[Evaluation of the left ventricular function in ischemic heart disease: an old problem with new solutions].
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Coronary Disease↗
Biomedical subjects
D Pavan
Publications and source records attributed to D Pavan.
Echocardiographic findings of left ventricular hypertrophy and normalization of parameters of left ventricular function in patients with previous evidence of dilated and poorly contracting left ventricle and coexisting systemic hypertension.
We report 6 cases of dilated left ventricle with poor left ventricular function and coexisting systemic hypertension in whom left ventricular hypertrophy and normalization of left ventricular function and dimensions have been subsequently documented by M-mode and two-dimensional echocardiographic follow-up studies. Four patients were in New York Heart Association functional Class IV, one in Class III, and one in Class II when first seen. Normalization of left ventricular function and dimensions and features of left ventricular hypertrophy (fractional shortening from 15.0 +/- 5.2 to 39.7 +/- 5.4, left ventricular end-diastolic diameter from 6.6 +/- 0.6 to 4.6 +/- 0.6 cm, left ventricular end-systolic diameter from 5.6 +/- 0.8 to 2.8 +/- 0.6 cm, left ventricular end-diastolic radius/posterior wall thickness from 3.1 +/- 0.5 to 2.0 +/- 0.4, interventricular septum thickness from 1.2 +/- 0.3 to 1.5 +/- 0.3 cm, left atrium from 4.6 +/- 0.6 to 3.5 +/- 0.9 cm) were achieved after adequate medical treatment at the end of the follow-up (11-39 months). It appears from this study that normalization of left ventricular dimensions and function with features of left ventricular hypertrophy can occur after adequate treatment in patients with echocardiographic findings of dilated and poorly contracting left ventricle and coexisting systemic hypertension. It is conceivable, in such cases, to classify the dilatation of the left ventricle as secondary and to suggest the hypothesis of a cause-effect relationship between therapy and normalization of left ventricular parameters with findings of left ventricular hypertrophy. Further studies are needed to clarify this phenomenon.
Adult↗
[Apical hypertrophic cardiomyopathy: variability of bidimensional echocardiographic and electrocardiographic expression].
Apical hypertrophic cardiomyopathy is characterized by primary hypertrophy of the myocardium which is localized exclusively at the apex of the left ventricle. Previous studies have indicated that apical hypertrophic cardiomyopathy is characterized by a unique combination of cross-sectional echocardiographic and ECG findings ("giant" T wave inversion and high R wave voltage in the precordial leads). The aim of this study was to evaluate the possible relation between apical hypertrophy, quantitatively defined by cross-sectional echocardiography, and ECG findings in patients with apical hypertrophic cardiomyopathy. We studied 13 pts with apical hypertrophic cardiomyopathy, 10 men and 3 women (aged between 11 and 73 years, mean age 47). Apical hypertrophy was assessed quantitatively by determinating the muscle cross-sectional area in the apical region. From the end-diastolic apical 4 chamber view, endocardial and epicardial contours were digitized in order to obtain the muscle cross-sectional area of the left ventricle. The walls of the left ventricle were then divided into 3 regions (basal, mid-ventricular, apical). Final values of planimetered muscle areas are given as the average of the calculations obtained blindly and independently by 4 observers. The comparison between cross-sectional echocardiographic and electrocardiographic findings showed that patients with giant T wave inversion (T wave greater than 10 mm) and high R wave voltages (R greater than wave 25 mm) had a more severe degree of apical hypertrophy. However there was no complete agreement between cross-sectional echocardiographic and electrocardiographic findings. This study in fact demonstrates a wide variation in the degree of severity of apical hypertrophy among patients with apical hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Feasibility and variability of six methods for the echocardiographic and Doppler determination of cardiac output.
The feasibility and the intrinsic variability of six different methods of echocardiographic and Doppler flow determination of cardiac output were analysed in 34 healthy volunteers. Four were excluded because of poor quality echocardiograms. The mean (range) age of the remaining 30 (12 women, 18 men) was 21 years (13-36 years). Cardiac output was calculated by six methods as a product of echocardiographically determined cross sectional area of the aorta (apical and suprasternal views), pulmonary trunk, tricuspid annulus, and mitral annulus (circular and corrected for diastolic variations), and the flow velocity integral measured by Doppler. Cardiac output ranged from 2.79 to 6.56 1/min (4.45 (1.29) 1/min) (mean (SD)). The feasibility of the methods ranged from 87% (26 patients) for the aorta from the suprasternal notch to 100% (30 patients) for the mitral orifice corrected for diastolic variations and for the tricuspid valve. The corresponding results for all 34 individuals were 76% and 88% respectively. Three way analysis of variance was performed in the 23 healthy volunteers in whom all six methods were feasible. Interobserver and intraobserver interpretative variabilities were 6.8% and 5.9% respectively. The intrinsic variability of each single measurement of cardiac output, independently of the observer and the method used, was 25%. Provided the image was suitable for analysis echocardiographic and Doppler flow determination of cardiac output was feasible in most healthy volunteers. But there was significant intrinsic variability for each of different methods. A single value of cardiac output in an individual should be interpreted with caution.
