Search

Refractory angina pectoris (RAP) represents a clinical condition characterized by frequent episodes of chest pain despite therapy optimization. According to myocardial stunning and myocardial hibernation definitions, RAP should represent the ideal condition for systolic dysfunction development. We aim to investigate the evolution of left ventricular (LV) function in patients with RAP. A retrospective study which encompasses 144 patients with RAP referred to our institution from 1999 to December 2014 was performed. Of them, 88 met the inclusion criteria, and LV function was assessed by echocardiography. All of them had persistent angina episodes on top of optimal medical therapy and evidence of significant inducible myocardial ischemia and no further revascularization options. Nitrates consumption rate, time of angina duration, and the number of angina attacks were evaluated. In the whole population, ejection fraction (EF) was 44% ± 2. EF was significantly lower in patients with previous myocardial infarction (41% ± 1.5 vs 51% ± 1.8, p 5 years (5 years 44% ± 2 [n = 44]; p 0.02). Long-term LV function in patients with RAP is generally preserved. A previous history of myocardial infarction is the only determinant in the development of systolic dysfunction. In conclusion, frequent angina attacks and a long-term history of angina are not apparently associated to worse LV function.

Objective: To evaluate the feasibility of mitral valve (MV) reconstruction protocol by real-time 3D echocardiography (RT3DE) in the assessment mitral regurgitant (MR) lesions, and to determine the accuracy of RT3DE compared with transthoracic (TTE) and transesophageal (TEE) echocardiographies using surgical findings as gold standard. Patients and methods: Sixty-three consecutive patients (mean age 61.7 +/- 12.5 years, 35 men and 28 women) with severe organic MR were enrolled. Data were acquired in zoom and in full-volume modes from apical and/or parasternal windows. A volume rendered en-face view of MV and five serial longitudinal cut planes were reconstructed to visualize all segments of both leaflets. Results: The feasibility of RT3D reconstruction was 94%. Compared with surgical diagnosis, the accuracy of RT3D was 91% for aetiology, 92% for mechanisms, 94% for prolapse, 88% for flail and 94% for defect location. Diagnostic accuracy was significant higher for RT3D than TTE for all end points except for flail lesion and similar to TEE but inferior to this for flail lesion. The accuracy, sensitivity and specificity were higher in patients with good-excellent than those with poor image quality regarding aetiology, mechanisms and defect location (all p=0.0001). Conclusions: RT3D imaging of MV is feasible and accurate in defining aetiology, mechanism and defect location in patients with MR and has incremental diagnostic value if TTE is inconclusive and similar diagnostic value of TEE except for flail lesion. RT3D, at least in patients with good acoustic window, may obviate the need for subsequent TEE and/or can be considered a complementary technique to study MV in patients with MR. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

Background Doppler of mitral and pulmonary vein flows are used to estimate left ventricular (LV) filling pressure. Mitral regurgitation (MR) makes unreliable these parameters by inducing changes of both mitral inflow and pulmonary vein flow. Objectives To evaluate whether Doppler tissue imaging (DTI) diastolic indices obtained at the level of LV lateral mitral annulus can provide accurate estimation of LV filling pressure in patients with MR. Methods Forty-three patients (age 55 +/- 11 years) with severe MR and mean LV ejection fraction (EF) 58 +/- 13 were enrolled, 10 (23%) with LV EF 50%. Doppler signals from the mitral inflow, pulmonary venous flow, and DTI indices of the lateral mitral annulus were obtained. LV end-diastolic pressure (LVEDP) was measured invasively with fluid-filled catheter. Results In the overall population, the majority of standard Doppler and DTI indices correlated with LVEDP, but the multivariate analysis showed that the ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/Em ratio) (beta = .87, P = .0001) was independent predictor of LVEDP (R-2 = 0.74, SE = 4, P = .0001). An E/Em ratio >10 predicted an LVEDP >15 mm Hg (sensitivity 90%, specificity 83%). In both groups with LV EF >50% (beta = .77, P = .005; cumulative R-2 = 0.73, SE = 2.5, P = .0001) and 50% and

