Prognostic value of carotid intima-media thickness in detection of coronary atherosclerosis in patients with calcified aortic valve stenosis.

OBJECTIVE: Aortic stenosis (AS) coexists with coronary artery disease (CAD) in at least 30% of patients. Patients with concomitant CAD may benefit from simultaneous coronary bypass grafting. This study aimed to evaluate the prognostic value of carotid intima-media thickness (IMT) in patients with AS in assessing concomitant CAD. METHODS: Group I consisted of 33 patients (mean age +/- SD, 61.0 +/- 8.2 years; 18 men and 15 women) with AS but without CAD on angiograms. Group II consisted of 34 patients (64.4 +/- 8.0 years; 25 men and 9 women) with AS and CAD confirmed angiographically. A control group included 36 patients (61.2 +/- 4.9 years; 18 men and 18 women) with normal coronary arteries and no AS. Maximal IMT was assessed in all patients at the common carotid artery, bulb, and internal carotid artery and expressed as a mean value. RESULTS: There were no differences among the respective groups with regard to age, sex, frequency of hypertension, diabetes, and smoking habit, although patients with CAD were more often hyperlipemic (P = .038). The IMT of the common carotid artery, bulb, and internal carotid artery was significantly higher in patients with AS and CAD compared with both the control group and patients with AS only. The multivariable regression model revealed that CAD (P < .001), AS (P = .006), male sex (P = .034), age (P < .001), and diabetes mellitus (P = .047) were independent risk factors for IMT thickening. A mean IMT value of greater than 1.2 mm was predictive (sensitivity, 73.5%; specificity, 72.7%) of concomitant CAD in patients with AS. CONCLUSIONS: Intima-media thickness increases in patients with AS. The greatest IMT values are observed in patients with both AS and CAD. Patients with AS might be suspected of having CAD when the IMT value exceeds 1.2 mm.

[Relationship between Doppler indices of diastolic function and exercise capacity in patients with congestive heart failure]. / Ocena zaleznosci miedzy echokardiograficznymi parametrami funkcji rozkurczowej a tolerancja wysilku oceniana przy pomocy wysilkowych testów spiroergometrycznych u chorych z niewydolnoscia serca.

UNLABELLED: Exercise intolerance is a major symptom in patients (pts) with congestive heart failure (CHF). A lack of correlation between the left ventricular systolic dysfunction and exercise capacity was found. Recently, it has been proposed that diastolic dysfunction may contribute to significant impairment of exercise tolerance in pts with CHF. The aim of the study was to compare the relationship between Doppler indices of diastolic function and exercise capacity in patients with CHF. MATERIAL AND METHODS: The study included 29 pts (20 M, 9 F) 14 with idiopathic and 15 with ischaemic cardiomyopathy. The mean left ventricular ejection fraction (LVEF) was 31 +/- 8%, VO2peak was 16.4 +/- 4.6 ml/kg/min. The mean age was 55.4 +/- 12.1, ranged from 30 to 73 years. All pts underwent complete echocardiography study. Diastolic performance was estimated using conventional Doppler mitral inflow (E, A) velocities, E/A ratio, deceleration time of E velocity (E-DT), isovolumetric relaxation time (IVRT) and color Doppler M-mode flow propagation velocity (Vp). Resting spirometry and cardiopulmonary exercise test (CPX) were performed in all pts. Exercise capacity was measured as oxygen consumption at peak exercise (VO2peak). The association between echocardiography parameters and VO2peak was evaluated by Spearman's correlation coefficients (r). RESULTS: We found that VO2peak correlated significantly with the LV filling pattern estimated by the transmitral Doppler E/A ratio (r=-0.4, p=0.03), A-wave velocity (r=0.4, p=0.03) and velocity flow propagation (r=0.4, p=0.05). There was no correlation between VO2peak and following mitral inflow parameters: (E-wave, DT, IVRT). There was no correlation between VO2peak and LVEF. CONCLUSIONS: 1. Doppler indices of diastolic function are important determinants of exercise capacity in CHF pts. 2. Assessment of transmitral flow velocities holds a substantial diagnostic potential, which may be utilized in everyday clinical practice as a alternative in routine monitoring of systolic heart failure.

