Atrial Pacing Stress Echocardiography: an Alternative Diagnostic Test for Chest Pain in the Elderly

The American Journal of Geriatric Cardiology. Nov-Dec, 2002  |  Pubmed ID: 12417847

The authors utilized rapid right atrial pacing and handgrip exercise to provoke myocardial ischemia in 20 participants (age >65 years) who, for reasons of disability, were not candidates for exercise and pharmacologic stress testing. Echocardiographic left ventricular ejection fraction and left ventricular wall motions were obtained during pacing at baseline and at maximal pacing rates and were compared with coronary angiography. Using the failure of left ventricular ejection fraction to increase with pacing as an indicator of myocardial ischemia, the test yielded a sensitivity of 75%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 71%. When a pacing-induced decrease of wall-motion index was taken as an ischemia indicator, the sensitivity was 63%, specificity 100%, positive predictive value 100%, and negative predictive value 80%. Rapid atrial pacing echocardiography is a safe test. It may be considered in a select group of elderly patients as an alternative to exercise or pharmacologic tests before resorting to coronary angiography.

Tangier Disease with Unusual Clinical Manifestations

Clinical Genetics. Apr, 2003  |  Pubmed ID: 12702168

Usefulness of Right Ventricular Tissue Doppler Imaging to Predict Outcome in Left Ventricular Heart Failure Independent of Left Ventricular Diastolic Function

The American Journal of Cardiology. Apr, 2007  |  Pubmed ID: 17398192

It is unknown whether right ventricular (RV) tissue Doppler (TD) predicts outcome in patients with left ventricular (LV) heart failure (HF) independently of contemporary echocardiographic Doppler variables of LV diastolic function. Comprehensive echocardiographic Doppler examination was performed before discharge in 107 patients hospitalized with LV HF. The primary end point was cardiac death or rehospitalization for HF. Follow-up was complete for 100 of 107 patients a mean of 527 days after hospital discharge. There were no significant differences in baseline clinical variables (mean age 58+/-12 years, 46% women, 77% hypertensive, 48% diabetic, 41% current smokers, and 23% known coronary artery disease) in prediction of the primary end point. Compared with patients without an event, patients with an event had a larger left atrial volume index (42+/-16 vs 33+/-13 ml/m2, p=0.001), lower LV ejection fraction (35+/-19% vs 46+/-22%, p=0.01), higher mitral peak early diastolic flow velocity/TD early diastolic velocity (19+/-7 vs 14+/-7, p=0.001), lower RV fractional area change (39+/-11% vs 43+/-10%, p=0.04), and lower RV TD systolic velocity (8+/-2 vs 10+/-3 cm/s, p=0.005). On Cox proportional hazards multivariate analysis, left atrial volume index (p=0.01), mitral peak early diastolic flow velocity/TD early diastolic velocity (p=0.03), and RV TD systolic velocity (p=0.04) were independent predictors of outcome. Even when contemporary echocardiographic Doppler measures of LV diastolic function are considered, RV TD systolic velocity is an independent predictor of cardiac death or rehospitalization for HF in patients hospitalized with HF and appears to be superior to conventional 2-dimensional parameters of RV function.

Usefulness of B-type Natriuretic Peptide Levels to Predict Left Ventricular Filling Pressures in Patients with Body Mass Index >35, 31 to 35, and < or =30 Kg/m2

The American Journal of Cardiology. Oct, 2007  |  Pubmed ID: 17884382

Noninvasive left ventricular (LV) pressure estimation in obese patients has not been well described. Simultaneous B-type natriuretic peptide (BNP) and echocardiographic Doppler examinations were performed in patients with dyspnea undergoing cardiac catheterization. Patients were divided into body mass index (BMI) >35 (markedly obese), 31 to 35 (obese), and < or =30 kg/m2 (nonobese). BNP levels and mitral early diastolic/tissue Doppler annular velocity (E/Ea) were compared with invasively measured LV end-diastolic and pre-atrial (pre-A) pressures. Seventy-two patients were studied. Except for BMI, LV mass index, and LV diastolic dimension, there were no significant differences in baseline, echocardiographic Doppler, or hemodynamic characteristics among the groups. However, BNP was significantly lower in markedly obese compared with obese and nonobese patients (116 +/- 187 vs 241 +/- 674 and 277 +/- 352 pg/ml, respectively; p = 0.03). BNP did not correlate with LV pre-A pressure in markedly obese patients (R = 0.13, p = 0.47), whereas BNP significantly correlated with this variable in the obese (R = 0.64) and nonobese (R = 0.58) groups. Mitral E/Ea significantly correlated with LV pre-A and LV end-diastolic pressures in all BMI groups. In markedly obese patients with dyspnea, BNP did not correlate with invasively measured LV filling pressure, whereas this correlated in obese and nonobese patients. However, mitral E/Ea significantly correlated with LV filling pressures in all BMI groups. In conclusion, BNP is not recommended for LV filling pressure estimation in ambulatory patients with dyspnea with BMI >35 kg/m2.

Usefulness of New Diastolic Strain and Strain Rate Indexes for the Estimation of Left Ventricular Filling Pressure

The American Journal of Cardiology. May, 2008  |  Pubmed ID: 18471466

Tissue Doppler indexes of left ventricular (LV) filling pressure are prone to angulation errors and tethering and are less reliable in patients with preserved LV ejection fraction and indeterminate early peak transmitral diastolic flow (E)/mitral early diastolic velocity (Ea) (8 or =8 had higher sensitivity and specificity (95% and 94%, respectively; area under the curve = 0.96, p <0.0001) than E/Ea > or =15 (sensitivity 81%, specificity 75%; area under the curve = 0.85, p <0.0001) for the prediction of LV pre-A pressure > or =15 mm Hg (p = 0.01 for comparison). In patients with LV ejection fraction > or =50% and 8 or =50% or indeterminate E/Ea, both E/Ds and E/10DSr (a ratio based on global DSR) were better predictors of LV filling pressure than E/Ea.

