335 research outputs found
Utility of Speckle Tracking Echocardiography in Asymptomatic Mild to Moderate Aortic Stenosis at Rest and During Supine Bicycle Exercise Test
No full textPulmonary vasoreactivity testing in diagnosis and prognosis of pulmonary hypertension
No full textRight heart catheterization (RHC) is required for confirmation of the diagnosis of pulmonary hypertension (PH) and to asses the prognosis and etiology. Pulmonary vasoreactivity testing (PVT) is one of the most crucial parts of RHC especially in the suitable patient subsets of pulmonary arterial hypertension (PAH) defined by the most recent guidelines. PVT has substantial importance in defining the most appropriate treatment modality. The aim of this review is to provide a comprehensive review of the literature about PVT and the agents used in PVT, to emphasize the importance of this procedure when done with correct indications with a correct technique and to contribute in the accurate management of PH patients. (Anadolu Kardiyol Derg 2010; 10: Suppl 1; 43-9
The anatomical relationship between the axillary artery and vein investigated by radial coronary angiography
No full textAimsTo reduce the risk of inadvertent arterial puncture and bleeding, we aimed to define a safe puncture site by demonstrating the relation of the axillary artery and vein. MethodsThe anatomical course and relation as well as crossover sites of the axillary artery and vein, the presence of small arterial bridges over the axillary vein, and validation of commonly preferred axillary venous puncture sites were determined by simultaneous ipsilateral venography in patients (n=111; 80 men, age 60 10 years) who underwent coronary angiography by radial artery access. ResultsThe axillary vein was detected at the first costa-clavicular intersection in 62% and at the second anterior and third posterior costal intersection in 60% of the patients. Small arterial bridges over the axillary vein were observed in 77% of the patients and more frequently in females and body mass index 25kg/m(2) (P=0.034 and P=0.03, respectively). The axillary artery crossed the vein in 24% of the patients and almost always within the region close to the first costa-clavicular intersection site. ConclusionOur study demonstrated a high crossover rate (24%) of axillary artery and vein and a high degree of variation in the course of axillary vein. Small arterial bridges over the axillary vein were observed in 77% of the patients
Determinants of Elevated NT-proBNP Levels in Patients With Hypertrophic Cardiomyopathy: An Echocardiographic Study
No full textBackground: The purpose of this study was to explore the relationship between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and extensive echocardiographic variables in patients with hypertrophic cardiomyopathy (HCM). Methods: We evaluated plasma NT-proBNP levels in 88 patients with HCM and examined the plasma NT-proBNP levels' relationships with echocardiographic indexes. Echocardiographic variables were analysed using univariate and multivariate logistic regression to identify predictors of NT-proBNP elevation. Results: Several echocardiographic variables predicted NT-proBNP elevation, including left atrial dimension index (LADI), left ventricular maximal wall thickness (MWT), left ventricular posterior wall thickness, severe mitral regurgitation, mitral septal and lateral tissue Doppler velocities, and mitral septal E/Ea ratio. Left ventricular ejection fraction, left ventricular dimensions, mitral early flow propagation velocity, isovolumic relaxation time, and left ventricular outflow tract obstruction were not significant predictors of NT-proBNP in this group of patients. With multivariate analysis LADI (HR 5.0; 95% CI 1.5-17.1, p = 0.01) and MWT (HR 4.0; 95% CI 1.2-13.2, p = 0.022) emerged as independent determinants of NT-proBNP elevation. Conclusions: In HCM plasma NT-proBNP is prominently increased. LADI and MWT are independent predictors of elevated levels. These data indicate that NT-proBNP elevations are mainly determined by diastolic load in HCM. (Heart, Lung and Circulation 2009;18:266-270) (c) 2008 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved
Effect of pulmonary endarterectomy on six-minute walking test and echocardiography in the early stage
No full textObjective: Pre- and postoperative changes in echocardiographic parameters and results of 6-minute walking test (6-MWT) were investigated in the present study. Methods: Seventy-six patients (32 males, 44 females; mean age 45.9 +/- 15.1 years) were included. Before and after surgery, 6-MWT and echocardiography were performed. Changes in postoperative parameters were compared to basal walking test and other basal parameters. Results: Distance covered in 6-MWT significantly increased after surgery (p<0.001). Significant decrease in right ventricular diameter and pressure, and significant increase in left ventricular diameter were also observed. While changes in ejection fraction (EF) were not significant, significant reduction in systolic pulmonary artery pressure (sPAP) and tricuspid regurgitation were observed. No statistically significant correlation was observed between baseline 6-MWT results and echocardiographic parameters. Conclusion: The present study was the first to investigate the correlation between baseline 6-MWT results and right ventricular echocardiographic parameters. Myocardial performance index (MPI) and TAPSE were important parameters in follow-up after pulmonary endarterectomy. Improvement in quality of life parameters was also important
Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy
No full textThe aim of the present study was to evaluate of the right and left heart mechanics by two-dimensional (2D) speckle tracking echocardiography (STE) in chronic thromboembolic pulmonary hypertension (CTEPH) patients before and after pulmonary thromboendarterectomy (PTE). A total of 40 consecutive CTEPH patients (mean age 49.3 +/- A 13.5 years, 27 female) were included. 2D STE was performed in all patients before, and 3 months, after PTE. 12 months of prognostic data were also recorded via the use of telephone calls. Postoperative 6-minute walk test (6MWT) distances were significantly longer than preoperative values (410.5 +/- A 61.5 vs. 216.6 +/- A 131.4 m, p < 0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher than preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher than preoperative values. Postoperative LV global radial and circumferential strain measurements were similar to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher, postoperative LA reservoir and conduit functions were similar to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, and RA reservoir and conduit functions in the preoperative and postoperative periods. 2D STE indices may help the clinician in assessing the effect of PTE on cardiac functions and may also be used for follow-up data in CTEPH patients
Value of latent outflow obstruction to predict clinical course of patients with hypertrophic cardiomyopathy
No full textObjective The frequency, significance and prognostic value of left ventricle obstruction (LVO) induced with provocation (latent LVO) is controversial for hypertrophic cardiomyopathy (HC) patients. This study was designed to assess the value of latent LVO in predicting the clinical course in 101 patients with HC. Methods and results Patients were followed for a mean of 82 +/- 48 months (range 2 to 148 months) for clinical end points defined as a composite of cardiovascular death resuscitated cardiac arrest, appropriate defibrillator shock or hospitalization due to worsening of heart failure symptoms. Presence of LVO (hazard ratio 3.63; 95% confidence interval, 1.85 to 7.12; P = 0.0001) and log NT-proBNP levels (hazard ratio, 1.40; 95% confidence interval, 1.14 to 1.72; P = 0.001) were the independent variables associated with an increased risk of experiencing clinical end points. HC patients with latent LVO have a trend toward decreased survival when compared with HC patients without LVO (log rank P = 0.027), but better survival than patients with resting LVO (log rank P = 0.007). HC patients with NT-proBNP levels < 1,000 pg/ml had also better survival. LVO and NT-proBNP levels are the major determinants of clinical end points in patients with HC. Conclusions Evaluation of patients without resting LVO to demonstrate latent obstruction is of critical importance in respect of outcome and selection of patients for septal reduction therapies, so routine provocative testing with physiological exercise and measurement of NT-proBNP is recommended in this patient population for risk stratification
Evaluation of left ventricular functions before and after iron therapy in patients with iron deficiency anemia
No full textThe aim of present study is to evaluate left ventricular (LV) functions using speckle tracking echocardiography (STE) after iron therapy in patients with iron deficiency anemia (IDA). We consecutively enrolled 92 patients with IDA who needed iron therapy and 82 age- and gender-matched healthy volunteers in our study. Their clinical, laboratory, conventional two-dimensional echocardiography (2DE), and STE examinations were performed to all patients before and after iron therapy. Echocardiographic measurements were compared with healthy controls. The hemoglobin level increased after iron therapy (7.2±2.9 vs. 12.1±2.0, p<0.001). There was no statistically difference in conventional echocardiographic measurements of patients before and after iron therapy. The LV global longitudinal strain (GLS: 19.3±4.0 vs. 23.2±3.6, p<0.001), but it was still statistically lower than the LV GLS of the healthy controls (23.2±3.6 vs. 25.9±3.1, p<0.001). The LV global systolic strain rate increased after iron therapy (1.7±0.1 vs. 2.2±0.3, p<0.03). IDA might be associated with impairment in LV longitudinal myocardial function. STE might be useful both for early identification of LV subclinical impairment in patients with IDA and also improvement in myocardial deformation indices after iron therapy
Three-dimensional finite element analysis of shaping curved root canals with the ProTaper and HeroShaper systems
No full textIn this study, we simulated the shaping of a curved root canal with the ProTaper and HeroShaper file systems using three-dimensional finite element modeling. A total of seven of the Ni-Ti rotary instruments were employed to investigate the influence of cutting geometry. A workflow was developed using the mechanical design and analysis software I-DEAS 11 and the LS-DYNA finite element package. The three-dimensional tooth model was constructed from a micro-computed tomography dental scan and a simulated canal. It was found that stresses concentrated towards the outer aspect of curvature in the apical portion of the canal when the ProTaper file system was employed. For the HeroShaper files, the stresses concentrated in the middle portion of the tooth model. Our simulated root canal procedure enables the efficacy of rotary NiTi instruments to be evaluated in a patient-specific setting. This may aid the dentist in choosing the optimal tool set and provides data for improving tool design
- …
