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CAP 127 Stress doppler echo — Beyond ischemic heart disease
SlO
Ultrasound
in Medicine
and Biology
Volume 23, Supplement
1,1997
CAP 127
CAP 129
STRESS DOPPLER ECHO. BEYOND ISCHEMIC HEART DISEASE AUTHOR9 Sued M : Simondi H : Jimener M : Marinarl # : Cbrdaba L.: Hunriksr G.; Charerrsta G.; Pieroni M.; Galetto R.; Cresta C.: C&que R.; Libiqmst V.; Manallotto R. INSTilUfO DE CARDlOLOGlA - HOSPITAL ITALIAN0 _ CORDOBA . ARGENTINA CENlRO MEDICO MONTE SINAl - CORDOBA _ARGENTlNA OBJECTlVES : Slress Doppler Echo (SD@ is a sensiiii method for the dmgnosis of segmentary abnonalltles of myOC9rdlal contractlllty (S&K) and for tha assessment of Iefi ventricular funcion (LM). Though it is not always specilrc for coronary head diseases and thnre are pathologies thal can produci an abnormal slress echo but contnbubna other elemsms lo carchac dleanosls III head dlssases. il~e~eim of this study wa; 10 assess the results of @E) in patients (p) tih dillerent cardiovascular diseases and to analize the rasufls obtained METHODS: 104 (p) wsrs studied and ths following parameters we assessed: 1) (SAWIC). 2) ejection fredion (EF). end systolic volume index @VI). systolic blood pressure (SBP /ES/I). 3) gradients and vahular areas, 4) vaivular I’egurgkatlOn, 5) right vemriculer systolic pressure (RVSP). The reasons for carrying out the (SDE) )*Bre lo assess the following dyspnea. cardial pain. arrhylhmla. (LVli). (S.AMC) and cardiac hean murmurs. The etiologies were the following: 1) ischemc heart disease in 68 (pJ @.7X). 2) cardiac murmur in 28 (p) @KS%) oul of whom 14 wure sonic with: sonic stenosis is p). bcuspid aorta (1~). aorlic colcificafions [e P) end in 14 (p) the origin was mitral vehe fllseasa with: mitral slanosis Q p), mitral valve annular calcification (2 p), 10 (p) mitral velve prolepses 0. 3) hypertension in 14 (p)(l3.5%) lncludlng 2 myocardlopafhles and 4) 4 (p) (3.9%) with venuicular aneurysm and 2 (p) with-atria1 septum aneurysms. RESULTS: B5% showad (SAMC) wilh @DE). Regarding the parameters of Lhe (LVF). we consrder 3 groups: A) wiih normal response 10 effort with en Increase of EF, decmase of (Em) and increase of the (SBP I ESVl) at which they warn 19.2%. 8) insficienr msponsa 10 effort but without a drop in the (EF) 73% C) decline ofthe parameters of (LVEF) in 7.8%. Regarding the gradiems and valvular arees. aE4% of aoruc murmurs showed a slight increase of ifs peak gradianl. and 38% fyl4) showed a modarata mcrease 01 the peak gradients @Xi% of increase). Of them Ql 4%) did not chenge Ihe aodic v&a area and f 14.3%) decreased the sonic vahe ama (19% to 49%) with a eJectton fraction below 40%. In these (p) w?3 used dobutamine (SDE).The (p) with mitral valve calcification (MVC) shownd a slight increase of hts gradient and two (p) with mnral stenosis showed a mild mcrease though meinlaininp the valvular area. In (t&F’): 38% shorrsd mitral InsuiIciency. oul of wtlich $7 were considered mdd and 3 moderate. We poinl out lhet only 11 5?b of the pal~ents showud a mild mitral insvfficiency et rest. Regarding (RVSP) wa noticed an Increase in only 3.8% in morn it was nOt possible to obserm tricuspid regurgitation. CONCLUSIONS. The (SDE) allows for the assessment not only of myocardial contracltlrty bul else of dflerent parameters of the (LVF). pressures, gradrents. vahdar regurgrlations at rest and its responses lo effort. tiich mpmsents e potential clinical usefulness not only for diagnosis but for dynamic assessment and thbrapeutical monitoring in diierent csrdlovascular pathologies.
OPTlYuM DRY wEwrr. IT8 EVALwTlMl BY wouc ECHO DOPPLER. UAMETER OF lNFERl*R VEM CAVA Mul c%waEs IN THEVmRlwUR QEOMETRY IN DtALYslS PAnENs.
