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In patients with acute coronary syndromes, it is desirable to identify a sensitive serum marker that is closely related to the degree of myocardial damage, provides prognostic information, and can be measured rapidly. We studied the prognostic value of cardiac troponin I levels in patients with unstable angina or non-Q-wave myocardial infarction.In a multicenter study, blood specimens from 1404 symptomatic patients were analyzed for cardiac troponin I, a serum marker not detected in the blood of healthy persons. The relation between mortality at 42 days and the level of cardiac troponin I in the specimen obtained on enrollment was determined both before and after adjustment for baseline characteristics.The mortality rate at 42 days was significantly higher in the 573 patients with cardiac troponin I levels of at least 0.4 ng per milliliter (21 deaths, or 3.7 percent) than in the 831 patients with cardiac troponin I levels below 0.4 ng per milliliter (8 deaths, or 1.0 percent; P0.001). There were statistically significant increases in mortality with increasing levels of cardiac troponin I (P0.001). Each increase of 1 ng per milliliter in the cardiac troponin I level was associated with a significant increase (P = 0.03) in the risk ratio for death after adjustment for the base-line characteristics that were independently predictive of mortality (ST-segment depression and ageor = 65 years).In patients with acute coronary syndromes, cardiac troponin I levels provide useful prognostic information and permit the early identification of patients with an increased risk of death.

present with chest pain (female: 88.9%; male: 85.1%; P 0.55). Women were more likely to feel neck/throat pain (61.1% vs. 38.3%; P 0.01) as well as left arm/shoulder pain (77.8% vs. 53.9%; p0.01). However, women were more likely to report severe vs. mild/moderate chest pain compared to young men (71.9% vs. 53.4%; P 0.06). The number of symptoms experienced were also greater in women compared to their male counterparts [female P 5 (3.0, 7.8); for male 4 (3.0, 6.0); P 0.14]. CONCLUSION: The results of this study provides evidence that young women with confirmed diagnosis of AMI are as likely as young men to present with typical symptoms of chest pain; Of note, women report both a higher severity of chest pain and a wider range of other pain symptoms during AMI. This finding may indicate that only young women with more severe symptoms are identified as having an AMI. Whether young women with AMI who experience more subtle symptoms are more likely to be missed or not needs to be further studied. The Heart and Stroke Foundation of BC & Yukon

Background We performed the first human case of successful transapical transcatheter aortic valve implantation on a beating heart in October 2005, and therefore we have the longest follow-up on transapical aortic valve implantation in humans. We now report clinical and echocardiographic outcomes of transapical aortic valve implantation in 71 patients. Methods Between October 2005 and February 2009, 71 patients (44 female) underwent transcatheter transapical aortic valve implantation with either 23- or 26-mm Edwards Lifesciences transcatheter bioprostheses. All patients with symptomatic aortic stenosis were declined for conventional aortic valve replacement owing to unacceptable operative risks and were not candidates for transfemoral aortic valve implantation because of poor arterial access. Clinical and echocardiographic follow-ups were performed before discharge, at 1 and 6 months, and then yearly. The mean follow-up was 12.9 ± 11.5 months with a total of 917.3 months of follow-up. Results Mean age was 80.0 ± 8.1 years and predicted operative mortality was 34.5% ± 20.4% by logistic EuroSCORE and 12.1% ± 7.7% by The Society of Thoracic Surgeons Risk Calculator. Valves were successfully implanted in all patients. Twelve patients died within 30 days (30-day mortality: 16.9% in all patients, 33% in the first 15 patients, and 12.5% in the remainder), and 10 patients died subsequently. Overall survival at 24 and 36 months was 66.3% ± 6.4% and 58.0% ± 9.5%, respectively. Among 59 patients who survived at least 30 days, 24- and 36-month survivals were 79.8% ± 6.4% and 69.8% ± 10.9%, respectively. Late valve-related complications were rare. New York Heart Association functional class improved significantly from preoperative 3.3 ± 0.8 to 1.8 ± 0.8 at 24 months. The aortic valve area and mean gradient remained stable at 24 months (1.6 ± 0.3 cm 2 and 10.3 ± 5.9 mm Hg, respectively). Conclusion Our outcome suggests that transapical transcatheter aortic valve implantation provides sustained clinical and hemodynamic benefits for up to 36 months in selected high-risk patients with symptomatic severe aortic stenosis.

