The Merete BioBall system in hip revision surgery: A systematic review.

BACKGROUND: Modular hip arthroplasty is widely recognized in hip surgery; nevertheless, despite advances in prosthetic design, the incidence of hip revision surgery is increasing. In these procedures, a modular adapter that engages the femoral stem and the modular femoral head could be useful in order to protect the neck-head junction and restore preoperative biomechanics and soft tissue tension when the femoral or acetabular component should be retained. The Merete™ BioBall™ system (Merete Medical, Berlin, Germany) could fill this need. However the literature regarding this device is sparse, therefore we performed a systematic review to analyze: the indications for its use and clinical results and the causes of second revision and survival in hip revision surgery, mainly focus in complications of its use. MATERIALS AND METHODS: Databases including PubMed and Google Scholar were searched for English-language articles published between 01/01/1999 and 01/04/2017, using search terms related to the system Merete™ BioBall™. Studies that reported the clinical use of the Merete™ BioBall™ system in hip revision surgery were selected. Data related to the indications, characteristics of the implant, clinical results, causes of second revision and survival were gathered. RESULTS: A total of 14 studies with a level IV evidence were analyzed. Information related to the implant was provided in 194 cases. Isolated acetabular revision was the main indication of implant use (139/194 [71.6%]). The most common combination used was the standard implant (69/110 specified [59.4%]), 3XL length (28/107 specified [26.2%]) with 32mm metal head (58/187 specified [31%]). After a follow-up ranging from 2 to 97 months, there were 16 complications, thirteen (81,2%) were revised, including one neck fracture of the stem (6.25%), two ceramic head fractures (12,5%) and six recurrent dislocations (37,5%). Implant survival was 92.8% at 52.5 months of follow-up in the longest published series. Clinical and functional results were provided in a heterogeneous way. CONCLUSIONS: There is insufficient evidence to recommend for or contraindicate the use of the Merete™ BioBall™ system. The Isolated acetabular revision was the main indication of implant use. When dislocation is the indication of its use the rate of second revision is high. Some important complications possibly related with the implant design have been reported but as isolated cases. The neck adapter failure or corrosion phenomena have not been reported. Further prospective and controlled trials are needed to assess the use of this type of implant and its survival. LEVEL OF EVIDENCE: Level III systematic review of case series.

Thromboembolic risk in atrial fibrillation: association between left atrium mechanics and risk scores. A study based on 3D wall-motion tracking technology.

BACKGROUND/OBJECTIVES: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a significantly high risk of stroke and systemic embolism. The aim of our study was to assess the association between left atrium (LA) mechanics measured by 3D wall-motion tracking (3DWMT) technology and the most common thromboembolic risk scores (CHADS2, CHA2DS2-VASc). METHODS: A total of 101 consecutive patients with permanent AF referred were included. Conventional bidimensional (2D) LA parameters, and LA mechanics by means of 3DWMT were studied. Association between LA 2D and 3DWMT parameters and both risk scores was evaluated as well as its correlation with every component of the score individually. RESULTS: Mean age was 78 ± 10 years. Mean CHADS2 was 2.7 ± 1.3 and mean CHA2DS2-VASc was 4.4 ± 1.7. Values of 2D and 3DWTM LA parameters were: 2D area 26.4 ± 9.7 cm(2) , 2D volume index 49.4 ± 10.1 mL/m(2) , 3DWMT left atrial emptying fraction (LAEF) 15.9 ± 8.4%, longitudinal strain 9.1 ± 4.5% and area strain 14.9 ± 8.8%. Linear regression analysis showed statistically significant correlation between LA longitudinal strain and LAEF with CHADS2 and CHA2DS2-VASc scores. For each 10% variation in longitudinal strain, CHADS2 and CHA2DS2-VASc scores change in 0.7 and 0.8 points, respectively. CONCLUSIONS: Left atrial longitudinal strain and emptying fraction assessed by 3D WMT technology have correlation with both CHADS2 and CHA2DS2-VASc scores. Each 10% of variation in longitudinal strain represents a 0.7 and 0.8 points change in those risk scores. LA mechanics evaluation might provide additional value to risk scores and could be considered to be a predictor of stroke in patients with AF.

Early myocardial deformation changes associated to isolated obesity: a study based on 3D-wall motion tracking analysis.

