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Szilard Voros

Publications and source records attributed to Szilard Voros.

12 recordsLinked to original sources
PubMed2007

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

BACKGROUND: New left ventricular systolic dysfunction affects 500,000 Americans and coronary artery disease (CAD) is responsible for two-thirds of cases. Identifying CAD has both prognostic and therapeutic implications. We evaluated the ability of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance imaging (CMR) to detect CAD as the etiology of recent onset congestive heart failure (CHF). METHODS: CMR and LGE were performed in 26 patients with new onset left ventricular systolic dysfunction. All patients received an x-ray angiography for identification of CAD. Patients with an acute coronary syndrome with troponin I > 1.0 ng/ml or a history of CAD were excluded. The presence and distribution of LGE was evaluated. RESULTS: Significant coronary stenoses were present in 5 of 26 patients (19%). LGE in an infarct pattern was found in 2 of the 5 patients with CAD. Of the 21 patients without CAD, 2 had midwall enhancement but none had evidence of LGE in an infarct pattern. CONCLUSIONS: When present, LGE in an infarct pattern suggests CAD as the etiology of new onset CHF. However, the absence of LGE does not exclude CAD as the underlying etiology. A small proportion of patients with a nonischemic cause of new onset CHF have LGE limited to the midwall.

Adult↗
PubMed2006

Dobutamine response and myocardial infarct transmurality: functional improvement after coronary artery bypass grafting--initial experience.

The Investigational Review Board approved the protocol, and all patients provided signed informed consent. The protocol was compliant with HIPAA. The purpose of the study was to prospectively test the hypothesis that addition of low-dose dobutamine and quantification of inotropic reserve in segments with 1%-50% infarct transmurality (IT) would improve the predictive value for functional recovery after revascularization in chronic infarction. Fifteen patients with multivessel coronary artery disease and left ventricular systolic dysfunction were enrolled prior to coronary artery bypass grafting (CABG). Late gadolinium-enhanced cardiac magnetic resonance (MR) imaging was used to assess IT. The percentage of wall thickening was measured with cine cardiac MR imaging at rest and during infusion of 10 (microg . kg(-1))/min dobutamine. Repeat cardiac MR imaging was performed 20 weeks +/- 4 (standard error) later. Functional parameters according to segment were compared before and after CABG by using F tests with repeated-measures models. In segments with 1%-50% IT, similar functional recovery was noted in those with 1%-25% or 26%-50% IT. However, in the same segments, those that improved with dobutamine to normal range demonstrated greater improvement in the percentage of wall thickening (22% +/- 4) after revascularization than those that did not (9% +/- 4) (P < .04). In 1%-50% IT, a normal dobutamine response helps differentiate segments with greater functional recovery after CABG.

Adult↗
PubMed2006

A unique case of pulmonary artery leiomyosarcoma.

Primary pulmonary artery leiomyosarcomas are rare, and the diagnosis is usually confused with other, more common, diseases, especially pulmonary embolism. A 52-year-old male, previously healthy, sustained a cardiac arrest. Chest CT-angiography diagnosed a "saddle embolus". Local thrombolysis was tried without any obvious success. At this point, the possibility of neoplasm was entertained. A cardiac MRI showed a nonhomogeneous mass in the proximal pulmonary artery. Successful surgery was performed, and histological examination of the resected mass was consistent with leiomyosarcoma. A follow-up cardiac MRI showed no residual mass. The dilemma associated with diagnosing pulmonary artery leiomyosarcomas will be discussed.

Diagnosis, Differential↗
PubMed2005

Interaction between AT1 and AT2 receptors during postinfarction left ventricular remodeling.

The relative contribution of the angiotensin II type 1 and 2 receptors (AT1-R and AT2-R) in postmyocardial infarction (MI) remodeling remains incompletely understood. We studied five groups of C57Bl/6 mice after 1 h of left anterior descending artery occlusion-reperfusion: 1) wild type, untreated (n = 12); 2) wild type, treated with the AT1-R blocker losartan (10-20 mg.kg(-1).day(-1) in drinking water) from day 1 to day 28 post-MI (n = 10); 3) cardiac overexpression of the AT2-R [AT2-transgenic (TG); n = 14]; 4) AT2-TG treated with losartan (n = 13); and 5) AT2-TG and null for the AT1a-R [AT2-TG/AT1 knockout (KO); n = 10]. Cardiac magnetic resonance imaging (CMR) measured ejection fraction and left ventricular end-diastolic and end-systolic volume (EDVI and ESVI) and mass indexed to weight on days 0, 1, 7, and 28 post-MI. Infarct size was measured on day 1 by late gadolinium-enhanced CMR. Regional myocyte hypertrophy and collagen content were measured on day 28 post-MI. Infarct size was similar among groups. Systolic blood pressure was lowest in AT2-TG/AT1KO. By day 28 post-MI, when corrected for baseline differences, EDVI and ESVI were higher and ejection fraction was lower in wild type than other groups. Ejection fraction was highest and EDVI and mass index were lowest in AT2-TG/AT1KO at day 28. The AT2-TG/AT1KO demonstrated less fibrosis in adjacent regions. Regional myocyte hypertrophy was similar in all groups. The AT1-R and AT2-R are intricately intertwined in post-MI remodeling. Pharmacological blockade of AT1-R is equivalent to AT2-R overexpression in attenuating post-MI remodeling. Genetic knockout of the AT1a-R is additive to AT2-R overexpression, due, at least in part, to blood pressure lowering.

