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Biomedical subjects

Sergio Severino

Publications and source records attributed to Sergio Severino.

17 recordsLinked to original sources
PubMed2006

Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis.

BACKGROUND: Anabolic androgenic steroids (AAS) are sometimes used by power athletes to improve performance by increasing muscle mass and strength. Recent bioptical data have shown that in athletes under the pharmacological effects of AAS, a focal increase in myocardial collagen content might occur as a repair mechanism against myocardial damage. OBJECTIVE: To investigate the potential underlying left ventricular myocardial dysfunction after chronic misuse of AAS in athletes by use of Doppler myocardial imaging (DMI) and strain rate imaging (SRI). METHODS: Standard Doppler echocardiography, DMI, SRI and ECG treadmill test were undertaken by 45 bodybuilders, including 20 athletes misusing AAS for at least 5 years (users), by 25 anabolic-free bodybuilders (non-users) and by 25 age-matched healthy sedentary controls, all men. The mean (SD) number of weeks of AAS use per year was 31.3 (6.4) in users, compared with 8.9 (3.8) years in non-users, and the mean weekly dosage of AAS was 525.4 (90.7) mg. RESULTS: The groups were matched for age. Systolic blood pressure was higher in athletes (145 (9) vs 130 (5) mm Hg) than in controls. Left ventricular mass index did not significantly differ between the two groups of athletes. In particular, both users and non-users showed increased wall thickness and relative wall thickness compared with controls, whereas left ventricular ejection fraction, left ventricular end-diastolic diameter and transmitral Doppler indexes were comparable for the three groups. Colour DMI analysis showed significantly lower myocardial early: myocardial atrial diastolic wave ratios in users at the level of the basal interventricular septum (IVS) and left ventricular lateral wall (p<0.01), in comparison with both non-users and controls. In addition, in users, peak systolic left ventricular strain rate and strain were both reduced in the middle IVS (both p<0.001) and in the left ventricular lateral free wall (both p<0.01). By stepwise forward multivariate analyses, the sum of the left ventricular wall thickness (beta coefficient = -0.32, p<0.01), the number of weeks of AAS use per year (beta = -0.42, p<0.001) and the weekly dosage of AAS (beta = -0.48, p<0.001) were the only independent determinants of middle IVS strain rate. In addition, impaired left ventricular strain in users was associated with a reduced performance during physical effort (p<0.001). CONCLUSIONS: Several years after chronic misuse of AAS, power athletes show a subclinical impairment of both systolic and diastolic myocardial function, strongly associated with mean dosage and duration of AAS use. The combined use of DMI and SRI may therefore be useful for the early identification of patients with more diffused cardiac involvement, and eventually for investigation of the reversibility of such myocardial effects after discontinuation of the drug.

Adult↗
PubMed2006

Myocardial systolic activation delay in patients with left bundle branch block and either normal or impaired left ventricular function.

AIM OF THE STUDY: to evaluate determinants of myocardial activation delay of both left (LV) and right (RV) ventricle in patients with left bundle branch block (LBBB) and either normal or impaired LV ejection fraction (EF). METHODS: From an initial cohort of patients with LBBB, 42 patients with dilated cardiomyopathy (group A) and 33 with normal global LV systolic function (group B), all comparable in age and sex, underwent standard Doppler echo, pulsed Doppler myocardial imaging (DMI), and coronary angiography. Using DMI, the following regional parameters were evaluated in five different basal myocardial segments (LV anterior, inferior, septal, lateral walls-RV lateral wall): systolic (Sm), early- and late-diastolic (Em and Am) peak velocities. As index of myocardial systolic activation was calculated: precontraction time (PCTm) (from the beginning of Q-wave of ECG to the onset of Sm). Intraventricular systolic dyssynchrony was analyzed by difference of PCTm in different LV myocardial segments. Interventricular activation delay was calculated by the difference of PCTm between the most delayed LV segment and RV lateral wall. RESULTS: Patients of group A showed increased heart rate (HR), QRS duration and LV end-diastolic diameter, and reduced LV EF. By DMI, patients of group A showed reduced myocardial peak velocities and a significant intraventricular delay in activation of LV lateral wall, with increased regional PCTm (P < 0.001). In addition, patients with dilated cardiomyopathy showed a more pronounced interventricular dyssynchrony, even after adjustment for HR and QRS duration. By receiver operating characteristic (ROC) curve analysis, a cut-off value of 55 msec of interventricular delay showed 86% sensitivity and 92% specificity in identifying patients with impaired EF. In the overall population, by use of stepwise forward multivariate linear regression analyses, LV end-diastolic diameter (beta coefficient = 0.52; P < 0.001) and LV EF (beta coefficient =-0.58; P < 0.0001) were the only independent determinants of interventricular activation delay. CONCLUSIONS: Pulsed DMI is an effective noninvasive technique for assessing the severity of regional delay in activation of LV walls in patients with LBBB. The impairment of interventricular systolic sychronicity is strongly related to LV dilatation and to the degree of global systolic dysfunction. Therefore, patients with dilated cardiomyopathy suitable for cardiac resynchronization therapy may be better selected.