Obesity is considered as a strong risk factor for cardiovascular morbidity and mortality. 3D-wall motion tracking echocardiography (3D-WMT) provides information regarding different parameters of left ventricular (LV) myocardial deformation. Our aim was to assess the presence of early myocardial deformation abnormalities in nonselected obese children free from other cardiovascular risk factors. Thirty consecutive nonselected obese children and 42 healthy volunteer children were enrolled. None of them had any cardiovascular risk factor. Every subject underwent a 2D-echo examination and a 3D-WMT study. Mean age was 13.9 ± 2.56 and 13.25 ± 2.68 years in the nonobese and obese groups, respectively (59.7% and 40.3% male). Statistically significant differences were found for: interventricular septum thickness, LV posterior wall thickness, LV end-diastolic volume, LV end-systolic volume, left atrium volume, LV mass, and lateral annulus peak velocity. Regarding the results obtained by 3D-WMT assessment, all the evaluated parameters were statistically significantly different between the two groups. When the influence of obesity on the different echocardiographic variables was evaluated by means of multivariate logistic regression analysis, the strongest relationship with obesity was found for LV average circumferential strain (ß-coefficient: 0.74; r(2): 0.55; P: 0.003). Thus, obesity cardiomyopathy is associated not only with structural cardiac changes, but also with myocardial deformation changes. Furthermore, this association occurs as early as in the childhood and it is independent from any other cardiovascular risk factor. The most related parameter to obesity is LV circumferential strain.

Ergonovine stress echocardiography: Recent experience and safety in our centre.

AIM: To study recent experience and safety of ergonovine stress echocardiography in our centre. METHODS: In this study we collected the clinical variables of patients referred since 2002 for ergonovine stress echocardiography, in addition to indications, the results of this test, complications, blood pressure and heart rate values during the test and the number and results of tests requested before this technique. RESULTS: We performed 40 tests in 38 patients, 2 tests were carried out to verify therapy efficacy. The prevalence of classic cardiovascular risk factors was low and the most frequent indication was chest pain (57.5%). Coronary angiography was performed in 32 patients, and showed normal coronary arteries in 27 patients and non-significant stenosis in 5 cases. In 16 patients, coronary angiography was carried out after a positive or inconclusive ischemia test. Another 6 patients had a normal stress test (5 exercise electrocardiography tests and 1 nuclear imaging test). Of the 40 ergonovine stress echocardiography tests, 6 were positive (4 in the right coronary artery territory and 2 in the circumflex coronary artery territory), all of them by echocardiographic criteria, and by electrocardiographic criteria in only 3 (50%). The presence of non-significant coronary artery stenosis was more frequent in patients with positive ergonovine stress echocardiography (50% vs 6%, P = 0.038), and were related to ischemic territory. During the maximum stress stage, there was a higher systolic (130.26 ± 19.17 mmHg vs 136.58 ± 27.27 mmHg, 95% CI: -12.77 to 0.14 mmHg, P = 0.055) and diastolic blood pressure (77.89 ± 13.49 mmHg vs 83.95 ± 15.73 mmHg, 95% CI: -10.41 to -1.69 mmHg, P = 0.008) than at the baseline stage, and the same was registered with heart rate (73 ± 10.96 beats/min vs 79.79 ± 11.72 beats/min, 95% CI: -9.46 to -4.11 beats/min, P < 0.01). Nevertheless, there were only 2 hypertensive reactions during the last stage, which did not force a premature end to the test, without sustained tachy or bradyarrhythmias, and the technique was well tolerated in 58% of cases. A unique complication (2.5%) of this test was a prolonged vasospasm with a slight increase in necrosis biomarkers, however, this was without repercussion. CONCLUSION: Ergonovine stress echocardiography can be performed with safety, is well tolerated in the majority of cases, and is useful for determining the ischemia mechanism in selected cases.

Assessment of myocardial deformation: Predicting medium-term left ventricular dysfunction after surgery in patients with chronic mitral regurgitation.

