Biomedical subjects

Viviana Serra

Publications and source records attributed to Viviana Serra.

13 recordsLinked to original sources

PubMed2006

Prognostic significance of functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome.

AIMS: The development of mitral regurgitation (MR) after an acute myocardial infarction (AMI) is a recognized and frequent complication and its negative impact on survival has been observed. However, few data exist regarding MR after non-ST-segment elevation acute coronary syndrome (NSTSEACS). Our aim was to investigate the incidence, clinical predictors, and prognostic implications of MR in the setting of NSTSEACS. METHODS AND RESULTS: We studied 300 consecutive patients (71.7% men, mean age 66.9+/-13 years) admitted to our coronary care unit for an NSTSEACS. Every patient underwent an echocardiographic study during the first week after the index NSTSEACS and was clinically followed up. MR was detected in 42% (126 patients; 88 men, mean age 71.3+/-11 years). Mean follow-up was 425.6+/-194.8 days. Only age and left ventricular (LV) ejection fraction (EF) were found as independent markers of the development of MR; no variable was found as an independent predictor of in-hospital mortality and only MR was found as an independent predictor of long-term outcome. CONCLUSION: MR is frequent after an NSTSEACS. Age and a low LV EF are factors associated to its development. The presence and degree of MR confer a worse long-term prognosis to patients after a first NSTSEACS. Thus, the presence of MR should be specifically assessed in every patient after an NSTSEACS.

Aged↗

PubMed2005

Identification of stunned myocardium with parametric imaging-based, quantitative myocardial contrast echocardiography after acute myocardial infarction.

Microvascular integrity demonstrated by myocardial contrast echocardiography (MCE) predicts functional recovery after an acute myocardial infarction (AMI). Recently, parametric imaging-based quantitative MCE has been developed. Our aim was to assess the usefulness of parametric imaging-based quantitative MCE parameters to predict the functional recovery of akinetic segments after primary percutaneous transluminal coronary angioplasty (PTCA). Fifty-three consecutive patients with a first AMI were enrolled. They underwent primary PTCA. Standard echocardiography and real-time MCE were performed. Qualitative analysis and parametric imaging-based quantitative parameters were measured offline by different blinded investigators. Dobutamine stress echocardiography was performed 1 month later. A new standard echocardiogram to assess the functional status of the akinetic segments and coronary angiography to evaluate the presence of restenosis at the level of the culprit lesion were performed 6 months later. The mean patient age was 62.9 +/- 14 years, and 42 were men (79%); 170 segments were akinetic. Of these, 105 (62%) recovered their function. The best parameter to predict functional recovery was the myocardial blood flow velocity (beta). These results were better than those obtained using dobutamine stress echocardiography and qualitative MCE to predict functional recovery. In conclusion, parametric imaging-based quantitative MCE is an accurate diagnostic tool to detect stunned myocardium after AMI. Its diagnostic accuracy in predicting the functional recovery of akinetic segments after primary PTCA is better than the accuracy of dobutamine stress echocardiography and qualitative MCE.

Aged↗

PubMed2005

Comparison of left ventricular volumes and ejection fractions measured by three-dimensional echocardiography versus by two-dimensional echocardiography and cardiac magnetic resonance in patients with various cardiomyopathies.

End-diastolic volume and end-systolic volume were measured in 35 consecutive patients with cardiomyopathy using 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography (2, 4, and 8 planes) and cardiac magnetic resonance imaging. Three-dimensional echocardiography correlates better with magnetic resonance imaging than does 2-D echocardiography. Its accuracy improves with the increase in the number of planes used. Two-dimensional echocardiography underestimates volumes, mainly in the subgroup with an ejection fraction of <50%, whereas 3-D echocardiography does not, if enough planes are used. However, in patients with an end-diastolic volume > or =150 ml, the underestimation of 3-D echocardiography is statistically significant. Increasing the number of planes to 8 reduces this bias. Conversely, patients with an end-diastolic volume <150 ml are accurately studied with just 4 planes.

