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| 2. |
- Henein, Mark, et al.
(författare)
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Atrial fibrillation (mechanistic view point)
- 2009
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 134:2, s. 270-272
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Ramzy, Ihab S., et al.
(författare)
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Ventricular endocrine and mechanical function following thrombolysis for acute myocardial infarction
- 2007
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 117:1, s. 51-58
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objective of this study was to assess natriuretic peptide release following acute myocardial infarction, and its relationship with ventricular function. Methods A total of 44 patients with acute myocardial infarction were studied; 13 anterior, age (57 ± 12 years) and 31 inferior, age (58 ± 12 years). Peptide levels and left ventricular function by echocardiography were assessed at admission and on days 7 and 30 after thrombolysis. Healthy volunteers (n = 21) served as controls. Results Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) levels rose from admission to day 7 (p = 0.002). While ANP remained elevated at day 30 in both groups, BNP levels fell in patients with anterior myocardial infarction (p = 0.03). Left ventricular fractional shortening was reduced at admission in the two groups (p = 0.01) but returned towards normal in 7 days (p = 0.001) in inferior myocardial infarction and in 30 days in anterior myocardial infarction (p = 0.02). Left ventricular long axis amplitude was universally reduced at admission (p = 0.01) and remained abnormal at day 30 (p = 0.01) in both groups. At day 7, BNP and ANP levels inversely correlated with long axis amplitude of lateral wall in anterior myocardial infarction; (r = − 0.7, p = 0.01). BNP correlated inversely with fractional shortening in anterior myocardial infarction (r = − 0.7, p = 0.01) at day 30. Conclusion The elevated peptide levels at 7 days post-myocardial infarction correlate with reduced mechanical activity of the adjacent noninfarcted segment. Natriuretic peptides release seem to be related to failure of compensatory hyperdynamic activity of the noninfarcted area rather than directly from the injured myocardial segments.
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| 4. |
- Renna, Maurizio, et al.
(författare)
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Remifentanil plus low-dose midazolam for outpatient sedation in transesophageal echocardiography.
- 2008
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The search for optimal sedation for transesophageal echocardiography (TEE) continues. We hypothesized that the ultra-short acting opioid remifentanil combined with very low-dose midazolam would provide a better sedation and recovery profile compared to midazolam alone. METHODS: 41 consecutive outpatients scheduled for TEE received either IV midazolam (group M, 2.5 mg bolus plus 1 mg increments repeated as needed, n=18) or a combination of a low-dose IV bolus of midazolam (0.5 mg) plus an infusion of remifentanil (group RM, 0.1 mcg/kg/min, reduced to 0.08 mcg/kg/min after probe insertion, n=23). All patients received topical pharyngeal anesthesia with 2 puffs of lidocaine 4% spray. We recorded BP, SpO(2), HR, time-to-discharge (modified Aldrete score of 13), duration of procedure, resource utilization, complications, ease of probe introduction, ease and quality of the procedure. Patients' satisfaction with sedation was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS). RESULTS: Mean dose of midazolam in group M was 3.7+/-1.3 mg. Median time-to-discharge was significantly reduced in the RM group compared with the M group (5 (5-10) vs. 30 (5-240) min, p<0.0001), with 22 of the 23 group RM patients ready for "street discharge" within 5 min of removal of the TEE probe. Ease of probe insertion (p=0.001), resource utilization (p=0.0001), patient satisfaction (p=0.03) and overall ease and quality of the procedure (p=0.0001) were significantly better in the RM group than in the M group. No episodes of desaturation were observed. CONCLUSIONS: This is the first report of the use of an ultra-short acting opioid, remifentanil, combined with a low-dose of midazolam, as a sedative technique for outpatient TEE. In this pilot, non-randomized prospective study, remifentanil plus low-dose midazolam provided better sedation than our current practice of higher bolus doses of midazolam alone. This novel approach is associated with improved procedure tolerance, faster recovery and minimal resource utilization. A randomized, controlled study is under way to verify our preliminary results.
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| 5. |
- Bajraktari, Gani, et al.
(författare)
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Prolonged total isovolumic time predicts cardiac events following coronary artery bypass surgery
- 2008
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Ingår i: European Journal of Echocardiography. - : Oxford University Press. - 1525-2167 .- 1532-2114. ; 9:6, s. 779-783
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Left ventricular (LV) systolic dysfunction may be associated with compromised stroke volume, which may be caused by asynchrony, reflected on the prolongation of isovolumic time (t-IVT). To assess the prognostic role of Doppler echocardiographic measurements in predicting cardiac events after coronary artery bypass grafting (CABG).METHODS AND RESULTS: The study included 74 patients undergoing routine CABG. A pre-CABG Doppler echocardiographic assessment of LV dimensions, filling and ejection was performed and t-IVT was determined as [60 - (total ejection time + total filling time)]. Follow-up period was 18 +/- 12 months. Of the 74 patients (age 65 +/- 16 years, 59 males), 29 underwent hospital admission for a cardiac event or died. There were no differences in age, gender, incidence of previous infarct or mitral regurgitation, LV-EDD (left ventricular end-diastolic dimension), left atrial or right ventricular size in patients with cardiac events compared with those without events. Left ventricular end-systolic dimension (LV-ESD) was greater (4.5 +/- 0.9 vs. 3.9 +/- 0.9 cm, P = 0.003), fractional shortening (FS) was lower (21 +/- 4 vs. 32 +/- 8%), E:A ratio and Tei index were higher (2.1 +/- 0.8 vs. 1.0 +/- 0.6 and 0.9 +/- 0.3 vs. 0.6 +/- 0.3, all P < 0.001), and t-IVT was longer (16 +/- 5 vs.10 +/- 4 s/min, P < 0.001) in patients with events. Multivariate predictors of post-CABG events (odds ratio 95% confidence interval) were low FS [0.66 (0.50-0.87), P < 0.001], high E:A ratio [l4.13 (1.17-14.60), P = 0.028], large LV-ESD [0.19 (0.05-0.84), P = 0.029], and long t-IVT [1.37 (1.02-1.84), P = 0.035].CONCLUSION: Despite satisfactory surgical revascularization, long t-IVT and systolic dysfunction suggest persistent ventricular dyssynchrony that contributes to post-CABG cardiac events. Early assessment of such patients for potential benefit from electrical resynchronization may optimize their cardiac performance and hence clinical outcome.
