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Biomedical subjects

J Jezková

Publications and source records attributed to J Jezková.

At least 19 recordsLinked to original sources
PubMed1991

Three echocardiographic methods in right ventricular function evaluation.

We employed two-dimensional echocardiography for the assessment of right ventricular (RV) volumes and/or function in a series of 44 patients. The results of three different echocardiographic approaches were compared with the data obtained from single-plane RV angiography following ultrasound within a 7-day interval. Only the echocardiographic area length method with two orthogonal imaging planes employed (apical 4-chamber and subcostal projections) yielded the beneficial results. The correlations between echocardiographic and angiographic RV volume estimates were rather high (end-diastolic volume: r = 0.83, end-systolic volume: r = 0.82, stroke volume: r = 0.81) and satisfactory in ejection fraction (r = 0.75). Using the method mentioned, the differentiation of patients with an angiographic evidence of RV failure (echocardiographic ejection fraction less than 0.55) from those without it was possible with a sensitivity of 0.68 and a specificity of 0.82. Concerning the clinical impact of the presented study, we can recommend the technique in question as a screening procedure for the detection of changes in RV function exceeding 12% (95% confidence limits).

Cineangiography↗
PubMed1991

The effect of acute and chronic nitrate administration in precapillary and postcapillary pulmonary hypertension.

The effect of nitrates was monitored in 16 patients with precapillary, and in 12 patients with postcapillary pulmonary hypertension (PH). The patients had haemodynamic examination on acute administration of 10 mg of isosorbide nitrate (ID) in infusion and after 2-month therapy with 120 mg of isosorbide dinitrate retard daily. Acute ID administration decreased filling pressure of both ventricles, pulmonary and aortic pressure, pulmonary and systemic resistance and increased blood flow. No significant difference was found between the two types of PH. Long-term administration resulted in a statistically significant decrease in filling pressure (in both ventricles) and pulmonary pressure, even though the decrease was less pronounced than those seen following acute administration. Again, no statistical differences were noted between the two types of PH. While acute administration of nitrates decreases both preload and afterload, chronic administration decreases only preload. The implications of this finding for therapeutic practice are discussed.

Cardiomyopathy, Dilated↗
PubMed1991

[2-dimensional echocardiography in the evaluation of right ventricular volume and function. Comparison with echocardiography].

Using two-dimensional echocardiography (ECHO), the authors examined within one week preceding right-sided catheterization of the right ventricle (RV) 44 patients. Of three tested ECHO techniques for calculation of right ventricular volumes and/or function the best correlations were obtained by the method of evaluation of area-length of the right ventricle from two orthogonal projections (apical 4-cavity and subcostal with visualization of the outflow portion of the RV). The following correlations were assessed: telediastolic volume--r = 0.831, telesystolic volume--r = 0.815 stroke volume--r = 0.810 and ejection fraction (EF)--r = 0.752 (p less than 0.001 for all correlations). The tested method enables us at the same time to screen at least existing right ventricular dysfunction (sensitivity 0.68; specificity 0.82). In the presence of tricuspidal insufficiency (TI) increase in right ventricular function occurs which may mask its existing failure (dependence of EF on the mean pressure level in pulmonary artery was proved only in patients without TI--r = 0.594). We assume that information on right ventricular function is important not only in diseases affecting primarily the right heart but also in advanced stages of left-sided failure. Follow-up of the natural course of the disease and the effect of provided treatment by the non-invasive ECHO method is thus useful not only in research but also in clinical practice.

Cardiac Volume↗
PubMed1990

[Estimation of systolic pressure in the right ventricle (pulmonary artery) using Doppler and its importance in the detection of pulmonary hypertension].

Using the pulsed Doppler system with a high reparative frequency (HPRF), the authors made within 1 hour and 3 days after diagnostic right-sided catheterization 38 measurements of the trans-tricuspid pressure gradient in 31 consecutive patients. To the gradient calculated from the absolute velocity of flow through the jet of tricuspid regurgitation the authors added two different arbitrarily determined pressure values in the right atrium to obtain the systolic pressure in the right ventricle--RVSP (which assuming the absence of an obstruction between the right ventricle and pulmonary artery equals the systolic pressure in this artery). The calculated RVSP from the Doppler assessment correlated highly significantly with the directly manometrically obtained values of the same indicator (r = 0.973; p less than 0.001). An even closer correlation was obtained when using a differentiated estimate of the pressure in the right atrium/according to the filling of the jugular veins) (r = 0.977; p less than 0.001). From the RVSP values the authors tried to predict the presence of pulmonary hypertension (PH) diagnosed from the median pressure in the pulmonary artery (PAP greater than or equal to 20 mm Hg which was considered conclusive). Using the arbitrarily assessed range of systolic PH greater than 35 mm Hg, the sensitivity of the ultrasonographic estimate was 79% with a 60% specificity, while when the criterium of greater than 40 mm Hg was used, the corresponding values were 64% and 90%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Long-term effect of isosorbide dinitrate and nifedipine, singly and in association, in patients with chronic heart failure.

