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Human immunodeficiency virus infection and systolic myocardial performance. Int J Angiol 2011. [DOI: 10.1007/bf02014934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Thomas L, Foster E, Hoffman JIE, Schiller NB. Prospective validation of an echocardiographic index for determining the severity of chronic mitral regurgitation. Am J Cardiol 2002; 90:607-12. [PMID: 12231085 DOI: 10.1016/s0002-9149(02)02564-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study is to prospectively validate a recently reported semiquantitative index of mitral regurgitation (MR) severity. MR is a common echocardiographic finding with no single reference standard to evaluate its severity. We recently developed and retrospectively tested a semiquantitative index of MR severity. The MR index is a composite of 6 echocardiographic variables: jet penetration, proximal isovelocity surface area, continuous-wave Doppler characteristics of the regurgitant jet, pulmonary artery pressure, pulmonary venous flow pattern, and left atrial size. Sixty-two consecutive patients with varying grades of MR were prospectively studied. Patients were divided into 3 groups for comparison: mild MR, moderate MR, and severe MR. Each patient was evaluated for the 6 variables, with each variable scored on a 4-point scale (0 to 3). The reference standards for MR severity were qualitative evaluation by an expert, measurement of the regurgitant fraction (RF), and the effective regurgitant orifice area. The MR index increased in proportion to MR severity with a significant difference among the 3 groups (F = 84; p <0.0001). The MR index also correlated with RF (r = 0.73; p <0.0001) and the effective regurgitant orifice area (r = 0.74; p = 0.0001). A MR index > or = 2.2 identified 13 of 16 patients with severe MR (sensitivity 82%, specificity 98%, positive predictive value 93%). No patient with severe MR had a score <2.0 and no patient with mild MR had a score >1.67. These results concurred with those obtained in a previously published retrospective study. Thus, the MR index is a simple, reproducible semiquantitative estimate of MR severity, that is widely applicable in routine clinical practice.
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Affiliation(s)
- Liza Thomas
- Adult Echocardiogaphy Laboratory, Moffitt Hospital, University of California-San Francisco, San Francisco, California 94143-0214, USA
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Ozdemir K, Altunkeser BB, Sökmen G, Tokaç M, Gök H. Usefulness of peak mitral inflow velocity to predict severe mitral regurgitation in patients with normal or impaired left ventricular systolic function. Am Heart J 2001; 142:1065-71. [PMID: 11717613 DOI: 10.1067/mhj.2001.118465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the reliability of peak mitral inflow (E-wave) velocity, which was thought to be easier and more practical than qualitative and quantitative methods used to grade mitral regurgitation (MR) in patients both with normal and low left ventricular (LV) ejection fraction (EF). It is known that peak E-wave velocity increases in MR. But correlation of this increase with regurgitant fraction (RF), its usefulness in grading MR, and the effect of EF on peak E-wave velocity have not been studied in detail. METHODS We prospectively examined 135 consecutive patients with varying grades of MR with echocardiography. MR was evaluated both qualitatively and quantitatively, and concordance of these 2 methods was determined. Peak E-wave velocity, A-wave velocity, and E-wave deceleration time were measured and the E/A ratio was calculated. LV isovolumetric relaxation and contraction times were measured. Different MR groups classified by RF were compared with each other. RESULTS Concordance of quantitative and qualitative evaluation was low in patients with low EF (kappa 0.37 vs 0.65). Peak E-wave velocity and E/A ratio showed significant differences between MR groups. Peak E-wave velocity correlated with the RF and EF (r = 0.47, r = 0.33, respectively, P <.001). Sensitivity, specificity, and negative predictive value of peak E-wave velocity >1.2 m/s suggesting severe MR were found to be different in patients with normal and low EF (96% vs 66%, 78% vs 83%, 97% vs 78%, respectively). E-wave deceleration, LV isovolumetric relaxation, and contraction time did not show a correlation with RF. CONCLUSION Peak E-wave velocity is a screening method that could be used in common for determining severity of MR semiquantitatively, especially in patients with normal EF.
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Affiliation(s)
- K Ozdemir
- Department of Cardiology, Faculty of Medicine, Selçuk University, Konya, Turkey.
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Thomas L, Foster E, Hoffman JI, Schiller NB. The Mitral Regurgitation Index: an echocardiographic guide to severity. J Am Coll Cardiol 1999; 33:2016-22. [PMID: 10362208 DOI: 10.1016/s0735-1097(99)00111-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study was to develop a semiquantitative index of mitral regurgitation severity suitable for use in daily clinical practice and research. BACKGROUND There is no simple method for quantification of mitral regurgitation (MR). The MR Index is a semiquantitative guide to MR severity. The MR Index is a composite of six echocardiographic variables: color Doppler regurgitant jet penetration and proximal isovelocity surface area, continuous wave Doppler characteristics of the regurgitant jet and tricuspid regurgitant jet-derived pulmonary artery pressure, pulse wave Doppler pulmonary venous flow pattern and two-dimensional echocardiographic estimation of left atrial size. METHODS Consecutive patients (n = 103) with varying grades of MR, seen in the Adult Echocardiography Laboratory at UCSF, were analyzed retrospectively. All patients were evaluated for the six variables, each variable being scored on a four point scale from 0 to 3. The reference standards for MR were qualitative echocardiographic evaluation by an expert and quantitation of regurgitant fraction using two-dimensional and Doppler echocardiography. A subgroup of patients with low ejection fraction (EF < 50%) were also analyzed. RESULTS The MR Index increased in proportion to MR severity with a significant difference among the three grades in both normal and low EF groups (F = 130 and F = 42, respectively, p < 0.0001). The MR Index correlated with regurgitant fraction (r = 0.76, p < 0.0001). An MR Index > or =2.2 identified 26/29 patients with severe MR (sensitivity = 90%, specificity = 88%, PPV = 79%). No patient with severe MR had an MR Index <1.8 and no patient with mild MR had an MR Index >1.7. CONCLUSIONS The MR Index is a simple semiquantitative estimate of MR severity, which seems to be useful in evaluating MR in patients with a low EF.