Bundle-Branch Block↗
PubMed2006

The athlete's heart and hypertrophic cardiomyopathy: two conditions which may be misdiagnosed and coexistent. Which parameters should be analysed to distinguish one disease from the other?

According to the statements from the International Cardiological Committees on Eligibility for Sports, athletes with a clinical diagnosis of hypertrophic cardiomyopathy (HCM) should be excluded from most competitive sports, with the possible exception of those of low intensity. Clinical distinctions between physiological athlete's heart and pathological conditions such as HCM have critical implications especially for trained athletes. Even if the standard two-dimensional echocardiography represents an irreplaceable method in the evaluation of cardiac adaptations to physical exercise, the data currently available suggest the usefulness of Doppler myocardial imaging (DMI) in the assessment of the myocardial systolic and diastolic function of the athlete's heart. On this ground, the combined use of standard two-dimensional echocardiography and DMI may be taken into account for a valid, non-invasive and easily repeatable evaluation of both physiological and pathological ventricular hypertrophy, and in selecting a subgroup of HCM patients at higher risk of cardiac events. In particular, DMI analysis in the trained individual has demonstrated an interesting opportunity for: (1) the differential diagnosis from pathological left ventricular hypertrophy due to HCM; (2) the prediction of cardiac performance during physical effort; (3) the evaluation of bi-ventricular interaction; (4) the analysis of myocardial adaptations to various training protocols; and (5) the early identification of specific genotypes associated with cardiomyopathies.

Cardiomyopathy, Hypertrophic↗
PubMed2006

Potential clinical perspectives of Doppler myocardial imaging and strain rate imaging during stress echocardiography.

Stress echocardiography has become a common non-invasive test in patients with chest pain and known or suspected coronary artery disease, but, as with exercise electrocardiography, it shows several major limitations. Analysis of gray-scale images based on subjective visual interpretation of wall motion and thickening has considerable variability even among experts. Doppler myocardial imaging and strain rate imaging echocardiography provides additional information in comparison with conventional echocardiography. These techniques provide quantification of regional wall motion at rest and during stress. Quantification of both systolic and diastolic myocardial function by either Doppler myocardial imaging or strain rate imaging mapping during dobutamine stress test has been shown to be a feasible, accurate, non-invasive tool that should be considered to be a sensitive alternative to the present echocardiographic and scintigraphic imaging techniques for stress tests. Time consuming off-line analysis of color images is required in the present state of technology. However, these non-invasive techniques are rapidly evolving and expanding. Further refinements in signal processing and quantitative analysis are likely in the near future.

Blood Flow Velocity↗
PubMed2005

Prognostic value of intra-left ventricular electromechanical asynchrony in patients with hypertrophic cardiomyopathy.

