[Significance of the relationship between myocardial mass and systolic work in the functional assessment of the left ventricle in heart valve diseases].
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In 85 patients (22 with myocardial infarct and 63 with valvular heart disease) echocardiographical examination simultaneously by classical and transesophageal methods was done. The transesophageal method was better in assessing the aortic valve and similar to the classical method in reference to the mitral valve. Heart contractility assessment was better with the classical method. Transesophageal echocardiography is the method of choice in patients in whom classical echocardiography cannot be done (obesity, emphysema, chest deformation).
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It is believed that a significant V wave in pulmonary capillary wedge pressure (PWP) is a sign of mitral regurgitation. Of 358 patients with acquired valvular heart disease in 24-cases a significant V wave (15 mm Hg of PWP) was recorded during right heart catheterization. All patients underwent right heart catheterization with a flow- directed, balloon-tipped, thermodilution catheters (Edwards Labs). Mean pulmonary, capillary wedge, and right atrial pressures were monitored and recorded. Cardiac output was determined by thermodilution technique using iced 5% dextrose. After measurements of flow, pulmonary and systemic resistance morphology of V wave from PWP recordings was assessed. We measured dp/dt of the ascending limb of V wave and Libanoff and Rodbard V wave index (dp/dt:CI). Nine patients with significant V wave had no signs of mitral regurgitation and had mainly significant mitral stenosis (group III). Group II (6 patients) consisted of patients with different combinations of acquired left heart valve disease and mitral regurgitation. Group I (9 pts) consisted of patients with isolated mitral regurgitation. There were no differences in right atrial, pulmonary, and capillary wedge pressures, cardiac index, pulmonary and systemic valvular resistance among groups I, II and III. There were significant differences as far as dp/dt V wave was concerned (gr I--136 +/- 31.4, gr II--112.2 +/- 30.7, gr III--72.7 +/- 31.2 mm Hg/s). Libanoff's index of V wave was also significantly different in all three groups--gr I--12.7 +/- 6.2; gr II--8.0 +/- 2.3; gr III--4.8 +/- 1.7 mm Hg/s). It seems that V wave in PWP recordings is not only a sign of mitral regurgitation, but also could be a sign of decreased pulmonary veins compliance.
In this paper, a decision support system that classifies the Doppler signals of the heart valve to two classes (normal and abnormal) is presented to support the cardiologist. The paper uses our previous paper where ANN is used as a classifier, as feature extractor from measured Doppler signal. To make this, it uses wavelet transforms and short time Fourier transform methods. Before it classifies these features, it applies Wavelet entropy to them. In this paper, our aim is to develop our previous work by using least-squares support vector machine (LS-SVM) classifier instead of ANN. We use LS-SVM and backpropagation artificial neural network (BP-ANN) to classify the extracted features. In addition, we use receiver operator characteristic (ROC) curves to compare sensitivities and specificities of these classifiers and compute the area under the curves. Finally, we evaluate two classifiers in all aspects.
In 58 patients suffering from either stenosis or insufficiency of a single heart valve, gated blood pool scintigraphy was performed to determine the ejection fraction as well as the peak filling and peak ejection rates. It could be demonstrated that in patients with valvular disorders the ejection fraction was only moderately decreased, generally remaining in the lower reference range. The peak filling and ejection rates showed no pathologic changes with the exception of patients with aortic regurgitation where these rates were significantly decreased. Thus, the estimation of left ventricular peak filling and ejection rates may permit diagnosis of myocardial impairment in patients with valvular disease even under resting conditions.
Quantitative nuclear cardiography was applied to 400 patients with valvular heart disease proven by heart catheterisation. The study yielded the following results: 1. The parameters used were directly related to th4 cardiac index, the enddiastolic volume of the left ventricle and the pressures in the pulmonary vascular system. 2. The method proved to be highly sensitive in stating whether there was a hemodynamically effective valvular disease present or not. Differential diagnosis, however, was not possible. 3. The prolongation of the circulation times correlated with the hemodynamic severity of the disease. 4. The method could be used in evaluation of corrective surgery and for follow-up after operation.