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Noninvasive measurement of cardiac output: Two methods compared in patients with mitral regurgitation

ANGIOLOGY 1999年第2期50卷 95-101页

作者： van der Meer, NJM Noordegraaf, AV Kamp, O de Vries, PMJM Univ Amsterdam Acad Med Ctr Dept Anesthesiol NL-1105 AZ Amsterdam Netherlands Vrije Univ Amsterdam Acad Hosp Dept Med Phys Amsterdam Netherlands Vrije Univ Amsterdam Acad Hosp Dept Pulm Med Amsterdam Netherlands Vrije Univ Amsterdam Acad Hosp Dept Cardiol Amsterdam Netherlands

In search for the origin of the less reliable cardiac output (CO) estimations by means of electrical impedance cardiography (EIC), the authors hypothesized that cardiac valve pathology might be one of the reasons. Twenty-six patients were examined by means of echo Doppler (ED) and EIC. The cardiac valve status was obtained by means of echocardiography and color Doppler flow, while CO was obtained by means of both methods. Seventeen patients had no valve pathology (nVP) while nine patients had mild to moderate mitral regurgitation (MVR). The overall correlation between the calculation of CO by means of the two methods was good (r = 0.85, p < 0.001, mean difference and standard deviation: 0.20 +/- 0.74 L/min), while there was no significant difference between the paired values. After division into an nVP and an MVR population, the results showed an even closer agreement between the CO values in the nVP population (r = 0.88, p < 0.001, mean difference and standard deviation: 0.15 +/- 0.68 L/min). Furthermore, significant differences were found in the first derivative of the impedance (dZ/dt) signals of these groups. Although the agreement between ED and EIC was slightly lower in the MVR population, EIC reliably estimated CO, even in case of MVR. The impedance signal itself gave an indication for the existence of MVR.

关键词：主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/超声检查心排血量/生理学心动描记术阻抗/方法超声心动描记术多普勒超声心动描记术多普勒彩色心率/生理学线性模型二尖瓣/病理生理学二尖瓣/超声检查二尖瓣闭锁不全/分类二尖瓣闭锁不全/病理生理学二尖瓣闭锁不全/超声检查可重复性结果每搏输出量/生理学三尖瓣闭锁不全/病理生理学三尖瓣闭锁不全/超声检查心室功能左/生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Characteristic cardiovascular manifestation in homozygous and heterozygous familial hypercholesterolemia

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AMERICAN HEART JOURNAL 1999年第3期137卷 410-418页

作者： Kawaguchi, A Miyatake, K Yutani, C Beppu, S Tsushima, M Yamamura, T Yamamoto, A Natl Cardiovasc Ctr Res Inst Dept Etiol & Pathophysiol Suita Osaka 565 Japan Natl Cardiovasc Ctr Res Inst & Hosp Dept Etiol & Pathophysiol Suita Osaka 565 Japan

Background The aortic valve dysfunction of patients with homozygous familial hypercholesterolemia (FH) suggests that hypercholesterolemia affects not only coronary arteries but also the aortic valve. We studied the aortic root of patients with homozygous FH and those of patients with heterozygous FH to characterize the premature atherosclerotic lesions by using histopathologic specimens, Methods and Results The aortic roots of 10 patients with homozygous FH, age 9 to 58 years, were studied by cardiac catheterization with several angiographies. The aortic roofs of 39 patients with heterozygous FH under age 60 years were also examined For aortic and mitral valvular functions by color Doppler echocardiography, and 30 normocholesterolemic patients with coronary artery disease were examined as control subjects. In addition, in 22 patients with FH and 20 control subjects, the internal diameter of the aortic annulus and the aortic ridge in cardiac cycles were measured. Of the 10 homozygotes with FH, 8 patients had aortic regurgitation demonstrated by aortography;3 ct them showed significant transvalvular pressure gradients. Stenotic changes of coronary ostia were observed in 8 of the 10 homozygotes with moderate coronary atherosclerosis. Of the 39 heterozygotes with FH, 10 patients had aortic regurgitation shown by Doppler echocardiography, as did only 1 of the 30 control subjects (P < .05). The average diameter and distensibility of the ascending aorta were significantly reduced in the heterozygotes compared with the control subjects, The surgically resected cusp specimens of aortic valves obtained from 1 homozygous and 1 heterozygous patient showed significant thickening of the cusp with foam cell infiltration. Conclusions :Premature atherosclerosis in FH had a characteristic distribution, affecting the aortic root dominantly. The involvement of the aortic valve indicating "hypercholesterolemic valvulopathy" was a peculiar feature of FH, especially ifs homozygous form, b