INTRODUCTION AND OBJECTIVES: The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery. METHODS: This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively using speckle-tracking echocardiography and TDI. The LVEF was determined preoperatively and postoperatively using 3-dimensional echocardiography. Echocardiographic assessments were performed in the 48 hours prior to surgery and 6 months postoperatively. RESULTS: The patients' mean age was 59.9+/-11.3 years and 10 (29.4%) were male. Both speckle-tracking echocardiography and TDI were found to be predictors of a >10% decrease in LVEF at 6 months. However, the predictive value of speckle-tracking echocardiography was greater than that of TDI. The longitudinal strain at baseline in the interventricular septum as measured by speckle-tracking echocardiography was the most powerful predictor; the area under the curve was 0.85 and the optimal cut-off value was -0.11. CONCLUSIONS: Speckle-tracking echocardiography can be used to predict a decrease in LVEF over the medium term after mitral valve replacement. Moreover, the predictive accuracy of speckle-tracking echocardiography was greater than that of TDI.

Estudio de la deformación miocárdica: predictor de disfunción ventricular a medio plazo tras cirugía en pacientes con insuficiencia mitral crónica / Assessment of myocardial deformation: predicting medium-term left ventricular dysfunction after surgery in patients with chronic mitral regurgitation

Introducción y objetivos. El desarrollo de disfunción ventricular izquierda tras la sustitución valvular mitral es un problema frecuente en pacientes con insuficiencia mitral grave crónica. El análisis de la deformación miocárdica permite estimar con precisión la contractilidad miocárdica. Nuestro objetivo fue comparar el valor predictivo de strain (S) y strain rate (SR) preoperatorios obtenidos por speckle-tracking y Doppler tisular (DTI) para predecir la disminución de la fracción de eyección del ventrículo izquierdo (FEVI) a medio plazo tras la cirugía. Métodos. Treinta y ocho pacientes consecutivos con insuficiencia mitral grave crónica programados para sustitución valvular mitral fueron incluidos prospectivamente. Se analizó el S y el SR longitudinal del septo interventricular en el periodo preoperatorio mediante speckle-tracking y DTI. La FEVI preoperatoria y postoperatoria se obtuvo por ecocardiografía tridimensional. Los estudios ecocardiográficos se realizaron dentro de las 48 h previas a la cirugía y 6 meses después de la cirugía. Resultados. La media de edad de los pacientes era 59,9 ± 11,3 años; 10 pacientes (29,4%) eran varones. Tanto el speckle-tracking como el DTI resultaron predictores de disminución de la FEVI > 10% a 6 meses. Sin embargo, el valor predictivo del speckle-tracking fue superior al del DTI. El S longitudinal del septo interventricular basal mediante speckle-tracking fue el parámetro con mayor poder predictivo, con un área bajo la curva de 0,85 y un punto de corte óptimo de -0,11. Conclusiones. El speckle-tracking permite predecir la disminución de la FEVI a medio plazo tras la sustitución valvular mitral. Además, el speckle-tracking es más preciso que el DTI para este fin (AU)

Introduction and objectives. The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery. Methods. This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively using speckle-tracking echocardiography and TDI. The LVEF was determined preoperatively and postoperatively using 3-dimensional echocardiography. Echocardiographic assessments were performed in the 48 hours prior to surgery and 6 months postoperatively. Results. The patients’ mean age was 59.9±11.3 years and 10 (29.4%) were male. Both speckle-tracking echocardiography and TDI were found to be predictors of a >10% decrease in LVEF at 6 months. However, the predictive value of speckle-tracking echocardiography was greater than that of TDI. The longitudinal strain at baseline in the interventricular septum as measured by speckle-tracking echocardiography was the most powerful predictor; the area under the curve was 0.85 and the optimal cut-off value was –0.11. Conclusions. Speckle-tracking echocardiography can be used to predict a decrease in LVEF over the medium term after mitral valve replacement. Moreover, the predictive accuracy of speckle-tracking echocardiography was greater than that of TDI (AU)

[Quantification of aortic valve area using three-dimensional echocardiography]. / Utilidad de la ecocardiografía tridimensional en la cuantificación del área valvular aórtica.

