Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
-
J Am Soc Echocardiogr · Oct 2002
Comparative StudyUse of transesophageal contrast echocardiography for excluding left atrial appendage thrombi in patients with atrial fibrillation before cardioversion.
Transesophageal echocardiographic (TEE) guidance of cardioversion in patients with atrial fibrillation is an alternative method to conventional anticoagulation. Although TEE is considered the gold standard for excluding left atrial (LA) thrombi, in some patients dense spontaneous echo contrast (SEC) and artifacts may hamper the identification or exclusion of LA thrombi. Often those patients are refused cardioversion. ⋯ Those patients underwent cardioversion. None of those patients had a cerebral embolic complication as assessed by cranial magnetic resonance imaging. Thus, the application of echo contrast may facilitate the TEE exclusion of LA appendage thrombi and, hence, improve the safety of TEE-guided cardioversion.
-
J Am Soc Echocardiogr · Oct 2002
Independent value of tissue harmonic echocardiography for risk stratification in patients with non-ST-segment elevation acute chest pain.
Clinical factors, electrocardiography, and cardiac troponins provide a satisfactory, although not ideal, means for risk-stratifying patients with non-ST-segment elevation acute chest pain. Tissue harmonic echocardiography enables improved assessment of wall motion abnormalities compared with fundamental echocardiography and may be a useful adjunct for the detection of myocardial ischemia and infarction. We aimed to determine the value of tissue harmonic echocardiography in relation to electrocardiographic and biochemical factors for risk stratification of these patients. ⋯ Tissue harmonic echocardiography provides independent information for risk stratification of patients with non-ST-segment elevation acute chest pain.
-
J Am Soc Echocardiogr · Oct 2002
Comparative StudyRight atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension.
Primary pulmonary hypertension (PPH) is a fatal illness. In advanced stages only transplantation is able to increase survival. Echocardiography is useful for the assessment of these patients, but there is limited information about its prognostic value. ⋯ In the univariate analysis, RAA (HR: 1.1, P =.0004), TR (HR: 2.7, P =.02), and RVET (HR: 0.98, P =.02) showed statistically significant relation with survival free from transplantation. Multivariate analysis showed that RAS (HR: 1.10, 95% CI: 1.04-1.17, P =.001) and TR (HR: 2.52, 95% CI: 1.01-6.3, P =.047) were independent risk factors of transplantation and death. The use of these findings on the management of patients with PPH should be tested in larger studies.
-
J Am Soc Echocardiogr · Oct 2002
Comparative Study Clinical TrialPrevalence of left ventricular diastolic dysfunction by Doppler echocardiography: clinical application of the Canadian consensus guidelines.
We evaluated diastolic filling patterns using Doppler echocardiography in 520 consecutive patients referred to our laboratory for transthoracic echocardiograms retrospectively and applied the standard guidelines used to characterize left ventricular (LV) diastolic function. Patients were classified by the Canadian consensus guidelines using transmitral and pulmonary venous Doppler echocardiographic parameters to have normal diastolic function or mild (abnormal relaxation), mild-to-moderate, moderate (pseudonormal), or severe (restrictive) diastolic dysfunction. ⋯ In the subset of patients with clinical evidence of congestive heart failure (99 patients), the prevalence of primary diastolic heart failure was 38% and most patients had underlying coronary or hypertensive heart disease. Standard guidelines of Doppler echocardiographic parameters allow semiquantitation of diastolic function and can be applied to studying large number of patients in a large clinical practice.
-
J Am Soc Echocardiogr · Oct 2002
Comparative StudyIntraoperative transesophageal echocardiographic assessment of the effect of protamine on paraprosthetic aortic insufficiency immediately after stentless tissue aortic valve replacement.
Mild paravalvular aortic insufficiency (AI) is common immediately after stentless bioprosthetic aortic valve replacement. Although resolution of paraprosthetic jets with protamine has been described, the predictability of resolution has not been addressed. Intraoperative transesophageal echocardiography was performed before and after protamine administration among 2 groups. ⋯ Paravalvular AI occurred in 13 of 20 (65%) patients. Using a threshold value of 0.3 cm or less jet width, prospective testing revealed positive and negative predictive values for AI resolution with protamine of 93% (14 of 15) and 100% (3 of 3), respectively. Protamine administration is associated with resolution of small AI jets immediately after implantation of a stentless aortic bioprosthesis, with a jet width 0.3 cm or less strongly predictive of resolution.