Adult↗

PubMed2005

[Usefulness of parametric imaging-based quantitative myocardial contrast echocardiography in predicting the functional recovery of akinetic segments following primary angioplasty in acute myocardial infarction patients].

INTRODUCTION AND OBJECTIVES: Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE; and b) to assess the usefulness of these measurements in predicting functional recovery of these segments. PATIENTS AND METHOD: The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images. RESULTS: The patients' mean age was 62.3+/-14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (beta): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion. CONCLUSIONS: Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods.

Aged↗

PubMed2004

Right atrial rupture.

Cardiac rupture is a rare complication of primary cardiac tumors. We present a very uncommon case of cardiac angiosarcoma presenting as a right atrial rupture. A 58-year-old patient presented progressive dyspnea, weight loss, anorexia and asthenia. A chest X-ray revealed global cardiac enlargement, mainly from the right atrium. Transthoracic echocardiography gave rise to the suspicion of right atrial pseudoaneurysm, which was confirmed by transesophageal echocardiography. The ruptured atrial wall was clearly seen using contrast echo. In addition, magnetic resonance imaging provided an excellent tool in the anatomic evaluation of this uncommon complication. The diagnosis of angiosarcoma was hystologically confirmed.

Female↗

PubMed2003

Myocardial perfusion in real-time using power modulation. In vivo evidence for microcirculatory damage after acute myocardial infarction.

BACKGROUND AND OBJECTIVES: In addition to the myocardium, the microvasculature may be also damaged in acute myocardial infarction. The aim was to evaluate the capability of myocardial contrast echocardiography in the detection of microvasculature damage after myocardial infarction. PATIENTS AND METHODS: Twelve patients with recent acute myocardial infarction and five control subjects with normal coronary arteries and without history of myocardial infarction were studied. Myocardial contrast echocardiography with power modulation was performed, and quantitative data were measured off-line. Power modulation uses a combination of low (0.1) and high (1.7) mechanical indexes, allowing a real-time evaluation of myocardial perfusion. Contrast agent was administered as a 3-min bolus. The quantitative analysis was performed off-line by a different blinded investigator. The refilling velocity was calculated as the difference between the peak myocardial refilling value and the value at 1 s after the impulse divided by the time from the first second after the impulse to the peak refilling value. RESULTS: Eighty-one myocardial segments (75%) were analysed qualitatively and quantitatively in AMI patients, and 18 (60%) in control subjects (P=NS). The peak refilling intensity was not significantly different in patients and control subjects (6.62+/-5.85 vs. 7.53+/-4.06 dB, respectively). However, time to peak refilling intensity was significantly longer (5.25+/-1.57 vs. 4.00+/-0.53, P=0.004) and the velocity of refilling was significantly lower (2.74+/-5.34 vs. 6.58+/-8.02, P=0.028) in patients with myocardial infarction. CONCLUSION: There is microvasculature damage after myocardial infarction that is reflected as a delayed velocity of refilling in myocardial contrast echocardiography.

Adult↗

PubMed2003

Evaluation of myocardial perfusion with grey-scale ultra-harmonic and multiple-frame triggering. The need for quantification.

