Aortic valve sclerosis and clinical outcomes: moving toward a definition.

The presence of aortic valve sclerosis has been suggested as a marker of increased cardiovascular risk, including increased mortality. However, it remains unclear whether aortic valve sclerosis is independently associated with risk or merely a marker of coexistent cardiovascular risk factors. Aortic valve sclerosis is usually diagnosed on transthoracic echocardiography, the most widely used imaging modality in observational and natural history studies of aortic valve disease.

Is the standard weight-based dosing of dobutamine for stress testing appropriate for patients of widely varying body mass index?

Background: Although a gradual increase in heart rate (HR) during dobutamine stress testing (DST) is desired, few data exists regarding whether this is similarly achieved in patients of widely varying body mass index (BMI). Whether difference in BMI contributes to variation in the hemodynamic and symptomatic response to dobutamine is also unknown.

Methods: From prospectively acquired data of 2776 consecutive patients who underwent DST according to standard weight-based clinical protocol, we classified patients into 4 groups of BMI (kg/m( 2)): <25 (normal), 25 to 29.

Sex differences in morphology and outcomes of mitral valve prolapse.

Background: Mitral valve prolapse is more common in women than in men, but men more often have surgery for severe regurgitation.

Objective: To compare morphology and outcomes of mitral valve prolapse in men and women.

Design: Retrospective cohort study.

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.

Prognostic significance of ST-segment elevation during dobutamine stress echocardiography.

Background: Limited data are available concerning the significance of ST-segment elevation during dobutamine stress echocardiography (DSE). The purpose of this study was to assess the prognostic significance of new ST-segment elevation during DSE and its relationship to angiographic severity of coronary artery disease (CAD).

Methods: From 4240 consecutive patients who had DSE, we identified 134 (3%) patients with new stress-induced ST-segment elevation > or =1 mm in at least two contiguous electrocardiographic leads.

Echocardiography or auscultation? How to evaluate systolic murmurs.

Objective: To compare cardiac physical examination with echocardiography for evaluating systolic murmurs.

Quality Of Evidence: Three databases were searched for studies comparing echocardiography and auscultation as to sensitivity and diagnostic accuracy: MEDLINE (Ovid Online), EMBASE, and Current Contexts. The quality of reported data is lowered by subjective interpretation of results of both cardiac physical examination and echocardiography, especially Doppler colour flow imaging.

Clinical profile of autosomal dominant polycystic liver disease.

Most reports on the natural history, manifestations, and treatment of polycystic liver disease are based on the disease as it manifests in patients with autosomal dominant polycystic kidney disease (ADPKD). The purpose of this study was to develop a clinical profile of isolated autosomal dominant polycystic liver disease (ADPLD) using nonaffected family members as controls. The study included 146 probands, known affected relatives, and first-degree relatives of affected individuals.

Natural history of asymptomatic mitral valve prolapse in the community.

Background: The outcome of mitral valve prolapse (MVP) is controversial, with marked discrepancies in reported complication rates.

Methods And Results: We conducted a community study of all Olmsted County, Minn, residents first diagnosed with asymptomatic MVP between 1989 and 1998 (N=833). Diagnosis, motivated by auscultatory findings (n=557) or incidental (n=276), was always confirmed by echocardiography with the use of current criteria.

Hypertensive response to exercise: a potential cause for new wall motion abnormality in the absence of coronary artery disease.

Objectives: We sought to characterize patients with a hypertensive response during exercise echocardiography and its effect on results of the test.

Background: A hypertensive response to exercise has been shown to cause false-positive results in perfusion imaging, radionuclide angiography and exercise electrocardiography, but its influence on exercise echocardiography has not been reported.

Methods: We identified 548 of 6,686 patients who had coronary angiography within four weeks after exercise echocardiography from 1992 through 1996.

Exercise echocardiography for the prognostic stratification of patients with low pretest probability of coronary artery disease.

Purpose: The aim of this study was to determine whether exercise echocardiography provides incremental data for risk stratification of patients with a low pretest probability of coronary artery disease.