Census of Population and Housing and location of cardiac catheterisation laboratories data from state health departments. Results:Results indicate that approximately65.5%of the population (12,978,041persons) were within 1h of cardiac catheterisation laboratories; however 6,835,768 (34.5%) persons lived outside of this range. Of the group with less accessibility to cardiac catheterisation laboratories, 2,825,352 (41.3%) were aged 45 plus. Of the 453,448 Aboriginal and Torres Strait Islanders in 2006, 37.6% (170,597) were within 1h, but 62.4% (282,851) were outside the 1h access to catheterisation laboratories. Conclusion: The majority of Australian’s are located in communities that have timely access for survival. Therefore, it appears that it is how quickly systems mobilize (response time) rather than distance that will affect the outcomes of a cardiac event. doi:10.1016/j.hlc.2010.06.954

To determine whether histamine alters human left ventricular contractility we measured heart rate, calibrated carotid arterial pressure, and left ventricular dimensions (echocardiogram) in nine healthy volunteers. We assessed baseline contractility using the end-systolic pressure-dimension relationship and the end-systolic meridional wall stress-rate-corrected velocity of circumferential fiber shortening relationship determined over a wide range of afterloads using phenylephrine and nitroprusside infusions. We then infused histamine for 3–5 min at a dose predetermined to decrease mean arterial pressure by 20%, both before and after H1 receptor antagonist pretreatment (diphenhydramine 50 mg i.v.). Histamine decreased end-systolic pressure but, unlike an equally hypotensive infusion of nitroprusside, did not decrease end-systolic dimension or increase fractional shortening. Histamine also decreased velocity of circumferential fiber shortening at the same end-systolic meridional wall stress as controls (P < 0.05). These effects of histamine were inhibited by H1 antagonist pretreatment. We conclude that the dominant effect of histamine on the human heart is to decrease left ventricular contractility and that this decrease in contractility is dependent, at least partially, on H1-receptor activation.

A 74-year-old man who had dyspnea and cyanosis demonstrated venous thrombosis and multiple lung ventilation-perfusion mismatches suggesting pulmonary emboli. Transthoracic echocardiography demonstrated a right atrial mass and a microbubble contrast study did not reveal right-to-left shunt. Transesophageal echocardiography revealed an embolus entrapped in the foramen ovale projecting into the left atrium that was subsequently removed. Embolic occlusion of patent foramen ovale is an important cause of false negative microbubble contrast study.

Granulopoiesis constitutes a dynamical system, able to respond acutely to internal or external stimuli, with production of neutrophils. Because neutrophils are short-lived (

7 Dittrich H, Nicod P, Hoit B, Dalton N, Sahn D. Evaluation of Bjiirk-Shiley prosthetic valves by real-time two-dimensional Doppler echocardiographic flow mapping. AM HEART J 1988; 115:133-8. Peifer J, Goldschlager N, Sweat ‘I’, Gerbode F, Selzer A. Malfunction of mitral valve prosthesis due to a trombus. Am J Cardiol 1972;29:95-9. Bernal-Ramirez JA, Phillips JA. Echocardiographic study of malfunction of the Bjijrk-Shiley prosthetic heart valve in the mitral position. Am J Cardiol 1977;40:449-53. Dittrich HC, McCann HA, Walsh TP, Blanchard DG, Oppenheim GE, Waack TC, Donaghey LB, Wheeler K. Transesophageal echocardiography in the evaluation of prosthetic and native aortic valves.-A& J Cardiol 1990;66:758-61. Chaudhrv FA. Herrera C. DeFrino PF. Mehlman DJ, Zabalgoitia M. Pathologic and’angiographic’ correlations of transesophageal echocardiography in prosthetic heart valve dysfunction. AM HEART 5~1991;122:1057-64. Rocchioli C. Chastre J. Lecomnte Y. Gandibakhch I, Gibert C. Prosthetic ;alve endocarditis. The case for prompt surgical management. J Thorac Cardiovasc Surg 1986;92:784-9. Alfonso F, Rodrigo JL, Bafiuelos C, Ifiiguez A, Macaya C, Zarco P. Echocardiographic detection of abnormal attachment of a BjBrk-Shiley prosthesis to the interatrial septum causing an atrial septal aneurysm. AM HEART J 1989;117:695-7.

