Search

Unlabelled: Aortic pulsation is caused by the arterial blood pressure variation during the cardiac cycle. Thickening of arterial intima, as well as the presence of atherosclerotic plaques may influence vessel pulsation by increasing wall stiffness. There is no data available concerning regional changes in aortic elasticity in relation with local wall thickness and the magnitude of atherosclerosis. The study group comprised 36 patients (27 men, 9 women, mean age 53 +/- 10 years) referred to our echocardiographic laboratory for transesophageal echocardiography (TEE). TEE probe was placed at the depth of 35 cm. The spatial interval between acquired images was 3 degrees. The reconstructed data sets were reviewed and the border between the aortic wall, plaque and lumen was determined. The reconstruction of a two-centimeter-long segment of aorta was divided by coaxial planes into four longitudinal sections. Thereafter the diastolic and systolic radius of each section, thickness of atherosclerotic plaques and intima-media thickness in each section were measured. The regional beta-index was calculated as Ln (systolic pressure/diastolic pressure)/relative change in regional aortic lumen, where relative change in regional aortic lumen was calculated as the difference between aortic lumen volume in systole and diastole divided by aortic lumen volume in diastole. In total, 144 aortic sections were analyzed. The volume of two-centimeter-long segments of descending aorta ranged from 6.9 cm3 to 31.5 cm3 (mean 12.8 +/- 5.2 cm3) in systole and from 4.9 cm3 to 29.2 cm3 (mean 11.2 +/- 4.9 cm3) in diastole. The volume of the examined sections of the aortic segments ranged from 1.3 cm3 to 10.6 cm3 (mean 3.2 +/- 2.6 cm3) in systole and from 1.1 cm3 to 8.7 cm3 (mean 2.8 +/- 1.5 cm3) in diastole. The pulsation of the aortic sections varied from 0.01 cm3 to 2.7 cm3 (mean 0.4 +/- 0.3 cm3), which constituted 0 to 37% (mean 13 +/- 8%) of the section volume. The thickness of atherosclerotic plaques in the studied aortic sections ranged from 0.0 mm to 1.1 mm (mean 0.3 +/- 0.2 mm) and the intima-media thickness was within the range 1.3 mm to 2.5 mm (mean 1.9 +/- 0.3 mm). The regional beta-index of the individual section ranged from 1.1 to 253.9 (mean 9.3 +/- 24.3). The regional beta-index was statistically significantly dependent on the intima-media thickness (p=0.02). We found no significant correlation between beta-index and the thickness of atherosclerotic plaques in the studied segments (p=0.38)., Conclusions: Transoesophageal three-dimensional echocardiography facilitates quantitative analysis of aortic wall stiffness and regional beta-index measurements. The local variability of beta-index is correlated with intima-media thickness, whereas the correlation with the thickness of atherosclerotic plaques is not statistically significant. These measurements may be of importance in the assessment of the degree of atherosclerosis advancement. It forms new perspectives in diagnostics with the ability to evaluate the influence of pharmacotherapy and life-style modifications.

Unlabelled: There are several parameters of left ventricular (LV) systolic function assessment. The calculation of the ejection fraction (EF) strongly relates to the preload and afterload conditions. Wall motion score index (WMSI) seems to be to impractical as the semi-quantitative method. Measurement of the LV pressure rise by Doppler evaluation of mitral regurgitation is a reproducible and an accurate method for dP/dt evaluation. As a method for LV systolic function estimation it does not depend on loading conditions. We have compared the prognostic value of these three methods in patients with a broad spectrum of systolic dysfunction. The study group consisted of 75 patients evaluated by all these methods in years 1995-1999 in our echocardiographic laboratory (73%--men, mean 54 +/- 12 years). In 13 patients the coronary artery disease was diagnosed but LV function was apparently normal, in 35--regional dysfunction after myocardial infarction was described, and in 27--global dysfunction due to idiopathic dilated cardiomyopathy. The EF ranged from 11% to 70% (mean 34 +/- 14%), WMSI--from 1 to 3.6 points (mean 2.2 +/- 0.7), and dP/dt from 235 to 4000 mmHg/s (mean 1108 +/- 698 mmHg/s). The closest relationship was noted between EF and dP/dt (R2=0.50). During 38 +/- 19 months of follow-up, 40 patients died (53%). In the multivariate logistic analysis the only significant parameter related to prognosis was EF (p=0.001). WMSI (p=0.12) and dP/dt (p=0.16) were not statistically significant correlated to death., Conclusion: The left ventricular ejection fraction still remains the most important parameter for the evaluation of prognosis in patients with depressed systolic function. Left ventricular pressure rise describes the systolic function but does not have impact on the prognostic evaluation.

