Diastolic function study with conventional and pulsed tissue Doppler echocardiography imaging in acromegalic patients.

UNLABELLED: Acromegaly is associated with myocardial hypertrophy and it can progress to diastolic and systolic dysfunction. PURPOSE: To evaluate diastolic function in acromegalic patients through conventional echocardiography (CD) and tissue Doppler imaging (TDI). METHODS: Seventeen acromegalic patients were submitted to CD and TDI, and early (E) and atriogenic (A) transmitral flow were evaluated in mitral, septal, and tricuspid regions. RESULTS: In comparison with controls the means of conventional (1.06), septal (1.01), and tricuspid (0.98) E/A ratio were significantly lower in acromegalic patients. E/A ratio <1.0 was demonstrated in 41% and 49% of acromegalics by DC and TDI, respectively, with no statistical difference among the two methods. An inverse linear correlation was shown between mitral E/A ratio and acromegalic age (r =-0.7). CONCLUSION: In this study, DC and TDI were equally effective in demonstrating diastolic dysfunction, a common finding in acromegalic patients.

[Correlation and concordance between echocardiographic measurements obtained during echocardiography and digitized image measurements--transversal study]. / Correlação e concordância entre medidas ecocardiográficas obtidas durante o exame no ecocardiógrafo com medidas de imagens digitalizadas. Estudo transversal.

OBJECTIVE: To evaluate the correlation and concordance between the measurements of echocardiographic analysis of cardiac dimensions obtained through the Echo off-line applicative (software for obtaining digitized image measurements in a dedicated workstation) available to public domain, and those obtained through the conventional method. METHOD: Transversal contemporary study, of 56 randomized patients whose images were obtained during examinations. The measurements of the M mode and 2D, were done in the ventricles, left atrium, and aorta by the Echo off-line program. These measurements were compared to those obtained by another professional, through Pearson's correlation test (r), alpha = 0.05 and by concordance analysis (Bland and Altman). RESULT: The measurements carried out by the Echo off-line system showed r that varied from 0.85 to 0.98. The analysis of concordance showed that for most measurements, the mean difference between the methods was approximately zero. The variation of absolute values did not show, in average, a clinical significance. The Echo off-line applicative allows a reduction of approximately 30% in the time spent to obtain the measurements. CONCLUSION: This study demonstrated the accuracy of the Echo off-line program to measure cardiac dimensions in a dedicated workstation, showing that it can be routinely used in echocardiography labs.

Correlação e concordância entre medidas ecocardiográficas obtidas durante o exame no ecocardiógrafo com medidas de imagens digitalizadas: estudo transversal / Correlation and concordance between echocardiographic measurements obtained during echocardiography and digitized image measurements: transversal study

OBJETIVO: Avaliar a correlação e concordância entre medidas ecocardiográficas das dimensões cardíacas, obtidas através do aplicativo Echo off-line (programa para obtenção de medidas de imagens digitalizadas em estação de trabalho dedicada), com as realizadas convencionalmente. MÉTODOS: Estudo transversal, contemporâneo, sendo randomizados 56 pacientes. Através do programa Echo off-line foram mensuradas as medidas ao modo M e 2D ao nível dos ventrículos, do átrio esquerdo e da aorta. Estas medidas foram comparadas às realizadas por outro profissional, através do teste de correlação de Pearson (r), com alfa crítico de 0,05 e pela análise de concordância (Bland e Altman). RESULTADOS: As mensurações realizadas no sistema Echo off-line demonstraram r de 0,85 a 0,98. A análise de concordância mostrou que, para a maioria das medidas, a diferença média entre os métodos foi aproximadamente zero. A variação de valores absolutos não apresentou, em média, significância clínica. O aplicativo Echo off-line permite uma redução de, aproximadamente, 30 por cento no tempo para realização das medidas. CONCLUSÃO: Este trabalho demonstrou a acurácia do programa Echo off-line para mensurar as dimensões cardíacas em estação de trabalho dedicada, podendo ser utilizado rotineiramente nos laboratórios de ecocardiografia.

Randomized study of surgery for patients with permanent atrial fibrillation as a result of mitral valve disease.