AIMS: We sought to assess the indexes of myocardial activation delay, using Doppler myocardial imaging (DMI), as potential predictors of cardiac events in patients with hypertrophic cardiomyopathy (HCM). The distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with HCM, which results in heterogeneity of regional LV systolic function. METHODS AND RESULTS: The study population included 123 HCM patients (39.4+/-5.9 years) and 123 age- and sex-matched healthy subjects, followed up for 48.4+/-8.8 months. By use of pulsed DMI, the following regional parameters were evaluated in six different basal myocardial segments: myocardial peak velocities and systolic time-intervals; myocardial intraventricular (intra-V-Del) and interventricular (inter-V-Del) systolic delays. DMI analysis in HCM showed lower myocardial systolic and early-diastolic peak velocities of all the segments. As for time intervals, HCM showed significant inter- and intra-V delays (P<0.0001), whereas homogeneous systolic activation of the ventricular walls was assessed in controls. During the follow-up, 16 cardiac deaths (12 sudden deaths) were observed in HCM patients. InHCM, DMI intra-V-Del was the most powerful independent predictor of sudden cardiac death (P<0.0001). In particular, an intra-V-Del>45 ms is identified with high sensitivity and specificity in HCM patients at higher risk of ventricular tachycardia and sudden cardiac death (test accuracy: 88.8%). CONCLUSION: In HCM patients, DMI indexes of intra-V-Del may provide additional information for selecting subgroups of HCM patients at increased risk of ventricular arrhythmias and sudden cardiac death at follow-up. Accordingly, such patients may be more actively identified for early intensive treatment and survey.

Adult↗
PubMed2005

Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study.

BACKGROUND: Accurate echocardiographic parameters to predict maintenance of sinus rhythm in patients with atrial fibrillation (AF) are poorly defined. This study was conducted to assess the atrial myocardial properties during AF through myocardial velocity, strain rate, and strain and to compare their prognostic value in maintaining sinus rhythm in patients with lone AF with standard transthoracic (TTE) and transesophageal echocardiography (TEE). METHODS AND RESULTS: Sixty-five consecutive patients with lone AF for < or =3 months underwent TTE, TEE, and myocardial velocity and strain and strain rate imaging examinations before successful external cardioversion. Maintenance of sinus rhythm was assessed during a 9-month follow-up. Atrial myocardial velocity, strain, and strain rate values in AF patients were compared with those of age- and sex-matched referents. Moreover, clinical and echocardiographic parameters of patients with maintenance of sinus rhythm (MSR patients) over the 9-month follow-up period (n=25) were compared with those from patients with AF recurrence (AFR patients; n=40). Atrial myocardial properties assessed by myocardial velocity, strain rate, and strain were significantly reduced (P<0.0001) in patients (velocity, 3.2+/-1.4 cm/s; strain, 23.3+/-19%; strain rate, 2+/-0.9 seconds(-1)) compared with referents (velocity, 5.7+/-1.3 cm/s; strain, 92+/-26%; strain rate, 4.2+/-1.8 seconds(-1)). The individual predictors of sinus rhythm maintenance were atrial appendage flow velocity (MSR patients, 39+/-12 cm/s; AFR patients, 32+/-15 cm/s; P<0.01) assessed by TEE and atrial strain (MSR patients, 33+/-27%; AFR patients, 17+/-9%; P=0.0007) and strain rate (MSR patients, 2.7+/-1 seconds(-1); AFR patients, 1.6+/-0.6 seconds(-1); P<0.0001) peak systolic values. Atrial strain (P<0.0001; coefficient, 0.015; SE, 0.003) and strain rate (P<0.0001; coefficient, 0.372; SE, 0.075) parameters alone were confirmed as independent predictors of sinus rhythm maintenance by multivariable analysis. CONCLUSIONS: Patients with higher atrial strain and strain rate appear to have a greater likelihood of staying in sinus rhythm. If the current data are verified in future studies, then additional pharmacological therapy and maintenance of anticoagulants for a longer period may need to be considered in those with lower atrial strain and strain rate measurements.

Adult↗
PubMed2005

Prognostic value of supine bicycle exercise stress echocardiography in patients with known or suspected coronary artery disease.