CAP
CAP 130
128
Contrast Echccmdiognphy E. Kreuber, G. Narfdziart,
in By-Passing of the H. Vazqwz, M. Reman.
Right Ventricle M. Siarelo,
A.
CUWro, A SdJibRer M. Grlppo, 0. MeuUzer. CatiovasagF Dept. Gulimez Childrem? Hospital. Bwnos Aires, Argmllna. Wispossibletowabate!hefcbwingcompka8onsof bfal(TBP)or partial (PBP) bypass of the II@ vent&la: pthomuy arferio.venaus tishtaa (PAVF), whteral chuMon (CCW) from superior vena cays to infetia wna cava (NC) , and resi&ai abial bmi, using ccnlmst emoeradoqaphy
right to leR shmt
s(RRLS)
at
CotmectiOn
Ume X 3.7~ (3.2 to 6,6 y). I)
(CE). bfafWb1 and me(hadp: 58 F’fttiWtS (P) sged 2,5 to 33 yeWS (X9,4y) W-i TBPaPBPinves(igatsdbyCE,~~ngarapldin)ectionof3mlol shelctn Sawna (p<2oKg) tmd 6ml (p CtOIQ) Into an arm vain. Presenca of conha. in the puhonary artary (PA) veft8w.l in Hp. in thesa paflents theprocadrrewasmpaatadlookingforconbastinlJleIVcor qrahepatk veins (CCW in BPP). An ifjeciion ws parfotmed to vadfy Iha prssence of contart In Uw M aWun (RRLS) and in p&onary veins (PAM). m43 p. Pos@araW tbm ws x:2y ( 3m to 4,7y) 1)29 p with bkSrectional cavw@ncwy stunt (BCPS) wlm aduiiulal flow ;2) 10 p with parbl Mvenlrlurlar cwe.cWn (PBC) ; 3) 2p wim KawasiWa (K) type BCPS; 4) 2p. WHh ctassic Gkm cave punmary (G). =:I
10~: abi-
(X) PAVF
1 P. i’dOp@aW
(APA). . . iI1, 10. with tow
arWom&
-
PEAK VELOCITIES “A” TRANSMITRAL WAVE/“A” PULMONARY VEIN WAVE RATIO: RELATION TO lNTRAvENTwCULARPRESSUREs Maria E. Adaniva Rkardo A. Migiiore, Rodolfo Remoso, Florencio T. Guerwro, Christian Rando, Jaime Poch, Maria 1. Ardid, Horatio Tamagusuku. Adriana Ci~eco, Jose L Rojas, M Gomez Hospital Eva Per& San Martin, Pcia de Buenos Aires, Argentina. The iefi atrium (LA) ejects during systoie blood forward to fill the letI ventricle and backward to the pulmonary veins(PV). The peak velocity of the “A” transmitrai wave (Am) and of the “A” reversal wave of pulmonary veins (Apv) registered by Doppler technique reflects this t&t, but the absolute value of each of these wave cm be influenced by systolic timction of left atrium and intraventricuiar pressurea (IP). The ratio Am/Apv should be useful to evahtate IP, independently of the LA systolic fimction. Objective: Assessment of the relation between Am/Apv ratio and IP. Metho&: Sixty nine patients(p) with ischemic heart disease were studied with Doppler echocardiography an hour before cardiac catheterization. Fifty eight p(84%) had adequate register of PV by transthoracic echocardiography and were included in this study. There were 43 male and 15 female (age average 58 +/- 10 years). We performed them a complete &w-dimensional and Doppler study, to measure peak velocity of Am and Apv and to calculate AmIApv ratio. Left intraventricuiar pressures (end-diastolic (EDP), pre-A) were recorded during catheterization. Results: AmlApv had an inverse correlation with pm-A pressure (r = -0,43 ’ p
y.
4 26 22
1
3 1 : -CON 2 2 _ CCDI Conc&~skm: 1) CE was tech&a& adewade in 54159p (91.5%) In PA 2) In P36,PAVF was (temkb& tycicin PiendLAinimp
6 32 26
bv CE
(13.9%). while CCVVwas c&bed tvy CE in NC w 8lpahepatk ydm in 33431, (74,5%), mosfty In BCPS (89.8%) qqasing to fhe PBC gap (30%). 3) In TBP. RRLS was detacbd by CE in LA in zlllp ( 18%) and noPAVFwewde@ctadbyCEinPVinllpinvasDigatsd.