INTRODUCTION AND OBJECTIVES: To determine whether the reproducibility of left ventricular outflow tract (LVOT) area measurement is greater with three-dimensional echocardiographic (3D-echo) planimetry than with conventional 2D-echo. To determine the LVOT circularity index by means of 3D-echo. To determine the usefulness of measuring the LVOT area by 3D-echo for quantifying the severity of valvular aortic stenosis. METHODS: The study included 40 patients, of whom 22 had an aortic stenosis. The LVOT area was measured using both 2D-echo and 3D-echo, and the circularity index, using 3D-echo alone. In addition, the severity of valvular aortic stenosis was categorized using both 2D-echo and 3D-echo. RESULTS: The levels of inter- and intra-observer agreement on LVOT area measurements were better with 3D-echo. The circularity index was 1.50 (0.25), and there was a very poor linear correlation with LVOT area (r=-0.34; P=.47). Patients with valvular aortic stenosis were categorized according to the severity of their stenoses using both 2D-echo and 3D-echo. The level of agreement between the two techniques was poor (kappa=0.36). CONCLUSIONS: Measurements of the LVOT area made using 3D-echo were more reproducible than those made using 2D-echo. Consequently, 3D-echo may be a better technique for assessing the LVOT area. In addition, 3D-echo showed that the LVOT is elliptical in form and that its size is not related to its circularity. Moreover, 3D-echo could also be helpful in classifying the severity of valvular aortic stenosis.

Utilidad de la ecocardiografía tridimensional en la cuantificación del área valvular aórtica / Quantification of Aortic Valve Area Using Three-Dimensional Echocardiography

Introducción y objetivos. Determinar si la estimación del área del tracto de salida del ventrículo izquierdo (TSVI) mediante planimetría con ecografía tridimensional (Eco-3D) es más reproducible que con ecografía bidimensional (Eco-2D). Determinar el grado de circularidad del TSVI mediante Eco-3D. Determinar el impacto de la valoración del área del TSVI mediante Eco-3D en la cuantificación de la severidad de la estenosis aórtica valvular. Métodos. Se reclutó a 40 pacientes con valvulopatía aórtica, 22 con estenosis aórtica. Se calculó el área del TSVI mediante Eco-2D y Eco-3D. Se calculó el índice de circularidad del TSVI mediante Eco-3D. Por último, se clasificó la severidad de las estenosis aórticas mediante Eco-2D y Eco-3D. Resultados. El grado de acuerdo tanto entre observadores como intraobservador a la hora de determinar el área del TSVI fue superior cuando se usó Eco-3D. El índice de circularidad fue 1,5 ± 0,25 y presentó un grado de asociación lineal con el área del TSVI muy bajo (r = ­0,34; p = 0,47). Los pacientes con estenosis aórtica valvular fueron clasificados de acuerdo con su severidad determinada con Eco-2D y Eco-3D. El grado de acuerdo entre los métodos fue débil (κ = 0,36). Conclusiones. La medición del área del TSVI mediante Eco-3D es más reproducible que con Eco-2D. Por lo tanto, probablemente se trate de un método más preciso para evaluarla. La Eco-3D demuestra que el TSVI tiene una forma elíptica y que su tamaño no se relaciona con su morfología más o menos circular. La Eco-3D podría ayudar a clasificar la severidad de la estenosis aórtica (AU)

Introduction and objectives. To determine whether the reproducibility of left ventricular outflow tract (LVOT) area measurement is greater with three-dimensional echocardiographic (3D-echo) planimetry than with conventional 2D-echo. To determine the LVOT circularity index by means of 3D-echo. To determine the usefulness of measuring the LVOT area by 3D-echo for quantifying the severity of valvular aortic stenosis. Methods. The study included 40 patients, of whom 22 had an aortic stenosis. The LVOT area was measured using both 2D-echo and 3D-echo, and the circularity index, using 3D-echo alone. In addition, the severity of valvular aortic stenosis was categorized using both 2D-echo and 3D-echo. Results. The levels of inter- and intra-observer agreement on LVOT area measurements were better with 3D-echo. The circularity index was 1.50 (0.25), and there was a very poor linear correlation with LVOT area (r=­0.34; P=.47). Patients with valvular aortic stenosis were categorized according to the severity of their stenoses using both 2D-echo and 3D-echo. The level of agreement between the two techniques was poor (κ=0.36). Conclusions. Measurements of the LVOT area made using 3D-echo were more reproducible than those made using 2D-echo. Consequently, 3D-echo may be a better technique for assessing the LVOT area. In addition, 3D-echo showed that the LVOT is elliptical in form and that its size is not related to its circularity. Moreover, 3D-echo could also be helpful in classifying the severity of valvular aortic stenosis (AU)

[Usefulness of parametric imaging-based quantitative myocardial contrast echocardiography in predicting the functional recovery of akinetic segments following primary angioplasty in acute myocardial infarction patients]. / Utilidad de la ecocardiografía de contraste miocárdico con cuantificación basada en imagen paramétrica para la predicción de la recuperación funcional de segmentos acinéticos en pacientes con infarto agudo de miocardio sometidos a angioplastia primaria.