Adolescent↗
[Normally functioning mitral prosthesis: visualization and characterization of the trans-valvular flow using color-coded Doppler].
Color flow imaging (CFI) allows real time visualization of intracardiac and transvalvular blood flow, superimposed on two-dimensional echocardiographic images. Therefore it can be useful in the identification and characterization of spatial configuration of jets through valve prosthesis. The aim of this study was to define the transvalvular flow pattern of jet in 54 patients (pts) with mitral valve prosthesis which were functioning well. Thirty-six of these pts were females and 18 males; their ages ranged from 40 to 73 years, mean age: 58. Prosthetic mitral inflow was evaluated utilizing the parasternal long axis, apical long axis and apical 4 chamber views; in addition ("off axis") intermediate sections were used when needed. Adequate CFI for detailed frame by frame analysis was obtained in 50 pts (92%). Fourteen pts had biological prosthesis (9 Hancock, 4 Carpentier-Edwards, 1 Ionescu-Shiley). Thirty-six pts had mechanical prosthesis: 13 Björk-Shiley, 8 Starr-Edwards, 9 Sorin, 5 Lillehey-Kaster, 1 Smeloff-Cutter. Variable jet configurations were identified, which were related to the type of prosthetic valve. Bioprosthetic valve characteristically had a wide, homogeneous transvalvular flow, directed towards the interventricular septum. Björk-Shiley prosthesis presented typically a jet with two components. Trans-prosthetic flow was dependent on the spatial position of the prosthesis and on the orientation of the tilting disc. Thus, the main jet, coming from the major orifice, could be directed towards the apex, flowing parallel to the left ventricular postero-lateral wall while the jet coming from the minor orifice was thin and directed towards the interventricular septum.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Comparison of continuous wave Doppler and heart catheterization in the determination of the mean transvalvular gradient in mitral stenosis. A simultaneous beat to beat analysis].
Continuous wave Doppler echocardiography (CWD) is widely used in the assessment of pressure gradients in patients with valvular heart disease, utilizing the simplified Bernoulli equation. However determination of non-simultaneous mean pressure gradient (MG) in mitral stenosis (MS) from CWD recordings has often been described as being unsatisfactory. Therefore, the purpose of this study was to compare the estimates of trans-mitral MG derived from CWD with gradients measured simultaneously at cardiac catheterization (beat to beat analysis). We studied 3 patients (pts) with MS (1 man and 2 women, aged 55, 55 and 62 years respectively); one patient (pt) was in sinus rhythm and 2 were in atrial fibrillation. In each pt the trans-mitral flow velocity curve was obtained simultaneously with trans-mitral gradient measured directly at cardiac catheterization (cath). In this way it was possible to obtain a beat to beat correlation between Doppler and cath in 181 beats taken from the 3 pts. These beats were selected from a total number of 321 beats because of their excellent quality for analysis (74 beats were obtained from the first pt, 38 from the second pt and 69 from the third pt). Mean diastolic velocity, defined as the mean of maximal velocities throughout diastole, was obtained for each beat by planimetring the envelope of the spectral velocity profile. MG was calculated from mean velocity by applying the simplified Bernoulli equation (delta P = 4V2).(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiac Catheterization↗
Secondary neoplastic infiltration of the myocardium diagnosed by two-dimensional echocardiography in seven cases with anatomic confirmation.
In seven patients with different types of neoplasm, secondary myocardial infiltration was diagnosed in vivo by two-dimensional echocardiography and confirmed by direct inspection. In all patients, clinical and electrocardiographic findings were suggestive but nonspecific for myocardial involvement. Two patients had cardiac tamponade and three had pericardial effusion. In three patients, the echocardiographic diagnosis made it possible to plan specific therapy. Clinical, electrocardiographic and echocardiographic aspects are discussed. A two-dimensional echocardiographic examination should be performed in all patients when cardiac metastatic involvement is suspected from clinical electrocardiographic findings, because the in vivo diagnosis of such a condition may have important therapeutic implications for such patients.
Adult↗
Normalization of variables of left ventricular function in patients with alcoholic cardiomyopathy after cessation of excessive alcohol intake: an echocardiographic study.