BACKGROUND: The Cox Maze procedure has been used to treat atrial fibrillation in patients with mitral valve disease. Recently, ectopic foci, originating in the pulmonary veins, were demonstrated in patients with atrial fibrillation, and the indication was that their arrhythmia could have a focal origin. In the light of this new evidence, a simplified surgical technique to isolate the pulmonary veins was developed to eliminate permanent atrial fibrillation in patients undergoing mitral valve surgery. This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery. METHODS: A prospective clinical trial of 30 patients with mitral valve disease and permanent atrial fibrillation who had undergone mitral valve surgery were randomized in accordance with the type of surgery used on each: (1). associated en bloc isolation of pulmonary veins, (2). the Maze procedure, or (3). mitral valve correction alone. The preoperative clinical characteristics were similar in the three groups. RESULTS: The overall postoperative complications were similar in all three groups. The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group, but this factor bore no relation to increased morbidity in the intervention groups. The relative risk of atrial fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins (p = 0.010; 95% confidence interval, 0.01 to 0.71) and 0.20 in the Maze group (p = 0.044; 95% confidence interval, 0.04 to 1.02) compared with the control group. CONCLUSIONS: En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with permanent atrial fibrillation.

[Short- and long- term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis]. / Resultados imediatos e tardios da valvoplastia percutânea com balão na estenose valvar pulmonar.

OBJECTIVE: To assess the long-term results of percutaneous balloon valvuloplasty at a single institution. METHODS: This study comprised 189 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty from 1984 to 1996, whose mean age was 7.97+/-9.25 years. The procedure was classified as successful when the RV-PA gradient was reduced to levels < 36 mmHg; restenosis was indicated by RV-PA gradients > 36 mmHg after an effective procedure. RESULTS: After the procedure, the peak-to-peak transvalvular gradient decreased from 70.12+/-30.06 to 25.11 +/-20.23 mmHg (P<0.001). Immediate success was obtained in 148 (78.72%) patients. A later reduction in the gradient to values < 36 mmHg was obtained in 24 other patients previously categorized as unsuccessful. Therefore, percutaneous balloon valvuloplasty was considered effective in 172 (91.01%) patients. Effectiveness increased to 93.53% (159/170) in the cases of typical morphology. Follow-up ranged from 4.39+/-3 years to 13.01 years. Restenosis was observed in 24 (13.95%) patients. Pulmonary regurgitation was detected in 95.1% of the patients, being more intense than mild in 29.5% of the patients. The probability of maintaining an appropriate result, at any time point, with no restenosis was 92.29% in 2 years, 87.38% in 5 years, 82.46% in 8 years, and 64.48% in 10 years. CONCLUSION: Percutaneous balloon valvuloplasty was effective and safe for the treatment of pulmonary valve stenosis with excellent short- and long-term results.

Resultados imediatos e tardios da valvoplastia percutânea com balão na estenose valvar pulmonar / Short- and long- term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis

OBJETIVO: Determinar os resultados em longo prazo da valvoplastia percutânea por balão em uma instituição isolada. MÉTODOS: Estudados 189 pacientes com estenose valvar pulmonar submetidos a valvoplastia percutânea por balão, entre 1984-1996, com idade média de 7,97±9,25 anos, classificando-se como bem sucedida, a redução do gradiente VD-AP em níveis < 36mmHg e reestenose gradientes > 36mmHg após procedimento eficaz. RESULTADOS: Após o término do procedimento, o gradiente pico a pico transvalvar reduziu-se de 70,12±30,06 para 25,11±20,23 mmHg (p<0,001). Obtiveram sucesso imediato 148 (78,72 por cento) pacientes. Houve redução posterior do gradiente para valores < 36mmHg em outros 24 pacientes categorizados sem sucesso no grupo. Assim a valvoplastia percutânea por balão foi considerada efetiva em 172 (91,01 por cento) pacientes. A efetividade aumentou para 93,53 por cento (159/170) nos casos de morfologia típica. O tempo de seguimento foi de 4,39±3anos até o período máximo de 13,01 anos. Observou-se reestenose em 24 (13,95 por cento). A presença de regurgitação pulmonar foi detectada em 95,1 por cento dos pacientes, sendo que em 29,5 por cento com grau maior do que leve. A probabilidade de se manter um resultado adequado, até qualquer ponto no tempo, sem a ocorrência de reestenose, foi de 92,29 por cento em 2 anos, de 87,38 por cento em 5 anos, de 82,46 por cento em 8 anos e de 64,48 por cento em 10 anos. CONCLUSAO: A valvoplastia percutânea por balão foi efetiva e segura no tratamento da estenose valvar pulmonar com excelentes resultados imediatos e a longo prazo.