Variants of trophic factors and expression of cardiac hypertrophy in patients with hypertrophic cardiomyopathy.

Patients with hypertrophic cardiomyopathy (HCM) exhibit variable expression of left ventricular hypertrophy (LVH), a major determinant of mortality and morbidity, which is partly due to the diversity of causal mutations, genetic background (modifier genes), and probably environmental factors. We determined association of functional variants of tumor necrosis factor (TNF)- alpha, interleukin-6 (IL6), insulin-like growth factor-2 (IGF2), transforming growth factor- beta 1 (TGFB1), and aldosterone synthase (CYP11B2) genes, all previously implicated in cardiac hypertrophy, with the severity of LVH in patients with HCM. Two-dimensional echocardiography was performed and demographic variables were recorded in 142 genetically independent patients.

Altered adrenergic receptor density in myocardial hibernation in humans: A possible mechanism of depressed myocardial function.

Background: Alterations in adrenergic receptor densities can potentially contribute to myocardial dysfunction. Their relevance to myocardial hibernation in humans is unknown.

Methods And Results: Accordingly, 22 transmural myocardial biopsies were obtained in 11 patients with ischemic ventricular dysfunction during bypass surgery, guided by transesophageal echocardiography.

Tissue Doppler imaging consistently detects myocardial contraction and relaxation abnormalities, irrespective of cardiac hypertrophy, in a transgenic rabbit model of human hypertrophic cardiomyopathy.

Background: Hypertrophic cardiomyopathy (HCM) is diagnosed clinically by the presence of left ventricular hypertrophy (LVH). However, LVH is absent in a significant number of genotype-positive patients. Because myocyte dysfunction and disarray are the primary abnormalities in HCM, we reasoned that tissue Doppler imaging could identify contraction and relaxation abnormalities, irrespective of hypertrophy, in a transgenic rabbit model of human HCM.

Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans.

Objectives: We sought to evaluate the relation of segmental tissue Doppler (TD) velocities to both the regional amount of interstitial fibrosis and the myocyte beta-adrenergic receptor density in humans.

Background: The systolic myocardial velocity (Sm) and early diastolic myocardial velocity (Em) acquired by TD are promising new indexes of left ventricular function. However, their structural and functional correlates in humans are still unknown.

Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up.

Objective: The objective of this study is to evaluate the one-year outcome of the first 50 patients who underwent nonsurgical septal reduction for symptomatic hypertrophic obstructive cardiomyopathy at our institution.

Background: Left ventricular outflow tract obstruction is an important determinant of clinical symptoms in patients with hypertrophic obstructive cardiomyopathy. Nonsurgical septal reduction is a new therapy that has been shown to result in left ventricular outflow tract gradient reduction and resolution of symptoms immediately after the procedure and on midterm follow-up.

End-diastolic wall thickness as a predictor of recovery of function in myocardial hibernation: relation to rest-redistribution T1-201 tomography and dobutamine stress echocardiography.

Objectives: The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of myocardial viability in patients with suspected myocardial hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (T1-201) scintigraphy.

Background: Because myocardial necrosis is associated with myocardial thinning, preserved EDWT may provide a simple index of myocardial viability that is readily available from the resting echocardiogram.

Methods: Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution T1-201 tomography before revascularization and a repeat resting echocardiogram > or =2 months later.

Comparison of global and regional left ventricular function assessed by gated-SPECT and 2-D echocardiography.

Left ventricular (LV) function and volumes have major diagnostic and prognostic importance in patients with heart diseases. Those measurements are most commonly obtained with echocardiographic techniques. Recently, with the use of electrocardiographic gating during the acquisition of myocardial perfusion scintigraphy, it has become possible to simultaneously assess LV perfusion, function and volumes.

Estimation of mean right atrial pressure using tissue Doppler imaging.

Sixty-two patients underwent simultaneous right atrial pressure measurement and Doppler echo including tissue Doppler to evaluate the utility of this technique in the estimation of right ventricular filling pressure. Mean right atrial pressure related weakly to the ratio of tricuspid peak early inflow velocity to annular early diastolic velocity (r = 0.75, p <0.

Gated myocardial perfusion tomography for the assessment of left ventricular function and volumes: comparison with echocardiography.