BACKGROUND AND OBJECTIVE: Contrast echocardiography has been recently introduced as a new technique for evaluating myocardial perfusion in a qualitative basis. The objective of this study was to test whether a visual subjective evaluation of myocardial perfusion by myocardial contrast echocardiography adequately matches the data obtained with an off-line quantification of myocardial perfusion. METHODS: Sixty-one myocardial segments were evaluated by myocardial contrast echocardiography with Ultra-harmonic and Multiframe Triggering in 11 patients 3-7 days after an anterior myocardial infarction, using SH-U 563A (Levovistâ, Schering AG, Berlin, Germany) as contrast agent. Myocardial perfusion was classified as grade 1 (absent), 2 (patchy or incomplete) and 3 (complete) in each segment. The quantitative analysis was performed off-line by a different investigator blinded to the qualitative evaluation, using a commercially available software. The quantitative data on grey-scale obtained were compared between grade 1, 2 and 3 segments. RESULTS: Of the 61 segments, 45 (73.8%) were classified as grade 3, whereas the remaining 16 (26.2%) were considered to be abnormally perfused (grade 2: n=12, 19.6%; grade 1: n=4, 6.6%). Segments with grade 1 perfusion had a significantly higher grey-scale value (123.6 +/- 41.3 vs. 70.1 +/- 34.3, p=0.004). However, there were no significant differences between segments with perfusion grade 2 and 3 (76.8 +/- 33.2 vs. 68.3 +/- 34.8, p=0.452). CONCLUSION: Qualitative assessment of myocardial perfusion by Ultra-harmonic and Multiframe Triggering is of limited value, since only myocardial segments with absent perfusion may be reliably identified. This findings support the need of quantification in the evaluation of myocardial perfusion by contrast echocardiography.

Aged↗

PubMed2003

Differences between endocarditis with true negative blood cultures and those with previous antibiotic treatment.

BACKGROUND AND AIM OF THE STUDY: High morbidity and mortality are attributed to patients with culture-negative endocarditis. The main reason for negative blood culture in infectious endocarditis (IE) is administration of antibiotics before sample withdrawal. The study aim was to determine any difference in prognosis between patients with 'aborted' culture-negative endocarditis (A-CNE) and those with true culture-negative endocarditis (T-CNE). METHODS: A total of 107 patients with a diagnosis of IE was studied retrospectively. Diagnosis was confirmed pathologically during surgery, at post-mortem examination, or by fulfillment of Duke's criteria. Twenty patients (18.7%) had negative-culture endocarditis and comprised the study population. Of these patients, 14 (70%) had received previous antibiotic therapy (A-CNE), and six (30%) were considered T-CNE cases. In-hospital outcome and clinical characteristics were compared between both patient groups. The main end-point was death or need for surgical repair of the heart valves during hospitalization. RESULTS: There were no significant inter-group differences with respect to mean age, gender distribution, and other clinical characteristics. The composite endpoint of death or surgical repair occurred more frequently in T-CNE patients (100% versus 64%, p = 0.0394). Anatomic complications also occurred more frequently in T-CNE patients, but the difference was statistically not significant. CONCLUSION: Among patients with IE and a negative blood culture, those without previous antibiotic therapy (T-CNE) have the worse prognosis.

Antibiotic Prophylaxis↗

PubMed2003

Relationship between the changes in myocardial perfusion and left ventricular ejection fraction after acute myocardial infarction. Study with myocardial contrast echocardiography.

BACKGROUND AND OBJECTIVE: Myocardial contrast echocardiography has recently been proposed as a valid technique in the evaluation of myocardial perfusion after myocardial infarction. The objective of this study was to evaluate the relation between changes in myocardial perfusion assessed by myocardial contrast echocardiography and left ventricular ejection fraction after myocardial infarction. PATIENTS AND METHODS: We prospectively studied 17 patients with acute myocardial infarction, on whom two echocardiographic studies were performed, at 48-72 hours and at 6 months. Left ventricular ejection fraction and myocardial perfusion were evaluated with myocardial contrast echocardiography (Multiple-Frame Triggering and Harmonic Angio). Basal, medial and distal segments of the interventricular septum (anterior location infarction) and inferior wall (inferior infarction) were assessed. Myocardial perfusion was classified semi-quantitatively as grade 0, 1 or 2 (absent, heterogeneous or homogeneous opacification, respectively), giving a perfusion score. RESULTS: Left ventricular ejection fraction improved in 9 patients (53%), the proportion of grade 0 segments decreasing by 11 +/- 17%; by contrast, this proportion increased by 9 +/- 13% in patients with no improvement in ejection fraction (p = 0.028). Additionally, a significant correlation was observed between changes in ejection fraction and both perfusion score (r = 0.625; p = 0.007) and the proportion of grade 2 segments (r = 0.649; p = 0.005). CONCLUSION: After myocardial infarction, there is a significant relation between changes in left ventricular ejection fraction and myocardial perfusion assessed by myocardial contrast echocardiography with i.v. agents.

