Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness.

Hypoxic exposure depresses myocardial contractility in vitro, but has been associated with indices of increased cardiac performance in intact animals and in humans, possibly related to sympathetic nervous system activation. We explored left ventricular (LV) function using speckle tracking echocardiography and sympathetic tone by spectral analysis of heart rate variability (HRV) in recently acclimatized lowlanders versus adapted or maladapted highlanders at high altitude. Twenty-six recently acclimatized lowlanders, 14 healthy highlanders and 12 highlanders with chronic mountain sickness (CMS) were studied.

Quantification of low-gradient severe aortic stenosis using a hybrid approach combining Doppler echocardiography and thermodilution.

Background And Aim Of The Study: Estimation of stroke volume in the left ventricular outflow tract (LVOT) is a main limitation to aortic valve area (AVA) calculation by echocardiography when using the continuity equation. In this study, the hypothesis was tested that a hybrid method using thermodilution-derived cardiac output measurement and simultaneous Doppler estimation of the systolic ejection period and transvalvular aortic velocities could be used to accurately assess AVA in patients with low-gradient severe aortic stenosis (AS).

Methods: Eighteen patients with low mean gradient (< 40 mmHg) and nine patients with conventionally defined (> or = 40 mmHg) severe AS (< 1 cm2), as assessed by the echocardiographic continuity equation (baseline echocardiography), underwent catheterization and simultaneous Doppler recording of trans-aortic velocities.

Looking at the frame after the picture: "retrocardiac echocardiography".

We report three cases of mediastinal structures encroaching on the left atrium without haemodynamic compromise. These cases emphasize the potential role of echocardiography for the diagnosis and the management of several extracardiac mediastinal abnormalities.

Left ventricular adaptation to acute hypoxia: a speckle-tracking echocardiography study.

Background: Hypoxia depresses myocardial contractility in vitro but does not affect or may even improve indices of myocardial performance in vivo, possibly through associated changes in autonomic nervous system tone. The aim of this study was to explore the effects of hypoxic breathing on speckle-tracking echocardiographic indices of left ventricular function, with and without β1-adrenergic inhibition.

Methods: Speckle-tracking echocardiography was performed in 21 healthy volunteers in normoxia and after 30 min of hypoxic breathing (fraction of inspired oxygen, 0.

Pulmonary hypertension and the right ventricle in hypoxia.

Hypoxia causes pulmonary vasoconstriction. Regional hypoxic vasoconstriction improves the matching of perfusion to alveolar ventilation. Global hypoxic vasoconstriction increases right ventricular afterload.

Infective endocarditis presenting as an isolated aneurysm of the posterior mitral leaflet.

We describe the case of a 64-year-old woman in whom an aneurysm located on the posterior mitral leaflet was detected. Blood cultures grew methicillin-sensitive Staphylococcus epidermidis, and histologic examination of the operative specimen showed polymorphonuclear neutrophilic infiltration of the valve wall associated with fibrin and necrosis, consistent with a diagnosis of endocarditis. The posterior mitral location of the aneurysm and the absence of vegetation are exceptionally rare in this setting.

Ischemic mitral regurgitation: not only a bystander.

Ischemic mitral regurgitation (MR) is a common complication of left ventricular (LV) dysfunction related to chronic coronary artery disease. This complex multifactorial disease involves global and regional LV remodeling, as well as dysfunction and distortion of the components of the mitral valve including the chordae, the annulus, and the leaflets. Its occurrence is associated with a poor prognosis.

Normal left ventricular ejection fraction and mass but subclinical myocardial dysfunction in patients with Friedreich's ataxia.

Aims: Myocardial involvement in Friedreich's ataxia (FRDA) is characterized by iron deposits, diffuse fibrosis, and focal necrosis. We hypothesized that subclinical left ventricular (LV) dysfunction may occur in 'FRDA patients who have normal LV ejection fraction (LVEF) and mass.

Methods And Results: Twenty patients homozygous for the GAA expansion in the frataxin gene (mean age: 35 ± 16 years) and twenty age- and sex-matched controls (mean age: 34 ± 15 years) were studied using conventional echocardiography and speckle-tracking imaging.

Republished review: Mitral regurgitation in patients with aortic stenosis undergoing valve replacement.

Mitral regurgitation is a frequent finding in patients with aortic stenosis scheduled for aortic valve replacement. Detection of mitral regurgitation in such patients has important implications, as it can independently affect functional status and prognosis. When mitral regurgitation is moderate to severe, a decision to operate on both valves should only be made following a careful clinical and echocardiographic assessment.

Management of multiple valve disease.

Multivalvular heart disease is not an uncommon situation, but the paucity of data for each specific situation does not allow the proposal of a standardised, evidence-based management strategy. This paper aims at reviewing the available evidence on the management of multivalvular disease, taking into account the interactions between different valve lesions, the diagnostic pitfalls and the strategies that should be considered in the presence of multiple valvular disease.

Impact of prosthesis-patient mismatch on mitral regurgitation after aortic valve replacement.

Background: Mitral regurgitation is frequently observed in patients undergoing aortic valve replacement (AVR) for aortic stenosis and often improves postoperatively, mainly due to left ventricular remodelling and changes in loading conditions. Aortic prosthesis-patient mismatch (PPM) is associated with poor outcome and lesser left ventricular remodelling. This study tested the hypothesis that aortic PPM affects mitral regurgitation.

Myocardial homing and coronary endothelial function after autologous blood CD34+ progenitor cells intracoronary injection in the chronic phase of myocardial infarction.

Transcoronary transplantation of progenitor cells has been proposed as a novel therapy for ischemic heart failure. The primary aims were to assess the feasibility of obtaining CD34+ cells from blood without mobilization in chronic conditions and to compare homing with results reported in acute conditions. We also evaluated the effect of CD34+ on endothelial function.

Mitral regurgitation in patients with aortic stenosis undergoing valve replacement.

Mitral regurgitation is a frequent finding in patients with aortic stenosis scheduled for aortic valve replacement. Detection of mitral regurgitation in such patients has important implications, as it can independently affect functional status and prognosis. When mitral regurgitation is moderate to severe, a decision to operate on both valves should only be made following a careful clinical and echocardiographic assessment.

C-reactive protein increase in acute myocardial infarction.

Objective: Considering acute myocardial infarctions (AMI), data demonstrate that C-reactive protein (CRP) levels reflect the severity of myocardial damage and that high CRP level is associated with a worse outcome. This study evaluates the prognostic value of CRP and the determinants of its increase during AMI.

Methods And Results: A retrospective observational study of 126 patients with a ST-segment elevation myocardial infarction (STEMI); 101 patients had reperfusion therapy (93 thrombolysis, 8 PTCA).