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Because left atrial (LA) volume plays a critical role in determining cardiovascular outcomes, it was hypothesized that this might be related to the distensibility of the left atrium and how this relates to left ventricular filling pressure (LVFP). Echocardiographic estimates of LVFP were compared to cardiac catheterization measurements in 521 consecutive patients with acute myocardial infarction and correlated with short- and long-term outcomes. Receiver-operating characteristic curve analysis was performed to investigate the sensitivity and specificity of echocardiographic parameters for predicting elevated LVFP (>15 mm Hg). LA distensibility was calculated as (maximal volume − minimal volume) × 100%/minimal volume. and was found to be logarithmically associated with LVFP (p <0.0001). LA distensibility was superior to mitral E/annular Em for identifying increased LVFP (area under the receiver-operating characteristic curve 0.92 vs 0.78). A total of 44 patients died during hospitalization, and 89 patients had died or experienced heart failure requiring rehospitalization at 12-month follow-up. In a multivariate Cox regression model, LA distensibility was an independent predictor of in-hospital mortality (hazard ratio 2.373 for LA distensibility ≤60%, p = 0.026), while LA volume was an independent prognostic factor of 1-year death or heart failure (hazard ratio 2.266 for LA volume ≥34 ml/m2, p = 0.007). In conclusion, LA distensibility accurately identifies patients with increased LVFP after acute myocardial infarction and is an independent predictor of in-hospital mortality. [ABSTRACT FROM AUTHOR]

Echocardiograms and left ventricular (LV) filling pressure were obtained from 95 patients with chronic severe mitral regurgitation (MR) and 16 patients with acute severe MR. All patients underwent catheterization for preoperative examinations and LV filling pressure measurements. A total of 52 age-, gender- and co-morbidity–matched patients with negative coronary angiographic results served as the controls. Echocardiography, including assessment of left atrial (LA) distensibility, was performed simultaneously. LA distensibility correlated logarithmically with the LV filling pressure. However, the early-diastolic mitral inflow velocity divided by the early-diastolic mitral annular velocity (mitral E/E′) correlated linearly with the LV filling pressure. Bivariate correlation analysis revealed that LV filling pressure correlated positively with the maximum and minimum indexed LA volume, as well as the E/E′, but the LV filling pressure correlated negatively with LA distensibility, LA ejection fraction, and LV ejection fraction. However, the MR regurgitation volume was associated only with the maximum and minimum indexed LA volume. Receiver operating characteristic curve analysis indicated that LA distensibility was not inferior to E/E′ for identifying a LV filling pressure >15 mm Hg. However, to identify acute severe MR, LA distensibility was superior to E/E′. In conclusion, LA distensibility, as is E/E′, is a valuable diastolic parameter. In patients with severe MR, it offers adequate power to assess the LV filling pressure and to identify acute severe MR. [Copyright &y& Elsevier]

The objective of this study was to develop tissue Doppler parameters that could be used to differentiate right ventricular (RV) volume overload from RV pressure overload. The RV-pressure-overload group consisted of 40 patients with severe pulmonary hypertension, and the RV-volume-overload group consisted of 40 patients who had an atrial septal defect without evidence of right-to-left shunt, significant pulmonary hypertension, or Eisenmenger’s complex. Another 40 healthy subjects were enrolled and served as a control group. Routine echocardiography and tissue Doppler imaging were performed. RV myocardial performance index was determined based on data collected during tissue Doppler imaging over the lateral tricuspid annulus. In patients with RV pressure overload, tissue Doppler parameters showed characteristically lower systolic velocity over the tricuspid annulus (RV myocardial systolic wave [Sm]) and longer isovolumic relaxation time (RV-IVRT). Nevertheless, in patients with RV volume overload, RV-Sm increased significantly, but early-diastolic velocity over tricuspid annulus was relatively low. In conclusion, RV-MPI, RV-Sm/early-diastolic velocity over tricuspid annulus, and RV-IVRT/RV-Sm were all useful to differentiate RV pressure overload from volume overload, although RV-IVRT/RV-Sm was the best parameter, with excellent sensitivity and specificity. [Copyright &y& Elsevier]

