Practical guide for three-dimensional transthoracic echocardiography using a fully sampled matrix array transducer.

Real-time three-dimensional (3D) echocardiography is a major innovation in the history of cardiovascular ultrasound. Advances in computer and transducer technologies, especially the fully-sampled matrix array transducer, have permitted real-time 3D image acquisition and display. Several vendors provide 3D imaging but use different terminology for similar functions, creating confusion for consumers.

Clinical characteristics and outcomes of patients with hypertrophic cardiomyopathy with latent obstruction.

Background: The purpose of this article is to describe the demographic and clinical features of patients with hypertrophic cardiomyopathy (HCM) and latent obstruction, with an emphasis on identifying factors associated with disease progression and survival. The presence of a resting left ventricular outflow obstruction in patients with HCM has been well described and is associated with increased symptoms and adverse long-term outcomes. However, less is known about patients with latent obstruction.

Comparison of usefulness of tissue Doppler imaging versus brain natriuretic peptide for differentiation of constrictive pericardial disease from restrictive cardiomyopathy.

Brain (B-type) natriuretic peptide (BNP) and tissue Doppler imaging may distinguish restrictive cardiomyopathy (RCMP) from idiopathic constrictive pericardial disease (CP). However, their comparative efficacy is unknown for patients with CP from secondary causes (e.g.

Anomalous insertion of the papillary muscle causing left ventricular outflow obstruction: visualization by real-time three-dimensional echocardiography.

Anomalous insertion of the papillary muscle (PM)/chordae tendineae is a rare but important cause of dynamic left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy or cardiac amyloidosis. These anomalies are often challenging to diagnose with 2-D Echo, yet accurate diagnosis is critical in determining whether to proceed with an extended septal myectomy instead of a standard septal myectomy for relief. We report two cases of anomalous insertion of the PM causing LVOT obstruction with diagnosis facilitated by real-time 3-D echocardiograms.

Relationship between sex, shape, and substrate in hypertrophic cardiomyopathy.

Background: Hypertrophic cardiomyopathy (HCM) is a disease characterized by substantial genetic, morphologic, and prognostic heterogeneity. Recently, sex-related differences in HCM were reported, with women being older at diagnosis and exhibiting greater left ventricular outflow tract obstruction than men. We sought to evaluate the influence of sex on the HCM phenotype in a large cohort of unrelated patients with genetically and morphologically classified HCM.

Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community.

Background: Bicuspid aortic valve is frequent and is reported to cause numerous complications, but the clinical outcome of patients diagnosed with normal or mildly dysfunctional valve is undefined.

Methods And Results: In 212 asymptomatic community residents from Olmsted County, Minn (age, 32+/-20 years; 65% male), bicuspid aortic valve was diagnosed between 1980 and 1999 with ejection fraction > or =50% and aortic regurgitation or stenosis, absent or mild. Aortic valve degeneration at diagnosis was scored echocardiographically for calcification, thickening, and mobility reduction (0 to 3 each), with scores ranging from 0 to 9.

Unlocking the mysteries of diastolic function: deciphering the Rosetta Stone 10 years later.

It has now been a quarter of a century since the first description by Kitabatake and his associates of the use of echo-Doppler to characterize the transmitral flow velocity curves in various disease states. A decade ago we described the role of echocardiography in the "Evaluation of Diastolic Filling of Left Ventricle in Health and Disease: Doppler Echocardiography Is the Clinician's Rosetta Stone." Over the ensuing decade, advances in echo-Doppler have helped to further decipher the morphologic and physiological expression of cardiovascular disease and unlock additional mysteries of diastology.

Clinical and echocardiographic variables fail to predict response to dual-chamber pacing for hypertrophic cardiomyopathy.

Background: Although dual-chamber pacing therapy for obstructive hypertrophic cardiomyopathy has been relegated to a limited role, there remains a subset of patients who are not good candidates for more definitive therapies.

Objective: The goal of this investigation was to determine whether preprocedural variables could help identify patients most likely to respond.

Methods: Retrospective review of 84 patients with hypertrophic cardiomyopathy who underwent dual-chamber pacing for obstructive physiology at Mayo Clinic, Rochester, MN, included baseline demographics and echocardiographic features known to favor left ventricular outflow tract obstruction.

Disparate patterns of left ventricular mechanics differentiate constrictive pericarditis from restrictive cardiomyopathy.

Objectives: The purpose of this study was to compare the longitudinal, circumferential, and radial mechanics of the left ventricle (LV) in patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM).

Background: Diastolic dysfunction in CP is related to epicardial tethering and pericardial constraint, whereas in RCM it is predominantly characterized by subendocardial dysfunction. Assessment of variations in longitudinal and circumferential deformation of LV might be useful to distinguish these 2 conditions.

Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study.

Objectives: The purpose of this study was to define the link between aortic regurgitation (AR) quantitation and clinical outcome in asymptomatic patients with AR.

Background: Quantitative American Society of Echocardiography (QASE) thresholds are recommended for AR assessment, but impact on clinical outcome is unknown.

Methods: We prospectively enrolled (1991 to 2003) 251 asymptomatic patients (age 60 +/- 17 years) with isolated AR and ejection fraction > or =50% with quantified AR and left ventricular (LV) volumes using Doppler-echocardiography.

Effects of surgical septal myectomy on left ventricular wall thickness and diastolic filling.