Unlabelled: It has been shown in several in-vitro studies that IVUS images correlate well with histology and angioscopy. The existing data on intravascular imaging of large-diameter elastic arteries are scant. The aim of this study was to compare the IVUS images of aorta with the reference method--histological section by evaluating the accuracy of measurements performed at corresponding aortic segments., Materials and Methods: 15 human aortic specimens were derived from post-mortem examination and in-vitro IVUS imaging was performed, including measurements of vessel diameters and cross-sectional areas in three specified areas. Corresponding regions of interest obtained with histology were subsequently evaluated and parameters matched to those by IVUS were calculated., Results: Total of 45 pairs of measurement were compared. Mean vessel internal diameter on IVUS was 14.4 mm (SD 2.7 mm) and intima thickness was 0.6 mm (SD 0.8 mm). The corresponding aortic internal diameter observed with histology was 13.2 (SD 2.6 mm) and intima thickness--0.3 mm (SD 0.03). An overall agreement between IVUS and histology specimens was high, yelling correlation ratio of 0.99. The highest level of agreement was observed for external vessel area validation--correlation ratio 0.98. The largest discrepancy was observed for intima and media thickness, with correlation ratios of 0.61 and 0.72, respectively., Conclusions: Our data suggest that examination of aorta with intravascular ultrasound is feasible and may provide additional information in assessment of cardiovascular pathology. More complete risk stratification, which includes IVUS examination of aorta, is an important factor to determine the necessity for early preventive treatment, especially in patients with normal coronary arteries.

Background: Mechanisms responsible for cardiological syndrome X are complex and not well understood. It has been postulated that impaired endothelial function and abnormal reactivity of coronary vessels may play a role in the pathogenesis of this condition., Aim: To assess mechanical properties of peripheral arterial vessels and both endothelium-dependent and endothelium-independent vessel reactivity in patients with or without atherosclerotic lesions in coronary arteries., Methods: The study group consisted of 100 patients with typical angina and positive exercise test who underwent coronary angiography. Based on angiographic results, the patients were divided into two groups: 50 patients with normal coronary angiograms and 50 age- and gender-matched patients with at least one significant coronary artery lesion (coronary artery disease (CAD) group). The control group consisted of 40 healthy volunteers without risk factors of atherosclerosis. The compliance of arterial vessels was assessed by automatic measurement of pulse wave velocity (PWV). Endothelial function was examined by ultrasonographic measurement of the diameter of brachial artery following passive hyperaemia (endothelium-dependent vessel distension) and following nitroglycerine (endothelium-independent mechanism)., Results: Among all three studied groups, the PWV values were the highest in patients with CAD. Patients with syndrome X had significantly higher PWV than in controls. A cut-off PWV value of 10.5 m/s distinguished patients with syndrome X from those with CAD. Endothelium-dependent arterial distensibility was significantly lower in patients with syndrome X than in controls; the lowest values were observed in patients with CAD. Among patients with syndrome X, the endothelium-dependent arterial vessel distensibility was the only parameter significantly influencing PWV results., Conclusions: PWV was significantly increased in patients with syndrome X which suggests a decreased arterial vessel compliance. These results and the impairment of endothelium-dependent relaxation suggest a similar pathomechanism of altered arterial reactivity in patients with syndrome X and in patients with CAD.

