Exercise capacity, breathing pattern, and gas exchange during exercise for patients with isolated diastolic dysfunction.

Background: Left ventricular diastolic dysfunction (DiaD) is as common as left ventricular systolic dysfunction. Whether these causes of heart failure lead to similar breathing pattern and gas exchange responses to exercise remains unclear.

Methods: Participants (control subjects [n = 47], systolic dysfunction [n = 46], and DiaD [n = 40]) underwent resting echocardiograms and cardiopulmonary exercise testing.

Detection of left ventricular systolic dysfunction in cardiac amyloidosis with strain rate echocardiography.

Background: We examined the potential role of Doppler myocardial imaging including tissue velocity imaging, strain imaging, and strain rate imaging for detection of left ventricular systolic dysfunction in cardiac amyloidosis (CA) and determined the minimum dataset required to make the diagnosis.

Methods And Results: Doppler myocardial imaging was performed in 103 patients with amyloidosis (AL). Peak longitudinal systolic tissue velocity, systolic strain rate (sSR), and systolic strain (sS) were determined for 16 left ventricular segments.

Prognostic value of ankle-brachial index and dobutamine stress echocardiography for cardiovascular morbidity and all-cause mortality in patients with peripheral arterial disease.

Background: Peripheral arterial disease (PAD) is associated with an excessive risk for cardiovascular events and mortality. To determine measures prognostic of adverse events, ankle-brachial index (ABI) was compared with dobutamine stress echocardiography (DSE) in patients referred to our vascular center for the evaluation of PAD.

Methods: The medical records of consecutive patients referred for the concurrent evaluation of PAD and coronary artery disease (CAD) between 1992 and 1995 were reviewed for subsequent cardiovascular events and death.

Adipose tissue of atrial septum as a marker of coronary artery disease.

Background: Paracrine effects of epicardial adipose tissue may promote coronary atherosclerosis. Adipose tissue is the main determinant of atrial septum thickness. The association between atrial septum thickness and coronary artery disease (CAD) has never been studied.

Relationship between low bone mineral density and exercise-induced myocardial ischemia.

Objective: To evaluate the relationship between bone mineral density (BMD) and ischemic heart disease and exercise capacity, as assessed by stress testing.

Patients And Methods: We retrospectively reviewed entries in the echocardiography database for 28,048 consecutive patients who underwent exercise echocardiography for standard clinical indications between August 1, 1998, and October 1, 2003, to determine which of these patients had also undergone dual-energy x-ray absorptiometry to measure femoral neck BMD before the procedure. Of the 1194 patients meeting both criteria, 28 were excluded because of missing data and 24 because they were tested with an exercise protocol other than the Bruce protocol, leaving 1142 patients to be included.

Carcinoid heart disease.

Carcinoid heart disease is a rare form of valvular heart disease. The management of these patients is complex, as the systemic malignant disease and the cardiac involvement have to be considered at the same time. Progress in the treatment of patients with carcinoid disease has resulted in improved symptom control and survival.

Influence of left ventricular filling pattern on exercise-induced changes of natriuretic peptides in patients with suspected coronary artery disease.

Background: Exertional change in brain natriuretic peptide (BNP) has recently been proposed as a biomarker of myocardial ischemia. However, in patients with abnormal left ventricular (LV) filling, BNP is frequently increased. Therefore, we studied the relationship of exertional changes in atrial and brain natriuretic peptides (ANP and BNP) with resting and exercise-induced changes of LV systolic function and filling pattern.

Vascular abnormalities in primary amyloidosis.

Aims: Primary amyloidosis (AL) is a systemic disease; however, there is limited information regarding the presence and character of vascular abnormalities.

Methods And Results: Validated ultrasound techniques were used to prospectively determine carotid artery intimal-medial thickness (IMT) and brachial artery flow-mediated dilatation (FMD) in 59 consecutive AL patients and 17 age-similar, healthy, asymptomatic volunteers (CON). Carotid IMT was increased in AL when compared with CON (0.

Pulmonary hypertension in patients with interstitial lung diseases.

Pulmonary hypertension (PH) in patients with interstitial lung diseases (ILDs) is not well recognized and can occur in the absence of advanced pulmonary dysfunction or hypoxemia. To address this topic, we identified relevant studies in the English language by searching the MEDLINE database (1966 to November 2006) and by individually reviewing the references of identified articles. Connective tissue disease-related ILD, sarcoidosis, idiopathic pulmonary fibrosis, and pulmonary Langerhans cell histiocytosis are the ILDs most commonly associated with PH.

Prognostic significance of exercise induced arrhythmias and echocardiographic variables in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HC) often presents with exercise-induced symptoms, including arrhythmias and sudden death. The investigators prospectively studied whether exercise testing is associated with immediate complications and if stress-induced arrhythmias and echocardiographic variables are associated with long-term adverse outcomes. Exercise echocardiography with 6-channel continuous monitoring for arrhythmias was performed in consecutive patients with HC clinically referred for the test.

Recurrent cardiac calcific amorphous tumor: the CAT had a kitten.

Background: Cardiac calcified amorphous tumors (CATs) represent degenerating intracavitary mural thrombi that can mimic neoplasms and cause symptoms due to embolization or obstruction. Surgical excision is generally curative. Postoperative recurrences have not been previously reported.

Prognostic value of dobutamine stress echocardiography in patients with chronic kidney disease.

Background: Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluation of patients with chronic kidney disease (CKD), there are limited data regarding its prognostic utility in this setting. The current study assesses the prognostic value of DSE in patients with CKD.

Methods: Four hundred eighty-five patients with CKD (on renal dialysis or with creatinine > 3 mg/mL) who had DSE were followed for 2.

Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome.

Objective: To assess the frequency, clinical presentation and outcome associated with saddle pulmonary embolism (PE) diagnosed by computed tomographic angiography (CTA).

Patients: Retrospective review of 546 consecutive patients diagnosed to have acute PE by CTA from 1 September 2002 to 31 December 2003.

Results: Fourteen of 546 patients (2.

Carcinoid heart disease in patients without hepatic metastases.

Most carcinoid tumors originate in the gut. Carcinoid heart disease typically occurs when tumor progression results in the formation of hepatic metastases, which allow vasoactive substances to reach the heart without being metabolized in the liver. Except for patients with primary ovarian carcinoid tumors, the occurrence of carcinoid heart disease without hepatic metastases has been reported only anecdotally.

Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease.

We investigated the influence of > or =70% luminal coronary artery stenosis on regional diastolic deformation at rest using 2-dimensional strain echocardiography. We prospectively imaged patients during/within 24 hours of coronary angiography. Longitudinal systolic (SRs), early (SRe), and late diastolic strain rates, systolic, early, and late diastolic strain and times to isovolumic relaxation and peak SRe were measured in the 3 major vascular territories.

Outcomes after normal dobutamine stress echocardiography and predictors of adverse events: long-term follow-up of 3014 patients.

Aims: Normal exercise echocardiography predicts a good prognosis. Dobutamine stress echocardiography (DSE) is generally reserved for patients with comorbidities which preclude exercise testing. We evaluated predictors of adverse events after normal DSE.

Relationship between coronary artery calcification detected by electron-beam computed tomography and abnormal stress echocardiography: association and prognostic implications.

Objectives: The purpose of this study was to compare the results and prognostic value of electron-beam computed tomography (EBCT) and exercise echocardiography.

Background: Although patients with elevated coronary artery calcium scores (CACS) might be referred for exercise echocardiography, the association of EBCT CACS with wall motion score index (WMSI) is not known.

Methods: Patients without known coronary artery disease who underwent both clinically indicated EBCT and exercise echocardiography within a 3-month period were identified.

Role of biplane and biplane echocardiographically guided 3-dimensional echocardiography during dobutamine stress echocardiography.

Image acquisition time and wall-motion score of conventional 2-dimensional (2D) dobutamine stress echocardiography (DSE) were compared with those of biplane and 3-dimensional (3D) DSE in 50 patients (age 67 +/- 13 years) with regular rhythms during clinically indicated DSE. Commercially available systems were used for the study. We used a conventional transducer for 2D and a matrix-array transducer (x4 or x3-1) for two biplane (60- and 120-degree) images and one 3D full-volume image.

Exertional changes in circulating cardiac natriuretic peptides in patients with suggested coronary artery disease.

Background: We measured plasma brain natriuretic peptide (BNP) and N-terminal atrial natriuretic peptide (ANP) levels before and after exercise stress testing and correlated results with echocardiographic evidence of ischemia.

Methods: Sixty patients with left ventricular ejection fraction greater than 50% referred for clinically indicated exercise echocardiogram were studied. Peptides were measured at rest and 5 minutes after symptom-limited exercise.

Safety of exercise stress testing in patients with abnormal concentrations of serum potassium.

The objective of this study was to determine the safety of performing exercise stress testing in patients with abnormal serum potassium concentrations. Data were reviewed from 9,084 patients (mean age 63 +/- 12 years) referred for exercise echocardiography who had serum potassium measured <48 hours before the test were reviewed, and the occurrence of arrhythmias during stress testing was determined. Of 10,272 studies, 9,067 (88%) were in patients with normokalemia and 1,205 (12%) were in patients with abnormal serum potassium concentrations: 309 (26%) with hypokalemia (mean 3.

Determination of interobserver variability for identifying inducible left ventricular wall motion abnormalities during dobutamine stress magnetic resonance imaging.

Aims: To determine the interobserver variability for identifying inducible left ventricular (LV) wall motion abnormalities during high-dose dobutamine/atropine stress cardiovascular magnetic resonance (DSMR).

Methods And Results: Four readers from various institutions were supplied with the image data from 150 consecutive DSMR examinations and asked to grade wall motion and image quality throughout graded doses of dobutamine infusion administered to achieve 85% of the maximum age-predicted heart rate. Inducible ischaemia was identified if more than one segment demonstrated a new or worsening LV wall motion abnormality, and significant stenosis was defined as > or =50% luminal diameter reduction by quantitative contrast coronary angiography.

Determining myocardial viability in chronic ischemic left ventricular dysfunction: a prospective comparison of rest-redistribution thallium 201 single-photon emission computed tomography, nitroglycerin-dobutamine echocardiography, and intracoronary myocardial contrast echocardiography.

Background: Detection of viable myocardium (VM) has important therapeutic implications for chronic ischemic left ventricular (LV) systolic dysfunction. We compared the ability of nitroglycerin-dobutamine echocardiography (NTG-DE), intracoronary myocardial contrast echocardiography (MCE), and rest-redistribution thallium 201 single-photon emission computed tomography (RRT-SPECT) to detect VM in this setting.

Methods: Patients with LV ejection fraction (LVEF) <40% and multivessel coronary disease suitable for revascularization underwent NTG-DE, MCE, RRT-SPECT, and radionuclide ventriculography to determine baseline LVEF.

Carcinoid heart disease.

Progress in the medical and surgical management of patients with carcinoid disease has resulted in improved symptoms and survival. Carcinoid heart disease remains a major cause of morbidity and mortality among patients with malignant carcinoid syndrome. Limited medical treatment options are available for patients with symptomatic carcinoid heart disease.