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Carlos Almería

Publications and source records attributed to Carlos Almería.

At least 19 recordsLinked to original sources
PubMed2006

Which method should be the reference method to evaluate the severity of rheumatic mitral stenosis? Gorlin's method versus 3D-echo.

INTRODUCTION: Several studies have shown a wide variability among different methods to determine the valve area in patients with rheumatic mitral stenosis. Our aim was to evaluate if 3D-echo planimetry is more accurate than the Gorlin method to measure the valve area. METHODS: Twenty-six patients with mitral stenosis underwent 2D and 3D-echo echocardiographic examinations and catheterization. Valve area was estimated by different methods. A median value of the mitral valve area, obtained from the measurements of three classical non-invasive methods (2D planimetry, pressure half-time and PISA method), was used as the reference method and it was compared with 3D-echo planimetry and Gorlin's method. RESULTS: Our results showed that the accuracy of 3D-echo planimetry is superior to the accuracy of the Gorlin method for the assessment of mitral valve area. CONCLUSIONS: We should keep in mind the fact that 3D-echo planimetry may be a better reference method than the Gorlin method to assess the severity of rheumatic mitral stenosis.

Adult↗
PubMed2006

Prognostic significance of functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome.

AIMS: The development of mitral regurgitation (MR) after an acute myocardial infarction (AMI) is a recognized and frequent complication and its negative impact on survival has been observed. However, few data exist regarding MR after non-ST-segment elevation acute coronary syndrome (NSTSEACS). Our aim was to investigate the incidence, clinical predictors, and prognostic implications of MR in the setting of NSTSEACS. METHODS AND RESULTS: We studied 300 consecutive patients (71.7% men, mean age 66.9+/-13 years) admitted to our coronary care unit for an NSTSEACS. Every patient underwent an echocardiographic study during the first week after the index NSTSEACS and was clinically followed up. MR was detected in 42% (126 patients; 88 men, mean age 71.3+/-11 years). Mean follow-up was 425.6+/-194.8 days. Only age and left ventricular (LV) ejection fraction (EF) were found as independent markers of the development of MR; no variable was found as an independent predictor of in-hospital mortality and only MR was found as an independent predictor of long-term outcome. CONCLUSION: MR is frequent after an NSTSEACS. Age and a low LV EF are factors associated to its development. The presence and degree of MR confer a worse long-term prognosis to patients after a first NSTSEACS. Thus, the presence of MR should be specifically assessed in every patient after an NSTSEACS.

Aged↗
PubMed2005

Effect of antithrombotic therapy in patients with mitral stenosis and atrial fibrillation: a sub-analysis of NASPEAF randomized trial.

AIMS: The randomized NASPEAF study included non-valvular with prior embolism and mitral stenosis patients in the same group. This is a sub-study to specially focus on the antithrombotic therapy in mitral stenosis. METHODS AND RESULTS: We analysed 311 patients with mitral stenosis, compared with 175 non-valvular atrial fibrillation patients with prior embolism, stratified by a history of previous embolism and assigned to anticoagulant therapy [target international normalized ratio (INR) = 2.0-3.0] or combined antiplatelet plus moderate intensity anticoagulant therapy. Median follow-up was 2.9 years. Outcomes were fatal and non-fatal embolism, stroke and myocardial infarction, sudden death, and death from bleeding. Combined therapy in mitral stenosis patients, compared with anticoagulant alone therapy, reduced the risk of vascular events by 58.3%. During equal therapy, the outcome annual rates were essentially the same in non-valvular and valvular patients [hazard ratio 0.90 (95% confidence interval 0.37-2.16), P = 0.81]. During anticoagulant alone therapy, the annual event rate in mitral stenosis patients without prior embolism was low (2.5%) and it was very high in patients with prior embolism (6.6%). CONCLUSION: Combined therapy was effective in mitral stenosis patients. Prior embolism patients are not efficiently protected with anticoagulant alone therapy for an INR of 2.0-3.0.

Aged↗
PubMed2005

Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index.

AIM: Myocardial performance index (MPI) is usually measured with pulsed wave Doppler (PWD). Our aim was to assess the degree of agreement between PWD and a method based on tissue Doppler imaging (TDI). METHODS AND RESULTS: Seventy-five patients with prior myocardial infarction and 20 healthy subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI at septal and lateral sides of mitral annulus. MPI and TDI-MPI at septal side showed the best intraclass correlation coefficient (ICC=0.54; p<0.0005). Ninety-five percent interval of agreement ranged from -0.27 to 0.22. These differences were attributed to discrepancies in isovolumic contraction and relaxation times. In the healthy group the results were similar (ICC=0.44), although the 95% interval of agreement was lower (from -0.13 to 0.12). CONCLUSIONS: The agreement between PWD and TDI in the measurement of MPI is only moderate. This should be taken into account in the interpretation of studies in which TDI is used for this measurement.