AIMS: To assess the prognostic significance of supine bicycle exercise stress echocardiography (ESE) for cardiac events, and the ESE additional role compared to other traditional clinical and echo variables, in patients with proven or suspected coronary artery disease (CAD). METHODS AND RESULTS: Clinical status and long-term outcome were assessed in 607 patients, for a mean period of 49.9 +/- 12.5 months. ESE was performed for the diagnosis of suspected CAD in 267 patients, and for the risk stratification in 340 patients. At baseline, the mean value of WMSI was 1.22 +/- 0.36, and the mean left ventricular ejection fraction was 58.2 +/- 10.9%. The ESE was positive for ischemia in 210 patients (34.9%), while the ECG was suggestive for ischemia in 157 patients. At peak effort, the mean WMSI was 1.38 +/- 0.46. Low work load was achieved by 158 patients (26.1%). During the follow-up period there were 222 events, including 48 cardiac deaths and 34 acute non-fatal myocardial infarction. By multivariable model, cigarette smoking, peak WMSI, positive ESE for ischemia and low work load were the only independent predictors of cardiac death. The cumulative 5-year mean survival rate according to ESE response was 95.9% in patients with negative ESE, and 81.7% in positive ESE (p < 0.00001). CONCLUSIONS: In patients with known or suspected CAD able to perform a physical stress, bicycle ESE is able to stratify patients at higher risk of cardiac events. The final report of an ESE performed for prognostic purpose should include both the assessment of induced dyssinergy and the evaluation of indexes of the extent and the severity of myocardial ischemia.

Bicycling↗
PubMed2005

[New echocardiographic techniques in the study of coronary artery disease: strain and strain rate].

Strain/strain rate are a new echocardiographic technique able to quantify regional myocardial deformation. Since myocardial velocity, obtained by standard tissue Doppler, is affected by global heart motion, cardiac rotation and influence from velocities in other segments, strain/strain rate have been introduced to measure regional shortening fraction and shortening rate, respectively. The present review discusses the most recent developments in the application of strain/strain rate in coronary artery disease.

Coronary Disease↗
PubMed2005

Risk stratification and prognosis of patients with known or suspected coronary artery disease by use of supine bicycle exercise stress echocardiography.

BACKGROUND: The aim of this study was to assess the long-term predictive values of supine bicycle exercise stress echocardiography (ESE), and the ESE additional role compared to other traditional clinical and rest echocardiographic variables, in 607 patients with low, intermediate and high pretest risk of cardiac events. METHODS: Clinical status and long-term outcome were assessed for a mean period of 46 months (range 12-60 months). ESE was performed for the diagnosis of suspected coronary artery disease (CAD) in 267 patients (43.9%), and for risk stratification of known CAD in 340 patients (56.1%). At baseline, the mean value of wall motion score index (WMSI) was 1.22 +/- 0.36, and the mean left ventricular ejection fraction was 58.5 +/- 10.9%. RESULTS: ESE was positive for ischemia in 210 patients (34.9%), while ECG was suggestive for ischemia in 157 patients (25.8%). During the test only 97 patients (15.9%) experienced angina. At peak effort, the mean WMSI was 1.38 +/- 0.46. A low workload was achieved by 158 patients (26.1%). During the follow-up period there were 222 events, including 82 hard events (36.9%), 48 deaths (21.6%) and 34 acute non-fatal myocardial infarction (15.3%). At stepwise multivariate model, cigarette smoking (p < 0.01), peak WMSI (p < 0.001), ESE positive for ischemia (p < 0.001) and low workload (p < 0.01) were the only independent predictors of cardiac death, while positive ESE, peak WMSI, angina during the test and hypercholesterolemia were the only independent determinants of hard cardiac events. The cumulative 5-year mean survival rate according to ESE response was 95.9% in patients with negative ESE, and 83.7% in patients with positive ESE (log rank 13.6; p < 0.00001). CONCLUSIONS: ESE yields prognostic information in known or suspected CAD, especially in patients with intermediate pretest risk level. The combined evaluation of clinical variables and other ESE variables, such as peak WMSI and exercise capacity, may further select patients at greatest risk of cardiac death in the overall population.

Coronary Artery Disease↗
PubMed2004

Analysis of right ventricular Doppler tissue imaging and load dependence in patients undergoing percutaneous closure of atrial septal defect.

In patients with volume overload due to atrial septal defect (ASD) and Doppler tissue imaging E'/A' <1 at baseline, right ventricular (RV) myocardial velocities show load independence after closure with a device. Conversely, in patients with ASD with basal E'/A' >1, regional velocities are load-dependent and positively correlate with RV dimension. Because RV Doppler tissue imaging velocities are still in the normal range 1 month after ASD closure, cardiac function does not seem to be affected by the presence of the occluder device.

