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Biomedical subjects

D Schoors

Publications and source records attributed to D Schoors.

15 recordsLinked to original sources
PubMed2004

Contrast harmonic imaging improves the evaluation of left ventricular function in ventilated patients: comparison with transesophageal echocardiography.

AIMS: The study examined the value of contrast echocardiography (CE) in the assessment of left ventricular (LV) wall motion in ventilated patients in comparison with transesophageal (TOE) and standard fundamental transthoracic imaging (SE). METHODS: Transthoracic echocardiograms were done in 40 ventilated patients. Wall motion was evaluated using the recommendations of the American Society of Echocardiography on SE, CE and TOE. A visualization score was assigned on a scale of 2-0 for each of 16 segments. The segment was assigned a value of 2 if the segment was seen in both systole and diastole, 1 if seen only in systole or diastole, and 0 if not seen at all. A confidence score was also given for each segment with each technique (unable to evaluate; not sure; sure). The ejection fraction (EF) was estimated visually for each technique, and a confidence score was also applied to the EF. RESULTS: Visualization score 0 was present in 6.2 segments/patient on SE, 1.2 on CE (P<0.0001) and 1.1 on TOE (P<0.0001). An average of 6.5 segments were read with surety on SE, 11.5 on CE (P<0.0001) and 12.3 on TOE ( P<0.0001 ). There was no significant difference for CE vs TOE. EF was uninterpretable in 32% on SE, 0% on CE (P<0.001 and 0% on TOE (P<0.001). The EF was read with surety in 53% of patients on SE, 88% on CE (P < 0.0001) and 93% with TOE (P<0.0001) with no difference for CE vs TOE. Thus, wall motion was seen with more confidence on CE and TOE. CONCLUSIONS: In the ventilated patients with suboptimal transthoracic echocardiograms for the evaluation of the LV function, CE provides image quality of regional and global LV function similar to that achieved with TOE echocardiography.

Aged↗
PubMed2003

Heart valvular disease in patients with Parkinson's disease treated with high-dose pergolide.

The authors report the clinical, echocardiographic, and pathologic findings in two patients treated with more than 5 mg of pergolide daily who developed symptomatic severe heart failure due to restrictive valvular disease. They also describe the echocardiographic data of another eight patients taking similar doses of pergolide presenting no clinical signs of heart failure. The findings suggest a possible role of high doses of pergolide in inducing restrictive valvular disease.

Aged↗
PubMed2003

Native valve endocarditis with aorta-to-left atrial fistula due to Corynebacterium amycolatum.

Infective endocarditis remains a pathology with a high rate of complications and mortality. One of the most dramatic complications is abscess formation. A rare evolution of abscess formation is the development of fistula. We describe an 88-year-old woman with an aortic root abscess and aorta-to-left atrial fistula. To our knowledge this has only been described with streptococcus species as causative micro-organism. In this case the abscess was caused by Corynebacterium amycolatum, which is an infrequently found micro-organism.

Abscess↗
PubMed2000

Comparison of transthoracic echocardiography with second harmonic imaging with transesophageal echocardiography in the detection of right to left shunts.

We compared the use of transthoracic echocardiography with second harmonic imaging after a peripheral intravenous injection of an agitated saline solution with transesophageal echocardiography (TEE) in the detection of right to left shunts at the cardiac and pulmonary level. Second harmonic mode transthoracic echocardiography and TEE are equally sensitive in detecting right to left shunts in patients undergoing a daily routine TEE.

Artifacts↗
PubMed2000

Tricuspid stenosis: a rare complication of pacemaker-related endocarditis.

We report a case of recurrent pacemaker lead endocarditis as the cause of acquired tricuspid stenosis. The diagnosis was made noninvasively by 2-dimensional Doppler echocardiography. The case was further complicated by a paradoxical septic embolism through a patent foramen ovale. This cascade of rear events after a pacemaker implantation has never been described in the literature before.

Aged↗
PubMed2000

Impact of second harmonic imaging on the determination of the global and regional left ventricular function by 2D echocardiography: a comparison with MIBI gated SPECT.