Aged↗
PubMed2005

Comparison of left ventricular volumes and ejection fractions measured by three-dimensional echocardiography versus by two-dimensional echocardiography and cardiac magnetic resonance in patients with various cardiomyopathies.

End-diastolic volume and end-systolic volume were measured in 35 consecutive patients with cardiomyopathy using 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography (2, 4, and 8 planes) and cardiac magnetic resonance imaging. Three-dimensional echocardiography correlates better with magnetic resonance imaging than does 2-D echocardiography. Its accuracy improves with the increase in the number of planes used. Two-dimensional echocardiography underestimates volumes, mainly in the subgroup with an ejection fraction of <50%, whereas 3-D echocardiography does not, if enough planes are used. However, in patients with an end-diastolic volume > or =150 ml, the underestimation of 3-D echocardiography is statistically significant. Increasing the number of planes to 8 reduces this bias. Conversely, patients with an end-diastolic volume <150 ml are accurately studied with just 4 planes.

Adult↗
PubMed2005

Long-term prognostic importance of transient left ventricular dilation during pharmacologic stress echocardiography.

OBJECTIVES: We sought to evaluate the prognostic significance of left ventricular (LV) transient ischemic dilation (TID) for patients with a positive stress echocardiogram (SE). BACKGROUND: TID during SE has been related to the presence of extensive coronary artery disease, but its long-term prognostic implications have not been reported. METHODS: In all, 99 consecutive patients with a positive SE comprised the study group. LV volumes were evaluated according to the modified Simpson's rule. TID during SE was defined as the presence of an increase in LV end-diastolic volume during the stress test. A clinical history was fulfilled for each patient and all of them were followed up. RESULTS: Of 99 patients, 32 (32.3%) showed TID. Mean age was 65.8 +/- 9.8 years for non-TID group and 70.2 +/- 8.4 for TID group (P = .048). Baseline characteristics and subsequent treatment were similar in both groups. Mean follow-up was 21.4 +/- 15.8 months. In non-TID group the mean survival free of acute myocardial infarction was 47.28 months and 39.7 months in TID group (log rank = 0.012). In the univariate and multivariate analysis only TID and the wall motion score index were found as independent predictors related to long-term prognosis (risk ratio = 6.9; 95% confidence interval = 0.8-59.6; P = .042; and risk ratio = 0.4; 95% confidence interval = 0.18-0.89; P = .047, respectively). CONCLUSIONS: LV TID during SE is an easy and independent prognostic marker. It helps to select patients with increased risk.

Aged↗
PubMed2005

Distinguishing between ischemic and non-ischemic dilated cardiomyopathy based on non-invasive ultrasonic evaluation of peripheral arteries.

BACKGROUND: Recently, high-frequency transducers have been introduced in echocardiography laboratories to non-invasively evaluate peripheral arteries. Our aim was to assess the usefulness of these non-invasive vascular ultrasonic techniques in differentiating between ischemic and non-ischemic dilated cardiomyopathy. METHODS: Forty patients with dilated cardiomyopathy of uncertain origin who underwent echocardiographic examination were studied. In all patients, carotid, femoral, and brachial arteries were scanned using high-frequency transducers in order to detect atherosclerotic plaques and to measure intima-media wall thickness. Also, flow-mediated vasodilation was measured at the brachial artery. RESULTS: Of the 40 patients studied, 24 (60%) had significant coronary lesions. In patients with ischemic cardiomyopathy, carotid plaques were found more frequently (79% vs. 25%, p=0.001), and intima-media wall thickness was higher in carotid (1.14+/-0.23 vs. 0.84+/-0.20 mm, <0.001), femoral (1.21+/-0.15 vs. 0.90+/-0.17 mm, p<0.001), and brachial (0.85+/-0.11 vs. 0.68+/-0.12, p<0.001) arteries. Carotid intima-media thickness of 1 mm or more was 83% sensitive and 69% specific for the diagnosis of ischemic cardiomyopathy. The highest diagnostic accuracy for any isolated vascular finding was obtained for femoral intima-media thickness greater than 1.1 mm (83% sensitivity, 88% specificity) and for brachial intima-media thickness greater than 0.7 mm (88% sensitivity and 81% specificity). The highest sensitivity (92%) was obtained for the presence of 1 or more vascular findings, and the highest specificity (94%) for 3 or more vascular findings. CONCLUSION: Non-invasive assessment of peripheral arteries is of help in differentiating between ischemic and non-ischemic dilated cardiomyopathy. These ultrasonic techniques should be considered as complementary examinations in the evaluation of patients with dilated cardiomyopathy in echocardiography laboratories.