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Affiliation(s)
- L Thomas
- Division of Cardiology, University of California, San Francisco 94143-0214, USA
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Abstract
With development of cine and velocity encoded magnetic resonance imaging, it is now feasible to detect and quantify aortic and mitral stenosis and regurgitation accurately. In addition, magnetic resonance imaging has the capabilities to assess simultaneously left and right ventricular mass, volumes, and function precisely. The high accuracy and reproducibility of magnetic resonance imaging in quantification of regurgitation and ventricular function has the potential to provide improved monitoring of therapy and optimal timing of surgery in patients with valvular dysfunction. In comparison to echocardiography and angiography, some current limitations of magnetic resonance imaging to an integrated approach of valvular heart disease exist, which may be removed with future refinement of magnetic resonance imaging technology for cardiovascular imaging.
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Affiliation(s)
- R Wyttenbach
- Magnetic Resonance Imaging Section, University of California, San Francisco, USA
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Abstract
OBJECTIVES Mitral regurgitation (MR) is a common echocardiographic finding; however, there is no simple accurate method for quantification. The aim of this study was to develop an easily measured screening variable for hemodynamically significant MR. BACKGROUND The added regurgitant volume in MR increases the left atrial to left ventricular gradient, which then increases the peak mitral inflow or the peak E wave velocity. Our hypothesis was that peak E wave velocity and the E/A ratio increase in proportion to MR severity. METHODS We performed a retrospective analysis of 102 consecutive patients with varying grades of MR seen in the Adult Echocardiography Laboratory at the University of California, San Francisco. Peak E wave velocity, peak A wave velocity, E/A ratio and E wave deceleration time were measured in all patients. The reference standard for MR was qualitative echocardiographic evaluation by an expert and quantitation of regurgitant fraction using two-dimensional and Doppler echocardiography. RESULTS Peak E wave velocity was seen to increase in proportion to MR severity, with a significant difference between the different groups (F = 37, p < 0.0001). Peak E wave velocity correlated with regurgitant fraction (r = 0.52, p < 0.001). Furthermore, an E wave velocity >1.2 m/s identified 24 of 27 patients with severe MR (sensitivity 86%, specificity 86%, positive predictive value 75%). An A wave dominant pattern excluded the presence of severe MR. The E/A ratio also increased in proportion to MR severity. Peak A wave velocity and E wave deceleration time showed no correlation with MR severity. CONCLUSIONS Peak E wave velocity is easy to obtain and is therefore widely applicable in clinical practice as a screening tool for evaluating MR severity.
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Affiliation(s)
- L Thomas
- Division of Cardiology, University of California San Francisco, 94142-0214, USA
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Rohmann S, Erhel R, Darius H, Makowski T, Meyer J. Effect of antibiotic treatment on vegetation size and complication rate in infective endocarditis. Clin Cardiol 1997; 20:132-40. [PMID: 9034642 PMCID: PMC6656264 DOI: 10.1002/clc.4960200210] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/1996] [Accepted: 11/26/1996] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction, and with congestive heart failure. Embolic events are more common in patients with echocardiographically discernible vegetations, especially when vegetations are > 10 mm in diameter. HYPOTHESIS The objective of the study was to follow vegetation morphology during native valve endocarditis, to compare it with the clinical course and antibiotic treatment chosen, and to evaluate whether the impact on vegetation size and complication rate of antibiotic regimens differed in patients with positive and negative blood cultures. METHODS The effect of different antibiotic regimes on vegetation size monitored by using transesophageal echocardiography was evaluated in 183 patients with echocardiographic evidence of infective endocarditis. A total of 223 vegetations attached to the aortic or mitral valves were detected using the transesophageal approach. The patients were followed for a mean of 76 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations. RESULTS Treatment with different kinds of antibiotics corresponded with significant differences in vegetation size; vancomycin-associated treatment was related to a 45% reduction, ampicillin to a 19% reduction, penicillin to a 5% reduction, penicillase-resistant drugs to a 15% increase, and cephalosporin to a 40% increase in vegetation size. Multivariate analysis showed that penicillin, cephalosporin, and penicillase-resistant drug treatments were associated with an increased embolic risk, vancomycin treatment with abscess formation, and cephalosporin medication with increased mortality. Plotting changes in vegetation size against the incidence of embolism and mortality, linear regression analysis suggested a 40-50% reduction in vegetation size, thereby greatly reducing the risk of embolism and mortality. CONCLUSION Our study shows that different antibiotics have different effects on vegetation size. The highest complication rate was observed when vegetations significantly increased in size during antibiotic treatment. Especially in culture-negative patients, monitoring vegetation size by means of transesophageal echocardiography may prove to be useful for estimating the efficacy of antibiotic treatment.
