseline to a maximum of 6.7+/-2.1 mg/l and than decreased to 5.0+/-1.2 mg/l at 72 hours. At 72 hours plasma concentration of CRP was lower than baseline in 11 patients (65%) and higher in 6 (35%). CONCLUSIONS: Inflammatory response to dexamethasone stent implantation in a native coronary artery is low and peaks at 24 hours. At 72 hours after stent implantation, mean CRP decreased comparing with baseline, CRP becoming lower in 65% patients. Using the stent itself as a platform for drug delivery may be an opportunity to modulate the inflammatory response to coronary stent implantation.

Echocardiographic evidences of increased left ventricular pressure and atrial dilatation in patients with drug-resistant paroxystic atrial fibrillation and structurally normal heart.

UNLABELLED: Global myocardial index (GMI) has been significantly related to left ventricular filling pressure. We hypothesized that GMI and echographic indicators of atrial dilatation were significantly different in pAF pts compared to normals. METHODS: 39 patients (pts) without structural heart disease, aged 52+/-10 years with pAF were compared to 36 control-matched pts aged 48+/-16 years. Following parameters were assessed: P-wave duration (Pd), GMI, left atrial dimensions (LAd=M-mode, parasternal, LAt and LAI are measurements of short and long-axis apical four chamber view), surface (LAs), volume (LAv), total ejection fraction (LA EF), right atrial dimension (RAd) and surface (RAs), total atrial surface (TAs=LAs+RAs). LAv was calculated using ellipse formula pi/6 (LAdxLAlxLAt). RESULTS: There was no difference between the 2 groups concerning Pd (p=0.1), LA EF (p=0.23), LAd (p=0.08) and LAt (p=0.06) while the rest of the parameters were significantly higher in pAF pts: GMI: 0.5+/-0.17 vs 0.36+/-0.06 (p=0.001); LAI: 5.4+/-0.5 vs 4.5+/-0.3 cm2 (p=0.001); LAs was founded increased in pAF pts (20.6+/-5.7 vs 16.3+/-2.1 cm2, p=0.001); TAs: 40.6+/-6.9 vs 30.6+/-5.1 cm2, p=0.0001; LAv: 51.6+/-10.4 vs 37.2+/-9.3 ml (p=0.0001). CONCLUSIONS: Although apparently without structural heart disease, pAF pts presented evidence of increased filling pressions in left ventricle and indirect markers of atrial stretch. The role of increased intra-atrial pressure in pts pFA and predictive value of these parameters need to be evaluated in a larger number of patients.

The value of intermittent inotropic therapy in unhospitalized patients with refractory heart failure.

The treatment of intractable heart failure (New York Heart Association--NYHA IV) with inotropic support is a well established adjunct in the control of clinical status of end-stage heart failure patients but usually needs many admissions and a long period of hospitalization. In this study we report on the follow-up findings of 64 patients for 18 months who were seen in an outpatients congestive heart failure program. All patients had their full standard oral drug treatment, received intensive patient teaching and weekly inotropic infusions. We assess the effects of this comprehensive therapeutic approach on: 1) the number of hospital admissions, 2) length of stay and 3) the number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. All our patients showed NYHA class IV heart failure and received dobutamine to manage their chronic heart failure in an outpatient setting. The cause of heart failure was ischaemic in 34 (53.12%), idiopathic in 14 (21.87%), hypertension in 10 (15.62%), pulmonary hypertension in 7 (10.93%) and valvular heart disease in 6 (9.37%) patients. The mean period of observation was 382 days. For the period before entry in the program patients had 67 emergency room visits, 184 admissions, and 832 days spent in the hospital. After enrollment all these figures significantly decreased (p<0.001), patients heading 35 emergency room visits, 112 admissions and 518 days spent in the hospital. In conclusion, the intermittent inotropic therapy as an outpatient setting may be a valuable cost-effective therapeutic method, in patients with refractory heart failure and is associated with the reduction of emergency room visits, admissions and days spent in the hospital.

Left atrial spontaneous echo contrast as a predictor of systemic arterial embolization in rheumatic mitral valve disease: a transesophageal echocardiographic study.

The relationship between systemic arterial embolization and left atrial spontaneous echo contrast (LASEC) was investigated in 90 consecutive patient with rheumatic mitral valve disease (52 patients had predominant mitral stenosis, 14 had significant mitral regurgitation and 24 with xenograft mitral valve replacement), during a 2-year period. LASEC was defined as the presence of dynamic echos (smoke-like) curling up in a circular pattern within the left atria, by transesophageal echocardiography (TEE). LASEC was observed in 27 patients (group A) and was absent in 63 patients (group B). Group A patients showed a higher frequency of left atrial thrombi or history of previous embolization than those in group B (59.2% vs. 7.3%; p < 0.001). Group A patients also had a higher frequency of recent (10 days before TEE study) and remote (more than 10 days before TEE study) embolization than did group B patients (recent: 22.2% vs. 1.6%; p < 0.001; remote: 11.1% vs. 4.7%, p < 0.001). Thus patients with LASEC had a significantly higher risk for thromboembolism and TEE is a useful modality to identify this subset of patients with rheumatic mitral valve disease.

