Transthoracic echocardiography (TTE) is often technically difficult on patient s in intensive care units. Contrast echocardiography can improve left ventricula r wall visualization and the assessment of regional and g...Transthoracic echocardiography (TTE) is often technically difficult on patient s in intensive care units. Contrast echocardiography can improve left ventricula r wall visualization and the assessment of regional and global left ventricular wall motion. Our study undertook to determine what proportion of nondiagnostic T TE studies on patients in intensive care units could be salvaged (i.e., converte d to diagnostic studies) with contrast. Ninety-two patients with nondiagnostic TTEs had a repeat study after contrast. Using predefined criteria, 51%of studie s were salvaged with contrast. Female gender emerged as the only factor associat ed with less likelihood of salvaging a study.展开更多
This study assessed apparently normal mitral valves from patients with congestive heart failure(CHF)using biochemical and echocardiographic measures of extracellular matrix(ECM)and anatomy. Mitral regurgitation(MR)is ...This study assessed apparently normal mitral valves from patients with congestive heart failure(CHF)using biochemical and echocardiographic measures of extracellular matrix(ECM)and anatomy. Mitral regurgitation(MR)is frequently found in patients with CHF. This MR is considered purely functional, yet animal studies suggest that altered left ventricular(LV)function leads to increased cellularity and fibrosis of the mitral valve. Therefore, we hypothesized that patients with CHF might have partly organic MR, via dysfunctional valvular remodeling. Mitral valves from transplant recipient hearts of patients with CHF(23 dilated, 14 ischemic)were analyzed for deoxyribonucleic acid(DNA), collagen, glycosaminoglycan(GAG), and water concentrations and compared with autopsy controls. Cardiac dimensions and functional parameters(measured from recent echocardiograms)were compared with biochemical parameters using a repeated measures generalized linear model. The mitral valves in CHF had up to 78%more DNA(p < 0.03), 59%more GAGs(p < 0.02), and 15%more collagen(p < 0.007), but 7%less water(p < 0.05)than normal. The absence of anterior leaflet redundancy was associated with these deranged biochemical measures(p< 0.03). Associations were found between leaflet thickness and DNA concentration(+, p=0.003), annular diameter and chordal collagen(+, p=0.03), and water concentration and both left atrial diameter(-, p=0.008)and LV collagen concentration(-, p=0.04). Mitral valves in CHF are biochemically different from normal, with ECM changes that are influenced by the altered cardiac dimensions. This remodeling suggests that MR in patients with CHF may not be purely functional, and that these valves are not “normal.”展开更多
文摘Transthoracic echocardiography (TTE) is often technically difficult on patient s in intensive care units. Contrast echocardiography can improve left ventricula r wall visualization and the assessment of regional and global left ventricular wall motion. Our study undertook to determine what proportion of nondiagnostic T TE studies on patients in intensive care units could be salvaged (i.e., converte d to diagnostic studies) with contrast. Ninety-two patients with nondiagnostic TTEs had a repeat study after contrast. Using predefined criteria, 51%of studie s were salvaged with contrast. Female gender emerged as the only factor associat ed with less likelihood of salvaging a study.
文摘This study assessed apparently normal mitral valves from patients with congestive heart failure(CHF)using biochemical and echocardiographic measures of extracellular matrix(ECM)and anatomy. Mitral regurgitation(MR)is frequently found in patients with CHF. This MR is considered purely functional, yet animal studies suggest that altered left ventricular(LV)function leads to increased cellularity and fibrosis of the mitral valve. Therefore, we hypothesized that patients with CHF might have partly organic MR, via dysfunctional valvular remodeling. Mitral valves from transplant recipient hearts of patients with CHF(23 dilated, 14 ischemic)were analyzed for deoxyribonucleic acid(DNA), collagen, glycosaminoglycan(GAG), and water concentrations and compared with autopsy controls. Cardiac dimensions and functional parameters(measured from recent echocardiograms)were compared with biochemical parameters using a repeated measures generalized linear model. The mitral valves in CHF had up to 78%more DNA(p < 0.03), 59%more GAGs(p < 0.02), and 15%more collagen(p < 0.007), but 7%less water(p < 0.05)than normal. The absence of anterior leaflet redundancy was associated with these deranged biochemical measures(p< 0.03). Associations were found between leaflet thickness and DNA concentration(+, p=0.003), annular diameter and chordal collagen(+, p=0.03), and water concentration and both left atrial diameter(-, p=0.008)and LV collagen concentration(-, p=0.04). Mitral valves in CHF are biochemically different from normal, with ECM changes that are influenced by the altered cardiac dimensions. This remodeling suggests that MR in patients with CHF may not be purely functional, and that these valves are not “normal.”