Aged↗

PubMed2002

Contrast agents provide a faster learning curve in dipyridamole stress echocardiography.

AIM: Interobserver variability is an important limitation of the stress echocardiography and depends on the echocardiographer training. Our aim was to evaluate if the use of contrast agents during dipyridamole stress echocardiography would improve the agreement between an experienced and a non-experienced observer in stress echo and therefore if contrast would affect the learning period of dypyridamole stress echo. METHODS AND RESULTS: Two independent observers without knowledge of any patient data interpreted all stress studies. One observer was an experienced one and the other had experience in echocardiography but not in stress echo. Two observers analysed 87 non-selected and consecutive studies. Out of the 87 studies, 46 were performed without contrast administration, whereas i.v. contrast (2.5 g Levovist by two bolus at rest and at peak stress) was administered in 41. In all cases, second harmonic imaging and stress digitalisation pack was used. The agreement between observers showed a kappa index of 0.58 and 0.83 without and with contrast administration, respectively. CONCLUSIONS: The use of contrast agents provides a better agreement in the evaluation of stress echo between an experienced and a non-experienced observer in stress echo. Adding routinely contrast agents could probably reduce the number of exams required for the necessary learning curve in stress echocardiography.

Clinical Competence↗

PubMed2002

Better prognosis of elderly patients with infectious endocarditis in the era of routine echocardiography and nonrestrictive indications for valve surgery.

OBJECTIVE: It has been reported that endocarditis in the elderly may have a poor outcome. Our aim was to assess the different features and prognosis, if any, in the present time. METHODS: Of 103 patients with proven endocarditis, 31 were 65 years or older and 72 were younger than 65 years. Degenerative heart disease was seen more frequently in the elderly (22.5% vs 2.7%, P =.003). Drug abuse and immunodeficiency virus infection were more common in the younger group, as was tricuspid endocarditis (26.3% vs 0%, P <.001). At clinical presentation cardiac failure (41.9 vs 19.4%, P =.02) and leukocytosis (61.2% vs 40.2%, P =.049) were seen more frequently in the elderly. RESULTS: Despite other similar clinical features, it took longer to diagnose older patients (7.2 +/- 6.2 vs 3.2 +/- 3.5 days, P <.001). Enterococcus infected the aged more often (32.2% vs 13.1%, P =.001). During hospitalization, heart failure and embolization tended to be more common in the elderly and the younger group, respectively. There were no significant differences in the incidence of anatomic complications, the need for operation, and overall mortality. CONCLUSION: Although a worse prognosis has been reported in elderly patients with infective endocarditis, the early use of transesophageal echocardiographic examinations and equal therapeutic options provides a similar outcome when compared with younger subjects.

Aged↗

PubMed2002

[Left ventricular free wall rupture during dobutamine stress echocardiography].

Dobutamine stress echocardiography is associated with a very low rate of serious complications, lower than 0.5% (death, infarction or sustained ventricular tachycardia). We report the case of a 75 year-old female patient that suffered a fatal left ventricular free wall rupture during a dobutamine stress echocardiography after acute myocardial infarction.

Aged↗

PubMedDate not supplied

[Usefulness of real time 3D echocardiography in assessment of rheumatic mitral stenosis].

To date, the assessment of rheumatic mitral stenosis has been based on Doppler methods, which have a high dependence on the hemodinamic conditions and on the planimetry obtained from 2D echo images. Real Time 3D echocardiography has been implemented in the daily clinical practice. It provides high quality 3D images and the acquisition time is very short. In the present work, we try to show the "state of the art" of Real Time 3D echocardiography in the assessment of rheumatic mitral stenosis. These findings are based on the experience of our "Unidad de Imagen Cardiovascular" at the Hospital Clinico San Carlos de Madrid.

Echocardiography, Doppler↗