INTRODUCTION AND OBJECTIVES: Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE; and b) to assess the usefulness of these measurements in predicting functional recovery of these segments. PATIENTS AND METHOD: The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images. RESULTS: The patients' mean age was 62.3+/-14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (beta): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion. CONCLUSIONS: Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods.

Utilidad de la ecocardiografía de contraste miocárdico con cuantificación basada en imagen paramétrica para la predicción de la recuperación funcional de segmentos acinéticos en pacientes con infarto agudo de miocardio sometidos a angioplastia primaria / Usefulness of parametric imaging-based quantitative myocardial contrast echocardiography in predicting the functional recovery of akinetic segments following primary angioplasty in acute myocardial infarction patients

Introducción y objetivos. La ecocardiografía de contraste miocárdico (ECM) es útil para predecir la recuperación funcional de los segmentos acinéticos en pacientes que reciben una angioplastia coronaria transluminal percutánea primaria. Se ha desarrollado recientemente la imagen paramétrica para la cuantificación de la perfusión. Los objetivos son: a) valorar de forma cuantitativa la perfusión de los segmentos acinéticos en pacientes que reciben angioplastia primaria, y b) evaluar la utilidad de la cuantificación con imagen paramétrica para predecir la recuperación funcional de los segmentos acinéticos.Pacientes y método. Se analizó a 49 pacientes con infarto agudo de miocardio (IAM) que recibieron angioplastia primaria. Se realizó ecocardiograma estándar y ECM entre los 2 y 5 días posteriores al IAM. Se realizaron ecocardiograma estándar y cateterismo a los 6 meses. La evaluación cualitativa y cuantitativa fue realizada off-line por 2 investigadores independientes. Resultados. La edad media fue de 62,3 ± 14,5 años (39 varones). En el estudio basal se detectaron 170 segmentos acinéticos. La recuperación funcional fue observada en 105 segmentos. El mejor parámetro cuantitativo para predecir la recuperación funcional fue la velocidad del flujo sanguíneo (β): el área bajo la curva ROC fue 0,96 (intervalo de confianza del 95%, 0,92-0,99). Para un punto de corte de 31dB/s, la sensibilidad fue del 87,62%, la especificidad del 95,31%, el valor predictivo positivo del 96,8% y el valor predictivo negativo del 82,43%. Estos resultados son mejores que los obtenidos con el método cualitativo. Conclusiones. La cuantificación de la perfusión con imagen paramétrica es una herramienta útil para predecir la recuperación funcional de los segmentos acinéticos en pacientes que reciben angioplastia coronaria transluminal percutánea primaria y es mejor que la valoración cualitativa

Introduction and objectives. Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE; and b) to assess the usefulness of these measurements in predicting functional recovery of these segments. Patients and method. The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images. Results. The patients' mean age was 62.3±14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (β): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion. Conclusions. Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods

Evidence of singularities for a family of contour dynamics equations.

In this work, we show evidence of the existence of singularities developing in finite time for a class of contour dynamics equations depending on a parameter 0 < alpha 0 corresponds to 2D Euler equations, and alpha = 1 corresponds to the surface quasi-geostrophic equation. The singularity is point-like, and it is approached in a self-similar manner.

[Hand-held echocardiographic devices: what do they add to the initial cardiovascular evaluation?]. / Ecocardiograma portátil: ¿qué añade a la valoración cardiovascular inicial?