AIMS: To evaluate the impact of second harmonic (SH) compared to fundamental mode (FM) imaging on the echocardiographic determination of ejection fraction (EF) and wall motion score index (WMSI), using MIBI gated SPECT as an independent reference. METHODS: Sixty-two consecutive patients underwent an echocardiography study and a MIBI gated SPECT over 24 hours. EF was estimated visually (estimated-E) and was calculated with the Simpson biplane method (Tracing-T), for both FM and SH. WMSI was determined by two independent echo-readers blinded to the nuclear imaging results. The same segmentation and scoring system was used for WMSI determined by MIBI gated SPECT. RESULTS: The percentages of unscored segments because of suboptimal endocardial border detection were 19.5% (FM) and 9.0% (SH). The correlation coefficients (r) between SPECT-EF and echo-EF were: FM (E)=0.705, FM (T)=0.546, SH (E)=0.771, SH (T)=0.743. Agreement between SPECT-EF and echo-EF was acceptable for both imaging modalities (mean of the difference +/- 2 S.D.): -2.8 +/- 18.5 (FM) and -3.5 +/- 16.4 (SH). Correlation coefficients (r) between WMSI calculated by SPECT and by echo were 0.715 (FM) and 0.789 (SH). Agreement between SPECT-WMSI and echo-WMSI was good for all imaging modes but better with SH compared to FM: 0.12 +/- 0.91 (FM), 0.10 +/- 0.77 (SH). The interobserver correlation coefficients (r) for the WMSI were 0.939 (FM) and 0.996 (SH). The agreement between the two observers was better for SH compared to FM. The systematic differences (mean differences) were 0.21 (FM) and -0.01 (SH), and the random differences between both observers (2 S.D.) decreased from 1.55 (FM) to 0.29 (SH). CONCLUSIONS: The use of SH echocardiography decreases the number of unscored segments. This results in an important gain in correlation and agreement for EF determination between echo and SPECT, and in a considerable decline of the interobserver variability for the echo-determined WMSI. WMSI determined by MIBI gated SPECT correlated closely with the SH WMSI, and agreement between both methods was excellent.

Aged↗
PubMed1999

Pulmonary stenosis caused by extrinsic compression of an aortic pseudoaneurysm of a composite aortic graft.

Pulmonic stenosis and stenosis of the right ventricular outflow tract related to extrinsic compression have been described in patients with tumors, in a patient with a pericardial cyst, and in patients with vascular abnormalities as an unruptured sinus of Valsalva aneurysm, a giant coronary artery pseudoaneurysm and an aortic arch aneurysm. Composite graft replacement of the ascending aorta and aortic valve with reimplantation of the coronary arteries has some inherent complications. Our case report describes a patient with a pericomposite graft aneurysm presenting as a stenosis of the pulmonary artery, detected by Doppler echocardiography.

Adult↗
PubMed1999

Quantitative assessment of regional dysfunction from gated single photon emission tomography myocardial perfusion studies: a non-segmental approach.

We present a modified (non-segmental) method for quantification of regional left ventricular dysfunction using gated myocardial perfusion SPET. Gated SPET is increasingly used to obtain complementary information on local perfusion and to assess the relevance of deficits in segmental count densities (attenuation vs perfusion deficit). The non-segmental approach was motivated by a hypothetical limitation regarding the validity of commonly used methods of quantitative wall thickening (WT) analysis. These methods are all based on segmental analysis, which could cause underestimation of 'true' contractile dysfunction in perfusion defects that do not have a strict segmental distribution. SPET images gated in eight time bins 60 min after the injection of 740 MBq 99Tcm-tetrofosmin or 99Tcm-sestamibi were recorded on a triple-headed camera in 20 normal subjects and in 16 patients within 2 weeks and again 3 months after myocardial infarction. Normal limits of wall thickening, calculated from pooled wall thickening profiles obtained in normal subjects, were used to identify and quantify areas with abnormal wall thickening in patients with coronary artery disease. The method was validated against data obtained from contrast ventriculography (CVG) and tested for reproducibility. The reproducibility of the method was excellent: r = 0.98 (WTsev measure 1 = 1.03WTsev measure 2 - 0.01). The localization of wall thickening abnormalities detected by gated SPET correlated well with the localization of regions with abnormal wall motion (WM) identified by CVG. The severity of the regional myocardial dysfunction assessed by gated SPET was closely correlated with the severity of the regional myocardial dysfunction derived from CVG: r = 0.85 (WMsev = 2.55WTsev + 2.30). Furthermore, a good correlation between the total wall thickening severity score and the global left ventricular ejection fraction (LVEF) was observed early and late after myocardial infarction: r = 0.80 (WTsev = -0.4LVEF + 0.46). We conclude that quantitative analysis of regional wall thickening assessed from gated SPET myocardial perfusion scintigraphy is a reliable parameter for regional ventricular function. Categorizing wall thickening abnormalities quantitatively may be helpful in assessing small changes in regional function that may occur between sequential gated SPET images.

Adult↗
PubMed1997

Dipyridamole-induced angina pectoris during sestamibi stress test in patients with significant coronary artery disease: clinical, angiographic, and nuclear determinants.