11
.
.
l
Ed
Ultrasound
in Medicine
and Biology
Volume 23, Supplement
1,1997
CAP 127
CAP 129
STRESS DOPPLER ECHO. BEYOND ISCHEMIC HEART DISEASE AUTHOR9 Sued M : Simondi H : Jimener M : Marinarl # : Cbrdaba L.: Hunriksr G.; Charerrsta G.; Pieroni M.; Galetto R.; Cresta C.: C&que R.; Libiqmst V.; Manallotto R. INSTilUfO DE CARDlOLOGlA - HOSPITAL ITALIAN0 _ CORDOBA . ARGENTINA CENlRO MEDICO MONTE SINAl - CORDOBA _ARGENTlNA OBJECTlVES : Slress Doppler Echo (SD@ is a sensiiii method for the dmgnosis of segmentary abnonalltles of myOC9rdlal contractlllty (S&K) and for tha assessment of Iefi ventricular funcion (LM). Though it is not always specilrc for coronary head diseases and thnre are pathologies thal can produci an abnormal slress echo but contnbubna other elemsms lo carchac dleanosls III head dlssases. il~e~eim of this study wa; 10 assess the results of @E) in patients (p) tih dillerent cardiovascular diseases and to analize the rasufls obtained METHODS: 104 (p) wsrs studied and ths following parameters we assessed: 1) (SAWIC). 2) ejection fredion (EF). end systolic volume index @VI). systolic blood pressure (SBP /ES/I). 3) gradients and vahular areas, 4) vaivular I’egurgkatlOn, 5) right vemriculer systolic pressure (RVSP). The reasons for carrying out the (SDE) )*Bre lo assess the following dyspnea. cardial pain. arrhylhmla. (LVli). (S.AMC) and cardiac hean murmurs. The etiologies were the following: 1) ischemc heart disease in 68 (pJ @.7X). 2) cardiac murmur in 28 (p) @KS%) oul of whom 14 wure sonic with: sonic stenosis is p). bcuspid aorta (1~). aorlic colcificafions [e P) end in 14 (p) the origin was mitral vehe fllseasa with: mitral slanosis Q p), mitral valve annular calcification (2 p), 10 (p) mitral velve prolepses 0. 3) hypertension in 14 (p)(l3.5%) lncludlng 2 myocardlopafhles and 4) 4 (p) (3.9%) with venuicular aneurysm and 2 (p) with-atria1 septum aneurysms. RESULTS: B5% showad (SAMC) wilh @DE). Regarding the parameters of Lhe (LVF). we consrder 3 groups: A) wiih normal response 10 effort with en Increase of EF, decmase of (Em) and increase of the (SBP I ESVl) at which they warn 19.2%. 8) insficienr msponsa 10 effort but without a drop in the (EF) 73% C) decline ofthe parameters of (LVEF) in 7.8%. Regarding the gradiems and valvular arees. aE4% of aoruc murmurs showed a slight increase of ifs peak gradianl. and 38% fyl4) showed a modarata mcrease 01 the peak gradients @Xi% of increase). Of them Ql 4%) did not chenge Ihe aodic v&a area and f 14.3%) decreased the sonic vahe ama (19% to 49%) with a eJectton fraction below 40%. In these (p) w?3 used dobutamine (SDE).The (p) with mitral valve calcification (MVC) shownd a slight increase of hts gradient and two (p) with mnral stenosis showed a mild mcrease though meinlaininp the valvular area. In (t&F’): 38% shorrsd mitral InsuiIciency. oul of wtlich $7 were considered mdd and 3 moderate. We poinl out lhet only 11 5?b of the pal~ents showud a mild mitral insvfficiency et rest. Regarding (RVSP) wa noticed an Increase in only 3.8% in morn it was nOt possible to obserm tricuspid regurgitation. CONCLUSIONS. The (SDE) allows for the assessment not only of myocardial contracltlrty bul else of dflerent parameters of the (LVF). pressures, gradrents. vahdar regurgrlations at rest and its responses lo effort. tiich mpmsents e potential clinical usefulness not only for diagnosis but for dynamic assessment and thbrapeutical monitoring in diierent csrdlovascular pathologies.
OPTlYuM DRY wEwrr. IT8 EVALwTlMl BY wouc ECHO DOPPLER. UAMETER OF lNFERl*R VEM CAVA Mul c%waEs IN THEVmRlwUR QEOMETRY IN DtALYslS PAnENs.