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Affiliation(s)
- S Rohmann
- 2nd Medical Clinic, University of Mainz, Germany
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Winoto SH, Shah DA, Liu H. Estimation of turbulent shear stress in free jets: application to valvular regurgitation. Ann Biomed Eng 1996; 24:321-7. [PMID: 8678361 DOI: 10.1007/bf02667358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In an attempt to better assess the severity of valvular regurgitation, an in-vitro experiment has been conducted to estimate turbulent shear stress levels within free jets issuing from different orifice shapes and sizes by means of hot-wire anemometry. On the basis of the measured mean velocities and the jet profiles, the distributions of the normalized kinematic turbulent shear stress (uv/Um2) were estimated for different jets by using an equation available for self-preserving circular jet. The results indicate that the equation can estimate the distributions of uv/Um2 independent of the orifice shape and Reynolds number of the jet. For the range of Reynolds numbers considered, the estimation of maximum turbulent shear stress inferred from these distributions suggests that the critical shear stress level of approximately 200 N/m2, corresponding to destruction of blood cells, is exceeded for typical blood flow velocity of 5 m/s at the valvular lesion.
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Affiliation(s)
- S H Winoto
- Department of Mechanical and Production Engineering, National University of Singapore, Republic of Singapore
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MacIsaac AI, McDonald IG, Kirsner KL, Graham SA, Gill RW. Quantification of mitral regurgitation by integrated Doppler backscatter power. J Am Coll Cardiol 1994; 24:690-5. [PMID: 8077540 DOI: 10.1016/0735-1097(94)90016-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We attempted to determine whether continuous wave Doppler backscatter power could be used to quantify mitral regurgitation. BACKGROUND The power of a Doppler backscatter signal is proportional to the number of scatterers insonated and, hence, to the moving volume of blood. The relative power of the continuous wave Doppler signals from mitral inflow and aortic outflow is therefore proportional to the relative volumes of blood in motion. METHODS Computer postprocessing was used to derive the relative power of the Doppler backscatter signal from the intensity of the pixels within the spectral display of anterograde aortic and mitral flow. The power ratio was used to calculate the regurgitant fraction in 20 patients (mean age 61.4 years) with mitral regurgitation. This Doppler regurgitant fraction was compared with that derived from angiographic left ventricular volume and thermodilution cardiac output. In addition, 12 normal control subjects were studied by the Doppler method. RESULTS Mean (+/- SD) catheterization regurgitant fraction was 0.50 +/- 0.26, and mean Doppler regurgitant fraction was 0.47 +/- 0.25 (r = 0.89). The limits of agreement between the two methods by Bland-Altman analysis were -0.21 + 0.27. In normal control subjects with an expected regurgitant fraction of close to zero, mean Doppler regurgitant fraction was 0.03 +/- 0.05. CONCLUSIONS Doppler backscatter power from mitral and aortic inflow provides a new and accurate method for quantifying mitral regurgitation.
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Affiliation(s)
- A I MacIsaac
- Cardiac Investigation Unit, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Fujita N, Chazouilleres AF, Hartiala JJ, O'Sullivan M, Heidenreich P, Kaplan JD, Sakuma H, Foster E, Caputo GR, Higgins CB. Quantification of mitral regurgitation by velocity-encoded cine nuclear magnetic resonance imaging. J Am Coll Cardiol 1994; 23:951-8. [PMID: 8106701 DOI: 10.1016/0735-1097(94)90642-4] [Citation(s) in RCA: 168] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The feasibility of velocity-encoded cine nuclear magnetic resonance (NMR) imaging to measure regurgitant volume and regurgitant fraction in patients with mitral regurgitation was evaluated. BACKGROUND Velocity-encoded cine NMR imaging has been reported to provide accurate measurement of the volume of blood flow in the ascending aorta and through the mitral annulus. Therefore, we hypothesized that the difference between mitral inflow and aortic systolic flow provides the regurgitant volume in the setting of mitral regurgitation. METHODS Using velocity-encoded cine NMR imaging at a magnet field strength of 1.5 T and color Doppler echocardiography, 19 patients with isolated mitral regurgitation and 10 normal subjects were studied. Velocity-encoded cine NMR images were acquired in the short-axis plane of the ascending aorta and from the short-axis plane of the left ventricle at the level of the mitral annulus. Two independent observers measured the ascending aortic flow volume and left ventricular inflow volume to calculate the regurgitant volume as the difference between left ventricular inflow volume and aortic flow volume, and the regurgitant fraction was calculated. Using accepted criteria of color flow Doppler imaging and spectral analysis, the severity of mitral regurgitation was qualitatively graded as mild, moderate or severe and compared with regurgitant volume and regurgitant fraction, as determined by velocity-encoded cine NMR imaging. RESULTS In normal subjects the regurgitant volume was -6 +/- 345 ml/min (mean +/- SD). In patients with mild, moderate and severe mitral regurgitation, the regurgitant volume was 156 +/- 203, 1,384 +/- 437 and 4,763 +/- 2,449 ml/min, respectively. In normal subjects the regurgitant fraction was 0.7 +/- 6.1%. In patients with mild, moderate and severe mitral regurgitation, the regurgitant fraction was 3.1 +/- 3.4%, 24.5 +/- 8.9% and 48.6 +/- 7.6%, respectively. The regurgitant fraction correlated well with the echocardiographic severity of mitral regurgitation (r = 0.87). Interobserver reproducibilities for regurgitant volume and regurgitant fraction were excellent (r = 0.99, SEE = 238 ml; r = 0.98, SEE = 4.1%, respectively). CONCLUSIONS These findings suggest that velocity-encoded NMR imaging can be used to estimate regurgitant volume and regurgitant fraction in patients with mitral regurgitation and can discriminate patients with moderate or severe mitral regurgitation from normal subjects and patients with mild regurgitation. It may be useful for monitoring the effect of therapy intended to reduce the severity of mitral regurgitation.
