Aims To assess left atrial (LA) function and determine the prevalence of LA dysfunction in AL amyloidosis (AL) using conventional and strain echocardiography. Methods and results LA ejection ...fraction, LA filling fraction, LA ejection force, peak LA systolic strain rate (LAsSR), and LA systolic strain (LA ε) were determined in 95 AL patients (70 with and 25 without echocardiographic evidence of cardiac involvement, abbreviated CAL and NCAL, respectively), 30 age-matched controls (CON), and 20 patients with diastolic dysfunction and LA dilatation (DD). Peak LAsSR >2 standard deviations below mean CON value was used as the cut-off for normal LA function. LA ejection fraction was lower in CAL when compared with CON (40.4±13.6 vs. 67.0±6%, P=0.01). Left atrial septal strain rate and strain were lower in CAL (0.8±0.5 s–1 and 5.5±4%, respectively) compared with CON (1.8±0.8 s–1 and 14±4%, respectively, P=<0.0001), NCAL (1.6±0.8 s–1 and 13±7%, respectively, P<0.0001) and DD (1.3±0.4 s–1 and 10±2%, respectively, P<0.0001). Based on peak LA systolic strain rate criteria, the cut-off values for normal LA function were –1.1 s–1 and –1.05 s–1 for lateral and septal walls. Using these criteria, LA dysfunction was identified in 32% (lateral LA criteria) and 60% (septal LA criteria) of CAL patients. Lateral and septal LAsSR were lower in CAL patients with vs. those without symptoms of heart failure. Inter- and intra-observer agreement was high for LA strain echocardiography. Conclusion LA function assessment using strain echocardiography is feasible with low intra- and inter-observer variability. LA dysfunction is observed in AL patients without other echocardiographic features of cardiac involvement and may contribute to cardiac symptoms in CAL.
Vascular abnormalities in primary amyloidosis Modesto, Karen M; Dispenzieri, Angela; Gertz, Morie ...
European heart journal,
2007-April, 2007-Apr, 20070401, Letnik:
28, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Aims
Primary amyloidosis (AL) is a systemic disease; however, there is limited information regarding the presence and character of vascular abnormalities.
Methods and results
Validated ultrasound ...techniques were used to prospectively determine carotid artery intimal-medial thickness (IMT) and brachial artery flow-mediated dilatation (FMD) in 59 consecutive AL patients and 17 age-similar, healthy, asymptomatic volunteers (CON). Carotid IMT was increased in AL when compared with CON (0.07 ± 0.02 vs. 0.04 ± 0.01 mm, P < 0.01). Similarly, brachial artery FMD was significantly lower in AL when compared with CON subjects (3 ± 7 vs. 12 ± 8%, P < 0.01). Multivariable analysis revealed that AL was associated with larger IMT and lower FMD after controlling for several confounding variables. However, within AL cases, there was not a significant association of cardiac vs. non-cardiac involvement with IMT or FMD (P = 0.1 and 0.2, respectively).
Conclusion
AL is associated with abnormal vascular morphology and endothelial dysfunction. Vascular abnormalities do not appear to be related to echocardiographic evidence of cardiac involvement.
Strain echocardiography can depict segmental mechanical activity with high temporal and spatial accuracy, and may allow assessment of segmental relaxation not possible with conventional ...echocardiography.
Conventional and strain echocardiography were performed in healthy volunteers (young group 1 and old group 2) and patients with normal 2-dimensional and stress echocardiography, with either normal global diastolic function (group 3a) or grade I or II global diastolic dysfunction (DD) (group 3b). Standard echocardiography criteria were used to define global DD. Early to late diastolic strain rate ratio less than 1.1 was defined as altered segmental relaxation.
All participants had normal wall motion and ejection fraction. Participants of group 1 had normal segmental and global diastolic function. Participants of groups 2 and 3a demonstrated a wide range of altered segmental relaxation in the absence of global DD. All patients of group 3b had 12 or more segments with altered relaxation and global DD. Age and hypertension were associated with a larger number of altered segments, a lower mean early to late diastolic strain rate ratio, and global DD.
A wide range of altered segmental relaxation can exist in the absence of global DD. Age and hypertension are associated with altered segmental relaxation and global DD. Assessment of segmental relaxation may be beneficial in the elderly and patients with hypertension.
This study evaluated the clinical, exercise stress test, and echocardiographic predictors of mortality and cardiac events in patients with left ventricular hypertrophy (LVH).
Left ventricular ...hypertrophy is associated with an increased risk of cardiovascular morbidity and mortality.
Symptom-limited treadmill exercise echocardiography was performed for evaluation of coronary artery disease in 483 patients (age, 66 ± 11 years; 281 men) with LVH. End points during follow-up were all-cause mortality and hard cardiac events (cardiac death and nonfatal myocardial infarction MI).