Animals↗
PubMed2005

Chagas myocarditis and syncope.

This case report describes the diagnosis of Chagas myocarditis in a patient from Honduras who presented with syncope. The discussion summarizes the pathophysiology of cardiac Chagas disease. Acute, latent, and chronic Chagas myocarditis are described. The role of CMR in diagnosing Chagas myocarditis is discussed.

Adult↗
PubMed2003

Hemodynamic evaluation of normally functioning Sulzer Carbomedics prosthetic valves.

The Sulzer Carbomedics prosthetic heart valve (CP) is a commonly used mechanical valve in clinical practice. In the present study, we used conventional and color Doppler echocardiography to assess the hemodynamics of normally functioning CP in the aortic (n = 73) and mitral (n = 127) positions. Our findings demonstrate no significant correlation of Doppler-measured peak and mean pressure gradients and effective orifice area with implanted valve size and actual orifice areas, measured directly by the manufacturer for CPs in both the mitral and aortic positions. However, it is still useful to measure effective orifice area by Doppler because a value in the normal or nonstenotic range points to an unobstructed prosthesis in the aortic or mitral position, in the absence of poor left ventricular ejection fraction. A value in the stenotic range could mean a normally functioning or obstructed prosthesis and, therefore, may need further investigation, such as assessment of valve leaflet motion by transthoracic or transesophageal echocardiography or fluoroscopy. Valve regurgitation as evaluated by color Doppler flow mapping was mild in practically all CPs in the aortic position, and in the majority of CPs in the mitral position.

Aortic Valve↗
PubMed2000

Transesophageal Echocardiographic Assessment of Proximal Coronary Artery Stenosis in Elderly Patients With Ischemic Stroke.

Coronary artery disease is common in elderly patients with ischemic stroke. Most patients with ischemic stroke undergo transesophageal echocardiography to rule out cardiac sources of cerebral embolism. Transesophageal echocardiography has been shown to be very accurate in diagnosing significant proximal coronary artery stenosis, and may be used to evaluate the coronary arteries for the presence of stenosis in elderly patients with ischemic stroke. Transesophageal echocardiographic detection of these lesions might lead to subsequent coronary angiography and revascularization, dramatically changing the management and outcome of these patients. (c) 2000 by CVRR, Inc.

Journal Article↗
PubMed1999

Lambl's Excrescences Involving the Pulmonary Valve Detected by Transesophageal Echocardiography.

We report the first case of echocardiographically detected Lambl's excrescences on the pulmonary valve in a 72-year-old man who was referred for transesophageal echocardiography as a part of an evaluation for ischemic stroke. A total of four excrescences were noted on the arterial aspect of the pulmonary valve; two of them were on the anterior cusp, one was on the left cusp, and one was on the right cusp. The excrescence on the left cusp was the largest, measuring 5 mm in length. These valvular strands (Lambl's excrescences) represented an incidental finding and were not associated with any disease process.

Journal Article↗
PubMed1999

Transesophageal Echocardiographic Diagnosis of Proximal Coronary Artery Stenosis in Patients with Ischemic Stroke.

Atherosclerosis is the leading cause of death worldwide. It encompasses several clinical entities, including coronary artery disease and cerebrovascular disease. Because the underlying pathophysiological mechanism is the same, coronary artery disease and cerebrovascular disease frequently coexist. Transesophageal echocardiography (TEE) is routinely done in patients with ischemic stroke to exclude possible cardiac sources of cerebral embolism. Since the introduction of multiplane transesophageal transducers, it has become easier to visualize the proximal coronary arteries during transesophageal examinations. We report three cases in which routine TEE for ischemic stroke revealed significant coronary artery disease that was not previously suspected. In one patient, the stroke was so severe that further evaluation of the coronary artery disease was not deemed useful. The other two patients underwent coronary angiography based on the echocardiographic findings, confirming the lesions noted on the echocardiogram. Subsequently, both patients were successfully revascularized: one by percutaneous transluminal coronary angioplasty and the other by coronary artery bypass graft surgery. We conclude that the examination of coronary arteries during routine TEE for ischemic stroke may become a useful screening tool for the detection of coexisting, asymptomatic, significant proximal coronary artery disease.

Journal Article↗
PubMed1999

Transesophageal Echocardiographic Examination of Left Subclavian Artery Branches.

This preliminary study demonstrates the feasibility of examining the proximal segments of the branches of the left subclavian artery during probe withdrawal toward the end of a routine transesophageal echocardiographic study. The branches identified most commonly were the vertebral and the internal mammary arteries.

Journal Article↗
PubMed1999

Lambl's Excrescences (Valvular Strands).

We review the literature on Lambl's excrescences (valvular strands). With the widespread use of cardiac imaging modalities, most importantly, with transesophageal echocardiography, abnormal valvular structures are frequently identified on both native and prosthetic heart valves. However, there is no consensus in the literature on the correct terminology of these structures. The relationship between valvular strands (the so-called Lambl's excrescences) and papillary fibroelastomas has not been well established. In this review, we attempt to summarize the available echocardiographic descriptors and the gross macroscopic and histological features of Lambl's excrescences (valvular strands). In addition, we review the etiology, pathogenesis, and clinical implications of these cardiac excrescences. Also, we describe features that help to distinguish between Lambl's excrescences and papillary fibroelastomas. Because valvular strands (Lambl's excrescences) have been implicated in systemic thromboembolism, we also review the available management principles for patients with valvular strands; unfortunately, no specific therapeutic guidelines can be proposed at the present time.

Journal Article↗