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Affiliation(s)
- N Fujita
- Department of Radiology, University of California, San Francisco 94143-0628
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Søndergaard L, Lindvig K, Hildebrandt P, Thomsen C, Ståhlberg F, Joen T, Henriksen O. Quantification of aortic regurgitation by magnetic resonance velocity mapping. Am Heart J 1993; 125:1081-90. [PMID: 8465731 DOI: 10.1016/0002-8703(93)90117-r] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The use of magnetic resonance (MR) velocity mapping in the quantification of aortic valvular blood flow was examined in 10 patients with angiographically verified aortic regurgitation. MR velocity mapping succeeded in identifying and quantifying the regurgitation in all patients, and the regurgitant volume determined with MR velocity mapping agreed well with the grade obtained by aortic root angiography (p < 0.02). The accuracy in quantification of the aortic valvular flow rate was demonstrated by a significant correlation between the stroke volume (ml) measured by MR velocity mapping and calculated from MR imaging of the left ventricular end-diastolic and end-systolic volumes in eight patients (Y = 0.89 x X + 11, r = 0.97, p < 0.001). This finding was confirmed by a good agreement between the net cardiac output (L/min) quantified with MR velocity mapping and simultaneous 125I-indicator dilution measurement in all subjects (Y = 0.89 x X + 0.08, r = 0.82, p < 0.01). In conclusion, MR velocity mapping may be used as a noninvasive tool in the quantification of aortic regurgitation.
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Affiliation(s)
- L Søndergaard
- Danish Research Centre of Magnetic Resonance, Hvidovre Hospital, University of Copenhagen
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Lavie CJ, Hebert K, Cassidy M. Prevalence and severity of Doppler-detected valvular regurgitation and estimation of right-sided cardiac pressures in patients with normal two-dimensional echocardiograms. Chest 1993; 103:226-31. [PMID: 8417884 DOI: 10.1378/chest.103.1.226] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
To assess the prevalence and severity of Doppler-detected valvular regurgitation, as assessed by multiple Doppler modalities, in patients with structurally normal hearts, we analyzed Doppler echocardiograms in a consecutive sample of 206 referred patients who were found to have completely normal M-mode and two-dimensional echocardiograms. Valvular regurgitation was detected by Doppler in 94 percent, and 56 percent had regurgitation in at least two valves (mitral, tricuspid, and/or aortic). Mitral, tricuspid, and aortic regurgitation was detected in 73 percent, 68 percent, and 12 percent, respectively, with moderate regurgitation occurring in 6 percent, 5 percent, and 2 percent, respectively. The presence of mitral and tricuspid regurgitation was not related to age, although the prevalence of moderate regurgitation was three times more prevalent (p < 0.05) in those > 50 years old compared with those < or = 50 years. Aortic regurgitation was two to three times more prevalent (p < 0.01) in patients > 50 years compared with younger subjects, and moderate aortic regurgitation was three times more prevalent in older patients. Of those with measurable right-sided cardiac pressures, estimated right atrial pressure was < 10 mm Hg in 93 percent of patients, and estimated pulmonary artery systolic pressure was < or = 30 mm Hg in 57 percent of patients. Estimated right atrial pressure was > 10 mm Hg in only 7 percent, and only 13 percent had estimated pulmonary artery systolic pressure > or = 40 mm Hg. These data indicate a very high prevalence of trivial and mild mitral and tricuspid regurgitation in patients with otherwise "normal" hearts, suggesting that these findings are physiologically normal. These data should be considered when addressing management in patients with Doppler-detected valvular regurgitation in order to prevent "iatrogenic heart disease."
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Affiliation(s)
- C J Lavie
- Department of Internal Medicine, Ochsner Clinic, New Orleans, LA
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Rohmann S, Erbel R, Darius H, Makowski T, Jensen P, Fischer T, Meyer J. Spontaneous echo contrast imaging in infective endocarditis: a predictor of complications? INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1992; 8:197-207. [PMID: 1527442 DOI: 10.1007/bf01146838] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infective endocarditis is associated with significant morbidity and mortality. Valvular destruction and congestive heart failure are more common in patients with echocardiographically detectable vegetations. In addition, spontaneous platelet aggregation is increased when vegetations are present on cardiac valves. The aim of the study was to assess the prognostic value of spontaneous echo contrast (SEC) imaging, as SEC is supposed to reflect red blood cell aggregates stimulated by platelet activity. We studied 293 patients with clinical signs of infective endocarditis. Vegetations, attached to the aortic or mitral valve, were found in 130 patients (44.4%) who were followed for a mean period of 12 months. In 34 of these 130 patients (26.2%) SEC was imaged during the initial transesophageal echocardiographic examination. In these patients SEC indicated a prolonged healing of infective endocarditis with a specificity of 91.2%, a sensitivity of 77.3%, a positive accuracy of 77.3%, a negative accuracy of 74.3%. Multivariate analysis revealed that SEC is a risk factor for valve replacement (p less than 0.001) and for embolic events (p less than 0.001), less for mortality (p less than 0.01), and lowest for abscess formation (p less than 0.05). The dose of ADP to induce half-maximal platelet aggregation was significantly lower in patients with SEC (0.71 +/- 0.15 microliters) than without SEC (1.05 +/- 0.12 microliters; p less than 0.05), implying an increased spontaneous platelet aggregation in the presence of SEC. Our data provide evidence that systemically activated coagulation plays an important role in infective endocarditis. SEC, the echocardiographic implication of an increased platelet aggregation, predicts complications such as thromboembolic events and the need for surgery and is closely related to the prolonged healing period of infective endocarditis. In addition to demonstrating vegetations, transesophageal echocardiography provides information helpful in assigning patients to a high-risk subgroup. Transesophageal echocardiography may play an important role in assessing the clinical outcome of these patients.