INTRODUCTION AND OBJECTIVES: Hand-held echocardiographic devices have recently become available. Our objective was to determine, on the basis of clinical data and basic diagnostic techniques, whether hand-held devices offer additional information useful not provided by the initial cardiovascular diagnosis. PATIENTS AND METHOD: We prospectively studied the presence and severity (absent, mild, significative) of 7 frequent heart diseases (aortic or mitral stenosis-regurgitation, tricuspid regurgitation, and left ventricular systolic dysfunction-hypertrophy) in 36 consecutive patients (50% men; mean age 68 12 years) with 3 different methods: clinical examination and basic complementary exams, hand-held echocardiography with 2D and color Doppler imaging (OptiGo, Philips Medical Systems, The Netherlands) and a standard, last-generation transthoracic echocardiogram (Sonos 550, Philips Medical Systems, The Netherlands). We compared the results obtained with the first two methods, and combined the results of both to compare these findings against the results obtained with standard electrocardiography. Percentage agreement and Somer's D, a measure of association between ordinal variables, were calculated. RESULTS: The hand-held device obtained better results than clinical examination (agreement 87 vs. 65%; D = 0.79 0.04 vs. 0.19 0.53) and identified severe lesions that were classified incorrectly by clinical examination in 39% (14/36) patients. However, in 8 patients (10 evaluations) it misclassified severe lesions. CONCLUSIONS: In experienced hands, a hand-held echocardiographic device offers additional information not obtained from an initial cardiovascular diagnosis for common cardiovascular disorders, but it is no substitute for complete echocardiographic examination.

Ecocardiograma portátil: ¿qué añade a la valoración cardiovascular inicial? / Hand-held echocardiographic devices: what do they add to the initial cardiovascular evaluation?

Introducción y objetivos. Desde hace poco tiempo disponemos de nuevos sistemas portátiles de ecocardiografía. Nuestro objetivo es determinar si un ecocardiograma portátil aporta información suplementaria al diagnóstico cardiovascular inicial, basado en datos clínicos y técnicas diagnósticas básicas. Pacientes y método. Estudiamos prospectivamente la presencia y severidad (ausente, leve, significativa) de 7 cardiopatías frecuentes: estenosis-insuficiencia aórtica y mitral, insuficiencia tricuspídea y disfunción-hipertrofia ventricular izquierda en pacientes consecutivos mediante 3 técnicas distintas: valoración clínica junto con pruebas complementarias básicas, ecocardiograma portátil con imagen 2D y Doppler color (Optigo®, Philips Medical Systems) y ecocardiograma estándar de última generación (Sonos 5500®, Philips Medical Systems). Comparamos los resultados obtenidos mediante las primeras 2 técnicas y combinando los resultados de ambas, respecto al ecocardiograma estándar, mediante el porcentaje de concordancia y la medida de asociación D de Somers. Resultados. Estudiamos a 36 pacientes (50 por ciento varones; edad, 68 ñ 12 años). El ecocardiograma portátil obtuvo mejores resultados que la valoración clínica (concordancia del 87 frente al 65 por ciento; D = 0,79 ñ 0,04 frente a 0,19 ñ 0,53) e identificó lesiones significativas incorrectamente valoradas por la clínica en un 39 por ciento (14/36) de los pacientes; sin embargo, en 8 pacientes (10 valoraciones) valoró erróneamente lesiones significativas. Conclusiones. El ecocardiograma portátil, en manos experimentadas, aporta información adicional al diagnóstico inicial de enfermedades cardiovasculares comunes, pero no resulta equivalente a un diagnóstico ecocardiográfico completo (AU)

Relationship between the changes in myocardial perfusion and left ventricular ejection fraction after acute myocardial infarction. Study with myocardial contrast echocardiography.

BACKGROUND AND OBJECTIVE: Myocardial contrast echocardiography has recently been proposed as a valid technique in the evaluation of myocardial perfusion after myocardial infarction. The objective of this study was to evaluate the relation between changes in myocardial perfusion assessed by myocardial contrast echocardiography and left ventricular ejection fraction after myocardial infarction. PATIENTS AND METHODS: We prospectively studied 17 patients with acute myocardial infarction, on whom two echocardiographic studies were performed, at 48-72 hours and at 6 months. Left ventricular ejection fraction and myocardial perfusion were evaluated with myocardial contrast echocardiography (Multiple-Frame Triggering and Harmonic Angio). Basal, medial and distal segments of the interventricular septum (anterior location infarction) and inferior wall (inferior infarction) were assessed. Myocardial perfusion was classified semi-quantitatively as grade 0, 1 or 2 (absent, heterogeneous or homogeneous opacification, respectively), giving a perfusion score. RESULTS: Left ventricular ejection fraction improved in 9 patients (53%), the proportion of grade 0 segments decreasing by 11 +/- 17%; by contrast, this proportion increased by 9 +/- 13% in patients with no improvement in ejection fraction (p = 0.028). Additionally, a significant correlation was observed between changes in ejection fraction and both perfusion score (r = 0.625; p = 0.007) and the proportion of grade 2 segments (r = 0.649; p = 0.005). CONCLUSION: After myocardial infarction, there is a significant relation between changes in left ventricular ejection fraction and myocardial perfusion assessed by myocardial contrast echocardiography with i.v. agents.