This study was conducted to examine the late effects of surgical myectomy on left ventricular (LV) structure and diastolic function in patients with obstructive hypertrophic cardiomyopathy. Patients with hypertrophic cardiomyopathy who had complete echocardiographic studies before and > or =6 months after myectomy were included in this retrospective analysis of cavity dimension, septal and LV posterior wall thicknesses, and Doppler flow variables. Compared with preoperative measurement, mean septal thickness (23.

Timing of operation in asymptomatic severe aortic stenosis.

Calcific aortic stenosis is now the main cause of aortic stenosis in the majority of patients, due to declining incidence of rheumatic fever. Risk factors such as hyperlipidemia play an important role in the progression of aortic stenosis. According to the most recent American College of Cardiology/American Heart Association guidelines, peak velocity greater than 4 m/sec, a mean gradient of more than 40 mmHg and a valve area of less than 1.

Usefulness of brain natriuretic peptide levels in the clinical evaluation of patients with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HC) is associated frequently with heart failure symptoms and diastolic dysfunction. Although the influence of brain natriuretic peptide (BNP) levels in the management of patients with systolic dysfunction is evolving, there are few data on the role of BNP in the management of patients with HC. BNP was compared with clinical and echocardiographic variables, including measures of diastolic filling, in 217 patients with HC.

Cetirizine, doxepine, and hydroxyzine in the treatment of pruritus due to sulfur mustard: a randomized clinical trial.

A 4-week randomized, double-blind safety and efficacy study was conducted to compare the safety and efficacy of cetirizine, doxepine, and hydroxyzine 5 in the treatment of chronic pruritus due to sulfur mustard. Patients were treated in the Dermatology Clinic of Baqiyatallah Hospital. The study population consisted of 75 patients with chronic pruritus due to sulfur mustard exposure.

Isolated left ventricular basal ballooning phenotype of transient cardiomyopathy in young women.

This report describes a variant of transient regional left ventricular dysfunction in which isolated basal left ventricular akinesia with normal mid-ventricular (papillary-level) wall motion and apical hypercontractility were noted in young women (mean age 31 years). This finding was demonstrated in 3 consecutive patients; the first patient was experiencing emotional life-altering events, and the second presented with an acute flare of multiple sclerosis. The third patient presented < 24 hours after methamphetamine use.

Safety of same-day coronary angiography in patients undergoing elective valvular heart surgery.

Objective: To maximize patient convenience, we developed a protocol for coronary angiography the same day as elective valvular surgery.

Patients And Methods: We analyzed the medical records from a single surgical service of 226 consecutive patients who had undergone cardiac catheterization on the day of elective valvular repair or replacement between August 1, 2000, and August 30, 2004. The rates of renal failure (creatinine >2.

Surgical septal myectomy decreases the risk for appropriate implantable cardioverter defibrillator discharge in obstructive hypertrophic cardiomyopathy.

Aims: To determine the impact of surgical myectomy on ventricular arrhythmias in obstructive hypertrophic cardiomyopathy (HCM). Left ventricular outflow tract obstruction (LVOTO) correlates with adverse outcomes, including sudden cardiac death (SCD) in patients with HCM. Surgical myectomy is the primary treatment strategy for relief of symptoms owing to LVOTO and has been hypothesized to decrease the potential for ventricular tachyarrhythmias.

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.

Comparison of hydroxyzine and doxepin in treatment of pruritus due to sulfur mustard.

Objective: To compare the safety and efficacy of doxepin and hydroxyzine in the treatment of chronic pruritus due to exposure to sulfur mustard.

Methods: In a randomized, double-blind safety and efficacy study, 50 patients with chronic pruritus were given either doxepin 10 mg/d or hydroxyzine 25 mg/d for 4 weeks. Pruritic score was calculated for each patient before treatment and 1 month after.

Laboratory evaluation of dimethyl phthalate against Anopheles stephensi and Culex pipiens.

Two repellents includes Iranian and Merck dimethyl phthalate (DMP) were evaluated against Anopheles stephensi and Culex pipiens, using American Society for Testing and Material (ASTM) standard ED 951-83 procedure, a free choice method based on the variable dose-fixed time. Also a modified of ASTM method we used for determination of effective dosages of the repellents. In ASTM method there were no significant differences between the two repellents (Iranian and Merck's DMP) as indicated by the ED50 and ED95 values (p > 0.

Comparison of surgical septal myectomy and alcohol septal ablation with cardiac magnetic resonance imaging in patients with hypertrophic obstructive cardiomyopathy.

Objectives: This study sought to describe the acute morphologic differences that result from septal myectomy and alcohol septal ablation using cardiac magnetic resonance (CMR) imaging.

Background: Surgical septal myectomy and alcohol septal ablation relieve left ventricular outflow tract obstruction in severely symptomatic patients with hypertrophic cardiomyopathy (HCM).

Methods: Cine and contrast-enhanced CMR images were obtained in HCM patients before and after septal myectomy (n = 24) and alcohol septal ablation (n = 24).

Aortic valve calcification: determinants and progression in the population.

Background: Aortic valve calcification (AVC) is considered degenerative. Recent data suggested links to atherosclerosis or coronary disease (CAD).

Methods And Results: AVC and coronary artery calcifications (CAC) were prospectively assessed by Electron-Beam-Computed-Tomography in 262 population-based research participants > or = 60 years.