[Left ventricle TEI index--assessment of clinical role in patients with aortic valve stenosis]. / Ocena przydatnosci indeksu TEI u chorych ze zwezeniem zastawki aortalnej.

AIM: The study aimed to assess the clinical efficacy of the TEI index in patients with aortic valve stenosis (AVS). METHODS: The study group comprised 30 consecutive patients (12 F; 18 M; mean age: 60.1 +/- 9.2; range: 48-70 years) with aortic valve stenosis. Their clinical status was evaluated according to the NYHA criteria. A complete 2-dimensional, Doppler and color flow Doppler examination was performed. To assess systolic and diastolic left ventricle function we used ejection fraction--EF (%) and transmitral inflow velocity E/A ratio, respectively. The TEI index was calculated as (a - b)/b, were a is the interval between the cessation and onset of mitral inflow, and b is the ejection time. We also determined: maximal transaortic gradient--Ao max gr (mmHg), aortic valve area--AVA (cm2) and left ventricular mass index--LV mass index (g/m2). Based on clinical symptoms we divided patients into two groups: Group 1 (NYHA I/II) and Group 2 (NYHA III and IV). RESULTS: There were no significant differences in age, Ao max gr, AVA, EF and ejection time (b) between groups. But we found significantly prolonged time interval (a) and consequently significantly higher TEI index (p<0.001) in the group with severe symptoms. LV mass index and E/A ratio were also related to the patient's clinical status (p<0.05) but the TEI index seems to be more sensitive in distinguishing severely limited patients. CONCLUSION: The TEI index revealed to be closely related to symptoms in patients with aortic valve stenosis. The patient's clinical status seems to depend more on the TEI than on the conventional measured parameters like aortic valve area and transaortic gradient.

[Quality of life after homograft aortic valve replacement and reoperation]. / Ocena jakosci zycia chorych po wszczepieniu homogennej zastawki aortalnej i po reoperacjach.

AIM: To evaluate quality of life (QoL) in patients after aortic homograft implantation for aortic valve disease and in those who had undergone reoperation due to homograft dysfunction. METHODS: QoL was assessed in 354 patients (72 women and 282 men, mean age 55.1 +/- 11.5 years, range 13-69) after aortic homograft implantation. Patients were divided into two groups: I--patients after aortic homograft implantation without reoperation (291 patients) and II--patients after reoperation (68 patients). We used two questionnaires: SF 36 (Short Formulation 36) and a self-developed questionnaire for patients after cardiac operation (SDQ). SF 36 has three levels: a) 36 items; b) eight scales: physical activity, social activity, limitations in every day activity, body pain, mental health, emotional problems, vitality and health perception; c) two summary measures that aggregate scales; general physical health which constitutes of physical activity, limitations in every day activities, body pain, health perception and general mental health which constitutes the rest of four scales: social activity, mental health, emotional problems, vitality. Each scale is standardized from 1 to 100 with > 50 indicating better than general population average. SDQ is focused on social and demographic factors, clinical symptoms before and after operation, risk factors and physical and occupational activity. RESULTS: By SF 36, only health perception was below general population average. We found a statistically positive relationship between QoL and high physical and occupational activity in both groups (p<0.05). The presence of dyspnea, chest pain, palpitations, edema, faints, fear/anxiety and hypertension were related to decreased general physical and mental health in both groups (p<0.05). CONCLUSIONS: Patients after aortic homograft implantation have high QoL. This holds also for those after reoperation for homograft dysfunction. Symptomatic patients have lower QoL. Higher QoL is associated with physical and occupational activity. There is no difference in general physical health in both groups. General mental health is decreased in reoperated patients. Since reoperated patients more often suffer from emotional problems, they may particularly benefit from the psychological support.

