Pericardial thrombus and cardiac tamponade after pericardiocentesis with intact heart walls.

A young patient affected by a lung neoplasm, presented at emergency department with cardiac tamponade, underwent pericardiocentesis with a prompt restoration of hemodynamic stability. An hour later, the patient presented again signs of tamponade, without evidence of fluids in the drainage that was left in pericardial space. The echocardiography revealed an intrapericardial thrombus compressing the right chambers.

Sustained prognostic value of dobutamine stress echocardiography for late cardiac events after major noncardiac vascular surgery.

Background: Late cardiac events after major noncardiac vascular surgery are an important cause of morbidity and mortality. We studied the prognostic value of preoperative dobutamine stress echocardiography, relative to clinical risk assessment, in predicting late cardiac events.

Methods And Results: Three hundred sixteen patients undergoing major vascular surgery were studied.

Diastolic abnormalities in systemic sclerosis: evidence for associated defective cardiac functional reserve.

Objective: To investigate the pattern of diastolic abnormalities in patients with systemic sclerosis (SSc) and the relationship between impaired ventricular filling and systolic function.

Methods: Twenty four patients with SSc underwent M-mode and two dimensional echocardiography using echo-Doppler and gated blood pool cardiac angiography, both at rest and after exercise.

Results: An impaired diastolic relaxation of the left ventricle was detected in 10 of the 24 patients with SSc.

T wave normalization during dobutamine stress testing in patients with non-Q wave myocardial infarction. A marker of myocardial ischaemia?

Unlabelled: Conflicting results in a heterogenous patient population have been described on the functional significance of stress-induced T wave normalization in the ECG. The aim of this study was to evaluate the relationship between T wave normalization during dobutamine stress testing and stress-induced ischaemia evaluated by echocardiography and myocardial perfusion scintigraphy in patients with previous non-Q wave myocardial infarction. Among 520 patients who underwent dobutamine stress, testing in conjunction with simultaneous echocardiography and 201 thallium or sestamibi SPECT for evaluation of suspected myocardial ischaemia, 36 were selected according to the following criteria: previous non-Q wave myocardial infarction, normal QRS, negative T waves in two or more ECG leads and no significant ST segment depression or elevation at rest or during stress.

Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms.

Objectives: This study sought to determine the degree of interinstitutional agreement in the interpretation of dobutamine stress echocardiograms.

Background: Dobutamine stress echocardiography involves subjective interpretation. Consistent methods for acquisition and interpretation are of critical importance for obtaining high interobserver agreement and for facilitating communication of test results.

Safety and feasibility of dobutamine-atropine stress echocardiography in patients with ischemic left ventricular dysfunction.

The aim of this study was to analyze whether left ventricular dysfunction affects the safety and feasibility of high-dose dobutamine-atropine stress echocardiography. We examined the results of the test in 318 consecutive patients who were referred for high-dose dobutamine-atropine stress echocardiography and also underwent diagnostic cardiac catheterization. Forty-four patients had a left ventricular ejection fraction of 25% or less (mean, 21%; range, 15% to 25%).

Improved cardiac risk stratification in major vascular surgery with dobutamine-atropine stress echocardiography.

Objectives: This study sought to optimize preoperative cardiac risk stratification in a large group of consecutive candidates for vascular surgery by combining clinical risk assessment and semiquantitative dobutamine-atropine stress echocardiography.

Background: Dobutamine-atropine stress echocardiography has been used for the prediction of perioperative cardiac risk in a small group of patients scheduled for elective major vascular surgery on the basis of the presence or absence of stress-induced regional left ventricular wall motion abnormalities.

Methods: Clinical risk assessment and dobutamine-atropine stress echocardiography were performed in 302 consecutive patients presenting for major vascular surgery.

Improved identification of coronary artery disease in patients with left bundle branch block by use of dobutamine stress echocardiography and comparison with myocardial perfusion tomography.

This study compared the efficacy of dobutamine stress testing using 2-dimensional echocardiography and perfusion tomography for the noninvasive identification of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). Twenty-four patients with permanent, complete LBBB (11 with previous myocardial infarction) were studied prospectively with dobutamine echocardiography and perfusion tomography. The presence of > 50% luminal diameter coronary stenosis was compared with the presence of dobutamine-induced fixed or reversible perfusion defects, and with resting or dobutamine-induced abnormalities of wall thickening.