Value of automated segmental motion analysis in the assessment of aortic stenosis severity.

BACKGROUND AND AIMS OF THE STUDY: Left ventricular (LV) contraction is slowed in patients with aortic stenosis (AS). Although the possible role of LV systolic function abnormalities in the assessment of AS severity has been evaluated, current echocardiographic techniques cannot offer precise quantification of LV motion velocity. The study aim was to evaluate an automated segmental motion analysis (ASMA) system to assess AS severity. METHODS: Twenty-two patients with AS, sinus rhythm and preserved LV ejection fraction were studied prospectively. Patients underwent both conventional Doppler echocardiography to measure transaortic gradient and aortic valve area by the continuity equation, and ASMA of the interventricular septum. The ASMA line graph mode displays changes in area through the cardiac cycle. The RR interval and time from the R-wave to peak maximum area shortening were measured, and an ASMA index was calculated. RESULTS: A significant and strong inverse correlation was found between aortic valve area and ASMA index (r = -0.78; 95% CI -0.90 to -0.55; p <0.001). The area under the ROC curve in the diagnosis of severe AS (aortic valve area < or =0.8 cm2) was 0.97 (95% CI 0.90-1.0). Sensitivity, specificity, positive and negative predictive values and overall accuracy for an ASMA index >0.40 were 100, 91.7, 92.3, 100 and 95.8%, respectively. CONCLUSION: The ASMA system may be valuable in evaluating AS, as it offers a strong correlation with aortic valve area calculated by the continuity equation, and very high sensitivity and specificity in the diagnosis of severe AS.

Perioperative mortality and long-term outcome of infective endocarditis.

INTRODUCTION AND OBJECTIVES: Infective endocarditis (IE) is a disease with a high morbidity and mortality during the active phase and a considerable risk of complications during follow-up. The aim of this study is to describe the clinical features of IE associated with perioperative mortality in patients undergoing surgery and the short- and long-term prognosis of this disease after surgical treatment. PATIENTS AND METHODS: The clinical files of 150 patients (pts) admitted to our institution between 1989 and 2001 and whose final diagnosis was IE (Duke criteria) were retrospectively reviewed. Thus all patients included underwent at least 1 transthoracic examination, and a transesophageal examination if indicated. The study population was 69 patients with IE, 62 of whom (90%) underwent prosthetic valve replacement and 7 (10%) underwent explanation of pacemaker electrocatheter. In the statistical analysis, quantitative variables are expressed as means +/- SD and qualitative variables as proportions (percentages). Differences in survival were determined using the Kaplan-Meier log rank method. Associations were considered statistically significant when the p value was < 0.05. RESULTS: The mean age was 56 +/- 15 years. Thirty-five cases (51%) had prosthetic valve endocarditis, 30 (39%) had native valve IE and 7 (10%) pacemaker electrocatheter IE. Fifty-two patients (75%) had positive blood cultures. The most frequent agents were S. epidermidis (14.5%), S. aureus (14.5%), Enterococci (13%) and S. viridans (10%). Total perioperative mortality was 17.4% (n = 12), and surgical mortality was 19.4%. Our study shows a statistical tendency for higher mortality in diabetic patients (50% vs. 14%, p = 0.052) and in women (29% vs. 11%, p = 0.065). In multivariate analysis, the presence of heart failure was an independent predictor of perioperative mortality (OR = 11.4; 95% CI: 2.0-215.2; p = 0.024). Accumulated mortality in the first year was 28% and 5-year mortality was 48%. CONCLUSIONS: Prosthetic valve replacement in patients with IE is associated with high perioperative mortality (17.4%). Despite good early postoperative results, the mortality rate increases during the first year as well as the need for reoperation.