Adolescent↗
PubMed2003

Different involvement of right ventricular myocardial function in either physiologic or pathologic left ventricular hypertrophy: a Doppler tissue study.

The aim of the study was to analyze right ventricular (RV) myocardial function in patients with left ventricular (LV) hypertrophy secondary to either hypertrophic cardiomyopathy (HC) or athletic endurance training. Doppler echocardiography and pulsed Doppler tissue imaging of the posterior septal wall, and mitral and tricuspid annulus were performed in 32 top-level endurance athletes (AT) and in 27 patients with HC, all men. LV mass index was comparable between the 2 groups. All transmitral Doppler indexes were higher in AT, whereas only tricuspid inflow peak E and E/A ratio were slightly decreased in the HC group. In the HC group, Doppler tissue analysis showed lower myocardial systolic and early-diastolic (Em) peak velocities, and longer time intervals at the level of all the analyzed segments, even after correction for age, heart rate, and LV mass index. Distinct multiple linear regression models revealed an independent positive association between RV peak Em velocity and LV end-diastolic diameter (beta coefficient = 0.72, P <.0001) in AT, and an independent inverse correlation of the same peak Em velocity of tricuspid annulus with septal thickness (beta = - 0.65, P <.001) in the HC group. Of interest, a RV Em peak velocity < 0.16 m/s differentiated AT and HC groups better than tricuspid Doppler (89% sensitivity and 93% specificity). In conclusion, Em RV myocardial function is positively influenced by preload increase in AT and negatively associated to increased septal thickness in patients with HC. Therefore, Doppler tissue imaging may represent a useful tool in the differential diagnosis between athlete's heart and HC, underlining the different involvement of RV myocardial function in either physiologic or pathologic LV hypertrophy.

Adult↗
PubMed2003

Myocardial ultrasound tissue characterization in patients with hypertrophic cardiomyopathy: noninvasive evidence of electrical and textural substrate for ventricular arrhythmias.

BACKGROUND: Although in patients with hypertrophic cardiomyopathy (HCM) pathologic studies seem to suggest a correlation between morphologic findings and arrhythmias, it has never been confirmed in the clinical setting. OBJECTIVE: We sought to noninvasively assess the electrical and textural properties of the myocardium and to define their potential relationship in patients with HCM. METHODS: We studied 48 patients: 22 with HCM (mean age: 22 +/- 5.1 years) and 26 age- and body surface area-matched healthy patients. They underwent a standard echocardiographic examination to assess left ventricular size and thickness. In addition, by integrated backscatter analysis, we assessed textural properties of left ventricular myocardium with calibrated averaged intensity (IB) and to assess functional properties of the myocardium with cyclic variation, both at the interventricular septum (IVS) and posterior wall. Finally, we studied ventricular late potentials (VLPs) by signal-averaged electrocardiography and performed a 24-hour electrocardiography Holter monitoring to respectively define electrical instability and ventricular arrhythmias. RESULTS: Compared with control patients, patients with HCM had, both at IVS and posterior wall, increased IB (-28.8 +/- 10 vs -35 +/- 4 dB [P =.007] and -29 +/- 8 vs -33 +/- 5 dB [P <.035], respectively) and decreased cyclic variation (6.8 +/- 2.7 vs 10.3 +/- 2.3 dB [P <.001] and 8.2 +/- 2.9 vs 11.4 +/- 2.1 dB [P <.001], respectively). In all, 5 patients with HCM had positivity of VLPs, and 4 of them showed nonsustained ventricular tachycardia (nsVT) on the Holter monitoring. Compared with patients who had HCM without VLPs and nsVT, patients with positivity of VLPs and nsVT showed higher IB both at IVS (-15.8 +/- 8.4 vs -32.6 +/- 5.9 dB [P <.001] and -16.6 +/- 9.5 vs -31.5 +/- 7.5 dB [P =.002], respectively) and at posterior wall (-19.08 +/- 8.42 vs -32.5 +/- 4.2 dB [P <.001] and -22.4 +/- 4.6 vs -31 +/- 7.5 [P =.04], respectively). A multivariate analysis showed IB at IVS (P =.042; odds ratio = 1.19) and positivity of VLPs (P =.026; odds ratio = 3.67) as independent predictors of nsVT. CONCLUSION: Patients with HCM showed abnormal morphologic and electrical properties of the myocardium. The correlation between VLPs and IB at IVS and their relationship with nsVT suggests a link between textural and electrical nonhomogeneity of myocardial fibers, a potential substrate of nsVT in patients with HCM.