Unlabelled: The purpose of this study was to evaluate left ventricular volumes and function by gated SPECT using different tracers and protocols in comparison with quantitative echocardiography. Gated myocardial perfusion scintigraphy permits simultaneous assessment of left ventricular perfusion, function and volumes. Information is scanty regarding the accuracy of absolute left ventricular volumes measurements by this technique.

Changes in left ventricular filling and left atrial function six months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy.

Objectives: The purpose of this study was to evaluate changes in left ventricular (LV) filling, left atrial (LA) volumes and function six months after nonsurgical septal reduction therapy (NSRT) for hypertrophic obstructive cardiomyopathy (HOCM).

Background: Patients with HOCM frequently have enlarged left atria, which predisposes them to atrial fibrillation. Nonsurgical septal reduction therapy results in significant reduction in left ventricular outflow tract (LVOT) obstruction and symptomatic improvement.

Assessment of myocardial viability with stress echocardiography.

Over the past two decades, there has been an increased realization that systolic myocardial dysfunction, outside of the setting of acute ischemia, does not necessarily imply irreversible myocardial injury. Echocardiographic techniques, particularly dobutamine stress echocardiography, have emerged as important diagnostic modalities that can identify residual viable myocardium in patients following acute myocardial infarction and in those with suspected myocardial hibernation. Dobutamine echocardiography can also help risk stratify patients with coronary artery disease and depressed ventricular function and identify patients who would benefit best from revascularization procedures.

Relation of the contractile reserve of hibernating myocardium to myocardial structure in humans.

Background: Although dobutamine echocardiography (DE) is widely used to assess myocardial viability in humans, little is known about the relation between contractile reserve and myocardial structure.

Methods And Results: We evaluated 20 patients with coronary disease (64+/-13 years old, ejection fraction 28+/-7.5%) with DE (up to 40 micrograms .

Noninvasive evaluation of hemodynamics by Doppler echocardiography.

Doppler echocardiography plays an invaluable role in the diagnosis and management of patients with heart disease. Noninvasive measurements of cardiac output, pulmonary artery pressures, and left and right ventricular filling pressures can be obtained with reasonable accuracy at baseline and at intervals to assess the response to therapy. Furthermore, simple measurements of Doppler-acquired mitral inflow parameters provide independent and incremental prognostic data in patients with restrictive heart disease and in patients with left ventricular systolic dysfunction and heart failure.

Supine bicycle versus post-treadmill exercise echocardiography in the detection of myocardial ischemia: a randomized single-blind crossover trial.

Objectives: We sought to determine the comparative accuracy of supine bicycle exercise echocardiography (SBE) and posttreadmill exercise echocardiography (TME) in detecting myocardial ischemia in patients with known or suspected coronary artery disease (CAD).

Background: Supine bicycle echocardiography and TME have been used for evaluation of CAD. However, the comparative accuracy of these modalities in the detection of ischemia in the same patients is not known.

Changes in left ventricular diastolic function 6 months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy.

Background: Nonsurgical septal reduction therapy (NSRT) decreases left ventricular outflow tract (LVOT) gradient and improves symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). NSRT effects on LV/left ventricular diastolic function are currently unknown.

Methods And Results: HOCM patients (n=29) had Doppler echocardiography at baseline and 6 months after NSRT to evaluate changes in LV volume, pre-A-wave pressure, early diastolic mitral annulus velocity (Ea) by tissue Doppler, and tau.

Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy.

Background: Conventional Doppler parameters are unreliable for estimating left ventricular (LV) filling pressures in hypertrophic cardiomyopathy (HCM). This study was undertaken to evaluate flow propagation velocity by color M-mode and early diastolic annular velocity (Ea) by tissue Doppler 2 new indices of LV relaxation, combined with mitral E velocity for estimation of filling pressures in HCM.

Methods And Results: Thirty-five HCM patients (52+/-15 years) underwent LV catheterization simultaneously with 2-dimensional and Doppler echocardiography.

Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters.

Objectives: We sought to determine the clinical and echocardiographic parameters that differentiate thrombus from pannus formation as the etiology of obstructed mechanical prosthetic valves.