Previous studies from our laboratory have shown that the position of the ventricular septum relative to the two ventricles at end-diastole is determined by the instantaneous transseptal pressure gradient (TSG) defined as left ventricular minus simultaneous right ventricular pressure. Since patients with mitral stenosis often have exaggerated leftward (paradoxic) motion of the ventricular septum during early diastole, we studied seven patients with mitral stenosis undergoing cardiac catheterization to determine if position (and therefore motion) of the ventricular septum was determined by TSG throughout diastole. M Mode echocardiograms derived from a two-dimensional parasternal short-axis view were recorded with simultaneous micromanometer measurements of left ventricular and right ventricular pressures. Six of seven patients demonstrated abnormal early diastolic leftward motion of the ventricular septum in at least one cardiac cycle. TSG measured at intervals throughout diastole ranged from -2.5 to +20 mm Hg, with abnormal TSG observed in most of the 40 cardiac cycles selected for analysis. The intracardiac position of the ventricular septum, defined as the distance from the right ventricular epicardium (RVEpi) to the left surface of the ventricular septum normalized for total cardiac dimension (RVEpi-VS), was plotted against left ventricular pressure, right ventricular pressure, and TSG. Linear regression of pooled data from all patients (164 observations) demonstrated a highly significant correlation between the instantaneous TSG and the relative intracardiac position of the ventricular septum (RVEpi-VS = 1.52 TSG + 42.7; r = .79, p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

The determinants of myocardial salvage after thrombolytic therapy during acute myocardial infarction (AMI) have not been clearly defined. In 1984, a prospective randomized trial was undertaken to define the relations between delay to treatment and effectiveness of perfusion to salvage of myocardium. Patients presenting within 2 hours of symptom onset received intravenous streptokinase immediately (group 1, 20 patients) or 5 hours after symptom onset (group 2, 16 patients). Effective perfusion (less than or equal to 90% residual stenosis with rapid distal runoff) occurred in 63% of patients in both groups. Five patients, all in group 1, had recurrent AMI; 4 of the 5 had effective perfusion. There was no group difference in left ventricular ejection fraction at baseline or before discharge. However, group 1 patients with effective perfusion tended to have a greater predischarge mean ejection fraction than those in group 1 with ineffective perfusion (53 +/- 13 vs 44 +/- 16%, p less than 0.10) and had a greater mean value than those in group 2 with ineffective perfusion (53 +/- 13 vs 38 +/- 17%, p less than 0.03). The ejection fraction did not change significantly between admission and discharge in either group, but it increased significantly in group 1 patients with effective perfusion and no recurrent AMI (delta EF = +6 +/- 8%, p less than 0.04). Group 1 patients with ineffective perfusion had a significant decrease in ejection fraction (delta EF = -4 +/- 4%, p less than 0.04). In group 2 patients the ejection fraction did not change, regardless of the state of perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Previously, we have shown that pericardial constraint cannot be measured by true (hydrostatic) pressure except when an excess of pericardial fluid is present and that a device such as a balloon (which reflects radial contact stress as well as hydrostatic pressure) must be used. Since radial contact stress is the major component of the constraint exerted by the pericardium when little pericardial liquid is present, it follows that the pressure measured by the balloon might be different over different parts of the heart. In an attempt to test this hypothesis, in 11 anesthetized dogs we placed pericardial balloons over the right and left ventricular free walls, instrumented the animals to measure ventricular dimensions (sonomicrometry) and pressure, mounted pneumatic constrictors on the aortic and pulmonary artery, reapproximated the pericardium, and closed the chest under suction. We studied the transient effects of constrictions of the ascending aorta and pulmonary artery and of angiotensin infusion before and after intravenous saline infusion. Aortic constriction and, to a lesser degree, angiotensin increased pericardial pressure over the left ventricle more than over the right ventricle. Pulmonary artery occlusion increased pericardial pressure over the right ventricle but significantly decreased pericardial pressure over the left ventricle. We conclude that there are significant local differences in pericardial pressure (recorded by balloon) over the lateral ventricular surfaces during acute changes in afterload. These observations may be explained in part by decreased venous return to the contralateral ventricle, the tendency of the heart to resist lateral displacement, and the limited mobility of the pericardium.

