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Duygu, Hamza; Zoghi, Mehdi; Nalbantgil, Sanem; Ozerkan, Filiz; Akilli, Azem; Akin, Mustafa; Onder, Remzi; Erturk, Umit
doi: 10.1007/s10554-008-9311-7pmid: 18373279
Purpose In this study, demographic, clinic, electrocardiographic and angiographic properties of patients, on whom coronary angiography was performed with the pre-diagnosis of coronary artery disease (CAD) and whose ventriculography demonstrated typical apical hypertrophic cardiomyopathy (AHCM), were investigated. Methods Seventeen patients (mean age 58 ± 10 years, 10 male) with CAD pre-diagnosis, on whom coronary angiography was performed and had typical spade-like appearance on left ventriculography, were included in the study between January 2000 and May 2005. Results As risk factor for CAD, 8 (47%) patients had hypertension, 8 (47%) patients had dyslipidaemia, 2 (11%) patients had type 2 diabetes mellitus, 13 (77%) patients had a history of smoking, and 2 (11%) patients had family history. Seven (42%) patients presented unstable angina pectoris, 8 (47%) patients presented stable angina pectoris and 2 (11%) patients were asymptomatic. On coronary angiography, it was determined that 10 (58%) patients had normal coronary arteries, 3 (17%) patients had non-significant stenosis and 4 (25%) patients had myocardial bridging. Five (30%) patients revealed mid-ventricular obstruction and intraventricular gradient was 25 ± 5 mmHg by the catheterization. All patients showed ‘‘giant’’ negative (≥ 10 mm) T waves in the precordial leads, whereas 2 patients had atrial fibrillation. Maximum wall thickness was measured as 18 ± 4 mm in the apical region by transthoracic echocardiography. One patient (5%) who had mid-ventricular obstruction developed atrial fibrillation during 2 years follow-up, though any other events did not occur during hospitalization or follow-up period. Conclusions Physicians caring for patients with chest pain should consider AHCM in their differential diagnosis in case of a patient with chest pain and electrocardiographic changes suggestive of CAD.
Lai, Wyman; Gauvreau, Kimberlee; Rivera, Ernesto; Saleeb, Susan; Powell, Andrew; Geva, Tal
doi: 10.1007/s10554-008-9314-4pmid: 18438737
Background The accuracy of the guidelines of the American Society of Echocardiography (ASE) for the two-dimensional (2D) quantitative assessment of right ventricular (RV) size and function has not been evaluated against MRI-derived RV volumes in patients with congenital heart disease and RV volume overload. Methods Three groups of patients were studied: a normal RV group (Group I, n = 31), a repaired tetralogy of Fallot group (Group II, n = 33), and an unrepaired atrial septal defect and/or partially anomalous pulmonary venous connection group (Group III, n = 23). Recommended 2D linear and cross-sectional area measurements were made on clinical echocardiographic and MRI studies performed less than 6 months apart. Results Most 2D RV parameters were smaller by echocardiography versus MRI. There was weak correlation between 2D RV measurements by echocardiography and MRI-derived RV volumes (Group I: r = 0.15–0.54, Group II: r = 0.33–0.61, Group III: r = 0.32–0.85), and only modest improvement when the same 2D measurements were performed by MRI (Group I: r = 0.37–0.61, Group II: r = 0.44–0.69, Group III: r = 0.28–0.74). The difference between 2D RV measurements by echocardiography and MRI-derived RV volumes was more pronounced in the RV volume overload groups. Conclusions The correlation between currently recommended 2D RV measurements by echocardiography and MRI-derived RV volumes was weak, and improved only modestly when MRI was used to make the same 2D measurements. Moreover, 2D echocardiographic assessment of the RV appears to be less accurate in patients with congenital heart disease and a dilated RV.
Willens, Howard; Fertel, Debra; Qin, Jianxin; Labrador, Eugenio; Lowery, Maureen
doi: 10.1007/s10554-008-9306-4pmid: 18454278
To evaluate the effects of age and pulmonary hypertension on phasic right atrial function we measured right atrial volumes at 3 different points in the cardiac cycle in 57 healthy subjects and 33 patients with pulmonary arterial hypertension. Right atrial reservoir function was assessed by systolic filling volume and passive and active emptying by passive and active emptying volume and fraction of total emptying. We compared these phases of right atrial function in 30 healthy subjects <60 and 27 ≥ 60 years old, and in a separate analysis, in 33 patients with pulmonary arterial hypertension and 33 matched controls. Healthy subjects ≥60 years had lower passive emptying fraction (46.0 ± 23.3% vs 59.9 ± 15.4%, P = 0.011) and larger active emptying volume (7.0 ± 3.5 vs 4.9 ± 2.5 ml/m2, P = 0.013 ) and fraction (54.0 ± 23.3% vs 40.1 ± 15.4%, P = 0.011) compared to those <60. Patients with pulmonary arterial hypertension had larger right atrial volumes, systolic filling volume (18.3 ± 6.9 vs 12.3 ± 4.9 ml/m2, P ≤ 0.001) and active emptying volume and fraction (11.2 ± 6.9 vs 5.4 ± 3.0 ml/m2, P ≤ 0.001; 60.7 ± 29.9 vs 44.9 ± 19.0%, P = 0.017 ) and smaller passive emptying fraction (39.3 ± 29.9% vs 55.1 ± 19.0%, P = 0.017) compared to controls. Aging and pulmonary arterial hypertension are associated with a decrease in passive right atrial emptying and an increase in right atrial active emptying.
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