关键词：主动脉/病理学主动脉/病理生理学主动脉疾病/病因学主动脉疾病/放射摄影术主动脉疾病/超声检查主动脉瓣/病理学主动脉瓣/病理生理学主动脉瓣关闭不全/病因学主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/放射摄影术主动脉瓣狭窄/病因学主动脉造影术动脉硬化/病因学动脉硬化/放射摄影术动脉硬化/超声检查血压/生理学冠状血管造影术冠心病/超声检查超声心动描记术多普勒彩色泡沫细胞/病理学心脏导管插入术心脏瓣膜疾病/病因学心脏瓣膜疾病/病理生理学杂合子纯合子高胆固醇血症Ⅱ型/遗传学高胆固醇血症Ⅱ型/放射摄影术高胆固醇血症Ⅱ型/超声检查二尖瓣闭锁不全/病因学二尖瓣闭锁不全/病理生理学青少年成年人儿童女(雌)性人类男(雄)性中年人

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Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation

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AMERICAN HEART JOURNAL 1999年第3期138卷 477-485页

作者： Tarasoutchi, F Grinberg, M Parga, J Izaki, M Cardoso, LF Pomerantezeff, P Nuschbacher, A da Luz, PL Univ Sao Paulo Sch Med Inst Heart BR-05403000 Sao Paulo Brazil

Background Because cardiac decompensation is subtle, the best time to perform aortic valve replacement surgery may be difficult to determine. We investigated the relation of symptoms to left ventricular (IV) function and the timing of valve replacement in patients with aortic regurgitation (AR) of largely rheumatic origin. Methods Sixty-eight initially asymptomatic patients (mean age 29 years) with severe chronic AR were monitored for 36 months. Assessments included baseline and yearly echocardiograms and radioisotope ventriculography (resting and exercise) and clinical examinations every 6 months. Results Forty-seven patients (69%) remained asymptomatic and 21 (31%) had symptoms develop after 24 to 36 months. Compared with symptomatic patients, asymptomatic patients had significantly (P < .05) lower baseline LV end-diastolic diameter, end-systolic diameter, end-systolic stress, and volume/mass ratio but greater shortening fraction and election fraction (EF) at rest. These variables remained stable without statistically significant change until surgical correction in symptomatic patients. Percent variation of EF from rest to exercise increased in patients who remained asymptomatic (EF 2.8% +/- 10.6%) but decreased in those who became symptomatic (EF -4.2% +/- 13%, P < .05). Twenty symptomatic patients (New York Heart Association class III/IV, angina and/or syncope) had valve replacement surgery, after which all were in New York Heart Association class I/II and had significant decreases of IV end-diastolic and end-systolic diameters and an increase on percent variation of EF from rest to exercise (P < .0001). Conclusions Development of symptoms did not correlate with change in any ventricular function indexes. Surgery on appearance of symptoms restored LV function to near normal.

关键词：主动脉瓣/外科学主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/外科学主动脉瓣关闭不全/超声检查生物假体超声心动描记术运动试验随访研究心脏瓣膜人工心脏瓣膜假体植入病人遴选风湿性疾病/并发症心室功能左成年人女(雌)性人类男(雄)性

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Analysis of agreement between dobutamine stress echocardiography and exercise nuclear angiography in severe aortic regurgitation

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期86卷 104-+页

作者： De Rito, V Natali, R Vigna, C Perna, GP Stanislao, M Lombardo, A Russo, A Forleo, G Fanelli, R Loperfido, F Univ Cattolica Sacro Cuore Inst Cardiol Complesso Integrato Columbus I-00168 Rome Italy IRCCS Casa Sollievo Sofferenza Div Cardiol San Giovanni Rotondo Italy

Dobutamine stress echocardiography was found to be in good agreement with exercise radionuclide angiography in assessing stress-induced left ventricular dysfunction in patients with asymptomatic moderate to severe aor... 详细信息

关键词：主动脉瓣关闭不全/诊断主动脉瓣关闭不全/病理生理学血流速度强心药/投药和剂量强心药/诊断应用慢性病冠心病/诊断多巴酚丁胺/投药和剂量多巴酚丁胺/诊断应用超声心动描记术多普勒运动试验/方法注射静脉内观察者偏差预后放射性核素血管显像术每搏输出量锡多磷酸盐类/投药和剂量锡多磷酸盐类/诊断应用女(雌)性人类男(雄)性中年人

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Medium-term determinants of left ventricular mass index after stentless aortic valve replacement

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ANNALS OF THORACIC SURGERY 1999年第2期67卷 411-416页