[Atrial septal defect associated with mitral valve prolapse--prevalence and clinical significance]. / Ubytek przegrody miedzyprzedsionkowej skojarzony z wypadaniem platków zastawki mitralnej--czestosc wystepowania i znaczenie kliniczne.

AIM: High incidence of mitral valve prolapse (MVP) associated with atrial septal defect (ASD) has been reported. The study aimed to evaluate the prevalence, etiology and clinical significance of MVP in patients with ASD. METHODS: Forty-seven consecutive patients with secundum type ASD (30 F; 17 M; mean age: 37.9 +/- 14.0; range: 16-62 years) were enrolled into the study. All patients underwent M-mode and two dimensional echocardiography to check for MVP, defined as the superior systolic displacement of mitral leaflets > or = 2 mm above annulus with coaptation point at, or superior to the annular plane. Pulmonary to systemic flow ratio (Qp/Qs), diastolic right ventricle dimension (RV), left ventricle dimension (LV) and left to right ventricle ratio (LV/RV) were measured. Furthermore, mitral and tricuspid valve insufficiency and right ventricle systolic pressure (RVSP) were evaluated. A symptom-limited, incremental exercise test (CPX)--modo Bruce on Marquette 2000 Treadmill was performed in every patient. We determined: time of exercise--Time (min), peak oxygen uptake--VO2peak (ml/kg/min), VO2peak expressed as % of predicted value--VO2% and anaerobic threshold--AT (expressed as % VO2 max). The study population was divided into two groups: Group I--patients with ASD and MVP and Group II--patients with ASD without MVP. RESULTS: MVP was recognized in 17 patients (36%); anterior MVP was found in 14, two cases revealed posterior MVP and one was diagnosed with both anterior and posterior MVP. MVP was not associated with significant mitral regurgitation. Echocardiographic and CPX data are summarized in table I. There were no significant differences in age, RVSP, RV and LV diastolic dimensions between groups, although Qp/Qs was significantly higher (p=0.01) and LV/RV significantly lower (p=0.02) in the MVP group. Moreover, there was a significant negative correlation between Qp/Qs and LV/RV ratio (r=-0.70; p<0.001) in a study group. No significant difference in time of exercise, VO2peak, VO2%, and AT was observed between respective groups. CONCLUSIONS: Our data support the thesis that MVP associated with secundum ASD is a functional disorder due to the atrial shunt and leftward shift of interventricular septum. MVP does not affect cardiopulmonary capacity in ASD patients.

[Relationship between carotid intima-media thickness, atherosclerosis risk factors and angiography findings in patients with coronary artery disease]. / Ocena zaleznosci pomiedzy gruboscia kompleksu intima-media a czynnikami ryzyka miazdzycy i zaawansowaniem choroby wiencowej.

UNLABELLED: The aim was to determine relationship between carotid intima-media thickness and atherosclerosis risk factors and angiographic findings in patients with coronary artery disease. METHODS: We examined 172 consecutive patients, men and women, aged 58.5 +/- 9.35 years. Eligibility criteria included presence of coronary artery disease that was defined as a history of a heart attack or cardiac catheterization demonstrating > 50% stenosis of at least 1 coronary artery. B-mode ultrasound quantification of carotid artery intima-media thickness was obtained in all patients. Intima-media thickness was measured at left and right carotid arteries and expressed as the mean of the maxima in the common carotid artery, bifurcation and the internal carotid artery. Moreover, the mean of the maxima (IMT) was calculated at all sites. A grade of stenosis was identified and quantified by analyzing Doppler velocity spectrum in combination with measurement of stenosis area in all patients with severe lesions. Obtained results were compared with risk factors of atherosclerosis and angiographic findings on coronary artery angiograms. RESULTS: There was a statistically significant positive correlation between age (p = 0.0001), hypertension (p = 0.0001), hyperlipidaemia (p = 0.008), non-insulin-dependent-diabetes mellitus (p = 0.043) and intima-media thickness. In 157 (91.3%) patients intima-media thickening and plaques were present in carotid arteries. We observed high-grade stenosis of carotid arteries in 15 patients (8.7%) with coronary artery disease, furthermore all these patients have had at least two-vessel coronary artery disease. CONCLUSIONS: Alterations within carotid arteries: intia-media thickening and plagues were identified in 91.3% patients. We observed statistically significant correlation between IMT and advancing coronary artery disease. High-grade stenosis of carotid arteries was observed in 8.7% patients with coronary artery disease, furthermore in 13.7% patients with advanced coronary artery disease. IMT increases with age. Hypertension, hyperlipidemia and non-insulin-dependent diabetes mellitus are related to a greater IMT, whereas other risk factors didn't reveal that correlation.