An excessive alcohol intake has been reported as one of the possible causes or risk factors of 'alcoholic cardiomyopathy'. The possibility that this cardiomyopathy may improve or even reverse if the alcohol abuse has been terminated has been suggested, but unequivocal echocardiographic documentation of this improvement has never been described. This study reports the normalization of cardiac chamber dimensions and of variables of left ventricular function documented by M-mode and cross-sectional echocardiographic follow-up studies, after cessation of excessive consumption of alcohol, in three cases of alcoholic cardiomyopathy.
Adult↗
Abnormal myocardial texture demonstrated by ultrasound in two patients with idiopathic haemochromatosis.
We studied by cross-sectional echocardiography seven patients affected by idiopathic haemochromatosis without clinical signs of heart failure. In two patients the heart muscle showed a peculiar echocardiographic texture at the level of the endocardium. No differences were noticed in clinical and haematological findings of the patients with and without abnormal texture. Increased echogenicity of the subendocardial myocardium should be looked for in patients with idiopathic haemochromatosis.
Adult↗
[Visualization and characterization of the transvalvular jet in mitral stenosis using color-coded Doppler].
Two-dimensional Color Doppler flow imaging is a new non-invasive technique which allows real-time visualization of intracardiac blood flow and provides informations about its direction, velocity and presence of turbulence. As a consequence the identification of jets configuration across stenotic valve orifices is now possible by Color flow imaging. This non invasive tool may be particularly helpful in patients with rheumatic mitral valve disease in whom distortion of mitral valve apparatus is often present, determining a non uniform and variable appearance of jets. Therefore the aim of this study was to describe our initial experience with color flow imaging in the visualization of transtenotic mitral jets in order to characterize different spatial configurations. We studied 45 patients with clinical and echocardiographic diagnosis of mitral stenosis. The mean age of these patients was 59 years (range from 36 to 72 years), 34 were women and 11 men. The different types of transmitral jets were characterized by real time and frame by frame analysis. The following characteristics of transmitral jets have been evaluated: A) appearance ("Candle flame", "Mushroom", "Scimitar"-shaped, "Double-jets"); B) direction (centrally directed or eccentric); C) extension into the left ventricle (basal, mid-ventricular and apical); D) persistence of turbulent flow during diastole (early-, mid-, late diastole). Mitral valve area was calculated from the velocity tracings obtained by continuous wave Doppler, applying the pressure half-time method. Color flow imaging of good quality for analysis was obtained in 41 of 45 patients (91%). In the other 4 patients the quality of color flow images was suboptimal however the direction and configuration of the jets could still be visualised.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Characterization of transmitral flow using color-coded Doppler in a case of left atrial myxoma].
The authors describe the transmitral flow pattern by color flow imaging in a patient with left atrial myxoma. The usefulness of color Doppler relays in the identification of the eccentric direction of transmitral flow, possibly present in such situation.
Blood Circulation↗
Heterogeneity of left ventricular wall dynamics in normal hearts and in chronic aortic regurgitation. A two-dimensional echocardiographic study.
The variation in shape, in the global and regional function of the left ventricle (LV) was quantitated by using Two-Dimensional Echocardiography (TDE) in 20 normal subjects (N) (17 males, 3 females, with a mean age of 21.2 years, age range 15 to 34) and compared to 20 patients with aortic regurgitation (AR) (14 males, 6 females with a mean age of 31 years, age range 16 to 51). The left ventricle was subdivided into two TDE short axis cross-sections at the papillary muscle (PM) and at the mitral valve (MV) level. Wall motion was assessed by the following indices; endocardial systolic fractional area change (FAC), wall thickening (Wth) and circumferential fiber shortening (S). The ejection fraction (EF), the diastolic (EID) and systolic eccentricity index (EIS), the end-diastolic volume (EDV), the end systolic volume (ESV) and the LV mass (M) were estimated using a 4 chamber apical view. Measurements of sectional cavity areas, muscle areas and endocardial perimeters were obtained twice independently by two observers using a computer aided system, to achieve the final results as the mean of the 4 measurements. Paired t-test showed a statistically significant variation between PM and MV for FAC in N (p less than 0.001). A statistically significant difference (p less than 0.01) was found for EID between N and AR. The EIS was not significantly different in the two groups. In AR a significant difference was found between EID and EIS (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
The reliability of a timeline method for assessing normal drinker college students' recent drinking history: utility for alcohol research.