CAP
CAP 130
128
Contrast Echccmdiognphy E. Kreuber, G. Narfdziart,
in By-Passing of the H. Vazqwz, M. Reman.
Right Ventricle M. Siarelo,
A.
CUWro, A SdJibRer M. Grlppo, 0. MeuUzer. CatiovasagF Dept. Gulimez Childrem? Hospital. Bwnos Aires, Argmllna. Wispossibletowabate!hefcbwingcompka8onsof bfal(TBP)or partial (PBP) bypass of the II@ vent&la: pthomuy arferio.venaus tishtaa (PAVF), whteral chuMon (CCW) from superior vena cays to infetia wna cava (NC) , and resi&ai abial bmi, using ccnlmst emoeradoqaphy
right to leR shmt
s(RRLS)
at
CotmectiOn
Ume X 3.7~ (3.2 to 6,6 y). I)
(CE). bfafWb1 and me(hadp: 58 F’fttiWtS (P) sged 2,5 to 33 yeWS (X9,4y) W-i TBPaPBPinves(igatsdbyCE,~~ngarapldin)ectionof3mlol shelctn Sawna (p<2oKg) tmd 6ml (p CtOIQ) Into an arm vain. Presenca of conha. in the puhonary artary (PA) veft8w.l in Hp. in thesa paflents theprocadrrewasmpaatadlookingforconbastinlJleIVcor qrahepatk veins (CCW in BPP). An ifjeciion ws parfotmed to vadfy Iha prssence of contart In Uw M aWun (RRLS) and in p&onary veins (PAM). m43 p. Pos@araW tbm ws x:2y ( 3m to 4,7y) 1)29 p with bkSrectional cavw@ncwy stunt (BCPS) wlm aduiiulal flow ;2) 10 p with parbl Mvenlrlurlar cwe.cWn (PBC) ; 3) 2p wim KawasiWa (K) type BCPS; 4) 2p. WHh ctassic Gkm cave punmary (G). =:I
10~: abi-
(X) PAVF
1 P. i’dOp@aW
(APA). . . iI1, 10. with tow
arWom&
-
PEAK VELOCITIES “A” TRANSMITRAL WAVE/“A” PULMONARY VEIN WAVE RATIO: RELATION TO lNTRAvENTwCULARPRESSUREs Maria E. Adaniva Rkardo A. Migiiore, Rodolfo Remoso, Florencio T. Guerwro, Christian Rando, Jaime Poch, Maria 1. Ardid, Horatio Tamagusuku. Adriana Ci~eco, Jose L Rojas, M Gomez Hospital Eva Per& San Martin, Pcia de Buenos Aires, Argentina. The iefi atrium (LA) ejects during systoie blood forward to fill the letI ventricle and backward to the pulmonary veins(PV). The peak velocity of the “A” transmitrai wave (Am) and of the “A” reversal wave of pulmonary veins (Apv) registered by Doppler technique reflects this t&t, but the absolute value of each of these wave cm be influenced by systolic timction of left atrium and intraventricuiar pressurea (IP). The ratio Am/Apv should be useful to evahtate IP, independently of the LA systolic fimction. Objective: Assessment of the relation between Am/Apv ratio and IP. Metho&: Sixty nine patients(p) with ischemic heart disease were studied with Doppler echocardiography an hour before cardiac catheterization. Fifty eight p(84%) had adequate register of PV by transthoracic echocardiography and were included in this study. There were 43 male and 15 female (age average 58 +/- 10 years). We performed them a complete &w-dimensional and Doppler study, to measure peak velocity of Am and Apv and to calculate AmIApv ratio. Left intraventricuiar pressures (end-diastolic (EDP), pre-A) were recorded during catheterization. Results: AmlApv had an inverse correlation with pm-A pressure (r = -0,43 ’ p
y.
4 26 22
1
3 1 : -CON 2 2 _ CCDI Conc&~skm: 1) CE was tech&a& adewade in 54159p (91.5%) In PA 2) In P36,PAVF was (temkb& tycicin PiendLAinimp
6 32 26
bv CE
(13.9%). while CCVVwas c&bed tvy CE in NC w 8lpahepatk ydm in 33431, (74,5%), mosfty In BCPS (89.8%) qqasing to fhe PBC gap (30%). 3) In TBP. RRLS was detacbd by CE in LA in zlllp ( 18%) and noPAVFwewde@ctadbyCEinPVinllpinvasDigatsd.
11
.
.
l
Ed