Journal Article↗
PubMed2005

Usefulness of real-time 3-dimensional echocardiography in the assessment of infective endocarditis: initial experience.

OBJECTIVE: Our aim was to provide an initial description of the usefulness of real-time 3-dimensional (3D) echocardiography when evaluating patients with infective endocarditis. METHODS: For this purpose, we describe 3 cases in which the usefulness of real-time 3D echocardiography is shown. RESULTS: Better definition of the morphologic characteristics of the vegetation and valvular apparatus was achieved with real-time 3D echocardiography. Furthermore, the information provided by the real-time 3D echocardiogram to the surgical team was accurate and direct because it was not based on detailed verbal information for performing a 3D mental reconstruction but was a simple image similar to what would be found in the operating room. In all cases, the information provided by the real-time 3D echocardiography was confirmed during surgery. CONCLUSIONS: Real-time 3D echocardiography is an important tool for aiding diagnosis or for fine tuning a suspected diagnosis when traditional echocardiography is not completely clear for both medical and surgical decision making.

Aged↗
PubMed2005

[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].

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.

Aged↗
PubMed2005

Infective endocarditis: mid-term prognosis in patients with good in-hospital outcome.

BACKGROUND AND AIM OF THE STUDY: The study aim was to analyze the mid-term prognosis of infective endocarditis (IE) in patients managed with medical therapy during the in-hospital phase and who had a good initial outcome. Comparison was made with the prognosis of patients treated surgically during this period. METHODS: A total of 151 patients diagnosed with IE was studied, and in-hospital outcome, clinical characteristics and mid-term follow up data were analyzed. The main end-point was a composite of death and need for surgical repair. RESULTS: Among 151 patients, 84 (56%) underwent surgery or died during the in-hospital phase, while 67 patients (44%) received medical treatment and were discharged clinically stable with a final diagnosis of healed infective endocarditis. A better baseline profile was seen in the medically treated group, but outcome in this group showed extensive mid-term morbidity/mortality. In total, 52.2% of patients underwent surgery to correct complications and 60% died as a consequence of the disease. The event-free survival rate was 20% at five years. CONCLUSION: Despite a favorable in-hospital clinical course and successful medical treatment, patients with IE are at risk of late complications that result in a need for surgical repair, or in death. A close follow up should be made in order to treat late complications.

Aneurysm, False↗
PubMed2004

Prognostic influence of mitral regurgitation prior to a first myocardial infarction.

AIMS: Mitral regurgitation (MR) following an acute myocardial infarction (AMI) confers an adverse prognosis during long-term follow-up. There are no studies evaluating the influence of pre-AMI MR in the short- and long-term prognosis of such patients. Our aim was to assess the prognostic value of pre-AMI MR in the short- and long-term follow-up of patients who suffered a first AMI and to assess its influence on left ventricular haemodynamics. METHODS AND RESULTS: Sixty-eight consecutive patients with a first AMI and an echocardiographic study before AMI (<3 months) were included in the study. The pre-AMI echo was performed for various reasons. Of these 68 patients, 42 had pre-AMI MR (Group 1) and 26 showed no pre-AMI MR (Group 2). The presence of degenerative changes at the level of the mitral valve was confirmed in all cases. Patients with any other cause of MR were excluded. Clinical and echocardiographic variables for both phases (pre-AMI and post-AMI) were analysed and patients were followed up. Mean age was 75.5+/-9.5 years; there were 38 males (55.9%). There were no statistical differences in baseline clinical variables between the groups, except for the presence of pre-AMI atrial fibrillation, which was more frequent in Group 1 (21.4 vs. 0%; P = 0.01). After AMI, only end-diastolic left ventricular diameter was significantly larger in Group 1 (54.9 +/- 4.7 vs. 48.1 +/- 5.6 mm; P < 0.001). During long-term follow-up, median survival times were 912 days (interquartile range: 690 days) in Group 1 and 1423 days (interquartile range: 520 days) in Group 2 (Log-rank P = 0.02). The multivariable analysis showed that the presence of pre-AMI MR relates to a statistically significant relationship with a worse post-AMI evolution [relative risk (95% confidence interval): 3.8 (1.1-13.1); P = 0.037]. CONCLUSION: The present study shows that the presence of pre-AMI MR is an independent prognostic marker among those patients suffering a first AMI.