Assessment of Left Ventricular Systolic Function Using Echocardiography in Patients with Preserved Ejection Fraction and Elevated Diastolic Pressures

The American Journal of Cardiology. Jun, 2008  |  Pubmed ID: 18549856

There is controversy regarding the nature of systolic function in patients with elevated filling pressure and preserved left ventricular (LV) ejection fraction. In this study, tissue Doppler variables and 2-dimensional echocardiographic systolic strain (SS) and systolic strain rate (SSr) were measured in patients who underwent cardiac catheterization to determine correlations with invasively measured LV end-diastolic pressure (LVEDP), dP/dt, and LV mass. Forty patients were studied. Their mean age was 55.9+/-9.9 years, and their mean LV ejection fraction was 59.8+/-5.2%. Tissue Doppler systolic annular velocity (5.4+/-1.1 vs 6.4+/-1.0 cm/s, p=0.04), SS (13.4+/-3.7% vs 18.8+/-2.3%, p <0.001), and SSr (0.73+/-0.17 vs 0.98+/-0.14 s(-1), p <0.001) were significantly lower in patients with LVEDP >20 mm Hg compared with those with LVEDP <20 mm Hg. Tissue Doppler systolic velocity, SSr, and SS were correlated with LV mass (R=0.58, R=0.57, and R=0.52, respectively, all p values <0.001) and with LVEDP (R=0.49, p=0.002; R=0.79, p<0.001; and R=0.70, p<0.001, respectively). However, dP/dt was not significantly different between patients with LVEDP >20 mm Hg and those with LVEDP <20 mm Hg (1,387+/-520 vs 1,495+/-594 mm Hg/s, respectively, p=0.55) and was not correlated with LV mass (R=0.18, p=0.25). The optimum cut-off values for LVEDP >20 mm Hg were SSr <0.85 s(-1) (area under the curve 0.88, p<0.001, positive predictive value 89%, negative predictive value 86%) and SS<16% (area under the curve 0.84, p=0.002, positive predictive value 88%, negative predictive value 79%). In conclusion, as opposed to invasively measured dP/dt, tissue Doppler systolic velocity and 2-dimensional echocardiographic SS and SSr are significantly depressed in patients with preserved LV ejection fraction and LVEDP >20 mm Hg, suggesting that systolic abnormalities are present in at least some of these patients. These differences are likely because invasively measured dP/dt and these echocardiographic variables measure different systolic properties in patients with preserved LV ejection fraction.

Hydrolyzed Casein Influences Intestinal Mucin Gene Expression in the Rat

Journal of Agricultural and Food Chemistry. Jul, 2008  |  Pubmed ID: 18558707

The effect of hydrolyzed casein (HC) on the expression of three mucin genes (Muc2, Muc3, and Muc4) in the rat intestine was investigated using quantitative real-time polymerase chain reaction. After a 10 day acclimatization period, rats received for 8 days the test diets containing either HC or a synthetic amino acid (SAA) mixture as the sole source of nitrogen or a protein-free (PF) diet (n = 12 per treatment). The addition of HC or the SAA mixture to the diet significantly improved average daily gain, average daily food intake, and gain:feed ratio as compared with the PF diet. Terminal ileal endogenous N flow was significantly higher for the HC-fed rats in comparison with either the SAA or the PF rats (p < or = 0.001). HC supported a significant increase of Muc3 mRNA (277 and 229% of that for diets PF and SAA, respectively; p < or = 0.05) in the small intestinal tissue and Muc4 mRNA (325 and 265% of that for diets PF and SAA, respectively; p < or = 0.05) in the colon. In conclusion, HC enhances ileal endogenous N flow and up-regulates in vivo the expression of some individual mucin genes.

Previous Left Main Coronary Artery Dissection: Detected Upon Multislice Computed Tomography

Texas Heart Institute Journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital. 2008  |  Pubmed ID: 18941597

Multislice Computed Tomography of a Repaired Anomalous Left Coronary Artery Arising from the Pulmonary Artery

Texas Heart Institute Journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital. 2008  |  Pubmed ID: 19156251

Correlation of Tissue Doppler and Two-dimensional Speckle Myocardial Velocities and Comparison of Derived Ratios with Invasively Measured Left Ventricular Filling Pressures

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. Mar, 2009  |  Pubmed ID: 19168324

There are a paucity of data comparing spectral and color tissue Doppler (TD) with non-Doppler, speckle-based myocardial velocities, and it is unknown how early transmitral diastolic velocity/mitral annular velocity (E/Ea) calculated using speckle velocities compares with TD-derived E/Ea.

Do Additional Echocardiographic Variables Increase the Accuracy of E/e' for Predicting Left Ventricular Filling Pressure in Normal Ejection Fraction? An Echocardiographic and Invasive Hemodynamic Study

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. Feb, 2010  |  Pubmed ID: 20152696

There are few data on adding left atrial volume index (LAVi) or pulmonary artery systolic pressure (PAP) to the ratio of early mitral inflow to mitral annular velocity (E/e') for the estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fractions (LVEFs) (>50%).

New, Simple Echocardiographic Indexes for the Estimation of Filling Pressure in Patients with Cardiac Disease and Preserved Left Ventricular Ejection Fraction

Echocardiography (Mount Kisco, N.Y.). Sep, 2010  |  Pubmed ID: 20849482

There are few data on echocardiographic indexes incorporating peak mitral inflow velocity (E), left atrial volume index (LAVi), and pulmonary artery pressure (PAP) for estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fraction (EF ≥ 50%).