American heart journal
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American heart journal · Aug 1996
Doppler transesophageal echocardiographic determination of aortic valve area in adults with aortic stenosis.
Two-dimensional transesophageal echocardiography has been shown to be an accurate method of measuring aortic valve area in patients with aortic stenosis. The accuracy of Doppler transesophageal echocardiography for this purpose is unknown. Thus 86 consecutive adult patients (mean age 68 +/- 11 years) with calcific (n = 79) or congenital bicuspid (n = 7) AS were studied by biplane or multiplane transesophageal echocardiography. ⋯ Mild, moderate, and severe aortic stenosis by two-dimensional transesophageal echocardiography was correctly identified in 93% (28 of 30), 79% (15 of 19), and 77% (10 of 13) of patients by Doppler transesophageal echocardiography, respectively. Doppler transesophageal echocardiography is an accurate method to measure aortic valve area in patients with aortic stenosis and should complement two-dimensional transesophageal echocardiography. The feasibility of Doppler transesophageal echocardiography for aortic valve area determination has a significant learning curve.
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American heart journal · Jul 1996
Randomized Controlled Trial Clinical TrialEffects of exercise training on left ventricular filling at rest and during exercise in patients with ischemic cardiomyopathy and severe left ventricular systolic dysfunction.
The aim of our study was to determine whether exercise training can augment left ventricular diastolic filling at rest and during exercise in patients with ischemic cardiomyopathy and whether any correlation exists between changes in diastolic filling and changes in exercise tolerance. Forty-three consecutive patients (mean age, 54 +/- 8 years) with ischemic cardiomyopathy and severe left ventricular systolic dysfunction (election fraction <30%) were studied. Group T (29 patients) was exercised on a cycle ergometer 3 times a week for 8 weeks at 60% of peak oxygen uptake. ⋯ The independent predictors of the increase in peak oxygen uptake were changes in work capacity and peak early filling rate. The data demonstrate that exercise training can improve the exercise capacity of patients with ischemic cardiomyopathy and severe systolic-dysfunction. The increase in early diastolic filling at rest and during exercise may contribute to the improvement in peak oxygen uptake.
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American heart journal · May 1996
Dipyridamole technetium-99m sestamibi myocardial tomography in patients evaluated for elective vascular surgery: prognostic value for perioperative and late cardiac events.
Dipyridamole thallium-201 myocardial imaging can provide information regarding risk of perioperative cardiac events in patients being considered for vascular surgery. The value for this purpose of myocardial imaging with technetium-99m sestamibi (MIBI), a radiotracer with biokinetic and imaging properties different from thallium-201, has not been established. To this end the prognostic value of dipyridamole MIBI tomography for perioperative and late cardiac events was evaluated in 229 consecutive patients being considered for elective vascular surgery. ⋯ Independent Cox multivariable predictors of increased risk of late cardiac events were a history of diabetes mellitus (relative risk [RR] 2.2, 95% confidence interval [CI] 1.0 to 4.9), an abnormal MIBI study (RR 3.7, 95% CI 1.2 to 11.4), and a reversible MIBI defect (RR 2.7, 95% CI 1.2 to 6.1). We conclude that, although its ability to assess increased perioperative cardiac risk remains uncertain, dipyridamole MIBI tomography does provide important prognostic information regarding the risk of serious cardiac events in patients having vascular surgery. The presence of an abnormal MIBI result, specifically one demonstrating a reversible perfusion defect, is associated with significantly increased risk.