Quantitative angiographic measurements of isolated left anterior descending coronary artery stenosis. Correlation with exercise echocardiography and technetium-99m 2-methoxy isobutyl isonitrile single-photon emission computed tomography.

Objectives: This study sought to assess the value of quantitative coronary arteriography in predicting an ischemic response at exercise echocardiography and technetium-99m 2-methoxy isobutyl isonitrile (mibi) single-photon emission computed tomography (SPECT) in patients with single-vessel disease of the left anterior descending coronary artery.

Background: The relation between severity of coronary stenosis and ischemic response to exercise echocardiography and perfusion scintigraphy in patients with single-vessel left anterior descending coronary artery disease is not well established.

Methods: Thirty-one patients without a previous myocardial infarction who had isolated stenosis of varying degrees in the proximal or midportion of the left anterior descending coronary artery were studied.

Prediction of improvement of regional left ventricular function after surgical revascularization. A comparison of low-dose dobutamine echocardiography with 201Tl single-photon emission computed tomography.

Background: Although both 201Tl scintigraphy and low-dose dobutamine echocardiography (LDDE) have been proposed as effective methods of assessing myocardial viability, their relative efficacies are unknown. The aim of the present study was to compare the two imaging techniques in the prediction of improvement of regional left ventricular (LV) function after surgical revascularization.

Methods And Results: Thirty-eight patients with severe chronic LV dysfunction (ejection fraction < or = 40%, one or more akinetic [Ak] or severely hypokinetic [SH] segments on resting echocardiogram) who underwent uncomplicated coronary artery bypass graft surgery were studied with simultaneous dobutamine stress echocardiography and poststress reinjection 201Tl single-photon emission computed tomography (SPECT) before surgery.

Effects of intravenous digoxin on pulmonary venous and transmitral flows in patients with chronic heart failure of different degrees.

Acute effects of digoxin on diastole were evaluated noninvasively by combining data simultaneously obtained by Doppler echocardiograms (echo-Doppler) of transmitral and pulmonary venous flow curves in 38 patients with dilated and failing hearts, who had been stable for at least 7 days before the study. According to the resting ejection fraction (EF), patients were subdivided into Group 1 (EF < 30%: n = 20, mean EF values 23 +/- 8%) and Group 2 (EF > or = 30%: n = 18, mean EF values 40 +/- 3%). Significant differences were observed at rest between the two groups in both transmitral (shorter deceleration time and isovolumic relaxation time and increased peak E and E/A ratio in Group 1 vs.

Dobutamine-atropine stress echocardiography in elderly patients unable to perform an exercise test. Hemodynamic characteristics, safety, and prognostic value.

Objective: To establish the hemodynamic effects, safety, and prognostic value of dobutamine-atropine stress echocardiography in patients 70 years of age or older.

Design And Setting: Observational study at a university hospital.

Patients: One hundred seventy-nine patients (mean age, 75 years; range, 70 to 90 years) referred for chest pain (n = 73) or preoperative risk assessment for major vascular noncardiac surgery (n = 106).

Dobutamine-atropine stress echocardiography and clinical data for predicting late cardiac events in patients with suspected coronary artery disease.

Purpose: To compare the relative value of clinical variables with dobutamine-atropine stress echocardiography to predict cardiac events during long-term follow-up. Dobutamine stress echocardiography is increasingly used for the detection of coronary artery disease, but little is known of its prognostic value.

Patients And Methods: A total of 430 patients (310 men; mean age 61 years, range 22 to 90) were enrolled in the study.

[Stress echocardiography: 4 years of experience at the Thoraxcenter].

In this article, we report the experience on stress echocardiography at the Thoraxcenter of Erasmus University of Rotterdam in the years 1990-1994. Different types of stress have been used in conjunction with ultrasound techniques. The results have been compared with other non-invasive methods (exercise ECG testing, myocardial perfusion scintigraphy with single photon emission computed tomography) and with coronary arteriography.

Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test.

Objectives: The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine stress echocardiography.

Background: Coronary angiography is the reference method for assessment of the accuracy of noninvasive diagnostic imaging techniques to detect the presence of significant coronary stenosis. However, use of arbitrary cutoff criteria for the interpretation of angiographic data may considerably influence the true diagnostic accuracy of the technique investigated.