Aged↗
PubMed2004

Differences in regional systolic and diastolic function by Doppler tissue imaging in patients with hypertrophic cardiomyopathy and hypertrophy caused by hypertension.

OBJECTIVE: Doppler tissue (DT) velocity abnormalities have been described in patients with pathologic left ventricular hypertrophy (LVH). Impaired myocardial function has been suggested as a primary disorder in hypertrophic cardiomyopathy (HCM) and differences in DT parameters have been reported to be distinguishable from other LVH causes. We evaluated DT differences for patients with LVH caused by hypertension and patients with HCM, assessing regional systolic and diastolic function. METHODS: A total of 62 participants were studied: 21 with HCM; 22 with LVH secondary to hypertension; and 19 control subjects. DT was used to record mitral annulobasal segment motion in the longitudinal axis. Systolic and diastolic velocities were measured at lateral and septal sites, and well-known ratios were obtained for diastolic assessment. A new global function index (GFI) that evaluates both systole and diastole was also calculated (GFI = [Emi/E(DT)]/S(DT) [s x cm(-1)], where mi is mitral inflow, E is E wave, and S is systolic wave). RESULTS: Comparison showed significant differences in all parameters evaluated at the septal-basal segment and a GFI value of 1.77 showed 85% sensitivity and 75% specificity for detecting HCM when interventricular septum thickness was increased. CONCLUSIONS: In the presence of unexplained LVH, markedly decreased DT velocities at basal septum efficiently detect myocardial dysfunction at this segment, and a calculated GFI > 1.77 strongly supports the diagnosis of HCM.

Cardiomyopathy, Hypertrophic↗
PubMed2004

Identifying patients without favourable long-term outcome among those with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram.

AIMS: Patients with medically stabilized unstable angina and a negative stress echocardiogram have a favourable outcome as a whole. This study sought to identify which subsets of patients are associated with serious events at long-term within this population. METHODS AND RESULTS: We studied and followed-up 128 patients (mean 2.2 +/- 1.3 years) with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram. Cumulative survival rates were 98.2 +/- 1.3%, 96.0 +/- 2.2% and 93.2 +/- 3.2%, at 1, 2 and 4 years, respectively. Freedom from events (death, myocardial infarction, and revascularization) were 98.2 +/- 1.3%, 96.0 +/- 2.2% and 86.3 +/- 6.0%, at 1, 2, and 4 years, respectively. Cumulative mortality rate was higher in men (3.6 +/- 2.5%, 8.5 +/- 4.1%, and 12.2 +/- 5.4% at 1, 2, and 4 years, vs. 0% at the end of the follow-up in women; p = 0.034), and in those with previous myocardial infarction (4.3 +/- 4.3%, 9.1 +/- 6.2%, and 18.2 +/- 2.3% at 1, 2 and 4 years, vs. 1.1 +/- 1.1%, 2.9 +/- 2.1%, and 2.9 +/- 2.1% in those without previous myocardial infarction, respectively; p = 0.047). CONCLUSION: Among patients with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram, male gender and previous myocardial infarction are associated with a non-favourable outcome.

Adult↗
PubMed2004

Right atrial rupture.

Cardiac rupture is a rare complication of primary cardiac tumors. We present a very uncommon case of cardiac angiosarcoma presenting as a right atrial rupture. A 58-year-old patient presented progressive dyspnea, weight loss, anorexia and asthenia. A chest X-ray revealed global cardiac enlargement, mainly from the right atrium. Transthoracic echocardiography gave rise to the suspicion of right atrial pseudoaneurysm, which was confirmed by transesophageal echocardiography. The ruptured atrial wall was clearly seen using contrast echo. In addition, magnetic resonance imaging provided an excellent tool in the anatomic evaluation of this uncommon complication. The diagnosis of angiosarcoma was hystologically confirmed.

Female↗
PubMed2004

Impact of echocardiography in the short- and long-term prognosis of patients with infective endocarditis and negative blood cultures.