The present study was undertaken to determine the sensitivity and specificity of echocardiography in the diagnosis of pulmonary embolism (PE). The study consisted of 2 stages. First, 600 patients were enrolled to measure bilateral pulmonary blood flow by echocardiography. Using multidetector row computed tomography, 200 subjects were diagnosed with pulmonary hypertension and 100 with defined PE. Another 300 subjects without cardiopulmonary distress served as controls. The time-velocity integral (TVI) and flow volume of both pulmonary arteries were obtained. The percentage differences in bilateral pulmonary arterial TVI (ΔTVI/mean) were 12.0 ± 9.3%, 13.8 ± 12.1%, and 38.6 ± 14.9% for controls, subjects with pulmonary hypertension, and subjects with PE, respectively. The percentage differences in bilateral pulmonary flow (Δflow/mean) were 15.1 ± 11.7%, 17.6 ± 14.9%, and 36.8 ± 17.5% for controls, subjects with pulmonary hypertension, and subjects with PE, respectively. By receiver-operating characteristic curve analysis, the cut-off points for ΔTVI/mean and Δflow/mean to identify PE were 25% and 26.5%, respectively. In the second part of study, the accuracy of ΔTVI/mean and Δflow/mean to screen 300 patients with suspected PE was tested. Echocardiography provided high degrees of sensitivity and specificity for the diagnosis of PE. In conclusion, bilateral pulmonary arterial flow measurement is a simple and useful test to assess the possibility of PE. [Copyright &y& Elsevier]

In this study, myocardial performance index (MPI) was used to identify pulmonary embolism (PE) in patients with echocardiographic signs of pulmonary hypertension. One hundred patients with echocardiographic signs of pulmonary hypertension were enrolled in this study after informed consent was obtained. All patients underwent multidetector-row computed tomography of the chest, and PE was found in 50 patients. Another 100 patients without any cardiopulmonary distress or echocardiographic signs of pulmonary hypertension served as the control group. All cohorts were enrolled after the exclusion of (1) any rhythm other than sinus rhythm; (2) complete bundle branch block; (3) ischemic heart disease proved by stress test, perfusion scan, or coronary angiography; (4) a left ventricular (LV) ejection fraction <50%; and (5) inadequate echocardiograms. Routine echocardiography and tissue Doppler imaging were performed, including the MPIs of the right and left ventricles. The right ventricular (RV) MPI was significantly higher in patients with PE than in others (p <0.0001). Patients without PE had concordant changes in the RV and LV MPIs. In patients with acute PE, the RV MPI became higher, but the LV MPI was relatively constant. Using the RV MPI divided by the LV MPI (the V index), PE could be distinguished in patients with echocardiographic signs of pulmonary hypertension. By receiver-operating characteristic curve analysis, the V index >1.2 identified PE with sensitivity of 82% and specificity of 83%. In conclusion, the V index is a useful parameter to assess the possibility of PE in patients with echocardiographic signs of pulmonary hypertension. [Copyright &y& Elsevier]

The objective of this study was to use tissue Doppler parameters to identify pulmonary embolism (PE) in patients with echocardiographic signs of pulmonary hypertension. One hundred fifty patients with echocardiographic signs of pulmonary hypertension were enrolled, 50 of whom had PE on multidetector row computed tomography of the chest. Another 150 patients without cardiopulmonary distress or echocardiographic signs of pulmonary hypertension served as a control group. All patients were in sinus rhythm. Routine echocardiography and tissue Doppler imaging were performed. The right ventricular (RV) myocardial performance index (MPI) was obtained during tissue Doppler imaging over the lateral tricuspid annulus. The M index was measured and defined as the peak early diastolic mitral inflow velocity divided by the RV MPI. Statistical analysis was preformed using receiver-operating characteristic curves. Peak early diastolic mitral inflow velocity was significantly less and the RV MPI was significantly greater in patients with PE than in patients without PE (both p values <0.0001). The RV MPI and the M index were useful in identifying PE in patients with echocardiographic signs of pulmonary hypertension. On statistical analysis, a RV MPI >0.55 identified PE with a sensitivity of 85% and a specificity of 78%. A M index <112 had a sensitivity of 92% and a specificity of 92%. In conclusion, the sensitivity and specificity of the RV MPI and the M index to identify PE were excellent. Echocardiography is a useful method to screen for PE. [Copyright &y& Elsevier]