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Affiliation(s)
- S Rohmann
- 2nd Medical Clinic, Johannes Gutenberg-University, Mainz, Germany
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Chao K, Moises VA, Shandas R, Elkadi T, Sahn DJ, Weintraub R. Influence of the Coanda effect on color Doppler jet area and color encoding. In vitro studies using color Doppler flow mapping. Circulation 1992; 85:333-41. [PMID: 1728465 DOI: 10.1161/01.cir.85.1.333] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We studied surface adherence and its effects on color Doppler jet areas and color encoding in an in vitro model with a noncompliant receiving chamber into which a steady flow jet was directed parallel to either a straight or a curved surface adjacent to and 4 mm away from the inflow orifice (1.50 mm2) with the control condition being a free jet matched for flow rates and driving pressures. Jets were imaged perpendicular to the plane of the surface, the plane in which most clinical images of jet-surface interactions are obtained. Ten different flow rates ranging from 0.13 to 0.30 l/min were used. Surface-adherent jet areas were smaller than control jets for every driving pressure-volume combination (paired t test, p less than 0.01). Computer analysis of color Doppler images showed more green and blue (reverse flow) pixels on the surface side of the adherent jets than the control jets (p less than 0.05), suggesting that viscous energy loss and flow deceleration and reversal play a role in the jet-surface interaction. Analysis of variance demonstrated that linear regression slopes of flow rate versus jet area for surface jets were lower (slopes, 11-21 cm2/l/min; r = 0.95-0.97) than those for the control (slope, 33 cm2/l/min; r = 0.97) (p less than 0.0001). Surface adherence (Coanda effect) influences jet size and color encoding, causing smaller color Doppler jet areas and greater variance and reverse velocity encoding.
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Affiliation(s)
- K Chao
- Department of Pediatric Cardiology, University of California San Diego
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Rohmann S, Erbel R, Darius H, Görge G, Makowski T, Zotz R, Mohr-Kahaly S, Nixdorff U, Drexler M, Meyer J. Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size. J Am Soc Echocardiogr 1991; 4:465-74. [PMID: 1742034 DOI: 10.1016/s0894-7317(14)80380-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The diagnostic value of transesophageal echocardiography in monitoring the clinical course has been evaluated in 83 patients with echocardiographic evidence of infective endocarditis. A total of 103 vegetations attached to the aortic or mitral valves were detected by use of the transesophageal approach. The patients were monitored for a mean of 74 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations. Group A included patients with increasing or remaining constant size of vegetation (8.2 +/- 1.5 to 11.2 mm, p less than 0.05) during 4 to 8 weeks of antimicrobial therapy, whereas group B was formed by patients with decreasing vegetation size (8.3 +/- 0.8 to 4.9 +/- 0.8 mm, p less than 0.05). The incidences of complications after diagnosis and onset of therapy was higher in group A than in group B: valve replacement (45% versus 2%, p less than 0.05), embolic events (45% versus 17%, p less than 0.05), perivalvular abscess formation (13% versus 2%, p less than 0.05), and mortality (10% versus 0%, respectively, p less than 0.05). Staphylococcus aureus was the most frequent organism isolated in group A (44% versus 11% in B, p less than 0.05) and Streptococcus viridans in group B (33% versus 18% in A, p less than 0.05). Blood cultures were negative in nearly 50% of the patients in each group. There was no difference in the incidences of complications in patients with positive or negative blood cultures. We conclude that an increase in vegetation size during antibiotic therapy predicts a prolonged healing phase of infective endocarditis. This prolonged healing period is associated with a significantly increased risk of complications, independent of blood culture results. Monitoring vegetation size contributes important information concerning prognosis and stage of risk, and it aids in the choice of patient management in infective endocarditis. Because embolic events after diagnosis and onset of treatment are less frequent in rapid-healing endocarditis, surgery cannot be recommended to prevent further events taking into account the high risk of surgery.