作者： Jin, XY Pillai, R Westaby, S John Radcliffe Hosp Oxford Heart Ctr Dept Cardiac Surg Oxford OX3 9DU England

Background. This study aimed to investigate the risk factors for elevated left ventricular mass index 3 to 5 years after stentless aortic valve replacement, and to elucidate the underlying physiologic mechanisms. Methods. Eighty-nine patients (age, 76 +/- 6 years, 51 males) having a stentless porcine valve for aortic stenosis (n = 76) or regurgitation (n = 13) were prospectively studied by Doppler echocardiography 3 to 5 years after operation. Left ventricular systolic function, mass index, blood pressure, cardiac rhythm, and New York Heart Association function class were all determined. Stentless valve effective orifice area, mean pressure drop, and the presence and degree of aortic regurgitation were quantified. Results. The mean stentless aortic valve size was 24 +/- 2 mm. At follow-up time of 45 +/- 9 months, effective orifice area index was 1.2 +/- 0.35 cm(2) m(-2), and mean pressure drop was 5.7 +/- 3.8 mm Hg. Left ventricular mass index was 128 +/- 47 g.m(-2), and ejection fraction was 63% +/- 14%. Multivariant analysis showed a greater left ventricular mass index to be associated with nonsinus rhythm (versus sinus) (163 +/- 8 versus 131 +/- 7 g m-2), greater pulse pressure (> 84 mm Hg) (161 +/- 7 versus 133 +/- 7 g: m-2), New York Heart Association class II or III (versus class I) (166 +/- 10 versus 128 +/- 5 g.m-2), and male sex (versus female) (160 +/- 7 versus 134 +/- 8 g. m-2), all p < 0.01. Mean pressure drop (> 8 mm Hg), effective orifice area index (< 1.0 cm2 m-2), the presence of mild regurgitation of the stentless valve, or the type of previous valve disease were insignificant determinants of left ventricular mass index. Conclusions. Three to five years after the implantation, stentless aortic valve hemodynamics remain excellent. Left ventricular hypertrophy caused by previous native aortic valve disease had largely regressed. However, patient-related factors, particularly systemic blood pressure, cardiac rhythm, and function, are significant causes

关键词：主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/外科学主动脉瓣狭窄/病理生理学主动脉瓣狭窄/外科学生物假体超声心动描记术多普勒随访研究心脏瓣膜人工肥大左心室/诊断肥大左心室/病理生理学手术后并发症/诊断手术后并发症/病理生理学假体设计危险因素心室功能左/生理学老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Effect of Oxymetholone on left ventricular dimensions in heart failure secondary to idiopathic dilated cardiomyopathy or to mitral or aortic regurgitation

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第1期83卷 123-+页

作者： Tomoda, H Tokai Univ Hosp Dept Cardiol Isehara Kanagawa 25911 Japan

This study suggests that the short-term administration of a small dosage of anabolic steroids may have a beneficial effect on the deteriorated myocardium, although long-standing exposure to a larger dosage of anabolic... 详细信息

关键词：同化剂/投药和剂量同化剂/药理学主动脉瓣关闭不全/并发症主动脉瓣关闭不全/病理学主动脉瓣关闭不全/病理生理学心肌病扩张型/并发症心肌病扩张型/病理学心肌病扩张型/病理生理学用药计划表心室/药物作用心室/病理学二尖瓣闭锁不全/并发症二尖瓣闭锁不全/病理学二尖瓣闭锁不全/病理生理学羟甲烯龙/投药和剂量羟甲烯龙/药理学心室功能左/药物作用老年人人类男(雄)性中年人

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Real-time three-dimensional echocardiography for measurement of left ventricular volumes

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第12期84卷 1434-1439页

作者： Schmidt, MA Ohazama, CJ Agyeman, KO Freidlin, RZ Jones, M Laurienzo, JM Brenneman, CL Arai, AE von Ramm, OT Panza, JA NHLBI Cardiol Branch Cardiac Energet Lab Ctr Informat Technol Bethesda MD USA NHLBI Lab Anim Med & Surg Ctr Informat Technol Bethesda MD USA Duke Univ Engineer Res Ctr Durham NC USA

