Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Dec 2005
Randomized Controlled Trial Comparative StudyLeft ventricle myocardial performance index derived either by conventional method or mitral annulus tissue-Doppler: a comparison study in healthy subjects and subjects with heart failure.
The aims of this study were to investigate the clinical agreement between myocardial performance index (MPI) measured conventionally and by pulsed-wave tissue Doppler (PW-TD) of the mitral annulus, and to test whether PW-TD MPI can accurately differentiate between healthy subjects and patients affected by congestive heart failure (CHF) with mild to moderate reduction of systolic function. ⋯ We performed a study in healthy adults and in patients with congestive heart failure to investigate the clinical agreement between MPI measured conventionally and by PW-TD of the mitral annulus. We found mild agreement between MPI measured by the conventional method and by PW-TD. Both methods had high diagnostic accuracy for CHF. PW-TD method requires a higher MPI cut-point for best diagnostic accuracy.
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J Am Soc Echocardiogr · Nov 2005
ReviewSubvalvular left ventricular outflow obstruction for patients undergoing aortic valve replacement for aortic stenosis: echocardiographic recognition and identification of patients at risk.
Persistently high gradients after aortic valve replacement (AVR), potentially caused by prosthesis-patient mismatch or superimposed but unrecognized nonvalvular obstruction, are associated with adverse clinical outcomes. Concomitant valvular and subvalvular left ventricular outflow obstruction was first hypothesized in 1957, and identified and further characterized in the 1960s, before the availability of echocardiography. ⋯ As such, subvalvular left ventricular outflow obstruction complicating valvular aortic stenosis is a potentially preventable cause of persistently high gradients that remains relatively frequently encountered after AVR. This review is intended to draw attention to this phenomenon, to describe its mechanisms, and to provide guidance for its preoperative or intraoperative recognition using echocardiographic imaging techniques, with the goal that recognition and appropriate intervention at the time of AVR will decrease its clinical impact.
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J Am Soc Echocardiogr · Oct 2005
Case ReportsMassive posterior mitral annular calcification causing dynamic left ventricular outflow tract obstruction: mechanism and management implications.
We report a case of massive posterior mitral annular calcification causing severe systolic anterior motion of the anterior mitral leaflet and dynamic left ventricular outflow tract obstruction. Mechanism of genesis of systolic anterior motion by this unusual mechanism is illustrated. Importance of recognizing this mechanism and its implications for surgical therapy are discussed. Our patient also had liquefaction necrosis of mitral annular calcification causing its extension into left ventricular myocardium mimicking a tumor.
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J Am Soc Echocardiogr · Aug 2005
Comparative StudyImpact of chronic obstructive pulmonary disease with pulmonary hypertension on both left ventricular systolic and diastolic performance.
The effects of chronic obstructive pulmonary disease (COPD) on right ventricular (RV) systolic and diastolic functions and left ventricular (LV) diastolic function have been shown. Whereas LV myocardial performance index (LVMPI), which incorporates ejection and isovolumic relaxation and contraction times and is an index of global ventricular function, has not yet been evaluated in COPD. ⋯ Both LV systolic and diastolic functions are impaired in COPD, especially in patients with pulmonary hypertension. This impairment is independently associated with pulmonary arterial systolic pressure, RVMPI, and forced expiratory volume in 1 second.
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J Am Soc Echocardiogr · Aug 2005
Biphasic Doppler pattern of the descending thoracic aorta: a new echocardiographic finding in patients with aortic valve stenosis.
A total of 59 patients (> or = 65 years of age) with normal left ventricular function (ejection fraction > 50%) and varying degrees of aortic valve structure and hemodynamics (normal to severely stenotic) were screened; 50 were subsequently enrolled. Continuous wave Doppler echocardiography in the descending thoracic aorta showed two general patterns: (1) in aortic stenosis, the pattern consisted of two peak systolic velocity components (S1 and S2); and (2) in normal aortic valve function, the pattern was a uniphasic signal with a single peak systolic velocity component. ⋯ Sensitivity was 96% in uniphasic signals during normal aortic valve function by conventional 2-dimensional and Doppler criteria. This article introduces characteristics of this Doppler velocity profile as a new diagnostic finding of aortic valve stenosis.