Dobutamine-atropine stress echocardiography for assessment of perioperative and late cardiac risk in patients undergoing major vascular surgery.

Objective: To determine the value of dobutamine-atropine stress echocardiography and clinical variables to predict perioperative and late cardiac events in patients scheduled for elective major non-cardiac vascular surgery.

Design: Blinded prospective study.

Patients: Patients (n = 187 mean age 69 yrs).

Safety of dobutamine-atropine stress echocardiography in patients with suspected or proven coronary artery disease.

The purpose of this study was to establish the safety of high-dose dobutamine-atropine stress echocardiography in patients with suspected or proven coronary artery disease. Six hundred fifty consecutive examinations were completed. Mean age of patients was 61 years; 300 had a previous myocardial infarction.

Potential and limitations of Tc-99m sestamibi scintigraphy for the diagnosis of myocardial viability.

Sestamibi is a Tc labeled radiotracer particularly suitable for myocardial perfusion studies, providing similar information as thallium scintigraphy for the diagnosis of coronary artery disease. In comparison with thallium, sestamibi has the advantage of improved imaging properties due to its higher gamma emission. This is particularly relevant when SPECT imaging is considered.

[The effects of the selective intracoronary administration of nifedipine on left ventricular filling anomalies during coronary angioplasty].

Eighteen patients with isolated stenosis of left anterior descending artery, were randomly given 0.2 mg of nifedipine (Group II) or its solvent (Group I) via balloon catheter positioned across the lesion immediately prior balloon occlusion. Peak velocity of early (E peak) and late (A peak) filling, velocity flow integral at early (E area) and late (A area) filling and their ratios (by echo-Doppler) and heart rate, mean aortic and wedge (W) pressures were measured at baseline, 15 and 30 s during balloon occlusion and 10 min after balloon deflation.

Effects of flecainide and propafenone on systolic performance in subjects with normal cardiac function.

Flecainide and propafenone are effective in suppressing both ventricular and supraventricular tachyarrhythmias, but their efficacy is often limited by dose-related side effects. This study was performed to evaluate noninvasively the effects of intravenous flecainide and propafenone on left ventricular systolic function indices in a selected population of 40 subjects (28 men and 12 women; mean age, 25 years) with normal cardiac structure and performance. Echocardiographic indexes of global systolic pump function (ejection fraction [EF] and percentage of fractional shortening [percent FS]) as well as monodimensional parameters of the intraventricular septum (IVS) and left ventricular posterior wall (PW) contractility (percent systolic thickening [percent th] and systolic excursion [ex]) were assessed in all subjects at baseline, immediately after, and in the early recovery (15 min) after randomized injection of either flecainide or propafenone.

Spectrum of cardiac involvement in systemic lupus erythematosus: echocardiographic, echo-Doppler observations and immunological investigation.

Cardiac involvement was noninvasively evaluated in 75 consecutive patients with systemic lupus erythematosus (SLE) by two-dimensional and Doppler echocardiography. In 50/75 patients anticardiolipin antibodies (aCL) were also investigated. Major endocardial damage, characterized by the simultaneous presence of both anatomical and functional valvular involvement (AFVI), was observed in three patients with valvular vegetations and in five patients with combined valvular stenosis and/or regurgitation.

Effects of short-term oral digoxin on left ventricular diastolic filling in patients with ventricular dysfunction. An echo-Doppler study.

34 patients with ventricular dysfunction (18 in NYHA class II and 16 in NYHA class III heart failure) whose clinical status was stabilized by diuretics and systemic vasodilators, entered a randomized trial to compare the effects of short-term oral digoxin and active placebo on left ventricular diastolic function, non invasively evaluated by echo-Doppler transmitral left ventricular filling flow. At baseline patients were subdivided by reversal--the ratio of peak early (E) and late (A) transmitral filling velocities--E/A < 1 (group I) or normal--E/A > or = 1 (group II) echo-Doppler E/A ratio; group II exhibited a shorter deceleration time (125 +/- 20 ms vs 198 +/- 38 ms, p > 0.05) and isovolumic relaxation time (64 +/- 15 ms vs 93 +/- 10 ms; p < 0.