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Affiliation(s)
- S Rohmann
- II. Medical Clinic, Johannes Gutenberg University, Mainz, Germany
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Cape EG, Yoganathan AP, Weyman AE, Levine RA. Adjacent solid boundaries alter the size of regurgitant jets on Doppler color flow maps. J Am Coll Cardiol 1991; 17:1094-102. [PMID: 2007708 DOI: 10.1016/0735-1097(91)90838-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Recent studies have attempted to predict the severity of regurgitant lesions from jet size on Doppler flow maps. Jet size is a function of both regurgitant volume and fluid entrained from the receiving chamber and, for a free jet, is a function of its momentum at the orifice. However, regurgitant jets often approach or attach to cardiac walls, potentially altering their momentum and ability to expand by entrainment. Therefore, this study addressed the hypothesis that adjacent walls influence regurgitant jet size as seen on Doppler flow maps. Steady flow was driven through circular orifices (0.02 to 0.05 cm2) at physiologic velocities of 2 to 5 m/s. At a constant flow rate and orifice velocity, orifice position was varied to produce three jet geometries: free jets, jets adjacent to a horizontal chamber wall lying 1 cm below the orifice and wall jets with the orifice at the level of the wall. Doppler color flow imaging was performed at identical instrument settings for all jets. Two long-axis views of the jet were obtained: a vertical view perpendicular to the wall, resembling that most commonly used in patients to image the length of the jet, and a horizontal view parallel to the chamber wall. Velocities along the jet were also measured by Doppler mapping.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E G Cape
- Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston 02114
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21
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Adams PB, Otto CM. Lack of improvement in coexisting mitral regurgitation after relief of valvular aortic stenosis. Am J Cardiol 1990; 66:105-7. [PMID: 2141754 DOI: 10.1016/0002-9149(90)90746-n] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P B Adams
- Division of Cardiology, University of Washington, Seattle 98195
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22
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23
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Jaffe WM, Morgan DE, Pearlman AS, Otto CM. Infective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality. J Am Coll Cardiol 1990; 15:1227-33. [PMID: 2184183 DOI: 10.1016/s0735-1097(10)80005-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The echocardiograms and clinical records of 70 patients with infective endocarditis seen between 1983 and 1988 were examined to evaluate the role of two-dimensional and Doppler echocardiography in the diagnosis of infective endocarditis and identify risk factors for morbidity and mortality. A blinded observer reviewed the echocardiograms for the presence and size of vegetations and the severity of the valvular regurgitation. Vegetations were identified in 54 (78%) of 69 technically satisfactory echocardiograms. In 38 patients whose heart was examined at surgery or autopsy, all vegetations diagnosed by echocardiography were confirmed, but six additional vegetations were found. Abnormal (greater than or equal to 2+) valvular regurgitation was present in 88% of patients. No patient with less than or equal to 1+ regurgitation (n = 8) died or required valve surgery for heart failure, but three of the eight patients did undergo surgery for mycotic aneurysm, recurrent embolism or paravalvular abscess. In patients without embolism before echocardiography, there was a trend toward a greater incidence of subsequent embolism in those with vegetations greater than 10 mm in size (26% [8 of 31] compared with 11% [2 of 18] with vegetations less than or equal to 10 mm) (p = 0.19). By multivariate analysis, risk factors for in-hospital death (n = 7) were an infected prosthetic valve (p less than 0.007), systemic embolism (p less than 0.02) and infection with Staphylococcus aureus (p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W M Jaffe
- Department of Medicine, University of Washington, Seattle 98195
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24
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Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Taliercio CP, Taylor CL, Bailey KR, Seward JB. Age-related prevalence of valvular regurgitation in normal subjects: a comprehensive color flow examination of 118 volunteers. J Am Soc Echocardiogr 1990; 3:54-63. [PMID: 2310593 DOI: 10.1016/s0894-7317(14)80299-x] [Citation(s) in RCA: 140] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We prospectively assessed the influence of aging on the prevalence of valvular regurgitation by using color flow imaging. One hundred eighteen healthy volunteers (21 to 82 years old) had a two-dimensional Doppler echocardiographic study that included color flow imaging to assess valvular regurgitation and that was semiquantitated by mapping the dimensions of the color flow regurgitant jet in orthogonal views. The subjects were divided into two groups: group 1 consisted of subjects who were younger than 50 years old (n = 61), and group 2 consisted of subjects who were at least 50 years old (n = 57). Mitral regurgitation was detected in 57 (48%) of the 118 subjects: 24 subjects (39%) in group 1 and 33 subjects (58%) in group 2. The severity of mitral regurgitation was trivial to mild. Aortic regurgitation was detected in 13 (11%) of the 118 subjects, all in group 2. The severity was trivial to mild. Tricuspid regurgitation was detected in 77 (65%) of the 118 subjects: 35 (57%) in group 1 and 42 (74%) in group 2. The severity was trivial to mild. Pulmonary regurgitation was detected in 24 (31%) of 78 subjects: nine (22%) in group 1 and 15 (41%) in group 2. The severity was trivial. These findings suggest that valvular regurgitation of a trivial or mild degree is a frequent finding in normal subjects and that it increases with age.
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Affiliation(s)
- A L Klein
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905
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25
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Cape EG, Yoganathan AP, Levine RA. A new theoretical model for noninvasive quantification of mitral regurgitation. J Biomech 1990; 23:27-33. [PMID: 2307689 DOI: 10.1016/0021-9290(90)90366-b] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The most common objective assessments of mitral regurgitation are limited by their invasive or semiquantitative nature. Recent attempts at correlation with jet size from Doppler flow maps have failed to produce a direct measure of regurgitant volume and are fundamentally limited by the dependence of jet dimensions on factors other than flow volume. The purpose of this paper was to develop an equation, based on the physics of turbulent regurgitant jets, for calculating regurgitant volume from quantities that can be measured by Doppler ultrasound. The result is an equation forw flow rate Q as a function of orifice velocity Uo, a downstream centerline velocity Um and the intervening distance chi: Q = pi U2m chi 2/160Uo. This equation can also be modified to obtain total regurgitant volume in clinical pulsatile flow. The assumptions made demand a free turbulent jet for which momentum is conserved, but should otherwise be physiologically applicable. The advantage of this technique compared to correlations with jet size are its theoretical justification and ability to quantify regurgitant volume directly.
