Echocardiographic profile of the transplanted human heart in clinically well recipients.

Thirty-four clinically well heart transplant recipients, aged 21 to 60 years, were selected for echocardiographic study at 12 +/- 2 months after transplantation. All had normal findings at stress thallium scintigraphy and at radionuclide left ventriculography, and no endomyocardial biopsy evidence of rejection was found within 36 hours of study. Multiple echocardiographic measurements were compared with those from two control groups. The first control group consisted of 15 normal subjects of similar ages as the donors, and the second group consisted of 15 normal subjects of similar ages as the recipients. Left ventricular mass (193 +/- 55 gm) was significantly increased in the transplant recipients compared with both control groups (p less than 0.001). Left ventricular volumes and ejection fractions of the transplanted heart, however, were normal. Right ventricular diastolic wall thickness (0.6 +/- 0.1 cm) and chamber area in both diastole (23.3 +/- 3 cm2) and systole (15.7 +/- 4 cm2) were significantly increased in the transplant patients (p less than 0.001), but fractional area change was similar to that of the normal group. Both left atrial area (26.9 +/- 4 cm2) and right atrial area (20.7 +/- 4 cm2) were significantly increased in the transplant recipients (p less than 0.001). One year after transplantation, clinically well recipients are characterized by increased left ventricular mass, but normal volumes and ejection fraction, increased right ventricular wall thickness and cavity size, but normal right ventricular systolic function, and markedly dilated atria.

Noninvasive estimation of left atrial pressure in patients with congestive heart failure and mitral regurgitation by Doppler echocardiography.

A completely noninvasive method for estimating left atrial pressure in patients with congestive heart failure and mitral regurgitation has been devised with the use of continuous-wave Doppler echocardiography and brachial sphygmomanometry. Of 46 patients studied with mitral regurgitation, 35 (76%) had jets with distinct Doppler spectral envelopes recorded. The peak ventriculoatrial gradient was obtained by measuring peak mitral regurgitant velocity in systole and using the modified Bernoulli equation. This gradient was then subtracted from peak brachial systolic blood pressure, an estimate of left ventricular systolic pressure, to yield left atrial pressure (left atrial pressure = systolic blood pressure - mitral regurgitant pressure gradient). Noninvasive estimates of left atrial pressure from 35 patients were plotted against simultaneous recordings of mean pulmonary capillary wedge pressure resulting in the correlation y = 0.88x + 3.3, r = 0.88, standard error of estimate = +/- 4 mm Hg (p less than 0.001). Therefore, continuous-wave Doppler echocardiography and sphygmomanometry may be used in selected patients with congestive heart failure and mitral regurgitation for noninvasive estimation of left atrial pressure.

Reversible segmental left ventricular dysfunction after coronary angioplasty.

Patients with chronic segmental myocardial dysfunction may demonstrate improvement after coronary revascularization. To evaluate the early effects of percutaneous transluminal coronary angioplasty (PTCA) on resting left ventricular segmental function, we obtained serial two-dimensional echocardiograms 1.1 +/- 0.9 days before and 3.1 +/- 2 days after elective PTCA in 40 patients. Echocardiograms were reviewed in a blind fashion; left ventricular segmental wall motion was analyzed in four short-axis views, and a score was assigned to each region (0, normal; 1, hypokinetic; and 2, akinetic). Abnormal regional wall motion was present in 20 of the patients before PTCA. Summed segment scores in these 20 patients showed an improvement in regional wall motion from 4.5 +/- 2.5 to 1.6 +/- 2.1 (p less than 0.01) after successful PTCA. Similar results were obtained when the patients were divided into those with or without a previous myocardial infarction. Improvement occurred in the seven patients without a previous myocardial infarction; the summed segment score decreased from 4.2 +/- 3.4 to 0.86 +/- 1.6 (p less than 0.05) after PTCA. Ten of the 13 patients with a prior myocardial infarction demonstrated improvement in wall motion after PTCA; the summed segment scores decreased 54% (p less than 0.001). Of the 260 segments analyzed in the study, 180 were normal before and after PTCA. Forty-nine of the 69 hypokinetic segments were normal, and 10 of 12 akinetic segments were hypokinetic after successful coronary revascularization. There was no deterioration in wall motion after PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris or acute myocardial infarction.

The effect of percutaneous transluminal coronary angioplasty (PTCA) on left ventricular (LV) diastolic function has not been systematically investigated in patients treated for unstable angina or ischemia after acute myocardial infarction (AMI). To assess the relation between reduction of stenosis severity and improvement in diastolic function in this setting, 42 patients with either unstable angina (n = 22) or post-AMI ischemia (n = 20) were serially monitored by Doppler echocardiography 8 +/- 5 hours before and 2 +/- 1 days after PTCA. Doppler LV filling indexes included isovolumic relaxation time, mitral deceleration time, E/A peak velocity ratio and atrial filling fraction. Eighteen aged-matched control subjects served to establish normal values for comparison. Before PTCA, both groups exhibited abnormal diastolic function demonstrated by prolonged isovolumic relaxation time and mitral deceleration time, decreased E/A ratio and increased atrial filling fraction. After PTCA isovolumic relaxation time and deceleration time decreased 18 +/- 28 (p less than 0.005) and 33 +/- 43 ms (p less than 0.002) in the unstable angina group and 18 +/- 23 (p less than 0.003) and 14 +/- 34 ms (difference not significant), respectively, in the post-AMI ischemia group. An increase in E/A ratio and a decrease in atrial filling fraction occurred in both groups; however, these changes were significant only in patients with post-AMI ischemia (+21%, p less than 0.03 and -11.4%, p less than 0.005, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Perfluorochemical perfusion during coronary angioplasty in unstable and high-risk patients.

Perfluorochemical perfusion during coronary angioplasty was performed in 38 patients with unstable ischemic syndromes or with high-risk lesions in a single-blind crossover study. Patients received alternate 90-second balloon inflations with and without distal perfusion of oxygenated perfluorochemical (Fluosol, Alpha Therapeutic Corp., Los Angeles, California) at 60 ml/min. Efficacy was assessed by anginal intensity, hemodynamic and electrocardiographic parameters, and left ventricular function determined by two-dimensional echocardiography during balloon inflations. There was a trend toward lower anginal intensity with Fluosol perfusion at 30, 60, and 90 seconds of occlusion. Pulmonary wedge pressure increased significantly with and without Fluosol perfusion, and the magnitude of change was not different. Cardiac output decreased significantly less with Fluosol perfusion than with routine inflation for the total group (-0.8 vs. -1.2 l/min, p less than 0.01) and in the subgroup with left anterior descending coronary artery (LAD) angioplasty (-0.7 vs. -1.5 l/min, p less than 0.001). Left ventricular ejection fraction (EF) by echocardiography declined significantly less with Fluosol perfusion (-4.0 vs. -7.9 EF units, p less than 0.004) than with routine inflation for the total population and declined significantly less with Fluosol in the subgroup with LAD angioplasty (-5.5 vs. -9.7 EF units, p less than 0.008). Regional wall-motion abnormality score increased significantly with routine inflation (from 0.7 +/- 1.4 to 3.5 +/- 3.2, p less than 0.001) and did not change with Fluosol perfusion (from 0.8 +/- 1.3 to 1.3 +/- 1.1, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)