Search

A 52-year-old man presented with a fever and malaise. Transthoracic echocardiogram was performed because of a holosystolic murmur, which showed mitral valve prolapse and a regurgitation jet toward the posterior wall of the left atrium. There was no apparent vegetation at any valves. Blood cultures were positive for Streptococcus mitis/oralis. Transesophageal echocardiogram revealed vegetation only at the posterior wall of the left atrium exposed to the mitral regurgitant jet. We diagnosed this condition as infective mural endocarditis. This case highlighted the need for a detailed observation of the valves and the atrial wall when infective endocarditis is suspected.

Recently, the development of two-dimensional speckle-tracking (2DST) technology has allowed the direct measurement of the elastic parameters of the carotid arterial wall. The aims of this study were to determine the feasibility of measuring peak circumferential strain (CS) of the carotid arterial wall using 2DST and to compare this value with conventional arterial stiffness parameters in subjects with and without hypertension. The study included 90 healthy subjects and 40 age-and sex-matched patients with hypertension. The short-axis view of the right common carotid artery was recorded. The CS in the posterior region of the carotid artery was calculated by 2DST using special software and corrected by the following equation: ɛ(circ)=ln (systolic blood pressure/diastolic blood pressure)/CS. We simultaneously measured the stiffness index β (β) at the same location and the brachial-ankle pulse wave velocity (baPWV). Sixty randomly selected healthy subjects were used to assess the inter/intra-observer variability of ɛ(circ) and β. In healthy subjects, ɛ(circ) was significantly correlated with β, age and baPWV. These correlations were slightly better than the corresponding correlations of β with age and baPWV. The hypertensive patients had a significantly larger ɛ(circ) than the healthy subjects (0.112 ± 0.074 vs. 0.066 ± 0.029/%, P<0.001). The inter/intra-observer variability for ɛ(circ) was significantly lower than that for β. Our data suggest that the measurement of carotid ɛ(circ) using 2DST is feasible and has better reproducibility than conventional carotid arterial stiffness.

Background: Visual or quantitative assessment of coronary angiography may not exactly predict the physiological significance of intermediate (40-70%) coronary stenosis. Coronary flow reserve is a well-established marker of the functional significance of coronary stenosis., Objectives: The aim of this study was to compare the coronary flow velocity reserve (CFVR) using contrast-enhanced transthoracic Doppler echocardiography (CE-TTDE) with thallium-201 imaging in assessment of intermediate lesions in the left anterior descending coronary artery (LAD)., Methods: A consecutive series of 50 patients with intermediate stenosis in the LAD underwent pharmacological stress thallium-201 imaging and CFVR measured by CE-TTDE., Results: CFVR could be measured in 49 of 50 patients by the present method. A CFVR <2.0 predicted the presence of a stress thallium defect in 12 of 14 patients (agreement=90%, kappa=0.76, P < 0.001). The sensitivity and specificity of CFVR for stress thallium-201 results were 86 and 91%, respectively. In contrast, significant stenosis (>50% by diameter) showed fair agreement for stress thallium defects (agreement=59%, kappa=0.28, P < 0.05)., Conclusions: In the evaluation of intermediate lesions in the LAD, CFVR as assessed by CE-TTDE could accurately predict the presence of ischemia on stress thallium imaging, whereas angiographic stenosis did not yield reliable results.

Background: This study assessed the feasibility of transthoracic Doppler scan echocardiography (TTDE) combined with echo-contrast agent in measuring coronary flow velocity (CFV) and coronary flow velocity reserve (CFVR) in the left anterior descending artery., Methods: In 68 consecutive patients who underwent cardiac angiography, TTDE was recorded before and after induction of a hyperemic condition with intravenous administration of adenosine triphosphate (0.14 mg/kg/min). After CFV values returned to baseline, the same measurements were repeated while an echo-contrast agent was continuously infused. CFVR was assessed as the ratio of hyperemic to basal CFV. The pulsed wave Doppler scan quality was graded from 1 to 3 (TTDE score: 1, no signal detection; 2, poor definition of outline; 3, optimal outline definition)., Results: Before enhancement, CFVR could not be measured in 20 patients. Prevalence of delayed stenosis (Thrombolysis In Myocardial Infarction [TIMI] II grade flow) in these patients (30%) was significantly greater than in those whose CFVRs could be measured without enhancement (2%; P <.01). TTDE scores both at baseline and after hyperemia were significantly improved with contrast enhancement (before, 2.8 +/- 0.6; after, 3.0 +/- 0.3; P <.01; before, 2.6 +/- 0.7; after, 3.0 +/- 0.3; P <.01; respectively). Overall contrast enhancement increased the rate of successful CFVR measurement from 70% to 97% (P <.01). Sensitivity and specificity of significant left anterior descending artery stenosis detection with CFVR of <2.0 were 94.4% and 87.8%, respectively., Conclusion: These data suggest that administration of echo-contrast agent improves pulse wave Doppler scan quality and thus the feasibility of measuring CFVR.

Serial changes of left ventricular (LV) geometry and function during the development of hypertension were studied in 50 Dahl salt-resistant (DR) and 88 Dahl salt-sensitive (DS) rats fed an 8% NaCl diet beginning at the age of 6 weeks. Echocardiography at 6, 8, 11, 13, 14, 15, and 18 weeks and in vivo invasive hemodynamic determination at 6, 8, 11, 14, and 18 weeks were performed. After 11 weeks, 33 DS rats were observed for survival analysis. The survival analyses showed that the incidence of death was 57.6% due to heart failure, 27.3% due to stroke, and 15.2% due to sudden death. However, death in the early stages of hypertension was due almost entirely to sudden death or stroke. A high value of relative wall thickness (RWT) and a small end-diastolic dimension were predictive of sudden death and stroke, but LV mass (LVM) was not. Concerning the change in LV geometric patterns, LVM continued to increase to 18 weeks. The RWT increased or remained at a plateau up to 13 weeks, and then progressively decreased after 13 weeks. In contrast, LV function was hyperdynamic between 8 and 11 weeks when compared to DR rats. However, after 13 weeks, all hemodynamic variables of DS rats deteriorated progressively, and all DS rats died of heart failure. Thus, our study indicates that the cardiovascular events associated with the progression of hypertension vary widely according to the stage of hypertension and that RWT is more sensitive in predicting LV conditions than LVM in hypertension.