[Dobutamine stress echocardiography in distinguishing ischemic from nonischemic dilated cardiomyopathy].

INTRODUCTION: The aim of this study was to evaluate the diagnostic accuracy of dobutamine stress echocardiography for detection of coronary artery disease in patients with dilated cardiomyopathy. Detection of regional wall motion abnormalities at rest does not reliably distinguish ischemic from nonischemic cardiomyopathy. MATERIAL AND METHODS: To distinguish between ischemic and nonischemic dilated cardiomyopathy (DCM), we studied 50 patients with left ventricular dysfunction (20 ischemic and 30 nonischemic, detected by coronary angiography) using dobutamine stress echocardiography. Echocardiographic images were obtained at baseline, low and paek dose of dobutamine. Rest and stress left ventricular wall motion scores were derived from analysis of regional wall motion. RESULTS: Dobutamine infusion was terminated after achievement of the target heart rate or maximal protocol dose in 16 (80%) patients with ischemic heart disease and in 23 (73.3%) patients with nonischemic heart disease. At rest, there were more normal segments (p<0.001) and a trend toward more akinetic segments (p, not significant) per ischemic than per nonischemic DCM patients. However, either at rest or with low-dose dobutamine, individual data largely overlapped. At peak dose, in ischemic DCM, regional contraction worsened in many normal or dyssinergic regions at rest (in some cases after inprovement with low-dose dobutamine); in contrast, in nonischemic DCM, further mild impovement was observed in a variable number of left ventricular areas. Thus, with peak-dose dobutamine, more akinetic and less normal segments were present per ishemic than per nonischemic DCM patient (both, p<0.001). A value of six or more akinetic segments was 90% sensitive and 98% specific for ischemic DCM. CONCLUSIONS: Our data show that analysis of regional contraction by dobutamine stress echocardiography can distinguish between.

[Effect of thrombolytic therapy on occurrence of complex ventricular arrhythmias in the late hospitalization period in acute myocardial infarct: relation with long-term remodeling of the left ventricle]. / Uticaj tromboliticke terapije na ucestalost kompleksnih komorskih aritmija u kasnoj hospitalnoj fazi akutnog infarkta miokarda: odnos sa dugorocnim remodelovanjem leve komore.

BACKGROUND: The impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias is not yet clarified. The aim of this study was to investigate the impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias, as well as long term association between complex ventricular arrhythmias and left ventricular remodelling, and their impact on five-year lethality. METHODS: Ninety seven consecutive patients with first acute myocardial infarction (streptokinase was administered in 58 patients), underwent 24-hours Holter monitoring at discharge. Ventricular arrhythmias were classified according to Lown classification, and patients were grouped into the group with simple ventricular arrhythmias (Lown class 0 to 2), and the group with complex ventricular arrhythmias (Lown class 3 to 5). Echocardiography was performed at discharge, and six and twelve months after the infarction. Left ventricular volume indexes and ejection fraction was determined using Simpson's biplane formula. RESULTS: In patients with complex ventricular arrhythmias left ventricular volume indexes were higher and ejection fraction was lower throughout the study, whereas wall motion score index was higher one year after the infarction. On the other hand, these variables were similar throughout the follow-up within the groups of patients with and without complex ventricular arrhythmias who received thrombolytic therapy. The incidence of complex ventricular arrhythmias was similar in thrombolyzed and non-thrombolyzed patients (11/58 vs. 5/39). There was no difference in five year lethality between patients with and without complex ventricular arrhythmias (4/16 vs. 13/81 patients). CONCLUSION: Our data indicated that left ventricular remodelling in patients with complex ventricular arrhythmias was not progressive after hospital discharge. The presence of complex ventricular arrhythmias was not associated with the increased five-year lethality, despite of more pronounced left ventricular remodelling. It occurred that thrombolysis per se had no influence on the incidence of complex ventricular arrhythmias in the late hospital phase after the first acute myocardial infarction.

Color Doppler Transesophageal Echocardiography in Detection of Massive Pulmonary Embolism: Is Pulmonary Angiography Always the Gold Standard?

In this article, the potential value of color Doppler in improving diagnostic accuracy of transesophageal echocardiography (TEE) in patients with incomplete obstruction of large pulmonary vessels is illustrated. We present an unusual case of massive pulmonary embolism that was unequivocally detected by color Doppler TEE both before and after pulmonary angiography, which failed to demonstrate filling defects in the pulmonary artery. (ECHOCARDIOGRAPHY, Volume 13, November 1996)

Prosthetic Aortic Valve Thrombosis Detected by Doppler Echocardiography.

Thrombosis of the prosthetic valve is a highly lethal medical emergency that requires immediate diagnosis and prompt therapy. Establishing the diagnosis may be difficult, despite numerous physical, echocardiographic, fluoroscopic, and angiographic signs, which have been described. We report a case of prosthetic aortic valve thrombosis diagnosed by Doppler echocardiography. (ECHOCARDIOGRAPHY, Volume 13, March 1996)