Biomedical subjects

E Bossone

Publications and source records attributed to E Bossone.

23 records · Page 2Linked to original sources

PubMed1999

Echocardiographic features of primary pulmonary hypertension.

Primary pulmonary hypertension (PPH) is essentially a diagnosis of exclusion and usually is made late because of the nonspecific nature of the early signs and symptoms. Echocardiography is a key screening test in the diagnostic algorithm of patients with suspected PPH. The purpose of this study was to define the echocardiographic Doppler features in patients with PPH at the time of diagnosis. From 1992 to 1997, 51 patients were diagnosed with PPH at our institution. All underwent a standardized transthoracic echocardiographic examination, including a contrast study and transthoracic echocardiographic examination if indicated. Pulmonary artery systolic pressure was calculated from the tricuspid regurgitation jet. The majority of patients had pulmonary artery systolic pressure greater than 60 mm Hg (96%) associated with systolic flattening of the interventricular septum (90%), enlarged right atrium (92%) and ventricle (98%), and reduced right ventricular systolic function (76%). There was an increase in the interventricular septal thickness (>1.2 cm) in 21 (43%) of 49 patients, accompanied by a septal/posterior wall ratio greater than 1.3 in 11 (22%) of 49. Although a reduction in both left ventricular systolic and diastolic volumes was noted, global left ventricular systolic function was preserved in all patients. Mitral E/A ratio was less than 0.7 in 7 (22%) patients studied. Color Doppler revealed moderate to severe tricuspid regurgitation and pulmonic insufficiency in 41 (80%) of 51 and 16 (31%) of 51 of cases, respectively. Pericardial effusion (7 small and 1 moderate) and patent foramen ovale (n = 12) were also frequently detected. At the time of initial diagnosis, PPH is associated with secondary cardiac abnormalities in the majority of patients.

Adolescent↗

PubMed1999

Echocardiographic predictors of an adverse response to a nifedipine trial in primary pulmonary hypertension: diminished left ventricular size and leftward ventricular septal bowing.

BACKGROUND: The clinical course in primary pulmonary hypertension (PPH) is improved by calcium channel blocker therapy in those with a favorable hemodynamic response during a trial of high-dose oral nifedipine. Although trials of nifedipine are performed only in patients who demonstrate pulmonary vasodilator reserve to short-acting agents, this response does not predict the safety of nifedipine treatment, which can result in severe first-dose hypotension and death. STUDY OBJECTIVES: To identify echocardiographic parameters that predict first-dose nifedipine-induced hypotension in patients with PPH. METHODS: The pretrial echocardiograms of 23 consecutive PPH patients (mean age, 42.3 +/- 13 years; 77% female) undergoing evaluation of pulmonary vasodilator reserve with nifedipine were analyzed. Patients were classified as those who suffered first-dose nifedipine hypotension (group 1) and those who did not (group 2). Echocardiographic measures of chamber size and septal geometry in the two groups were compared. RESULTS: Five measures reflecting diminished left ventricular (LV) size and leftward ventricular septal bowing were found to be associated with nifedipine hypotension: LV transverse diameter in systole (LVDs; p = 0.007), LV transverse diameter in diastole (LVDd; p = 0.05), LV area in systole (LVAs; p = 0.009), LV area in diastole (LVAd; p = 0.03), the ratio of RV to LVAs (p = 0. 02), and leftward ventricular septal bowing (p = 0.01). The LV dimensions found to best predict nifedipine-induced hypotension were LVDs < 2.7 cm, LVDd < 4.0 cm, LVAs < 15.5 cm(2), and LVAd < 20.0 cm(2). CONCLUSIONS: Readily available echocardiographic parameters in patients with PPH are predictive of nifedipine-induced hypotension, and can be used to select patients in whom a trial of nifedipine should be avoided.

Administration, Oral↗

PubMed1999

Perioperative cardiac risk assessment for noncardiac surgery.

Patients with coronary artery disease who undergo noncardiac surgery are at risk of cardiac complications. It is, therefore, imperative to assess the risk of noncardiac surgery in these patients in a variety of operative settings. We propose a simplified approach at perioperative risk assessment that ascertains risks based on the need and urgency of surgery, and the type of surgery. Furthermore, we suggest guidelines for perioperative risk assessment based on patient's history and physical exam, their functional capacity and prior procedures. Based on these clinical data, we identify patients into three categories for a cardiac event during noncardiac surgery: high, intermediate and low risk groups. We recommend that all urgent surgeries should be carried out with attempts made at proper perioperative management to reduce the risk of cardiac events. Further, low or intermediate risk patients undergoing minor surgery should be operated without any further cardiac evaluation. Intermediate risk patients, who need an intermediate or major surgery, should undergo a stress test to evaluate for ischemia. If there is evidence of a large ischemic burden and those patients at high risk should undergo cardiac catheterization and appropriate intervention. We also suggest methods of modifying risk in the perioperative period for all patients to reduce perioperative cardiac events with proper monitoring and use of medications including beta blockers. This article provides a detailed review on the current literature supporting the stepwise approach proposed by us.

Heart Diseases↗

PubMedDate not supplied

Evaluation of myocardial viability using stress echocardiography.

Stress echocardiography is a commonly employed technique for the diagnosis of coronary artery disease and for determining patient prognosis. More recently, it has been shown to be a valuable tool for determining myocardial viability in both acute and chronic ischemic coronary syndromes. The response of myocardial segments that are dysfunctional at rest to low dose stimulation with dobutamine predicts eventual recovery of function with a level of accuracy equivalent to that of the competing radionuclide techniques. Identification of patients with significant areas of viable myocardium plays a valuable role in decision making for high risk intervention and multivessel bypass surgery. Additionally, identification of viable myocardial carries significant prognostic implications for future cardiac events.

Animals↗

PubMedDate not supplied

Secondary pulmonary hypertension--diagnosis and management.

Secondary pulmonary hypertension (SPHtn) is generally attributable to abnormalities in structure or function of the heart or lung parenchyma. While often defined as a physiologic parameter, pulmonary hypertension (PHtn) can be a major contributor to death and disability in cardiopulmonary diseases. Both detection and management are a challenge. We will review the pathophysiology, diagnostic tools, and treatment strategies in SPHtn with an emphasis on cor pulmonale associated with chronic obstructive pulmonary disease (COPD), pulmonary vasculopathies, and pulmonary embolus. The pathophysiology and common etiologies of SPHtn can be divided into three major categories: (1) elevated pulmonary venous pressure (LV failure and mitral valve disease), (2) pulmonary vascular occlusive disease with or without pulmonary parenchymal disease (pulmonary emboli, COPD, connective tissue diseases), and (3) hypoxemia (sleep apnea). The echo-Doppler is a simple cost-effective tool for detecting PHtn, evaluating right ventricular function, and distinguishing common etiologies such as abnormal systolic and diastolic left ventricular function and mitral valve disease. The ventilation-perfusion radionuclide scan can be used to exclude thromboembolic PHtn, but a helical computer tomography with contrast or pulmonary angiography are necessary to distinguish patients that may benefit from a pulmonary thromboendarterectomy. The six minute walk oxygen saturation test is useful as a quantitative measure of functional capacity, prognosis, response to therapy, and oxygen requirement. Treatment strategies in cor pulmonale are tailored to the specific diagnosis, but generally include proper nutrition, exercise, oxygen supplementation, medications such as digoxin, diuretics, anti-coagulation, and pulmonary vasodilator therapy in selected patients.

Heart↗