Background: Distinction of thrombus from pannus on obstructed prosthetic valves is essential because thrombolytic therapy has emerged as an alternative to reoperation.

Methods: We analyzed clinical, transthoracic and transesophageal echocardiography (TEE) data in 23 patients presenting with 24 obstructed prosthetic valves and compared the findings to pathology at surgery.

Echocardiography-guided ethanol septal reduction for hypertrophic obstructive cardiomyopathy.

Background: Left ventricular outflow tract (LVOT) obstruction is frequently responsible for symptoms in hypertrophic obstructive cardiomyopathy (HOCM). Medical therapy is often not sufficient to control these symptoms, and surgical myotomy-myomectomy is required.

Methods And Results: We enrolled 33 symptomatic patients with HOCM and obstruction (>/=40 mm Hg gradient at rest or >/=60 mm Hg dobutamine-provoked).

Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging.

Background: Doppler echocardiography is frequently used to predict filling pressures in normal sinus rhythm, but it is unknown whether it can be applied in sinus tachycardia, with merging of E and A velocities. Tissue Doppler imaging (TDI) can record the mitral annular velocity. The early diastolic velocity (Ea) behaves as a relative load-independent index of left ventricular relaxation, which corrects the influence of relaxation on the transmitral E velocity.

Assessment of valvular regurgitation with Doppler echocardiography.

Echocardiography is routinely performed for the evaluation of valvular regurgitation. Different applications of Doppler echocardiography have been successfully applied to detect and quantify valvular regurgitation. Recent advances in color Doppler made possible the study of the dynamic behavior of the regurgitant orifice and, along with continuous wave Doppler, can provide data on the regurgitant volume and fraction.

Estimation of left and right ventricular filling pressures after heart transplantation by tissue Doppler imaging.

Current Doppler methods have been unreliable in estimating filling pressures in heart transplants. Tissue Doppler imaging is a technique that permits evaluation of myocardial relaxation; combined with transvalvular E velocity, it could improve estimation of these pressures. To investigate this possibility, we evaluated 50 patients by right-sided cardiac catheterization and Doppler echocardiography simultaneously.

Role of myocardial contrast echocardiography during nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy.

Objectives: This study was undertaken to evaluate the ability of myocardial contrast echocardiography (MCE) to guide the targeted delivery of ethanol during nonsurgical septal reduction therapy (NSRT) and to assess the relation between the MCE risk area and infarct size determined by enzymatic and radionuclide methods.

Background: NSRT with intracoronary ethanol is a new promising treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). Proper localization and quantification of the septal infarct before ethanol injection are highly desirable.

Effects of adenosine on left ventricular filling dynamics in patients with and without coronary artery disease: a Doppler echocardiographic study.

Objectives: Adenosine, a potent coronary vasodilator is used as a pharmacologic stress agent for the assessment of coronary artery disease. A paucity of data exists on its effects on filling dynamics. Accordingly, this study was undertaken to evaluate the effects of adenosine on left ventricular filling as assessed by Doppler echocardiography.

Dobutamine echocardiography versus nuclear cardiac imaging for evaluation of myocardial viability.

The presence of myocardial viability is an important determinant of functional recovery after revascularization. Radionuclide and echocardiographic techniques are highly valuable in the identification of viable myocardium. Several clinical studies have compared the two modalities.

Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures.

Objectives: This investigation was designed 1) to assess whether the early diastolic velocity of the mitral annulus (Ea) obtained with Doppler tissue imaging (DTI) behaves as a preload-independent index of left ventricular (LV) relaxation; and 2) to evaluate the relation of the mitral E/Ea ratio to LV filling pressures.

Background: Recent observations suggest that Ea is an index of LV relaxation that is less influenced by LV filling pressures.

Methods: One hundred twenty-five study subjects were classified into three groups according to mitral E/A ratio, LV ejection fraction (LVEF) and clinical symptoms: 34 asymptomatic subjects with a normal LVEF and an E/A ratio > or =1; 40 with a normal LVEF, an E/A ratio <1 and no heart failure symptoms (impaired relaxation [IR]); and 51 with heart failure symptoms and an E/A ratio >1 (pseudonormal [PN]).