Patients And Methods: The study included patients referred for exercise echocardiography whose probability of coronary artery disease was 25% or less. We calculated an exercise wall motion score index (on a 1-5 scale), an indicator of the extent and severity of exercise-induced abnormalities.

Contrast dobutamine stress echocardiography: clinical practice assessment in 300 consecutive patients.

In this study we compared non-contrast imaging with contrast imaging of the left ventricle during dobutamine stress echocardiography (DSE). Wall segment visualization, image quality, and confidence of interpretation were determined with and without the use of intravenous Optison, a second-generation echocardiographic contrast agent, in 300 consecutive patients undergoing rest and peak DSE. At rest and at peak stress, the percentage of wall segments visualized, image quality, and confidence of interpretation were better with contrast compared with non-contrast imaging.

Radiographic measurements of cardiac size as predictors of outcome in patients with dilated cardiomyopathy.

Background: Cardiac dilatation is a predictor of poor outcome in patients with dilated cardiomyopathy. Whereas cardiac chamber dimensions or volumes can be assessed by various noninvasive and invasive techniques, simple chest radiography also may provide a valuable assessment of cardiac size.

Methods And Results: To determine the relative power of radiographic heart measurements for predicting outcome in dilated cardiomyopathy, we retrospectively studied 88 adult patients with chest radiographs obtained within 35 days of echocardiography.

Identification of a locus for autosomal dominant polycystic liver disease, on chromosome 19p13.2-13.1.

Polycystic liver disease (PCLD) is characterized by the growth of fluid-filled cysts of biliary epithelial origin in the liver. Although the disease is often asymptomatic, it can, when severe, lead to complications requiring surgical therapy. PCLD is most often associated with autosomal dominant polycystic kidney disease (ADPKD); however, families with an isolated polycystic liver phenotype without kidney involvement have been described.

The Mayo Clinic's Clinician-Educator Award: A program to encourage educational innovation and scholarship.

In 1998, the Board of Governors of the Mayo Clinic requested that the Education Committee design and implement a program to grant time and resources to clinical faculty to support the development of educational projects. The essence of the resulting Clinician-Educator Award Program is the concept of using funding to award time and resources for educational projects judged to be meritorious by an impartial, peer-review-based faculty mentoring process. The authors report early experiences with the program, which was enthusiastically accepted by faculty, to provide a model to help other academic health centers, especially those with salary-based faculty, to facilitate educational innovation and scholarship despite the growing constraints on academic clinicians' time and resources.

Risk of patients with severe aortic stenosis undergoing noncardiac surgery.

Aortic stenosis (AS) is a major risk factor for perioperative cardiac events in patients undergoing noncardiac surgery. We previously showed that selected patients with AS who were not candidates for, or refused, aortic valve replacement could undergo noncardiac surgery with acceptable risk. We extended our previous experience over a subsequent 5-year period by retrospectively analyzing the perioperative course of all patients with severe AS (aortic valve area index < 0.

Hypertensive response during dobutamine stress echocardiography.

Among 3,129 dobutamine stress echocardiographic studies, a hypertensive response, defined as systolic blood pressure (BP) > or = 220 mm Hg and/or diastolic BP > or = 110 mm Hg, occurred in 30 patients (1%). Patients with this response more often had a history of hypertension and had higher resting systolic and diastolic BP before dobutamine infusion.

Is review of videotape necessary after review of digitized cine-loop images in stress echocardiography? A prospective study in 306 patients.

The interpretation of stress echocardiography has been made easier by the comparison of digitized prestress and poststress frame-grabbed images (cine-loops), each representing a portion of a single cardiac cycle. Often, review of these digitized images is substituted for review of the complete videotape record of the examination. An alternative is to review both the digitized images as well as the videotape record of the rest and stress images.

Two-dimensional echocardiographic calculation of left ventricular mass as recommended by the American Society of Echocardiography: correlation with autopsy and M-mode echocardiography.