Objectives This study sought to describe a method of paravalvular leak closure using a purpose-specific occlusion device. Background Transcatheter closure of paravalvular leaks has been hampered by technical challenges, the limitations of available imaging modalities, and the lack of closure devices specifically designed for this purpose. Methods Patients with severe symptomatic paravalvular regurgitation at high risk for repeat surgery underwent transcatheter leak closure. Both left ventricular puncture and retrograde transfemoral approaches were used with fluoroscopic and 3-dimensional transesophageal guidance. A purpose-specific occluder (Vascular Plug III, AGA Medical Corp., Plymouth, Minnesota) was used. Results Five patients with severe prosthetic mitral and aortic paravalvular leaks underwent attempted closure. Implantation of the device was successfully accomplished in all. In 1 patient, the plug interfered with closure of a mechanical valve leaflet and was removed and replaced with an alternate device. Complications included pericardial bleeding in 2 patients with a transapical approach. There was no procedural mortality. At a median follow-up of 191 days (interquartile range [IQR] 169 to 203 days) all patients were alive. New York Heart Association functional class fell from 4 (IQR 3 to 4) to 2 (IQR 2 to 3), hemoglobin rose from 89 g/l (IQR 87 to 108 g/l) to 115 g/l (IQR 104 to 118 g/l), creatinine fell from 109 μmol/l (IQR 106 to 132 μmol/l) to 89 μmol/l (IQR 89 to 126 μmol/l). Median echocardiographic follow-up at 58 days (IQR 56 to 70 days) reported residual regurgitation to be reduced from grade 4 to grade 2 (IQR 1.5 to 2.25). Conclusions Closure of mitral and aortic prosthetic paravalvular leaks with the Vascular Plug III using either a transapical (mitral) or a retrograde (aortic) approach appears promising.

OBJECTIVES This study compared a prediction of mean left atrial pressure (PLA) ascertained by Doppler echocardiography of pulmonary venous flow (PVF), with predicted PLA using the pulmonary artery occlusion pressure (PPAO). BACKGROUND In select patient groups, PVF variables correlate with PPAO, an indirect measure of PLA. METHODS In 93 patients undergoing cardiac surgery, we recorded with transesophageal echocardiography mitral valve early (E) and late (A) wave velocities, deceleration time (DT) of E (DTE), and pulmonary vein systolic (S) and diastolic (D) wave velocities, DT of D (DTD) and systolic fraction. The PPAO was measured using a pulmonary artery catheter zeroed to midaxillary level. A further catheter was held at midatrial level to zero a transducer and was then inserted into the left atrium. A prediction rule for PLA from DTD was developed in 50 patients and applied prospectively to estimate PLA in 43 patients. RESULTS A close correlation (r 52 0.92) was found between PLA and DTD. Systolic fraction (r 5 20.63), DTE (r 52 0.61), D wave (r 5 0.57), E wave (r 5 0.52), and E/A ratio (r 5 0.13) correlated less closely with PLA. The mean difference between predicted and measured PLA was 0.58 mm Hg for DTD method and 1.72 mm Hg for PPAO, with limits of agreement (mean 6 2 SE) of 22.94 to 4.10 mm Hg and 22.48 to 5.92 mm Hg, respectively. A DTD of ,175 ms had 100% sensitivity and 94% specificity for a PLA of .17 mm Hg. CONCLUSIONS Deceleration time of pulmonary vein diastolic wave is more accurate than PPAO in estimating left atrial pressure in cardiac surgical patients. (J Am Coll Cardiol 2001;37:2025‐30) © 2001 by the American College of Cardiology Pulmonary artery occlusion pressure (PPAO) is considered the clinical gold standard for estimation of mean left atrial pressure (PLA), an indirect indicator of left ventricular intracavity filling pressures (1,2). However, insertion of a pulmonary artery catheter is not a risk-free procedure, and a reliable, less-invasive alternative has been sought (3). Both pulsed-wave Doppler echocardiography of mitral inflow and, subsequently, pulmonary vein flow (PVF) have been extensively studied, and a clear relationship between selected variables and PPAO was found (4 ‐12). However, mitral inflow and PVF patterns are influenced by multiple factors including left atrial pressure, left ventricular relaxation (4,13), compliance and afterload (14,15), ventricular interaction (16,17), heart rate (18,19), cardiac output (20) and age (21). These confounding factors preclude routine clinical use of mitral inflow or PVF patterns to predict PLA. Two recent studies have found a close relationship between the deceleration time of the diastolic wave (DTD) of PVF and PPAO in selected patient groups (22,23). Therefore, this study set out to investigate the relationship between the DTD and directly measured PLA in a more general group of cardiac surgical patients. We then attempted to predict PLA in a test group using a regression equation developed from the correlation between DTD and PLA in the study group. Finally, we compared the accuracy of this method of estimating PLA with PPAO estimation of PLA.