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| 6. |
- Bukachi, Frederick, et al.
(författare)
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Age dependency in the timing of mitral annular motion in relation to ventricular filling in healthy subjects : Umea General Population Heart Study
- 2008
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Ingår i: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 9:4, s. 522-529
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Peak left ventricular (LV) relaxation normally precedes peak filling (E), which supports the hypothesis that LV suction contributes to early-diastolic filling. The significance of similar temporal discordance in late diastole has previously not been studied. We describe the time relationships between mitral annular motion and LV filling in early and late diastole and examine the effect of normal ageing on these time intervals. METHODS AND RESULTS: A total of 128 healthy subjects aged 25-88 years were studied. Transmitral and pulmonary venous flow reversals (Ar) were recorded by Doppler echocardiography. Mitral annular diastolic displacement-early (E(m)) and late (A(m))-were recorded by Doppler tissue imaging. With reference to electrocardiographic R and P-waves, the following measurements were made: R to peak E-wave (R-E) and E(m) (R-E(m)); onset P to peak A-wave (P-pA), A(m) (P-pA(m)), and Ar (P-pAr). The differences between [(R-E) and (R-E(m))] for early-diastolic temporal discordance (EDTD) and [(P-A) and (P-A(m))] for late-diastolic temporal discordance (LDTD) were calculated. Isovolumic relaxation time (IVRT) was also measured. Early-diastolic temporal discordance was approximately 26 ms in all age groups. Late-diastolic temporal discordance, however, was inversely related to age (r = -0.35, P < 0.001) and IVRT (r = -0.34, P < 0.001) and therefore decreased in the elderly vs. young (13 +/- 10 vs. 23 +/- 10 ms; P < 0.001). In multivariate analysis, age failed to predict LDTD in the presence of IVRT. A, A(m), and Ar were simultaneous at onset, and peak A(m) coincided with peak Ar in all age groups (r = 0.97, P < 0.001). No significant differences were noted in the RR intervals. CONCLUSIONS: Sequential prolongation of IVRT with ageing reduces LDTD, thus converging the peaks of A(m), A, and Ar (atrial mechanical alignment)-a potential novel method to identify subjects at increased dependency on atrial contraction for late-diastolic filling.
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| 7. |
- Byström, Björn, et al.
(författare)
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The right ventricle : knowing what is right
- 2008
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Ingår i: The International Journal of Cardiovascular Imaging. - Dordrecht : Springer. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 24:7, s. 701-702
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Chao, Guihua, et al.
(författare)
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Tei index : The earliest detectable cardiac structural and functional abnormality detectable in Hb Bart's foetal edema.
- 2009
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 134:3, s. e150-154
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Premature death and still births are common in Hb Bart's foetal edema which carries significant risk to mothers. We aimed to identify early changes in cardiac structure and function in a cohort of HB Bart's foetuses, using Doppler echocardiography. METHODS: We studied 97 HB Bart's foetuses in different gestation groups; I (20-24 weeks),..., V (37-42 weeks) and compared them with age matched controls. We measured right and left atrial diameters as well as right and left ventricular diameters. From the Doppler filling and ejection velocities of the right and left ventricles we measured Tei index in 30 foetuses and compared them with age matched normal controls. RESULTS: The four cardiac chamber dimensions were not significantly different from the respective controls (p=NS for all). The right atrial diameter was enlarged in groups II, III, IV and V (p<0.05 vs normal controls). The right ventricle was significantly dilated in group III, IV and V (p<0.05-0.01) compared with normals. The left atrium and left ventricle were enlarged in groups III and IV, respectively (p<0.05 vs normals). Transmitral and transtricuspid E/A ratio was significantly less than normal in groups III (p<0.01), IV (p<0.05) and IV (p<0.05). LV and RV fractional shortening and stroke distance of group IV and V were significantly less than the respective normals (p<0.05 for all). LV and RV Tei index increased progressively from 20-week gestation (p<0.05) with respect to controls. CONCLUSIONS: In HB Bart's foetuses left and right ventricular asynchrony develop earlier than overt cavity dilatation and impairment of systolic function. The use of such markers of ventricular asynchronous function may play an important role in optimum management of these pregnancies.
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| 9. |
- Chung, R, et al.
(författare)
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Beyond dyssynchrony in cardiac resynchronisation therapy.
- 2008
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Ingår i: Heart (British Cardiac Society). - : BMJ. - 1468-201X .- 1355-6037. ; 94:8, s. 991-4
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac resynchronisation therapy (CRT) in the form of biventricular pacing has emerged as a therapeutic option for patients with refractory heart failure. Patient selection and optimisation for CRT is based on the measurement of electromechanical ventricular dyssynchrony by electrocardiogram and echocardiographic techniques. The final common pathway for raising cardiac output on exertion is to minimise isovolumic time and maximise useful diastolic filling time, but correction of dyssynchrony alone may not lead to global improvement in about one-third of patients. Insights into pressure relations and abnormal timing, as well as clinical management, may hold the key to optimum outcome.
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