Electrophysiologic noninvasives parameters in patients with sick sinus syndrome and syncopal attacks.

21 patients accusing previous syncopal attacks, without myocardial infarction, preexcitation syndrome or severe cardiac failure were submitted to a 24 hrs Holter monitoring with 10 min. of esophageal electrocardiogram. Nine patients were considered as cases of sinus bradycardia (mean HR = 49.5 +/- 4.4 b/min). Other 12 patients with normal basic sinus rhythm were admitted for ventricular premature beats (HR = 65.5 +/- 8.7 b/min.). Fourier transformation analysis (mean method, linear interpolation) was used for determination of the heart rate variability (HRV) and other two variables: variation range (VR)--(longest-shortest cycle/mean basic sinus cycle, %) and differences of sinus cycle length (DSCL = maximal difference of any two consecutive sinus cycle, ms). In all the 9 patients with low sinus rhythm and in 7 patients with normal basic sinus rhythm, at least one episode of critical bradycardia (under 45 b/m) was observed. In 3 of the 9 patients with sinus bradycardia at least two episodes of nonsustained ventricular tachycardia were observed. In all the 12 patients with ventricular premature beats, many episodes of nonsustained ventricular tachycardia were registered. In all the 21 studied patients low and very low frequency HRV was observed. The VR and DSCL presented a significant dependence on age, but this relationship was weaker than the established limits of normality. In the cases of sick sinus syndrome with sinus bradycardia and/or severe ventricular tachyarrhythmias, the noninvasive Holter analysis of HRV can determine the correct diagnosis and indications for permanent cardiac pacing and antiarrhythmic drug therapy.

Doppler echocardiographic parameters of evaluation of left ventricular systolic function.

The authors suggest a new method using Doppler echocardiography for the evaluation of cardiac performance. Doppler echocardiography permits the calculation of left ventricular (LV) ejection force (according to Newton's second law of motion). The ejection force was calculated in 36 patients with heart failure subgrouped into 3 groups based on ejection fraction (EF) (> 60%; 41-60%; < 40%) compared to 11 normal subjects. The LV ejection force showed a good linear correlation with LV ejection fraction (r = 0.86). Data of the study suggest that the LV ejection force is a valuable and accurate index for the assessment of cardiac performance, especially in early stages of disease.

Mitral regurgitation and left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Analysis by Doppler echocardiography.

In a group of five patients with asymmetric septal hypertrophy, the presence of the mitral regurgitation and the left ventricular outflow tract gradient were studied by the Doppler echocardiographic technique. By means of Bernoulli's formula 4V2 = P1-P2, left ventricular maximal systolic pressure was assessed using mitral regurgitant and left ventricular outflow tract jets. Aortic systolic and diastolic blood pressures were measured by cuff sphygmomanometry, and simultaneous carotid pulse tracings were recorded. All patients had outflow tract pressure gradients (peak 84 +/- 11.7 mmHg) and mild mitral regurgitation. Continuous wave Doppler study recorded peak flow velocities in the outflow tract (4.6 +/- 0.26 m/sec) and mitral regurgitant (6.5 +/- 0.51 m/sec) jets. The values for ventricular systolic pressures by both methods were similar (180 +/- 24.2 vs 186 +/- 13.5 mmHg). This study confirms the presence of mitral regurgitation and actual obstruction in hypertrophic cardiomyopathy with asymmetric septal hypertrophy.

Prevalence of arrhythmias during exercise stress testing in patients with hypertrophic cardiomyopathy.

To identify the patients with hypertrophic cardiomyopathy at high risk of morbid events we investigated 25 patients with echocardiographic evidence of hypertrophic cardiomyopathy. All the patients were subjected to submaximal exercise test under electrocardiographic monitoring. More than 50% of the patients developed ventricular arrhythmias, about half of them presenting multiform or repetitive premature ventricular depolarizations; two patients presented ventricular tachycardia. Our results suggest the value of exercise test in identifying the patients at high risk of developing severe arrhythmias.

[Doppler echocardiography in mitral insufficiency]. / Eco Doppler în insuficienta mitrala.

The Doppler method (pulsatile and continuous) was used for finding out and semiquantitatively evaluating the mitral insufficiency of various etiologies: inflammatory (rheumatic); prolapse of mitral valve; obstructive hypertrophic cardiomyopathy; dilatative cardiomyopathy; calcification of valvular ring. The Doppler parameters obtained after automatic processing of the image (speed transvalvular pressure gradient, flow period and acceleration) offer data on the diastolic performance of the left ventricle. Registration of the aortic flow makes possible the calculation of the cardiac flow (the diameter of the aorta is measured in echo-B), and of the aortic flow permits the noninvasive evaluation of the lung arterial pressure. The method offers a large vista in the noninvasive evaluation of the patients suffering from mitral insufficiency.