Forty-six patients died and 14 had nonfatal MI. The cumulative mortality rate was higher in patients with abnormal exercise echocardiography (3% vs. 0.4% at one year, 11.7% vs. 3.7% at three years, and 18.3% vs. 9.5% at five years, p < 0.001). In a sequential multivariate analysis model of clinical, exercise test, and rest and exercise echocardiographic data, incremental predictors of mortality were workload (hazard ratio HR, 0.5; 95% confidence interval CI, 0.3 to 0.9), rate pressure product (HR, 0.7; 95% CI, 0.5 to 0.9), left ventricular (LV) mass index (HR, 1.4; 95% CI, 1.1 to 1.8), and failure to increase ejection fraction (EF) with exercise (HR, 2.1; 95% CI, 1.1 to 3.8). Predictors of cardiac events were history of coronary artery bypass grafting (HR, 2.6; 95% CI, 1.2 to 5.4), lower exercise rate-pressure product (HR, 0.6; 95% CI, 0.5 to 0.8), resting wall motion score index (HR, 1.4; 95% CI, 1.1 to 1.8), and failure to increase EF with exercise (HR, 3.3; 95% CI, 1.6 to 6.9).
In patients with LVH, LV mass index and EF response to exercise are independent predictors of mortality, incremental to clinical and exercise test data and resting LV function. A normal exercise echocardiogram predicts a relatively low mortality rate during the following three years.
Traditional cardiovascular risk factors have been shown to cause microvascular dysfunction. Most studies that have evaluated microcirculation rely on invasive measurement tools. We used dobutamine ...stress echocardiography, a validated method to measure coronary flow velocity (CFV) and coronary flow reserve (CFR), in a previously unstudied population without known significant coronary artery disease to determine the impact of traditional risk factors on CFR. Consecutive patients who had no evidence of regional wall motion abnormalities at rest or during dobutamine stress echocardiography were studied. Left anterior descending artery CFV was measured at baseline and at peak dobutamine stress and CFR was calculated as the ratio of peak stress CFV to baseline CFV. Fifty-nine consecutive patients (28 men) with mean age of 66.8 ± 14.5 years were studied. CFR was lower in patients with diabetes mellitus (DM) compared with those without (1.7 ± 0.74 vs 2.48 ± 0.98, p <0.007), in patients with hypertension compared with those without (2 ± 0.8 vs 2.6 ± 0.9, p <0.02), and in obese patients compared with nonobese patients (1.6 ± 0.5 vs 2 ± 0.6, p <0.02). CFR was further impaired in the presence of DM with hypertension, DM with obesity, DM with a wide pulse pressure (>50 mm Hg), and obesity with a wide pulse pressure. In a multivariate model, DM, obesity, and wide pulse pressure were significantly associated with variation in CFR (p <0.0008). In conclusion, CFR was abnormal in patients with DM, hypertension, and obesity. CFR impairment is exaggerated as the number of risk factors increases. Despite a negative dobutamine stress echocardiographic result, aggressive risk factor assessment and control should be implemented in patients with coronary risk factors due to an underlying abnormal CFR.
We report an unusual case of myocardial mycotic aneurysm of the left ventricle resulting from a healed myocardial abscess caused by an aortic regurgitant jet lesion. The diagnosis was made during ...intraoperative transesophageal echocardiography and confirmed by surgical inspection. The echocardiographic features are described.
Abstract We discuss the concept of ultrasound imaging at a distance by presenting the evaluation of a customized, lightweight, human-safe robotic arm for low-force, long-distance, telerobotic ...ultrasonography. We undertook intercity and trans-Atlantic telerobotic ultrasound simulation from master stations located in New York, New York and Munich, Germany, and imaged a phantom and a human volunteer located at a slave station in Burlington, Massachusetts, using standard Internet bandwidth <100 Mbps and <50 Mbps, respectively. The data from the robotic arm were tracked for understanding the time efficiency of the human interactions at the master stations. Comparison of a beginner in ultrasound operation with a professional sonographer revealed that although proficiency in using ultrasound was not a prerequisite for operating the robotic arm, previous experience in using clinical ultrasound was associated with progressively lower probe maneuvering time and speed due to an enhanced ability of the veteran operator in adjusting the finer angular motions of the probe. These results suggest that long-distance telerobotic echocardiography over a local nondedicated Internet bandwidth is feasible and can be rapidly learned by sonographers for cost-effective resource utilization.
The objective of this study was to determine the safety of performing exercise stress testing in patients with abnormal serum potassium concentrations. Data were reviewed from 9,084 patients (mean ...age 63 +/- 12 years) referred for exercise echocardiography who had serum potassium measured <48 hours before the test were reviewed, and the occurrence of arrhythmias during stress testing was determined. Of 10,272 studies, 9,067 (88%) were in patients with normokalemia and 1,205 (12%) were in patients with abnormal serum potassium concentrations: 309 (26%) with hypokalemia (mean 3.4 +/- 0.16 mmol/L) and 896 (74%) with hyperkalemia (mean 5.1 +/- 0.19 mmol/L). Ventricular and supraventricular ectopy were common during exercise. Only 1 patient (potassium 4.9 mmol/L) had sustained ventricular tachycardia; all other episodes were nonsustained. Although ventricular and supraventricular ectopy are common during exercise testing, life-threatening arrhythmias are not. Exercise testing is generally safe despite mild to moderate hypokalemia or hyperkalemia.
PDF