We evaluate, in 37 consecutive patients (mean age 67 +/- 9 years) with functional mitral regurgitation (FMR), several rest and stress echocardiographic predictors of outcome. Rest end-systolic volume, peak stress end-diastolic volume and effective regurgitant orifice were independent predictors of death at 25 months follow-up. Therefore, rest and stress echocardiographic evaluation of patients with FMR provides strong prognostic information. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

Aortic aneurysms (AAs) can develop in all parts of the aorta and a lot of them remain undetected unless incidentally discovered or until a lifethreatening complication occurs [1,2]. Thoracic aorta is usually studied with computed tomographic imaging (CT),magnetic resonance imaging and echocardiography [1,2]. Transthoracic echocardiography (TE) is commonly performed prior to abdominal AA (AAA) repair to evaluate the cardiac structure and function. In a recent paper, a highprevalence of thoracicAA(ATA) inpatientswithAAAassessedbyCThas been reported [3]. In our study we retrospectively enrolled 1942 patients in order to evaluate the prevalence of the ascending thoracic aortic and aortic arch dilatation/aneurysm in patients with AAA that underwent transthoracic echocardiography (TE) prior to surgery. The exclusion criteriawere: the presence of bicuspid aortic valve, previous aortic valve and/or ascending aortic surgery, genetic syndromes (Marfan syndrome, Ehlers–Danlos syndrome and others), and inflammatory and traumatic diseases. Thus, 1305 patients were considered eligible for the study. The aortic root and the proximal ascending aorta segments were visualized in the left and rightparasternal long-axis views. Inparasternal view the Valsalva sinuses and the proximal portion of the ascending aorta were measured. In the parasternal short axis bicuspid aortic valve was rule out. The aortic arch was evaluated by suprasternal view between the innominate and left carotid artery. Standardmeasurements were made by the leading edge-to-leading edge diameter in enddiastole taking care to obtain a true perpendicular dimension and appropriate gain settings [4]. Views used for measurements were those that showed the largest diameter of the aortic segment and in particular the maximum diameter measured perpendicular to the long axis of the vessel in that view. All the measurements were achieved in twodimensional mode. We used the absolute values as normal standard references of aortic sizes as follows: 1. Valsalva sinuses: 37 mm inmen and 33 inwomen; 2. Proximal ascending aorta: 34 mm inmen and 31 mm inwomen; and 3. Aortic arch: 32 mm in men and 29 mm in women. Sex-specific criteria wereused todefineanascendingaortic aneurysm:womenN42 mmand men N47 mm, and aortic arch aneurysm: women N32 mm and men N37 mm [5–7]. The study complies with the principles and guidelines of the Declaration of Helsinki. The clinical characteristics of the study population and the median diameters of the aorta are reported in Tables 1 and 2. 50% of the population had increased diameters of the Valsalva sinuses and proximal portion of ascending aorta, and 25% had the diameter of the aortic arch greater than normal range. Valsalva sinuses were increased in 25% of men and 75% of women. 50% of men and 75% of women had increased diameter of the proximal ascending aorta. The aortic arch diameter was above the normal range in 25% ofmen and 50% ofwomen. On the basis of sex-specific criteria for aneurysm4% of the patients had an ascending aortic aneurysm and 6.5% an aortic arch aneurysm. Furthermore, 2% men had an ascending aortic aneurysm compared with 25.8% of the women (p b 0.0001), and 6.6% men had an aortic arch aneurysm compared with 10.5% of the women (p b 0.4). Thus, we demonstrate a high prevalence of dilatation/aneurysm of the ascending aorta and the aortic arch in patients with AAA evaluated by TE during pre-operative risk stratification. Our study supports the common idea that ATA is commonly misdiagnosed because of its lack of symptoms. Itani et al. estimated the prevalence of asymptomatic ATA between 0.16 and 0.34% [8]. Larrson et al. evaluated the prevalence of ATA in AAA with CT scan, and they reported the presence of thoracic aorta dilatation in more than 25% of 422 patients [3]. Other retrospective studies had already assessed a higher incidence of thoracic aorta repair in patients that had previously undergone to abdominal aortic repair, although in their reports patients with connective disease were included as well. Alegret et al. stated that