Background: The echocardiographic assessment of left ventricular diastolic function is usually based on mitral inflow parameters. The main limitation of this method is caused by pseudonormalisation of mitral inflow profile in advanced stages of diastolic dysfunction., Aim: To evaluate the value of propagation velocity (Vp) of early and atrial mitral inflow wave in the diagnosis of pseudonormalisation., Methods: We examined 180 subjects (104 males, mean age 58+/-11) by transthoracic echocardiography with the assessment of propagation velocity in colour-M-mode. The studied group consisted of 120 patients with coronary artery disease and 60 healthy controls. The values of E/A (ratio of early to atrial mitral inflow peak velocity) were calculated and subjects with normal (early wave deceleration time, Edt > or =150 ms) and pseudonormal (Edt <150 ms) mitral inflow patterns were identified. Propagation velocities were compared between groups with normal and pseudonormal mitral inflow profiles and optimal cut-off values were estimated., Results: In the pseudonormal group, velocities of early and atrial propagation were significantly lower than those in the normal group: 25+/-11 vs 46+/-8 cm/s (p<0.001) and 33+/-10 vs 43+/-11 cm/s, (p<0.01), respectively. Both parameters showed the same optimal cut-off value for the diagnosis of pseudonormalisation which was < or =31 cm/s. Sensitivity, specificity and accuracy for the detection of pseudonormal mitral inflow pattern for early wave propagation were 87, 96 and 94%, and for atrial wave propagation - 60, 83 and 78%, respectively., Conclusions: Decreased value of mitral inflow early wave propagation velocity offers high sensitivity and specificity for the diagnosis of mitral inflow pseudonormalisation. Atrial wave propagation velocity has also potential value for advanced quantitative assessment of diastolic function.

Muscular interventricular septum is an extremely rare location for congenital aneurysm. A 48-year-old patient with a muscular interventricular septum aneurysm coexisting with atrial septal defect, pulmonary stenosis and ventricular preexcitation is presented. Three-dimensional echocardiographic reconstruction of the lesion aided in a precise morphologic and quantitative assessment of the condition. The review of 10 previously reported patients with the entity is presented.

Three-dimensional echocardiography has emerged as a novel non-invasive imaging modality enabling the registration and analysis of volumetric datasets containing information on cardiac structure. This review describes the principles of the method, different acquisition modes and the display options in perspective of clinical applications. Emerging clinical applications are discussed, including improved quantification of cardiac volumes and the ability of more complete, versatile and intuitional display of cardiac pathology. According to the available literature, the most probable fields for practical use of three-dimensional echocardiography are cardiac interventions in such conditions as valvular disease, congenital pathology (septal defects) or cardiac tumors. The most expected development is the introduction of fast, user-friendly systems allowing real-time data acquisition and data processing.

Unlabelled: Endothelial dysfunction is regarded as an early marker of atherosclerosis and decreased arterial disstensibility has similar significance. The aim of this study was to evaluate endothelial function and arterial distensibility in patients with impaired glucose tolerance which may constitute markers of atherosclerosis., Methods: Study group consisted of patients without chest pain, ischemic ECG changes, arterial hypertension or any risk factors for IHD, who were divided into two groups: Impaired glucose tolerance group (ITG)--48 patients with fasting glucose levels of 5.7 +/- 0.2 mmol/l and glucose levels of 9.2 +/- 0.6 mmol/l 2 hours after starting a 75 g oral glucose load and group 2-43 healthy age and sex matched controls with fasting glucose levels of 4.9 +/- 0.5 mmol/l and normal glucose tolerance. Endothelium dependent (EDV) and independent vasodilation (EIV) was assessed with 8 MHz high resolution ultrasound (Acuson Sequoia) according to Celermajer's method. PWV was measured with Complior Colson automatic device with measurement points above femoral and carotid artery., Results: Flow associated with vasodilation was significantly impaired in ITG group (6.1 +/- 3.1% vs 13.4 +/- 3.9%-controls, p < 0.001). EIV was not significantly different between both groups. PWV was significantly higher in patients with impaired glucose tolerance than in controls (9.9 +/- 0.5 m/s vs 7.8 +/- 0.9 m/s) p < 0.001., Conclusions: Increased values of PWV indicate an increased arterial stiffness in patients with ITG, coexisting with endothelial dysfunction. These results reveal vascular dysfunction and potentially increased risk for development of atherosclerosis in ITG patients.