The effect of 2-month treatment with isosorbide dinitrate (120 mg day-1), nifedipine (2 x 20 mg day-1) and their combination has been assessed in 16 patients with mild to moderate chronic cardiac failure. Isosorbide dinitrate decreased right atrial (-23%), pulmonary wedge (-20%) and pulmonary arterial (-17%) pressures but did not significantly change either cardiac output or systemic and pulmonary vascular resistance. Nifedipine increased cardiac output (+13%) and decreased systemic and pulmonary vascular resistance (both -17%) with no change of pressures. Combined therapy with both drugs decreased ventricular filling pressures (-8% and -15%), systemic (-20%) and pulmonary (-13%) arterial pressures, increased cardiac output (+26%) and decreased both systemic (-29%) and pulmonary (-29%) vascular resistances. Changes during exercise were almost the same as at rest. The effect of both drugs was more pronounced in patients with more severely pathological haemodynamic measurements before treatment. We conclude that combined treatment with both preload- and afterload-reducing agents can preserve or even potentiate a favourable haemodynamic effect of individual drugs.

Blood Pressure↗
PubMed1989

[The dipyridamole echocardiography test combined with isometric loading in the diagnosis of ischemic heart disease].

The authors compared the sensitivity of the simple dipyridamole test (DP test) and the dipyridamole test combined with an isometric load (DP + HG test). Evaluation by means of two-dimensional echocardiography was used. The sensitivity and specificity of the DP test, in case of a 50% or greater stenosis of one or several coronary arteries, as a criterion of classification of the group was 45% and 100%, as compared with 72% and 100% in the combined DP + HG test. The correct diagnosis was confirmed by a selective reference coronarographic findings in all patients. The electrocardiographic changes alone in both tests were positive for IHD only in 9 and 17% resp. Ergometry was more sensitive (44%) than electrocardiographically evaluated changes, using the mentioned intervention tests, but it did not attain the sensitivity of the echocardiographic evaluation. The work indicates that temporary changes of the regional kinetics evaluated by two-dimensional echocardiography are a highly specific manifestation of myocardial ischaemia which developed during a load, and these changes are detected sooner and more frequently than associated electrocardiographic changes.

Adult↗
PubMed1989

[Non-invasive diagnosis of pulmonary hypertension: Doppler versus echocardiography].

The authors examined a group of 50 patients incl. 28 (56%) with pulmonary hypertension (PH) at rest, mostly postcapillary. Using a Doppler device, they measured the acceleration time (ACT) in the outflow tract of the right ventricle and trunk of the pulmonary artery. Under conditions of concurrent Doppler and direct, catheterization measurements the authors found a close correlation between ACT and the mean pressure in the pulmonary artery (r = -0.88), which was, however, not confirmed after a 1-10 day interval (r = = -0.64). The authors conclude that Doppler ACT reflects only the actual pressure in the pulmonary circulation. The authors found a close correlation between ACT values in the right ventricular outflow tract and the pulmonary artery (r = 0.95), and no significant difference. Comparison of Doppler diagnosis of PH with former echocardiographic methods revealed unequivocally the priority of the Doppler method. Failure of echocardiography is most probably associated with the postcapillary type of PH in the group of patients and does not rule out the validity of original findings in precapillary PH. Rapid and easy assessment along with a simpler interpretation is in favour of the Doppler technique.

Adolescent↗
PubMed1989

[Long-term prognosis of patients with chronic post-infarct aneurysms. II. Comparison of patients treated conservatively and surgically].

UNLABELLED: Survival rates were determined for a group of 136 patients in whom left ventricular aneurysm was determined by angiography. They were treated medically (99 patients) or surgically (37 patients). Congestive heart failure was predominant in all patients. The two groups did not differ in regard to clinical and haemodynamic data except for a more extensive coronary artery disease in the surgical group. Survival rates at the 5, 7 and 9 years were 62.5%, 52.5% and 37.5% in the medicaly treated group and 50%, 40% and 32.5% in the surgical group. Functional improvement at least one Functional Class NYHA was present in 75% patients postoperatively, and in 27% of patients treated medically. CONCLUSION: In patients with left ventricular aneurysm with predominant congestive heart failure surgical treatment improved quality of life but did not increase long-term survival.