[Cardiopulmonary exercise capacity in adult patients with atrial septal defect]. / Ocena wydolnosci wysilkowej doroslych chorych z ubytkiem w przegrodzie miedzyprzedsionkowej.

UNLABELLED: The aim of the study was to evaluate cardiopulmonary exercise capacity (WTS) in adult patients with atrial septal defect (ASD). After excluding 10 patients with additional cardiac, pulmonary or muscle diseases, 53 patients with ASD (Gr-ASD; mean age 37.8 +/- 14.9 years; 35 women, 19 men) were enrolled in our study. In addition, we evaluated 22 healthy age and gender matched control subjects (Gr-K; mean age 36.6 +/- 14.9 years; 13 women, 9 men). First, all subjects underwent resting spirometry and forced vital capacity--(FVC; % of predicted value), one-second forced expiratory volume--(FEV1; % of predicted value) and FEV1/FVC (%) were determined. Then each subject performed a symptom-limited, incremental exercise test (modo Bruce). We evaluated the following parameters of resting metabolism: respiratory rate--(RR; L/min), minute ventilation--(VE; L/min), tidal volume--(Vt; L), oxygen uptake--(VO2; ml/kg/min), end-tidal carbon dioxide pressure--(PET CO2; mmHg), end tidal oxygen pressure--(PET O2; mmHg), ventilatory equivalent for carbon dioxide--(VE/VCO2) and ventilatory equivalent for oxygen--(VE/VO2). The following exercise parameters were analysed: peak oxygen uptake--(VO2 peak; ml/kg/min), VO2 peak expressed as % of predicted value--(VO2 %N), anaerobic threshold--(AT; % VO2 max), ventilatory equivalent for carbon dioxide--(VE/VCO2), end-tidal carbon dioxide pressure--(PET CO2; mmHg), O2 pulse, time of exercise--(T; min) and time to AT--(TAT; min). In addition, we performed a subgroup analysis for ASD patients below and > or = 40 years of age. All values were expressed as mean +/- SD. RESULTS: Although there was no significant difference in FVC, FEV1, FEV1/FVC, VO2, VE, Vt, RR between ASD patients and controls, the ASD patients aged 40 or older showed significantly lower FEV1/FVC and significantly higher RR. Expiratory gas exchange analysis showed significant differences between the ASD patients and controls (higher VE/VCO2, VE/VO2, PET CO2, and lower PET O2 respectively). Moreover, VO2 peak, VO2%N, AT, PET CO2 and O2 pulse were significantly lower while VE/VCO2 was significantly higher in ASD patients than in normal subjects. On average, VO2%N in ASD patients was only 61% of the predicted value for age and sex. Total time of exercise and time to AT were significantly shorter in ASD patients as well. CONCLUSIONS: WTS allows appropriate evaluation of cardiopulmonary capacity in ASD patients, though the mechanisms underlying ventilatory and hemodynamic abnormalities are still not fully understood. Adult patients with ASD reveal ventilatory abnormalities with an age-related trend towards deterioration. Cardiopulmonary exercise capacity in adults with ASD is markedly reduced in comparison with healthy population and deteriorates with age. WTS complements echocardiographic and hemodynamic evaluation of patients with ASD, and is helpful in indicating patients for ASD closure and their follow up.