Objectives This study sought to assess the impact of baseline left ventricular (LV) outflow, LV ejection fraction (LVEF), and transvalvular gradient on outcomes following transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS). Background Low flow (i.e., reduced stroke volume index [SVi]) can occur with both reduced and preserved LVEF. Low flow is often associated with low gradient despite severe stenosis and with worse outcomes following surgical aortic valve replacement. However, there are few data about the impact of low flow on outcomes following TAVR. Methods We retrospectively analyzed the clinical, Doppler-echocardiographic, and outcome data prospectively collected in 639 patients who underwent TAVR for symptomatic severe AS in 2 Canadian centers. Results In this cohort, 334 (52.3%) patients had a low flow (SVi 2 ) and these patients had increased 30-day mortality (11.4 vs. 5.9%, p = 0.01), 2-year all-cause mortality (35.3 vs. 30.9%, p = 0.005), and 2-year cardiovascular mortality (25.7 vs. 16.8%, p = 0.01) compared with patients with normal flow. Reduced flow was an independent predictor of 30-day mortality (odds ratio: 1.94, p = 0.026), cumulative all-cause mortality (hazard ratio: 1.27 per 10 ml/m² SVi decrease, p = 0.016), and cumulative cardiovascular mortality (hazard ratio: 1.29 per 10 ml/m² decrease, p = 0.04). Despite significant association in univariable analyses, low LVEF and low mean gradient were not found to be independent predictors of outcomes in multivariable analyses. Conclusions Low flow but not low LVEF or low gradient is an independent predictor of early and late mortality following TAVR in high-risk patients with severe AS. SVi should be integrated in the risk stratification process of these patients.

Objectives This study was designed to investigate the usefulness and limitations of echocardiography in optimizing the outcome of percutaneous aortic valve implantation. Background Percutaneous aortic valve implantation is an emerging technique that has the potential to revolutionize the treatment of aortic valve disease. To date, however, the technique has been limited by technical constraints. Precise positioning of the valve is essential to minimize the potential for paravalvular regurgitation or device migration. Initial experience with device placement utilized fluoroscopic guidance only. Methods Candidates for percutaneous aortic valve implantation were evaluated with transthoracic echocardiography (TTE) to assess aortic annular dimension and aortic valve hemodynamics. Fifty consecutive patients were deemed suitable for percutaneous aortic valve implantation. Seventy-four percent (37 of 50) of patients underwent transesophageal echocardiography (TEE) during the procedure. Results Eighty-six percent (43 of 50) of patients had successful implantation, of which 77% (33 of 43) had TEE. Transthoracic echocardiography was used to determine annular dimension and was useful in guiding correct device sizing. Transesophageal echocardiography was able to successfully guide device implantation in 97% (33 of 34) of patients in whom the native valve was crossed with the percutaneous heart valve. Transesophageal echocardiography was used for the early detection of paravalvular aortic regurgitation (AR) and complemented fluoroscopy in the detection of complications. Additional balloon dilatation of the percutaneous heart valve was performed in 12 patients because of significant paravalvular AR, with 7 showing improvement in AR grade. After the procedure, early outcomes were evaluated using TTE. All patients in whom the device was successfully placed (43 of 50) had improvement in their aortic stenosis. Paravalvular AR, although present in many patients, is usually mild and has not emerged as a significant problem. Conclusions Echocardiography has an important role in case selection, in guiding device placement, and in detecting complications of percutaneous aortic valve implantation.

Immunodeficiency with hyperimmunoglobulinemia M is a syndrome characterized by normal to elevated serum levels of IgM and low levels or absence of IgG and IgA. The defect in this syndrome is thought to reside within the B lymphocyte, which may be unable to undergo a "switch" in immunoglobulin class from IgM to IgG or IgA. To address this question more directly, we cultured B cells from nine patients with this syndrome with pokeweed mitogen and either "switch" T cells or normal control T cells. In cultures with normal T cells, only IgM was secreted, whereas in cultures with switch T cells, IgG as well as IgM, or IgM, IgG, and IgA were secreted. Furthermore, analysis of the immunoglobulin heavy-chain genes in these B cells by means of genetic probes of constant and switch regions revealed normal gene patterns. These data suggest that B cells from patients with hyperimmunoglobulinemia M may not be abnormal, as previously proposed, and that, at least in some patients with this syndrome, a defect in switch T cells may be pathogenic.