Left ventricular (LV) volumes are important prognostic indexes in patients with heart disease. Although several methods can evaluate LV volumes, most have important intrinsic limitations. Rear-time 3-dimensional echocardiography (RT3D echo) is a navel technique capable of instantaneous acquisition of volumetric images, The purpose of this study was to validate LV volume calculations with RT3D echo and to determine their usefulness in cardiac patients. To this end, 4 normal subjects and 21 cardiac patients underwent magnetic resonance Imaging (MRI) and RT3D echo on the same day, A strong correlation was found between LV volumes calculated with MRI and with RT3D echo (r = 0.91;y = 20.1 + 0.71x;SEE 28 ml). LV volumes obtained with MRI were greater than those obtained with RT3D echo (126 +/- 83 vs 110 +/- 65 ml;p = 0.002), probably due to the fact that heart rate during MRI acquisition was lower than that during RTSD echo examination (62 +/- 11 vs 79 +/- 16 beats/min;p = 0.0001). Analysis of intra- and interobserver variability showed strong indexes of agreement in the measurement of LV volumes with RT3D echo. Thus, LV volume measurements with RT3D echo are accurate and reproducible, This technique expands the use of ultrasound for the noninvasive evaluation of cardiac patients and provides a new tool for the investigational study of cardiovascular disease, (C) 1999 by Excerpta Medica, Inc.

关键词：主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/超声检查心脏容量/生理学心肌病肥厚性/病理生理学心肌病肥厚性/超声检查计算机系统超声心动描记术室间隔缺损/病理生理学室间隔缺损/超声检查肥大左心室/病理生理学肥大左心室/超声检查图像处理计算机辅助磁共振成像心肌缺血/病理生理学心肌缺血/超声检查前瞻性研究参考值心室功能左/生理学成年人老年人女(雌)性人类男(雄)性中年人

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Strategy for optimal aortic regurgitation quantification by Doppler echocardiography:: Agreement among different methods

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AMERICAN HEART JOURNAL 2000年第5期139卷 773-781页

作者： Evangelista, A del Castillo, HG Calvo, F Permanyer-Miralda, G Brotons, C Angel, J González-Alujas, T Tornos, P Soler-Soler, J Hosp Univ Vall dHebron Serv Cardiol Barcelona 08035 Spain

Background Although different Doppler methods have been validated for aortic regurgitation quantification, the benefit of combining information from different methods has not been defined. Methods Our study included 2 phases. In the initial phase (60 patients), Doppler parameters (jet width, short-axis jet area, apical jet area, regurgitant fraction from pulmonary and mitral flow, and deceleration slope) were correlated with angiography;range values for each severity grade were defined and intraobserver and interobserver and intermachine variability were studied. In the validation phase (158 patients), defined value ranges were prospectively tested and a strategy based on considering as the definitive severity grade that in which the two best methods agreed was tested. Results Jet width had the best correlation with angiography (r = 0.91), and its ratio with the left ventricular outflow diameter did not improve the correlation (r = 0.85) and decreased reproducibility. Apical jet area and regurgitant fraction from pulmonary flow permitted acceptable quantification (r = 0.87 and 0.86, respectively) but with worse reproducibility. The other methods were not assessable in 20% to 30% of studies. Concordance with angiography decreased in jet width when the jet was eccentric (90% vs 77%, P < .01), in apical jet area when mitral valve disease was present (84% vs 65%, P < .02), and in short-axis let area and regurgitant fraction from pulmonary flow with concomitant aortic stenosis (77% vs 44%, P < .002 and 77% vs 53%, P < .02, respectively). Agreement with angiography was very high (94 [95%] of 99) when severity grade coincided in both jet width and apical jet area. In 59 cases without concordance, regurgitant fraction from pulmonary flow was used as a third method. Overall, this strategy permitted concordance with angiography in 146 patients (92%). Conclusions Jet width is the best predictor in aortic regurgitation quantification by Doppler echocardiography. However, better

关键词：主动脉瓣/病理生理学主动脉瓣/超声检查主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/超声检查超声心动描记术多普勒彩色/统计学和数值数据超声心动描记术多普勒脉冲/统计学和数值数据观察者偏差敏感性与特异性成年人老年人女(雌)性人类男(雄)性中年人

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Associations of aortic and mitral regurgitation with body composition and myocardial energy expenditure in adults with hypertension: The Hypertension Genetic Epidemiology Network study

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AMERICAN HEART JOURNAL 2003年第6期145卷 1071-1077页

作者： Palmieri, V Bella, JN Arnett, DK Oberman, A Kitzman, DW Hopkins, PN Rao, DC Roman, MJ Devereux, RB Cornell Univ Weill Med Coll New York NY USA Univ Minnesota Minneapolis MN USA Univ Birmingham Birmingham AL USA Wake Forest Univ Bowman Gray Sch Med Winston Salem NC USA Univ Utah Sch Med Salt Lake City UT USA Washington Univ Sch Med St Louis MO USA