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Affiliation(s)
- E G Cape
- Cardiovascular Fluid Mechanics Laboratory, School of Chemical Engineering, Georgia Institute of Technology, Atlanta 30332-0100
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26
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Appleton CP, Hatle LK, Nellessen U, Schnittger I, Popp RL. Flow velocity acceleration in the left ventricle: a useful Doppler echocardiographic sign of hemodynamically significant mitral regurgitation. J Am Soc Echocardiogr 1990; 3:35-45. [PMID: 2310590 DOI: 10.1016/s0894-7317(14)80297-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Doppler echocardiography is a sensitive method to detect mitral regurgitation in patients with both native and prosthetic valves. However, estimates of the amount of mitral regurgitation remain semiquantitative, and even severe mitral regurgitation may be underestimated in the presence of markedly eccentric regurgitant jets or acoustic shadowing of the left atrium by mitral or aortic prostheses. This report describes the Doppler findings in 10 patients with severe native valve mitral regurgitation (angiographic grade III or IV) and in 15 patients with severe bioprosthetic mitral regurgitation that required valve replacement. An increase in peak mitral flow velocity above normal values was seen in eight of 10 patients with severe native valve mitral regurgitation (greater than or equal to 130 cm per second) and 11 of 15 patients with severe prosthetic valve mitral regurgitation (greater than or equal to 210 cm per second). One of 10 patients with a native valve and four of 15 patients with a bioprosthetic valve appeared to have only a localized left atrial systolic flow disturbance, incorrectly suggesting that the mitral regurgitation was mild. However, in all patients with severe mitral regurgitation, a low velocity (less than 100 cm per second) flow signal could be recorded in the left ventricle that was directed toward the mitral valve in systole. This flow signal showed a gradual increase in velocity as the sample volume was moved toward the mitral valve, with an abrupt further increase on entry into the left atrium. This signal was continuous with antegrade mitral flow and had the same orientation as mitral regurgitation recorded by continuous wave technique from the apex. A similar flow signal was not recorded in the left ventricle of any individual in a control group of 30 patients who had no mitral regurgitation or who had angiographic grade I or II mitral regurgitation. These findings suggest that acceleration of left ventricle flow toward the mitral valve in systole is only recorded when there is hemodynamically significant mitral regurgitation that is approximately equal to angiographic grade III or IV. Recognition of this Doppler finding may help in the estimation of mitral regurgitation severity, especially in difficult diagnostic situations.
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Affiliation(s)
- C P Appleton
- Section of Cardiology, University of Arizona School of Medicine, Tucson
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27
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Abstract
M-mode and two-dimensional echocardiography have greatly enhanced the evaluation of animals with congenital cardiac disease. Structural abnormalities can be seen and hemodynamic alterations inferred, e.g., ventricular wall concentric hypertrophy indicating pressure overload to the respective ventricle. Interrogation of the diseased heart by Doppler echocardiography allows acquisition of more direct hemodynamic information without cardiac catheterization, which enables the clinician to give a more precise description of a congenital abnormality. The purpose of this study is to illustrate and describe abnormal blood-flow patterns in selected congenital cardiac defects in animals. Basic background information concerning Doppler echocardiographic principles, flow patterns, and calculations will be briefly discussed. For more detailed descriptions other references should be sought. Interpretation of Doppler echocardiography in animals is based primarily on data derived from human studies since studies involving measurable numbers of veterinary patients have not yet been completed.
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Affiliation(s)
- N S Moise
- Department of Clinical Sciences, New York State College of Veterinary Medicine, Cornell University, Ithaca 14853
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28
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Jaffe WM, Coverdale HA, Roche AH, Brandt PW, Ormiston JA, Barratt-Boyes BG. Doppler echocardiography in the assessment of the homograft aortic valve. Am J Cardiol 1989; 63:1466-70. [PMID: 2729134 DOI: 10.1016/0002-9149(89)90009-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To determine the utility of Doppler echocardiography in the evaluation of the homograft valve in the aortic position, 27 patients with normally functioning valves (group 1) and 30 patients with suspected malfunctioning valves (group 2) were examined. Simultaneous cardiac catheterization and Doppler echocardiography were performed in 23 group 2 patients. Doppler and surgical findings were compared in 7 patients too ill for invasive studies. In group 1 patients, the maximal velocity (+/- standard deviation) was 1.8 +/- 0.37 m/s, the mean pressure gradient was 7.1 +/- 3.07 mm Hg and the mean aortic valve area was 2.2 +/- 0.79 cm2. The maximal velocity in group 2 patients with aortic regurgitation (AR) classified as moderate or greater was 2.5 +/- 0.55 m/s, compared with 1.8 +/- 0.44 m/s in patients with mild AR or less (p less than 0.01). In the quantitation of AR, pulsed-wave mapping and angiographic grades were identical in 18 patients and differed by 1 grade in 5. Seven patients too ill for catheterization had severe destruction of valve leaflets at cardiac surgery. In 6 patients, both Doppler grading methods suggested severe AR. In a seventh patient, who had an obstructed Starr-Edwards valve in the mitral position, AR was graded as mild by pulsed-wave mapping. Only 1 patient had homograft valve stenosis, with a withdrawal gradient at catheterization of 34 mm Hg and a Doppler maximal gradient of 36 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W M Jaffe
- Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
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29
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Cape EG, Skoufis EG, Weyman AE, Yoganathan AP, Levine RA. A new method for noninvasive quantification of valvular regurgitation based on conservation of momentum. In vitro validation. Circulation 1989; 79:1343-53. [PMID: 2720933 DOI: 10.1161/01.cir.79.6.1343] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The noninvasive Doppler assessment of regurgitant volume from jet size is limited by the fundamental inequality of jet volume and regurgitant volume and by the dependence of jet dimensions on driving pressure and instrument settings for a given flow volume. Therefore, this study addresses the hypothesis that an equation could be derived from basic physical principles to quantify regurgitant volume with velocities that can be directly measured by Doppler echocardiography. The principle of conservation of momentum for free turbulent jets resembling many cardiac lesions yields an equation for regurgitant volume as a function of maximum jet velocity, a distal centerline velocity, and the intervening distance. This theory was tested throughout a range of physiologic flow rates and pressures (orifice velocities) in steady flow for 0.08-0.40 cm2 circular orifices and a noncircular orifice and in physiologic pulsatile flow for 0.08 and 0.20 cm2 circular orifices. Plots of centerline velocities versus axial distance coincided with those expected for such jets. Calculated and actual volumetric flows agreed well by linear regression in the turbulent jet: for steady flow rates, y = 0.98x + 0.09 (r = 0.99, SEE = 0.14 l/min), with similar correlations for circular and noncircular orifices; for pulsatile flow, y = 1.02x + 0.03 for peak flow rate (r = 0.98, SEE = 0.18 l/min) and y = 1.02x + 0.58 for total regurgitant volume (r = 0.95, SEE = 0.81 ml). There was no significant effect of orifice size or location of velocity measurement within the turbulent jet. Therefore, for free jets resembling many clinical lesions, regurgitant flow rate and volume can be calculated noninvasively from Doppler velocities without planimetry of jet area. Because the required information is intrinsic to the jet, this method should apply regardless of associated valvular lesions. It should also apply to orifices of variable shape because turbulent eddies obliterate the details of flow at the orifice. The special case of jets impinging on walls must be considered separately for both this technique and flow mapping.