Adolescent↗
PubMed2003

Noninvasive assessment of left and right internal mammary artery graft patency using transthoracic color Doppler echocardiography.

BACKGROUND: The aim of this study was to evaluate the patency of left and right internal mammary artery grafts respectively on the left anterior descending and right coronary artery by noninvasive transthoracic color Doppler echocardiography. METHODS: Thirty eight patients (34 males, 4 females, mean age 59 +/- 2 years), with a history of coronary artery bypass grafting for a total of 42 mammary artery grafts, were studied by means of color Doppler echocardiography at baseline and after vasodilation with dipyridamole infusion (0.56 mg/kg i.v. over 4 min). The evaluated echocardiographic parameters included: systolic (SPV) and diastolic peak velocities (DPV), systolic (SVI) and diastolic velocity-time integrals (DVI), and the DPV/SPV and DVI/SVI ratios. We also calculated the dipyridamole infusion to baseline ratio of the diastolic peak velocities (DPVdip/DPVbaseline), the index of internal mammary artery graft blood flow reserve and the percent DPV increment as an index of graft stenosis. RESULTS: On the basis of coronary angiography, two groups were selected: group A (36 mammary grafts) with patent grafts and group B (6 mammary grafts) with moderate or severe stenosis of the grafts. Group A had a predominant diastolic pattern with a DPV of 0.24 +/- 0.13 m/s, whereas group B had a predominant systolic pattern with a reduced DPV of 0.12 +/- 0.03 m/s (p < 0.01). Dipyridamole induced an increase in the DPV respectively of 86.8 +/- 64.4% in group A and 13.8 +/- 15.9% in group B (p < 0.001). Statistical analysis (Mann-Whitney test) revealed a significant difference between the two groups for the baseline DPV (p < 0.01), DVI (p < 0.05), DPV/SPV ratio (p < 0.005), DVI/SVI ratio (p < 0.05), and for the after dipyridamole infusion values: DPV (p < 0.0001), DVI (p < 0.005), DPV/SPV ratio (p < 0.001), and DVI/SVI ratio (p < 0.05). Multivariate analysis showed that the percent DPV increment, the DPVdip/DPVbaseline ratio and the baseline DPV were independent determinants of the stenosis as evaluated at angiography (beta = -0.38, p < 0.01; beta = -0.37, p < 0.01, and beta = -0.33, p < 0.05, respectively; cumulative r2 = 0.25, standard error 0.30 m/s, p < 0.005). CONCLUSIONS: The echocardiographic evaluation of the mammary grafts is a simple, noninvasive method for the assessment of the graft patency and of the functional status of the vessel. The percent DPV increment and baseline DPV were independent determinants of mammary graft stenosis.

Blood Flow Velocity↗
PubMed2002

Effects of different training protocols on left ventricular myocardial function in competitive athletes: a Doppler tissue imaging study.

BACKGROUND: The aim of the study was to analyze the differences in myocardial function in case of left ventricular (LV) hypertrophy induced by either endurance or strength training in top-level athletes. METHODS: Standard Doppler echo and pulsed Doppler tissue imaging (DTI) of the interventricular septum and of the LV inferior wall were performed in 26 competitive endurance athletes (long-distance swimmers) (group A) and in 20 strength-trained athletes (short-distance swimmers) (group B). By means of DTI, the following parameters of myocardial function were assessed: the systolic peak velocities (Sm), the pre-contraction time, the contraction time, the early (Em) and late (Am) diastolic velocities, the Em/Am ratio and the relaxation time. RESULTS: The two groups were comparable for age and sex, but at rest group B showed a higher heart rate, systolic blood pressure and body surface area. The LV mass index and fractional shortening did not significantly differ between the two groups. However, group B showed an increased sum of the wall thicknesses (septum + posterior wall) (p < 0.001) and of the relative wall thickness, while the LV stroke volume and LV end-diastolic diameter (p < 0.001) were greater in group A. All transmitral Doppler indexes were higher in group A, with an increased E/A ratio. DTI analysis showed, in group A, a higher Em and Em/Am ratio as well as a longer relaxation time both at the septal and at the inferior wall levels, with comparable Sm, pre-contraction and contraction times. Distinct multiple linear regression models revealed an independent positive association between the inferior peak Em velocity and the LV end-diastolic diameter (p < 0.001) in group A, and an independent direct correlation of the inferior peak Sm velocity with the sum of the wall thicknesses (p < 0.001) and with the end-systolic stress in group B. CONCLUSIONS: The early diastolic myocardial function is positively influenced by the preload increase in group A, while an increased afterload and LV wall thickness in group B mainly seem to induce an enhancement of the regional myocardial systolic function.