Chronic Disease↗
PubMed1989

[Long-term prognosis in patients with chronic postinfarct aneurysms. I. Conservative treatment of patients].

Natural history of 99 patients with angiographically defined left ventricular aneurysm (LVA) has been studied. Congestive heart failure (CHF) was predominant in 52.5% patients. Mean follow-up was 94 months. The cumulative survival at 1, 5, 7, 10 years were 92, 65, 60 and 28% respectively. Left ventricular end-diastolic pressure averaged 2.8 kPa (LVEDP), ejection fraction (EF) 31%, contractile segment ejection fraction (CSEF) 45%, stroke work 6.7 mj. g-1, diastolic compliance 0.36 kPa-1 and passive elastic modulus 64.1 kPa. High risk groups of patients were those with LVEDP more than 3.3 kPa, CSEF less then 40%, EF less then 20% and with extent of LVA more then 40% of the diastolic area of the left ventricle. The Cox analysis of survival indicated following variables predicted outcome: functional impairment due to CHF, LVEDP, LVEDVI and number of vessels diseased.

Heart Aneurysm↗
PubMed1988

Long-term reduction of pulmonary hypertension in interstitial lung fibrosis by isosorbide dinitrate.

The effect of isosorbide dinitrate (ID) on the development of pulmonary hypertension (PH) has been examined in 18 patients with idiopathic diffuse interstitial lung fibrosis (IDILF) during two years of treatment. All patients responded favourably to acutely administered ID by a decrease in pulmonary vascular resistance (PVR) by 38 +/- 13% and of the pulmonary arterial pressure (PAP) by 35 +/- 11%. Two years ID therapy led to sustained haemodynamic improvement in patients in whom blood gases were stable PAP was reduced from 38 +/- 5 to 30 +/- 6 mmHg and PVR from 483 +/- 197 to 364 +/- 175 dyne s cm-5. No haemodynamic changes were noted in the subjects with progressive hypoxaemia whereas steady deterioration of central haemodynamics was recorded in those patients who died during the follow-up. It is concluded that some patients with IDILF and PH may benefit from long-term ID treatment, but that the outcome of this treatment cannot be reliably predicted from the results of the initial first ID administration.

Adult↗
PubMed1988

Natural variability of pulmonary haemodynamics.

In the interpretation of the effect of a drug or intervention in a single patient, it is desirable to know the spontaneous fluctuations of the variable under study. A few studies have determined pulmonary haemodynamic variability in acute and short-term intervals. It seems reasonable to adopt a confidence limit of 6 mmHg or 22% for PPA changes to be significant. The long-term evolution is difficult to determine because of the unavoidable patient selection for repeat examinations several years apart, and because of the necessary treatment. In slight or moderate pulmonary hypertension the changes in PPA with time seem to be of small magnitude: less than 1 mmHg per year.

Exercise↗
PubMed1988

Assessment of stroke volume and cardiac output by Doppler echocardiography.

The authors used the pulse and continuous-wave Doppler technique to perform 51 measurements of stroke volume and cardiac output in 37 persons. Results were compared with those obtained using Fick's principle of thermodilution (immediately subsequent or simultaneous). Regression analysis showed a close correlation between Doppler and haemodynamic values - r = 0.86 for stroke volume and 0.94 for cardiac output (p less than 0.001). Using the paired t-test, the methods did not differ significantly. Standard deviation of Doppler stroke volume values from reference haemodynamic values was 10%, and only two measurements differed by more than 25%. Doppler determination of cardiac output can be therefore recommended as an alternative method in patients with high-quality echo Doppler recordings.

Adult↗
PubMed1986

The importance of quantitative Doppler in assessment of mitral stenosis.

Duplex Doppler echocardiography with high pulse repetition frequency was used to study: group A - 7 patients with mitral stenosis (MS) during cardiac catheterization, and group B - 26 patients with MS in whom the Doppler examination was performed 24 h-3 months prior to catheterization. Using the peak flow velocity within the stenotic flow jet, the pressure drop and mitral valve area (MVA) were calculated and compared with data obtained invasively. The inter-observer variability of the two parameters was 12% and 5%, respectively. The correlation between Doppler pressure drop and invasive measurement was excellent in group A (r = 0.83), while less close in group B (r = 0.71). However, using only MVA estimates (group B), it was possible to recognize most of MS with catheterization MVA less than or equal to 1.0 cm2/m2 (sensitivity and predictive value both of 90%). Therefore, even nonsimultaneous quantitation of MS seems valuable in pre-operative patient evaluation, adding a new information to hitherto existing echocardiographic criteria.

Cardiac Catheterization↗