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Affiliation(s)
- E G Cape
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston 02114
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30
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Aguirre FV, Pearson AC, Lewen MK, McCluskey M, Labovitz AJ. Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure. Am J Cardiol 1989; 63:1098-102. [PMID: 2705380 DOI: 10.1016/0002-9149(89)90085-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
One hundred fifty-one consecutive patients with a diagnosis of congestive heart failure (CHF) referred for echocardiography were prospectively evaluated to (1) define the frequency of normal left ventricular systolic function in a referral-based population with CHF; (2) establish cardiac mechanisms responsible for symptomatology in these patients; and (3) assess the ability to clinically differentiate these subsets of patients based on routine history and physical examination. Of the 151 total patients, 51 (34%) had normal left ventricular systolic function (left ventricular ejection fraction greater than or equal to 55%). Primary valvular disease was present in 4 of these 51 patients (8%), and Doppler echocardiographic evidence of abnormal left ventricular filling (diastolic dysfunction) was evident in 10 (20%). In addition, no predefined resting abnormality was noted in 34 (66%) of them. Despite this finding, 51% of all patients with normal left ventricular systolic function were being treated with digoxin therapy in the absence of atrial arrhythmia. Clinical differentiation of this group of patients from those with abnormal left ventricular systolic function was difficult and may have accounted for this apparently inappropriate treatment. Thus, evaluation of left ventricular function and of causative mechanisms of CHF before initiation of long-term treatment is mandatory.
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Affiliation(s)
- F V Aguirre
- Department of Internal Medicine, St. Louis University School of Medicine, Missouri
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31
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Zavitsanos JP, Goldman AP, Kotler MN, Maze SS, Kochar G, Parry W. The echo Doppler spectrum of valvular abnormalities in the hospitalized octogenarian. Clin Cardiol 1988; 11:683-8. [PMID: 3224451 DOI: 10.1002/clc.4960111006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cardiac valves thicken and become more opaque with advancing age. As more individuals live longer and as more treatment modalities such as valvuloplasty evolve, the presence and significance of these valvular abnormalities become important. We retrospectively studied 628 octogenarian patients to try and define further the presence and significance of these abnormalities detected by Doppler echocardiography. A group of 547 patients were suitable for analysis. Age ranged from 80 to 96 years (mean 84.4). The female:male ratio was 1.9:1. Mitral, aortic, and tricuspid regurgitation (MR, AR, and TR) were significant if the jet moved greater than 2 cm from the plane of the valve away or toward the transducer, depending on transducer position. Mitral regurgitation was detected in 331 patients (60.5%) and was significant in 82 patients (15%). Aortic regurgitation was detected in 276 patients (50.5%) and was significant in 70 patients (12.8%). Tricuspid regurgitation was detected in 131 patients (23.9%) and was significant in 30 patients (5.5%). Regurgitant lesions were detected in two valves in 150 patients (27.4%) three valves in 57 patients (10.4%), in all four valves in 17 patients (3.1%). Aortic stenosis was detected in 160 patients (29.3%). The gradient range was 16-156 mmHg (mean 47.8). Significant aortic stenosis was present in 70 patients (12.8%) (gradient greater than 50 mmHg), of whom 54 had isolated pure aortic stenosis and 16 had mixed lesion. In 40% of these patients, significant aortic stenosis was an unexpected finding at two-dimensional echocardiography. Valvular pathology is common in the octogenarian population.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J P Zavitsanos
- Department of Medicine, Albert Einstein Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19141
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32
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PERRY GILBERTJ, NANDA NAVINC. Recent Advances in Color Doppler Evaluation of Valvular Regurgitation. Echocardiography 1987. [DOI: 10.1111/j.1540-8175.1987.tb01364.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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33
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Borow KM. Surgical outcome in chronic aortic regurgitation: a physiologic framework for assessing preoperative predictors. J Am Coll Cardiol 1987; 10:1165-70. [PMID: 2959711 DOI: 10.1016/s0735-1097(87)80362-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- K M Borow
- Department of Medicine, University of Chicago Medical Center, Illinois 60637
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