Adaptation, Physiological↗
PubMed2002

The usefulness of pulsed tissue Doppler for the clinical assessment of right ventricular function.

Standard Doppler echocardiographic evaluation of the right ventricular (RV) function has several limitations because of a difficult technical approach. The purpose of the present review was to investigate, even in the light of such problems, the usefulness of pulsed tissue Doppler (TD) during the assessment of RV transverse and longitudinal function on the basis of the regional velocities and time intervals. TD-derived (systolic and diastolic) velocities of the RV free wall and of the lateral tricuspid annulus have been used to establish reference values in healthy subjects and in different cardiac diseases. Some studies have shown the usefulness of myocardial systolic velocities for the detection of RV systolic failure at rest and of right coronary artery stenosis during stress. The myocardial early diastolic velocities, combined to Doppler standard tricuspid inflow measurements, represent reliable indexes of right chamber hemodynamics, the ratio between the Doppler tricuspid E velocity and the TD-derived early diastolic velocity of the lateral tricuspid annulus being positively related to the mean right atrial pressure after heart transplantation. Even the assessment of RV regional time intervals may have clinical implications. In particular, the relaxation time of the lateral tricuspid annulus, very short or even absent in healthy subjects increases progressively with the pulmonary systolic artery pressure and its length is strongly influenced also by the increasing RV wall thickness in septal hypertrophic cardiomyopathy and in hypertensive left ventricular hypertrophy. The interaction between the two ventricles is identified by assessing the TD velocities of the RV tricuspid annulus which are often associated with the corresponding velocities of the mitral annulus in different pathologies. On the grounds of these studies, the clinical use of pulsed TD merits consideration. Longitudinal follow-up of TD RV patterns will be useful to evaluate the progression from early RV wall dysfunction until the development of global RV failure and the possible beneficial effect of cardiac drugs on RV function as determined by TD evaluation.

Cardiomyopathy, Hypertrophic↗
PubMed2002

[Mitral stenosis: echocardiographic evaluation].

The diagnostic tools available for the evaluation of mitral stenosis are two-dimensional and Doppler echocardiography, which are able to identify morphologic and flow changes. Two-dimensional echocardiography can be used to assess the morphological appearance of the mitral valve apparatus, including its mobility and thickness and the presence of calcified leaflets and subvalvular fusion. Wilkins'score permits evaluation of each variable which, on the basis of its severity, is scored according to a point system ranging from 1 to 4. In patients with severe mitral stenosis, a low total score (< 8) and elastic symmetric commissures suggest valvuloplasty. A total score > 10 and the presence of more than mild mitral regurgitation or of calcification of both commissures suggest valvular replacement. The left atrial and ventricular chamber sizes and other associated valvular diseases can also be assessed at two-dimensional or Doppler echocardiography. The severity of obstruction can be assessed using two-dimensional and Doppler echocardiographic area (pressure half-time, proximal isovelocity surface area, continuity equation) and with the mean transmitral gradient measured using a continuous wave Doppler signal across the mitral valve. Valvuloplasty can also be performed in patients with a high score when surgery is contraindicated. During follow-up it is necessary to evaluate the area, the mean gradient, the right ventricular systolic pressure and the presence of a residual atrial septal defect and mitral regurgitation. Restenosis is diagnosed when the valve area decreases to 50% of that achieved during valvuloplasty or surgery.

Adult↗