The cascade concept for Doppler-cardiographic quantification.

On the basis of the presented original "cascade concept" from extrapolated formulas one could perform exactly the individual approximation for the left ventricular performance and for the diastolic cardiac function, respectively, according to the degree of absolute and procentual deviation from the given normal values excluding the influence of the body surface area (m2), the heart rate (min-1) and the life age (years). The Doppler-cardiographic indications for the left ventricular performance are the mitral filling index in the L/min/m2 and flow distance index in the cm/min/m2, the stroke volume in ml and flow volume in the L/min, the stroke distance in cm and the flow distance in the cm/min, the filling volume in ml/m2 and the distance index in the cm/m2, respectively.

An approximation of stenotic aortic valve area by phonomechanocardiographic method: the comparative study of noninvasive methods.

Phonomechanocardiographic and ultrasonocardiographic parameters were compared in the multiplex manner in order to assess a degree of narrowing of the stenotic aortic valve areas. Adult patients with aortic valve stenosis were included in the study. The main condition for admission in the research sample was that the mean rate of circumferential fibre shortening be greater than 1 s-1 i.e. "compensated" preejection period/ejection time ratio (PEP/LVET). The control group were persons as sample stratified from healthy population. A possibility of approximate assessment of valve areas in patients with aortic stenosis is rendered by inserting the phonomechanocardiographic parameters in the modified Gorlin and Gorlin formula, provided that values of the normalised ejection function index (PEP/LVET2) and the ejection-isovolumetric coefficient corrected for pulse transmission time (LVET/IVCT+PTT) are known. The phonomechanocardiographic indexes of the transvalvular aortic pressure gradient and normalised stroke volume correlate curvilinear. The value of the LVET/IVCT + PTT equal or greater than that extrapolated for the given PEP/LVET2 in our formula means critically stenotic aortic valve area below 0.8 cm2. The given approximation could be used as a noninvasive and nongeometric polycardiographic or phonomechanocardiographic pattern for assessing the degree of narrowing of aortic valve area. The aortic valve stenosis is an illness in which a lot is expected from noninvasive cardiologic parameters when a surgical indication is in question. A severe or tight aortic valve stenosis, which required a surgical treatment according to current views, existed when valve area is less than 0.8 cm2 or when the transvalvular aortic systolic pressure gradient is greater than 50 mm Hg or 6.67 kPa, but with normal cardiac index in the same time.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiographic and clinical anticipation of the left ventricular systolic function, systemic vascular resistance, and myocardial hypertrophy--normal values and validation of method in patients with arterial hypertension.

In order to study the hemodynamic effects of the antihypertensive drugs in patients with essential hypertension, systolic time intervals from ECG data were extrapolated. The study was performed in 36 healthy individuals and 38 patients with essential hypertension without a drug therapy and/or in the wash out period more than three weeks and after a treatment. The stroke volume (SV) was determined as a product of the ejection time (ET), the pulse pressure (PP) and the flow coefficient (Kf). The Kf was extrapolated from Doppler-cardiographic parameters and it significantly correlated with the normal diastolic blood pressure (TA(d)) if the QT is not prolonged and the electrical systole/mechanical systole ratio (QS2/MS) not disturbed: Kf = 9.356 e-0.008 TA(d); r = -0.9. In arterial hypertension the correlation was also curvilinear: kf = 3.962 e-0.001 TA(d); r = -0.99. The arteriolar stiffness was defined as the PP/SV ratio. The cardiac output (CO) and systemic vascular resistance (SVR) were determined according to conventional formulas by known clinical and extrapolated ECG data. The cardiac contractile or muscle performance was defined as corrected changes of the ejection function for the given afterload according to the formula: I (-0.004 TA(d) + PEP/ET) -0.014 x 100; the normal 95% confidence limits for the laboratory used are -6.6% to +6%. Systolic time intervals were extrapolated from ECG data in the consecutive manner: QS2 = kQS2 x QT, ET = kET x JT, and MS = kMS x ET. The correlation of kQS2 with QT is curvilinear: kQS2 = 2.760 e-2.732 QT.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of two-dimensional echocardiography in the diagnosis of mitral valve calcification--sensitivity and specificity]. / Znacaj dvodimenzionalne ehokardiografije u dijagnostici kalcifikacija mitralnog zaliska--senzitivnost i specificnost metode.