Purpose: Stress echocardiography (SE) and radionuclide perfusion imaging are competing diagnostic methods in patients with ischemic heart disease. The prognostic value of nuclear studies has been much better established so far. The purpose of the study was to evaluate the long term prognostic value of pharmacological stress echocardiography., Methods: We followed up 224 patients (62% men, aged 55 +/- 10 yrs) diagnosed with pharmacological stress echocardiography with ischemic heart disease, 46% with angina, 39% with hypertension, 43% with hypercholesterolemia, 12% current smokers, 44% previous smokers, 10% with diabetes mellitus. Positive SE result was defined as new or increased wall motion abnormalities. Follow-up period ranged from 12 to 91 months, average 53 +/- 19 months. Myocardial infarction, recurrent unstable angina requiring hospitalization and need for invasive surgical revascularization or death were defined as adverse outcome., Results: Positive SE result was observed in 109 patients (48%). During follow-up, 21 patients died (9%) and in 132 patients (59%) other cardiac events were observed. Positive predictive value (PPV) during follow-up was 51% (for cardiac death--8%) for the first year and 7-12% (for cardiac death--0-4%) in the years 2-5. 51% for first year and 7-12% for 2-4 year. Negative predictive value (NPV) was 82% for the first year (for cardiac death--98%) and 79-94% (for cardiac death--99-100%) in years 2-5. 82% for first year and 94-92% in further follow-up. However, 1-year PPV for mortality was 8% with a high NPV (98%). 5-year death-related NPV of the test is very high (100%)., Conclusion: Negative result of SE has a moderate NPV for 1 year cardiac event but high NPV for mortality. NPV in 2-5 years of follow-up in patients with negative SE results is high. PPV is higher in the first 1 year than in further follow-up which results partly from selection bias and remains stable thought area 5 years.

Unlabelled: 3-dimensional echocardiography (3DE) is a novel and rapidly evolving echocardiographic technique. Theoretically, 3DE should be helpful in difficult cases when 2-dimensional echocardiography (2DE) cannot deliver required information due to complex spatial relationships in diseased heart of inability to obtain a desired cross-sectional view. Accurate quantification is another potential benefit of 3DE., Methods: In this study we present our 3-year experience in 3DE applied to selected clinical population. Retrospective analysis of our database provided data of 204 3DE studies performed with TomTec Echoscan 3.1 using rotational device from transthoracic or transesophageal window., Results: A total of 474 3DE acquisitions were performed. The main indications for 3DE were: Assessment of left ventricular function (51);--valvular heart disease (47), assessment of thoracic aorta (36), congenital anomalies (36) and cardiac masses (22). Quality of resulting 3D image was graded as 0--bad, 1--satisfactory, 2--good, 3--demo. Average quality of reconstruction was 2.1 +/- 0.8, with 73% of interpretable (score 2-3) studies. Compared to 2DE, additional morphologic or quantitative information was obtained in 47% of patients, including: left ventricular function assessment (41%); valvular heart disease (40%); assessment of descending aorta assessment (31%); congenital anomalies (64%); and cardiac masses (64%)., Conclusion: 3DE can be incorporated into the routine diagnostic pathway with a high feasibility rate. 3DE is a valuable tool in clinically indicated cases by providing additional qualitative or quantitative information in 47% of cases.

A role of autoimmune process and its link with bacterial infections in initiation or aggravation of atherosclerosis symptoms has been suggested. Antigenic mimicry and cross-reactivity of circulating antibodies have been indicated as some major factors in this process. In this study, the prevalence and titers of IgG and IgA antibodies reacting with glycine extract of H. pylori surface antigens were determined immunoenzymatically (ELISA) in the group of patients with unstable ischaemic heart disease and in patients with aggravated dyspepsia. Our results reveal that elevated titers of IgG anti-H. pylori are more typical for cardiac patients and lower prevalence of IgA anti-H. pylori--for those with aggravated dyspepsia. This supports the hypothesis that intensed humoral response in immunoglobulins class G against some bacterial antigens may play a role in the aggravation of symptoms of coronary atherosclerosis.