The test-retest reliability of male (n = 40) and female (n = 40) college students' reports of recent drinking behavior was evaluated using a timeline (TL) procedure. The students also completed a quantity-frequency (QF) questionnaire (Cahalan, Cisin, & Crossley, 1969) often used to categorize subjects' drinking histories in alcohol research studies. The TL-derived data were found to have generally high reliability (usually r's greater than or equal to .87) for both males and females, with males having slightly higher reliabilities overall. Subjects were classified into drinker categories based on the QF questionnaire answers, and the resulting groups were compared using their TL-derived data on quantity, frequency, and quantity X frequency (mean number of drinks per drinking day) measures of drinking. The drinking behavior of subjects (as assessed by the TL) had great variability within the QF categories, and there was extensive overlap between subjects classified by the QF method as heavy, moderate and light drinkers. Thus, QF categorization provides a relatively insensitive measure of individual differences in drinking behavior as compared to TL-derived data. The TL method also can be used to generate a variety of potentially useful dependent variables, whereas the QF method generates a single variable.
Adult↗
Effect of television programming and advertising on alcohol consumption in normal drinkers.
The drinking behavior of 96 male normal drinking college students was assessed after they viewed a videotape of a popular prime-time television program complete with advertisements. Different versions of the videotape were used to evaluate the effects of a television program with and without alcohol scenes as crossed with the effects of three different types of advertisements (i.e., beer, nonalcoholic beverages and food). After viewing the videotape, the subjects, who were led to believe that they were participating in two separate and unrelated sets of experimental procedures, were asked to perform a taste rating of light beers, which actually provided an unobtrusive measure of their alcohol consumption. The results provided no support for the widely held assumption that drinking scenes in television programs or televised advertisements for alcoholic beverages precipitate increased drinking by viewers. This finding, however, must be considered in the context of the laboratory setting of the study, and thus may not generalize to real-life television viewing. Further research in this area is clearly needed, including an evaluation of the effects of television program content and advertisements on other populations (e.g., alcohol abusers).
Adult↗
[Study of the intracardiac flow by real-time bidimensional color-coded Doppler echocardiography. Preliminary experience].
The new technique of real-time two-dimensional color Doppler echocardiography has been recently developed to allow visualization of the blood flow inside the cardiac chambers. The blood flow informations are color coded and displayed in real-time into the two-dimensional echocardiographic images of the cardiac structures. The flow informations which are given are velocity, direction and variance, calculated from the Doppler signals obtained from all the sample points. Flow directed toward the transducer is coded in red; flow away from the transducer is coded in blue, while the echoes from the cardiac structures are imaged in gray scale. The magnitude of the velocity of flow is represented by the brightness of the color, with an 8-steps scale of brightness, beginning from the lowest grade, which is not colored on the screen. To represent the velocity spectrum variance, green is added to each color in proportion to the extent of turbulence. We report our preliminary experience with this technique in 91 subjects by using an Aloka SSD 880 commercial equipment (age range 18 days-82 years): 5 were normal, 15 had cardiomyopathy, 21 had congenital, 40 valvular, 6 ischemic and 4 other forms of heart disease. Color display of intracavitary flow allowed to identify normal and abnormal patterns. Valvular regurgitation and abnormal intracavitary shunts were easy to identify, suggesting the possibility of a semiquantitative assessment of the lesions. The possibility of a quantitative approach should be further investigated in the future.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Value and limitations of the echocardiographic definition of the bicuspid aortic valve].
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Adolescent↗
Reliability of a family tree questionnaire for assessing family history of alcohol problems.
The test-retest reliability of a brief, easily administered questionnaire to assess family history of drinking problems was studied. Twenty alcoholic and twenty non-alcoholic volunteers completed the questionnaire on each of two occasions separated by about 2 weeks. The reliability of classification of first- and second-degree relatives as problem drinkers or alcoholics was examined, using both liberal and conservative diagnostic criteria. In general, both sets of criteria produced satisfactory test-retest reliability; one possible exception occurred when alcoholics' second-degree relatives were classified using the conservative criteria. The liberal criteria seemed to provide a more sensitive index of familial alcoholism.
Adult↗
[2-dimensional echocardiography in the evaluation of pericardial pathology: new prospects for its differential diagnosis].
We examined retrospectively the M-mode and two-dimensional echocardiograms performed in our laboratory on 227 patients with pericardial diseases, in order to assess the capabilities and limits of echocardiography in this field. We observed 4 patients with congenital absence of the pericardium, 10 with of constrictive or infiltrative-adhesive pericarditis, 213 pericardial effusions, associated with left pleural effusion in 36 cases and with different kinds of intrapericardial masses in 33 cases. Through qualitative analysis of the echogenicity of such masses some aspects were singled out which may prove useful in identifying intrapericardial fat, as well as tumors. We also suggest new ways of using specific echocardiographic sections to differentiate left pleural effusions from pericardial effusions, and to identify very small pericardial effusions.
Adolescent↗