The effect of two-dimensional echocardiography in assessment mitral valve calcifications was compared to computed tomography (CT) in 50 patients with pure rheumatic mitral stenosis (MS). Echocardiography revealed no mitral calcifications in 23 patients, respectively 46 per cent (grade 0). Twelve patients (24 per cent) had calcifications smaller than 2.5 mm (grade 1). Eleven (22 per cent) had moderate calcifications, smaller than one half of length of the anterior mitral leaflet (grade 2) and four (8 per cent) had calcifications larger than one half of the length of the anterior mitral leaflet (grade 3). The last two groups were thought to have clinically important calcifications. Specificity and sensitivity were examined in comparison to CT. By echocardiography, five (ten per cent) false positive findings were found in the group 2. There were neither false positive nor false negative findings in the last two group. The first group when compared with other three groups showed sensitivity of 100, specificity of 85, and predictive accuracy of 81 per cent. But the first two groups together compared with the last two groups showed sensitivity, specificity and predictive accuracy of 100 per cent.

New noninvasive index of the left ventricular inotropic state.

In order to confirm in clinical material a new contractile index, the systolic circumferential wall stress/end systolic muscle index ratio (SCS/ESMI), there were compared two groups of patients with pressure overload ventricular hypertrophy, with and without global compliance disturbances (Group B1 = 36; Group B2 = 28) and two groups of age and body surface area-matched healthy individuals (Group A1 = 36; Group A2 = 28). The new index of the contractile or muscle function, the SCS/ESMI ratio, was so effective in the research sample as the systolic circumferential wall stress/cavitary volume ratio, the SCS/ESVI. The product of the systolic contractile index, the SCS/ESVI, and ejection fraction (SCI X EF), as an integrated left ventricular parameter, showed that the ejection or pump function reduction was artificial in patients with an increased afterload and normal preload. The confidence limit for the SCI X EF on the level of 95% is 3.5, and for the product of the new systolic muscle index and ejection fraction, the SMI X EF, is 99. The inaugurated functional parameters could serve for revealing "false positive" cardiac failure or they could reveal the true reduction of the muscle contractile cardiac function by the artificially increased and "normal" ejection phase indices.

The left ventricular ejection time/filling period ratio as derived and simplified new index for noninvasive approximation of primary lusitropy disturbances in chronic hypertensive heart disease: a comparative Doppler-cardiographic and digital-echocardiographic study.

A theoretical new Doppler-cardiographic index was developed for a noninvasive approximation of primary lusitropy disturbances from the peak filling/peak ejection rate ratio. This simplified index, the left ventricular ejection time/filling period ratio was directly extrapolated from the outflow and inflow sample volumes. An index was significantly lower in a group of hypertensive patients with global relaxation disturbance than in the group with "partial" lusitropy disturbance. Between this index (x) and the isovolumetric relaxation period (y) there exists a very tight linear correlation: y = -124 x + 148; r = -0.89. All patients had a pressure overload left ventricular hypertrophy and therefore a prolonged protodiastolic period from the aortic valve closure to the mitral valve opening without a significant difference between the groups of patients. There were significantly higher values of the isovolumetric relaxation period and the standard and normalised first time derivatives of protodiastolic left ventricular dimension changes in the group of patients with global relaxation disturbances. There were determined confidence limits for the appearance of primary lusitropy disturbances on the basis of defined parameter changes, the left ventricular ejection time/filling period ratio, the isovolumetric relaxation period and the standard and normalised first time derivatives of protodiastolic dimension changes. One could conclude that the left ventricular ejection time/filling period ratio is a simple and easily derived index for the noninvasive approximation of primary lusitrophy and global relaxation disturbances in the pressure overload left ventricular hypertrophy.

Cusp pliability of the mitral valve: Doppler-echocardiographic and computer-tomographic study.

In order to study the mitral cusp pliability and calcification "in vivo" on the basis of the difference in the maximal and effective valve area, the Doppler-echocardiographic and computer tomographic method was used. The cusp pliability on the basis of the difference between the maximal and effective mitral valve area in absolute measures of cm2 was significantly smaller in patients with mitral stenosis, but in the deviations from normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, there were no significant differences (normal values 0.00 +/- 27%). The normal relationship of the difference between the maximal and effective mitral valve area in absolute measures (y = cm2) and the maximal mitral valve area (x = cm2) is formulated with the regression equation: y = 0.317x - 0.245. The linear correlation of the normal mitral valve area and the stroke volume at rest in patients with the normal mitral valve is very tight. The stroke volume is significantly lower in mitral stenosis, and the time-velocity integral in the diastole or the mitral stroke distance was significantly greater. The relationship of the percentual deviation from the normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, on the one hand, and the computer-tomographic approximation of calcium incrustation in mitral leaflets on the other are defined with a tight linear correlation. One could conclude that the magnitude of cusp pliability or calcification can be approximated by the Doppler-echocardiographic method.