The American Society of Echocardiography (ASE) has recommended diastolic area length and truncated ellipsoid methods for estimating left ventricular (LV) mass by two-dimensional (2D) echocardiography. The major goals of this retrospective study were to (1) assess the correlation between ASE-recommended 2D and M-mode echo-derived measurements of LV mass, (2) compare the two ASE-recommended 2D echocardiography methods, and (3) compare the echo-derived LV mass with anatomic LV mass. The study included 2D echocardiograms obtained within 30 days of death from 34 patients who subsequently underwent autopsy and 2D echocardiograms of 56 normal subjects.

The value of two-dimensional echocardiography and Doppler examination in the assessment of hypertensive patients: a pilot study.

There has been hesitation in accepting the routine use of echocardiography in patients with hypertension. The concept of "limited" or "focused" echocardiography has been introduced but incompletely evaluated. In this prospective observational cohort study, 100 consecutive hypertensive adults underwent comprehensive two-dimensional echocardiography and Doppler assessment regardless of referral question.

Determination of left ventricular mass by echocardiography in a normal population: effect of age and sex in addition to body size.

Objective: In this study, we determined the effect of age, sex, and body size on left ventricular mass.

Design: Two-dimensional-guided M-mode echocardiography was used in an assessment of 111 healthy, normal adults.

Material And Methods: Left ventricular mass was calculated with the cube function formula corrected by a regression equation to agree with autopsy estimates of left ventricular mass.

Influence of prosthesis size on change in left ventricular mass following aortic valve replacement.

Current surgical practice regarding valve replacement has as its primary concern the appropriateness of tissue versus mechanical prostheses and perhaps lesser emphasis has been placed on the size of the device. Despite technical advances, which provide maximal valve orifice area in valve substitutes, small device implantation may be accomplished in the aortic root but not effectively relieve the obstructive nature of the original disease. We reviewed 39 patients who had undergone aortic valve replacement (AVR) for aortic stenosis (AS) and had preoperative and postoperative (6 months-3 years) echo measurements which permitted calculation of the left ventricular mass (LVM) and mass index (LVMI).

Primary cardiac angiosarcoma: a clinicopathologic study of six cases.

Autopsy or surgical specimens from six patients with primary cardiac angiosarcoma seen at the Mayo Clinic (all in men) between 1939 and 1988 were studied (patients' ages, 31 to 80 years; mean 50 years). The symptoms were nonspecific and included dyspnea and thoracoabdominal pain in six; anorexia in five; fatigue, hemoptysis, or orthopnea in four; nausea and vomiting, fever, or weight loss in three; and night sweats in two. Cardiomegaly was present in five, and a pericardial effusion or density, a mass adjacent to the heart, or nonspecific ST-T wave changes were present in three.

Significance of mildly elevated creatine kinase (myocardial band) activity after elective abdominal aortic aneurysmectomy.

The clinical significance of mildly elevated creatine kinase (CK) myocardial band (MB) enzyme levels in patients undergoing elective repair of an abdominal aortic aneurysm was evaluated retrospectively in 348 patients. For each patient, preoperative and postoperative electrocardiograms (ECGs) were interpreted blindly for left ventricular hypertrophy, ST segment abnormality, left bundle branch block, right bundle branch block, left axis deviation, atrial fibrillation, T wave abnormality, and Q waves. A total of 107 patients (31%) had postoperative CK-MB elevations of trace or greater; 37 had trace, 35 had 1% to 4%, and 35 had greater than or equal to 5% elevation.

Can anatomical left ventricular mass be estimated reliably by M-mode echocardiography? A clinicopathological study of ninety-three patients.

To evaluate the accuracy of M-mode echocardiography in the assessment of left ventricular mass, we compared various echocardiography-derived regression equations for left ventricular mass to postmortem left ventricular weights in 93 patients (mean age 68 +/- 11 years) who had autopsy within 30 days of technically adequate two-dimensional guided M-mode echocardiography and who had normal left ventricular shape. The left ventricle was enlarged in 36 patients (39%) and was involved by chronic ischemic disease in 48 patients (52%). Only a modest correlation was found between M-mode echocardiography and anatomical left ventricular mass (range of correlation coefficients, 0.