Background it has been reported that aortic regurgitation, mitral valve regurgitation, or both are associated with lower body mass index, an index of body adiposity. However, the relations of valvular regurgitation to body composition and myocardial bioenergetic expenditure have not been previously investigated in a population-based sample. Methods We selected 1496 patients with hypertension who did not have diabetes mellitus to participate in the Hypertension Genetic Epidemiology Network (HyperGEN) study. We excluded participants with severe aortic or mitral stenosis or with known coronary heart disease. Bioimpedance was used to assess body composition. Echocardiography was used to assess left ventricular (LV) structure and function and to calculate myocardial workload (expressed as energy expenditure) from end-systolic stress, ejection time, and stroke volume. The study sample was divided into groups without mitral or aortic regurgitation (control subjects, n = 1175), with mild valvular regurgitation (1 +, n = 246), and with at least moderate (greater than or equal to2+) mitral or aortic regurgitation (n = 75). Results The mean patient age was higher with more severe valvular insufficiency. Sex distribution and blood pressure were similar among the 3 groups. Body mass index and fat mass were significantly lower with more severe valvular regurgitation, whereas fat-free mass was only slightly lower in the group with greater than or equal to2+ regurgitation compared with control subjects. Skinfold thicknesses (brachial and subscapular) were lower with more severe valvular regurgitation, whereas self-reported physical activity per week was similar among the 3 groups. LV mass and circumferential end-systolic stress were higher with more severe valvular regurgitation. Noninvasively estimated myocardial energy expenditure was slightly higher in participants with 1 + valvular regurgitation and-was significantly higher with greater than or equal to2+ regurgitation. Ejectio

关键词：脂肪组织/病理学主动脉瓣关闭不全/代谢主动脉瓣关闭不全/病理生理学身体成分病例对照研究超声心动描记术能量代谢心室/超声检查高血压/遗传学高血压/代谢高血压/病理生理学二尖瓣闭锁不全/代谢二尖瓣闭锁不全/病理生理学心肌/代谢皮肤壁厚度心室功能左老年人女(雌)性人类男(雄)性中年人

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Testing the test: The reliability of echocardiography in the sequential assessment of valvular regurgitation

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AMERICAN HEART JOURNAL 2002年第1期144卷 115-121页

作者： Gottdiener, JS Panza, JA Sutton, MS Bannon, P Kushner, H Weissman, NJ St Francis Hosp Roslyn NY 11576 USA NHLBI Bethesda MD 20892 USA Hosp Univ Penn Philadelphia PA 19104 USA Mercy Hosp Pittsburgh PA 15219 USA BIOMED Comp Res Inst Philadelphia PA USA Cardiovasc Res Inst Washington DC USA

Background and Objective Substantial variability in serial echocardiographic qualitative assessment of valvular regurgitation may exist. Reader variability is generally well understood, but acquisition variability (portions of variability caused by equipment, sonographers, physiologic changes) has been less frequently assessed, particularly in combination with reader variability. We attempted to determine the relative contributions of acquisition and reader variability as components of total test-retest variability for aortic (AR) and mitral (MR) regurgitation. Methods Outpatient echocardiographic study was done at 2 clinical sites. Twenty-three predominantly obese middle-aged females had 3 echocardiograms, 2 performed 14 +/- 3 days apart and the third performed within I to 2 hours of the second. Triplets of echocardiograms were evaluated for change in grade of AR and MR. Medical history, anthropometrics, and blood pressures were obtained. Results Average intrareader variability (percentage of reads for which there is within-reader disagreement) was 5.6% for AR and 16.7% for MR. The average total test-retest variability (percentage of reads for which there is disagreement between visits) was 29.0% for AR and 24.6% for MR. The acquisition variability for AR was 23.4% +/- 7.7%;for MR, it was 7.9% +/- 10.2%. A significant predictor of change for AR/MR was the initial grade. Change in diastolic blood pressure was positively associated with change in AR and MR. Conclusions Intrareader agreement was substantial for AR and MR. Components of total test-retest variability found were reader, biological (change in diastolic blood pressure), and regression to the mean. Recommendations for clinical practice include monitoring blood pressure changes and understanding the confidence limits of the clinical test. Test-retest variability and its components should be considered in echocardiography and other diagnostic testing.

关键词：主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/超声检查超声心动描记术多普勒彩色/标准二尖瓣闭锁不全/病理生理学二尖瓣闭锁不全/超声检查肥胖症/病理生理学观察者偏差回归分析可重复性结果青少年成年人女(雌)性人类男(雄)性中年人

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