Predicting Outcomes in Patients With AsymptomaticModerate to Severe Aortic Stenosis.

Outcomes in asymptomatic patients with aortic stenosis (AS) have been reported primarily from tertiary centers. Whether observations from a community hospital cohort would be similar or if clinical variables would assume a more important role remains uncertain. This retrospective cohort study from one community hospital followed asymptomatic patients with moderate to severe AS for 3 years following an index echocardiogram.

Limitations and strengths of doppler/echo pulmonary artery systolic pressure-right heart catheterization correlations: a systematic literature review.

Aims: Because many recent studies have questioned the accuracy of Doppler echocardiography (D) in determining pulmonary artery systolic pressure (PASP), we performed a detailed literature analysis attempting add clarity.

Methods And Results: Studies through 2011 comparing D and right heart catheterization (RHC) PASP, with at least 25 studied patients and reporting correlation coefficients (r) were identified. Patient demographics, study characteristics, the percent of patients studied for left or right heart pathologies, and study biases were determined.

Right ventricular myocardial performance index derived from tissue Doppler echocardiography is useful in differentiating apical ballooning syndrome from cardiomyopathy due to left anterior descending coronary artery disease.

Background: Apical ballooning syndrome (ABS) and obstructive coronary artery disease of the left anterior descending coronary artery (LAD) can both result in similar left ventricular apical wall motion abnormalities. The right ventricle may more likely be involved in ABS, and its careful evaluation may help differentiate the two conditions. Therefore, the aim of this study was to determine the roles of echocardiographic measures of right ventricular (RV) function, namely, Doppler tissue imaging-derived RV index of myocardial performance (RIMP), RV basal free wall systolic excursion velocity (RV S'), and tricuspid annular plane systolic excursion, in differentiating ABS from obstructive LAD disease.

Discordant Doppler right heart catheterization pulmonary artery systolic pressures: importance of pulmonary capillary wedge pressure.

Background: Although the echo Doppler (D) estimation of pulmonary artery systolic pressure (PASP) was initially highly correlated with right heart catheterization (RHC), recent D-RHC studies have questioned its accuracy. The aim of this study was to reevaluate this relationship and to determine possible explanations for disparate D-RHC results.

Methods: We retrospectively identified all patients at one institution who underwent RHC and had an echocardiogram within the prior month.

Bleeding risk in patients with esophageal varices undergoing transesophageal echocardiography.

Background: Bleeding from esophageal varices is a major potential concern during transesophageal echocardiography (TEE) in patients with cirrhosis of the liver. As there are limited data on its risk in these patients, this was retrospectively assessed at our institution.

Methods: The hospital electronic medical record database at our university affiliated teaching hospital was searched for all patients with esophageal varices undergoing TEE from 2000 to 2012 and patient charts were reviewed for procedure-related bleeding complications.

The diagnostic utility of heart rate-corrected ST-segment depression during adenosine nuclear stress testing.

Background: Vasodilator stress testing relies heavily on the imaging portion so that clinically useful information from the electrocardiogram may be overlooked. Stress-induced ST-segment depression, although uncommon, is highly predictive of severe disease. We investigated whether minor ST depressions during adenosine nuclear stress testing corrected for the modest heart rate increases (ST/HR slope and ST/HR index) might be clinically relevant.

Prevalence and characteristics of left ventricular noncompaction in a community hospital cohort of patients with systolic dysfunction.

Background: Left ventricular noncompaction (LVNC) is felt to be a rare form of cardiomyopathy, although its prevalence in a nonreferred population is unknown. We examined the prevalence and clinical characteristics of LVNC in a community hospital cohort of adult patients with echocardiographic evidence of left ventricular (LV) systolic dysfunction.

Methods: All adult echocardiograms with global LV dysfunction and an LVEF < or = 45% over a 1-year period were reviewed for signs of LV noncompaction.

Extent of right and left ventricular focal wall-motion abnormalities in differentiating transient apical ballooning syndrome from apical dysfunction as a result of coronary artery disease.

Differentiating the ventricular dysfunction caused by apical ballooning syndrome (ABS) from that caused by apical involvement in an acute coronary syndrome (ACS) currently requires coronary angiography. We sought to determine if echocardiography could differentiate these two syndromes by the extent of regional left ventricular (LV) and right ventricular (RV) dysfunction. The location of the hinge point between normal and hypokinetic wall motion for both the RV and LV was blindly determined in 8 patients with ABS and in 16 patients with an initial ACS secondary to obstruction of the left anterior descending coronary artery and an associated apical wall-motion abnormality.

Characteristics and impact of obesity on the outpatient echocardiography laboratory.

The impact of the growing obesity epidemic on the outpatient echocardiography laboratory and the characteristics of these patients were retrospectively investigated. Over a 6-month period, 916 patients were referred for study, 49.7% of whom were obese (body mass index >29.

Seasonal diagnosis of echocardiographically demonstrated endocarditis.

Background: Many cardiac and infectious diseases have a seasonal incidence. It is not known whether similar variations exist for endocarditis.

Methods: As echocardiography plays a key role in diagnosing endocarditis, patients referred for echocardiography with suspected endocarditis from 1993 through 2001 were identified.

Contribution of Doppler tissue imaging and myocardial performance index to assessment of left ventricular function in patients with Duchenne's muscular dystrophy.

Doppler tissue velocities (DTV) are abnormal in a variety of cardiac conditions when standard measures of ventricular function are normal. Detection of left ventricular dysfunction in Duchenne's muscular dystrophy (DMD) has relied on 2-dimensional imaging yet often these images are suboptimal. This study was undertaken to determine if DTV and the myocardial performance index (MPI) could provide additional diagnostic information in DMD.

Relation of calcium-phosphorus product to the severity of aortic stenosis in patients with normal renal function.

Calcium-phosphorus product (CaxP) has been associated with severity of aortic stenosis (AS) in dialysis patients, but it is unknown whether a relation exists in patients with normal renal function. One hundred seven patients with AS and normal serum creatinine were studied to determine whether there was an association between CaxP and AS severity, and it was found that CaxP was inversely related to AS severity, as measured by aortic valve area and transvalvular gradients.

Transesophageal echocardiography-guided closed aortic plication for intraoperative aortic dissection.

A 71-year-old female who developed intraoperative aortic dissection after coronary artery bypass grafting underwent a successful closed aortic plication with obliteration of the intimal tear under image guided transesophageal echocardiography.

Screening for left ventricular systolic dysfunction among patients with risk factors for heart failure.

Background: The prevalence of left ventricular systolic dysfunction (LVSD) among individuals at risk for heart failure (HF) and the feasibility of screening have not been clearly defined. This study determined the prevalence of LVSD with the use of a limited screening echocardiogram among patients with risk factors for HF but no prior HF.

Methods: General medicine patients > or =60 years of age with hypertension, diabetes, coronary artery disease, or previous myocardial infarction (MI) but no history of HF or reduced left ventricular ejection fraction (LVEF) were eligible.

Unexplained pulmonary hypertension is associated with systolic arterial hypertension in patients undergoing routine Doppler echocardiography.

Study Objective: To determine the validity of the association between systemic hypertension (HTN) and unexplained pulmonary hypertension (PHTN) as identified with Doppler echocardiography.

Methods: All patients with a reported systolic pulmonary artery pressure (SPAP) on routine Doppler echocardiography from our 1997 echocardiographic database were identified. Exclusions included all diseases known to be associated with PHTN.