BACKGROUND AND AIM OF THE STUDY: Higher morbidity and mortality have been attributed to patients suffering endocarditis but with negative blood cultures. The study aim was to determine whether, in the present era of routine echocardiography, patients with negative-culture endocarditis had a worse short- and long-term outcome, and whether outcomes in patients with true negative and aborted positive blood cultures were different. METHODS: When endocarditis was clinically suspected, an early (<24 h) echocardiographic examination was performed in all patients, regardless of blood culture results. In total, 151 patients diagnosed with infective endocarditis (IE) comprised the study group. Among these patients, 40 (26%) had negative blood cultures, and 28 of this subgroup (70%) had received previous antibiotic therapy. Short- and long-term features and prognosis were compared between both groups. The combined main end-point was death or need for surgical repair. RESULTS: Similar anatomic and clinical characteristics were present among those patients with positive and negative cultures. In addition, mortality and need for surgery with regard to short- and long-term follow up of both groups was similar. There were no significant differences between patients with true- or aborted-negative cultures in terms of short- and long-term prognosis. CONCLUSION: No differences in short- and long-term prognosis were seen among patients with IE and positive versus negative blood cultures. The prognosis was also similar between those with true negative culture versus aborted negative cultures. Early echocardiography in patients with clinically suspected IE may have changed the outcome in patients with negative cultures.

Adult↗
PubMed2003

Myocardial perfusion in real-time using power modulation. In vivo evidence for microcirculatory damage after acute myocardial infarction.

BACKGROUND AND OBJECTIVES: In addition to the myocardium, the microvasculature may be also damaged in acute myocardial infarction. The aim was to evaluate the capability of myocardial contrast echocardiography in the detection of microvasculature damage after myocardial infarction. PATIENTS AND METHODS: Twelve patients with recent acute myocardial infarction and five control subjects with normal coronary arteries and without history of myocardial infarction were studied. Myocardial contrast echocardiography with power modulation was performed, and quantitative data were measured off-line. Power modulation uses a combination of low (0.1) and high (1.7) mechanical indexes, allowing a real-time evaluation of myocardial perfusion. Contrast agent was administered as a 3-min bolus. The quantitative analysis was performed off-line by a different blinded investigator. The refilling velocity was calculated as the difference between the peak myocardial refilling value and the value at 1 s after the impulse divided by the time from the first second after the impulse to the peak refilling value. RESULTS: Eighty-one myocardial segments (75%) were analysed qualitatively and quantitatively in AMI patients, and 18 (60%) in control subjects (P=NS). The peak refilling intensity was not significantly different in patients and control subjects (6.62+/-5.85 vs. 7.53+/-4.06 dB, respectively). However, time to peak refilling intensity was significantly longer (5.25+/-1.57 vs. 4.00+/-0.53, P=0.004) and the velocity of refilling was significantly lower (2.74+/-5.34 vs. 6.58+/-8.02, P=0.028) in patients with myocardial infarction. CONCLUSION: There is microvasculature damage after myocardial infarction that is reflected as a delayed velocity of refilling in myocardial contrast echocardiography.

Adult↗
PubMed2003

Evaluation of myocardial perfusion with grey-scale ultra-harmonic and multiple-frame triggering. The need for quantification.

BACKGROUND AND OBJECTIVE: Contrast echocardiography has been recently introduced as a new technique for evaluating myocardial perfusion in a qualitative basis. The objective of this study was to test whether a visual subjective evaluation of myocardial perfusion by myocardial contrast echocardiography adequately matches the data obtained with an off-line quantification of myocardial perfusion. METHODS: Sixty-one myocardial segments were evaluated by myocardial contrast echocardiography with Ultra-harmonic and Multiframe Triggering in 11 patients 3-7 days after an anterior myocardial infarction, using SH-U 563A (Levovistâ, Schering AG, Berlin, Germany) as contrast agent. Myocardial perfusion was classified as grade 1 (absent), 2 (patchy or incomplete) and 3 (complete) in each segment. The quantitative analysis was performed off-line by a different investigator blinded to the qualitative evaluation, using a commercially available software. The quantitative data on grey-scale obtained were compared between grade 1, 2 and 3 segments. RESULTS: Of the 61 segments, 45 (73.8%) were classified as grade 3, whereas the remaining 16 (26.2%) were considered to be abnormally perfused (grade 2: n=12, 19.6%; grade 1: n=4, 6.6%). Segments with grade 1 perfusion had a significantly higher grey-scale value (123.6 +/- 41.3 vs. 70.1 +/- 34.3, p=0.004). However, there were no significant differences between segments with perfusion grade 2 and 3 (76.8 +/- 33.2 vs. 68.3 +/- 34.8, p=0.452). CONCLUSION: Qualitative assessment of myocardial perfusion by Ultra-harmonic and Multiframe Triggering is of limited value, since only myocardial segments with absent perfusion may be reliably identified. This findings support the need of quantification in the evaluation of myocardial perfusion by contrast echocardiography.

Aged↗