OBJECTIVES: Recently, a novel method to measure strain from standard two-dimensional images has been developed. Our goal was to characterize global and regional systolic function abnormalities using this technique in ...OBJECTIVES: Recently, a novel method to measure strain from standard two-dimensional images has been developed. Our goal was to characterize global and regional systolic function abnormalities using this technique in patients with hypertrophic cardiomyopathy(HCM). BACKGROUND: Strain has been proposed as a sensitive tool to detect early systolic function abnormalities in HCM. However, the clinical application of conventional Doppler-derived strain has been limited by poor reproducibility and angle dependency. METHODS: Echocardiographic examinations were performed in 26 patients with nonobstructive HCM and 45 healthy subjects. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal and transverse strain in apical views and circumferential and radial strain in parasternal short-axis view. RESULTS: Despite apparently normal left ventricular systolic function, all components of strain were significantly reduced in HCM. Average longitudinal, transverse, circumferential, and radial strain in patients with HCM and controls were -15.1± 6.2% versus -20.3± 5.6% , 23.3± 17.0% versus 27.2± 14.9% ,-16.8± 7.1% versus 19.6± 5.2% , and 25.2± 13.9% versus 36.8± 17.2% , respectively(all p< 0.001). In patients with asymmetrical HCM, longitudinal septal strain was significantly lower than for other left ventricular segments combined:-9.2± 4.7% versus-12.7± 7.1% (p=0.001). Average interobserver and intraobserver variabilities were 11% and 11.3% , respectively. CONCLUSIONS: Two-dimensional strain is a new simple, rapid, and reproducible method to measure different components of systolic strain. This technique identified early abnormalities in patients with HCM that have apparently normal left ventricular systolic function.展开更多
Quantitative coronary angiography(QCA) is routinely performed before valve surgery for severe acquired valvular disease. This technique is relatively invasive, especially in a population with an average risk for signi...Quantitative coronary angiography(QCA) is routinely performed before valve surgery for severe acquired valvular disease. This technique is relatively invasive, especially in a population with an average risk for significant coronary stenosis. Multidetector computed tomography(MDCT) coronary angiography allows the noninvasive evaluation of the coronary anatomy. The aim of this prospective study was to evaluate the predictive values of 16-slice MDCT in the detection of significant coronary stenosis(≥50%) before valve surgery in patients with severe valvular disease without known coronary artery disease and average risk, in comparison with conventional QCA. Forty patients with severe acquired valvular disease(mean age 70±8.6 years; 20 women; 27 with severe aortic stenosis) underwent coronary MDCT 2 days before cardiac catheterization with QCA. The mean heart rate was 64.7±8.8 beats/min(range 41 to 78). Four hundred fifty-eight of 600 coronary artery segments(77.3%) were considered assessable by MDCT. In a per-segment analysis, the sensitivity of MDCT for the detection of significant coronary lesions ≥50%was 77.7%, the specificity was 98%, the positive predictive value was 42.4%, and the negative predictive value was 99%. The main cause of false-positive or false-negative results or nonassessable evaluations was severe coronary calcification. In a per-patient analysis, in comparison with QCA, MDCT correctly classified 33 of 40 patients(82.5%). In conclusion, in patients with an average risk for coronary stenosis before valve surgery, MDCT coronary angiography detected significant obstructive coronary artery disease, with a 99%NPV.展开更多
文摘OBJECTIVES: Recently, a novel method to measure strain from standard two-dimensional images has been developed. Our goal was to characterize global and regional systolic function abnormalities using this technique in patients with hypertrophic cardiomyopathy(HCM). BACKGROUND: Strain has been proposed as a sensitive tool to detect early systolic function abnormalities in HCM. However, the clinical application of conventional Doppler-derived strain has been limited by poor reproducibility and angle dependency. METHODS: Echocardiographic examinations were performed in 26 patients with nonobstructive HCM and 45 healthy subjects. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal and transverse strain in apical views and circumferential and radial strain in parasternal short-axis view. RESULTS: Despite apparently normal left ventricular systolic function, all components of strain were significantly reduced in HCM. Average longitudinal, transverse, circumferential, and radial strain in patients with HCM and controls were -15.1± 6.2% versus -20.3± 5.6% , 23.3± 17.0% versus 27.2± 14.9% ,-16.8± 7.1% versus 19.6± 5.2% , and 25.2± 13.9% versus 36.8± 17.2% , respectively(all p< 0.001). In patients with asymmetrical HCM, longitudinal septal strain was significantly lower than for other left ventricular segments combined:-9.2± 4.7% versus-12.7± 7.1% (p=0.001). Average interobserver and intraobserver variabilities were 11% and 11.3% , respectively. CONCLUSIONS: Two-dimensional strain is a new simple, rapid, and reproducible method to measure different components of systolic strain. This technique identified early abnormalities in patients with HCM that have apparently normal left ventricular systolic function.
文摘Quantitative coronary angiography(QCA) is routinely performed before valve surgery for severe acquired valvular disease. This technique is relatively invasive, especially in a population with an average risk for significant coronary stenosis. Multidetector computed tomography(MDCT) coronary angiography allows the noninvasive evaluation of the coronary anatomy. The aim of this prospective study was to evaluate the predictive values of 16-slice MDCT in the detection of significant coronary stenosis(≥50%) before valve surgery in patients with severe valvular disease without known coronary artery disease and average risk, in comparison with conventional QCA. Forty patients with severe acquired valvular disease(mean age 70±8.6 years; 20 women; 27 with severe aortic stenosis) underwent coronary MDCT 2 days before cardiac catheterization with QCA. The mean heart rate was 64.7±8.8 beats/min(range 41 to 78). Four hundred fifty-eight of 600 coronary artery segments(77.3%) were considered assessable by MDCT. In a per-segment analysis, the sensitivity of MDCT for the detection of significant coronary lesions ≥50%was 77.7%, the specificity was 98%, the positive predictive value was 42.4%, and the negative predictive value was 99%. The main cause of false-positive or false-negative results or nonassessable evaluations was severe coronary calcification. In a per-patient analysis, in comparison with QCA, MDCT correctly classified 33 of 40 patients(82.5%). In conclusion, in patients with an average risk for coronary stenosis before valve surgery, MDCT coronary angiography detected significant obstructive coronary artery disease, with a 99%NPV.