To test the hypothesis that scans with technetium-99m pyrophosphate (Tc-99m-PPi) are positive when performed early after successful thrombolytic therapy for acute myocardial infarction (AMI), 16 consecutive patients with AMI who received thrombolytic therapy within 5 hours after the onset of chest pain were studied. Patients were included if chest pain lasted for greater than 30 minutes, was unresponsive to sublingual nitroglycerin and was associated with at least 0.2 mV ST-segment elevation in at least 2 contiguous electrocardiographic leads. All patients received 1.5 million IU of streptokinase intravenously, a mean of 195 +/- 99 minutes after onset of chest pain. Tc-99m-PPi scans and coronary cineangiograms were recorded 491 +/- 156 minutes and 518 +/- 202 minutes, respectively, after the onset of symptoms. Effective reperfusion was present in 10 patients, 6 of whom had positive Tc-99m-PPi scans (sensitivity of 60% to detect reperfusion). Of the 6 patients without effective reperfusion, 3 had positive Tc-99m-PPi scans (specificity of 50%, p greater than 0.05). Analysis of the data using various definitions of effective reperfusion or artery patency yielded similar results. Thus, our findings indicate that early AMI scanning with Tc-99m-PPi does not accurately detect the presence or absence of reperfusion in patients with AMI after treatment with intravenous streptokinase. At this time, coronary cineangiography is the only reliable method to detect reperfusion promptly after thrombolytic therapy.

Cardiovascular disease occurs in patients with progressive renal disease both before and after the initiation of dialysis. Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis populations and is common in the renal insufficiency population. LVH is associated with numerous modifiable risk factors, but little is known about LV growth (LVG) in mild-to-moderate renal insufficiency. This prospective multicenter Canadian cohort study identifies factors associated with LVG, measured using two-dimensional–targeted M-mode echocardiography. Eight centers enrolled 446 patients, 318 of whom had protocol-mandated clinical, laboratory, and echocardiographic measurements recorded. We report 246 patients with assessable echocardiograms at both baseline and 12 months with an overall prevalence of LVH of 36%. LV mass index (LVMI) increased significantly (>20% of baseline or >20 g/m 2 ) from baseline to 12 months in 25% of the population. Other than baseline LVMI, no differences in baseline variables were noted between patients with and without LVG. However, there were significant differences in decline of Hgb level (−0.854 v −0.108 g/dL; P = 0.0001) and change in systolic blood pressure (+6.50 v −1.09 mm Hg; P = 0.03) between the groups with and without LVG. Multivariate analysis showed the independent contribution of decrease in Hgb level (odds ratio [OR], 1.32 for each 0.5-g/dL decrease; P = 0.004), increase in systolic blood pressure (OR, 1.11 for each 5-mm Hg increase; P = 0.01), and lower baseline LVMI (OR, 0.85 for each 10-g/m 2 ; P = 0.011) in predicting LVG. Thus, after adjusting for baseline LVMI, Hgb level and systolic blood pressure remain independently important predictors of LVG. We defined the important modifiable risk factors. There remains a critical need to establish optimal therapeutic strategies and targets to improve clinical outcomes.

Cardiac computed tomography (CT) imaging of the mitral annulus plays an integral role in appropriately sizing a transcatheter mitral valve implantation (TMVI) device. There are risks of TMVI including paravalvular regurgitation and left ventricular outflow tract (LVOT) obstruction. To mitigate these

A prospective clinical and echocardiographic study of 47 patients with systemic lupus erythematosus (SLE) and 46 age- and sex-matched controls showed an increased prevalence of echocardiographic abnormalities in the SLE group. Pericardial abnormalities were identified in ten patients with SLE and in no controls. Excluding mitral valve prolapse, valvular abnormalities were identified in ten patients with SLE (21%) and in three controls (7%). In the patients with SLE, abnormalities included mitral valve leaflet thickening in six, aortic valve thickening in five, and mitral annular calcification in two. The presence of valvular abnormalities correlated with duration but not with severity of SLE. The finding of systolic murmurs in 17 of 47 patients with SLE did not correlate with echocardiographic evidence of valvular disease. In six patients with SLE, valvular abnormalities detected by two-dimensional echocardiography were not seen on M-mode echocardiogram. ( JAMA 1985;253:3273-3277)

Measurement of aortic annular size is critical for prosthesis sizing in transcatheter aortic valve implantation (TAVI). Multi-Detector CT (MDCT) can be used to derive aortic annulus dimensions. Changes of MDCT-derived annulus dimensions between systole and diastole are unknown. We analyzed changes