Intravenous dipyridamole induces angina pectoris (AP) in some patients with significant coronary artery disease (CAD). The aim of this prospective study was to identify the angiographic, nuclear, and clinical determinants. The authors examined 50 patients consecutively with significant CAD on coronary angiography. All antiischemic medications were stopped twenty-four hours (nitrates only 6 hours) before injection of dipyridamole (0.84 mg/kg). ECGs were taken before, during, and after this injection. The regional myocardial activity of Tc-99m-Sestamibi at rest and after dipyridamole injection was measured with single-photon emission computed tomography (SPECT). During dipyridamole injection 20 patients had AP, of whom 15 had ST segment depression on ECG (P < 0.001). The only significant difference on coronary angiography between patients with dipyridamole-induced AP and those without AP was the presence of collaterals (P < 0.05). In patients with AP and collaterals, ECG and SPECT changes were always noted in the collateralized territory. Subgroup analysis showed that patients without previous myocardial infarction (MI, n = 17, P < 0.05) or nontransmural MI (n = 17, P < 0.05) had a good correlation between collaterals and AP, whereas patients with a history of transmural MI (n = 16) did not. No further significant variables could be found as a predictor of AP after dipyridamole injection. These findings suggest that AP during dipyridamole stress test is due to ischemia, which is not related to the severity of CAD. Ischemia is probably due to coronary steal to the collateralized territory in patients without transmural MI. Dipyridamole-induced angina pectoris is predictive for collaterals and may indicate viability in patients with MI.

Angina Pectoris↗
PubMed1996

Early electrocardiographic signs in acute massive pulmonary embolism.

As a result of the increasing accuracy in diagnosing acute pulmonary embolism by isotopic ventilation-perfusion scintigraphy and pulmonary arterial angiography, the electrocardiographic changes associated with acute cor pulmonale are being abandoned as a diagnostic tool for this life-threatening disease. Nevertheless, certain electrocardiographic findings can raise the suspicion of pulmonary embolism. In our view the electrocardiogram does have some merits in the emergency work-up of a patient with a high suspicion of pulmonary embolism. In this case report we emphasize the importance of the electrocardiographic findings which forwarded the diagnosis of pulmonary embolism. Hence the necessary invasive diagnostic and therapeutic measures, i.e. pulmonary arterial angiography and thrombolytic therapy, can be taken immediately after admission to the emergency department.

Acute Disease↗
PubMed1988

Antihypertensive efficacy of low dose torasemide in essential hypertension: a placebo-controlled study.

The blood pressure lowering effect of chronic treatment with the low, non-diuretic dose of 2.5 mg of torasemide, a new loop-diuretic, was assessed in 20 patients with mild to moderate essential hypertension (WHO stage I-II) in a randomised, double-blind, balanced, placebo-controlled, cross-over study. Blood pressure was significantly reduced after four weeks of torasemide as compared to four weeks of placebo. No significant diuretic effect was detected and there were no relevant metabolic or clinical side effects. The present results show that torasemide 2.5 mg once daily has a significant BP lowering effect and is well tolerated in patients with mild to moderate hypertension. This low dose, lacking significant diuretic activity, appears to be the recommended dose for starting antihypertensive treatment with this compound.

Adult↗
PubMedDate not supplied

Influence of posture on haemodynamics, sodium and hormonal homeostasis in cirrhotic patients with and without ascites.

BACKGROUND/AIMS: Previous studies in preascitic cirrhosis demonstrated sodium retention during upright posture and sodium hyperexcretion during bed-rest. In patients with ascites, sodium excretion and creatinine clearance decreased during upright posture. Head-down tilting (HDT) accentuated the natriuretic effect of bed-rest in short term studies. The aim of this study was to evaluate the effects of prolonged change in posture on sodium homeostasis and on haemodynamics in cirrhotic patients. METHODS: Eighteen cirrhotic patients (9 with, 9 without ascites), were studied during 12 h upright, supine and HDT position (-10 degrees). During each position, 12 h urine collections were performed and blood samples were obtained before and after change in position. Non-invasive systemic hemodynamic measurements were performed. RESULTS: There was no significant difference between HDT and supine position in both ascitic and preascitic groups for urinary volume, fractional sodium excretion, creatinine clearance, urinary and plasma hormones and hemodynamics. Urinary volume (in supine and HDT) and fractional sodium excretion (in supine) were significantly higher and urinary noradrenaline and plasma renin (in supine and HDT) significantly lower in the preascitic group compared with the ascitic patients. Cardiac output and heart rate decreased after 12 h supine and HDT, suggesting a deactivation of sympatic nervous system and catecholamines. CONCLUSION: Our results demonstrate that prolonged HDT had no advantage over normal bed-rest in both patient groups. Possibly, a short-term beneficial effect of HDT was lost after several hours.

Adult↗