OBJECTIVES: The purpose of this research was to study the effect of dobutamine on left ventricular(LV) filling in ischemic cardiomyopathy(ICM) and to determine whether restrictive filling pattern(RFP) at peak stress h...OBJECTIVES: The purpose of this research was to study the effect of dobutamine on left ventricular(LV) filling in ischemic cardiomyopathy(ICM) and to determine whether restrictive filling pattern(RFP) at peak stress has prognostic value. BACKGROUND: The prognostic value of RFP at peak stress in ICM is unknown. METHODS: A total of 69 patients with ICM were studied by Doppler echocardiography at rest and stress; RFP was defined as transmitral E∶A ratio ≥1.0, isovolumic relaxation time(IVRT)< 80 ms, and E-wave deceleration time(EDT)< 120 ms. RESULTS:A total of 42 of 69 had RFP at rest, which reverted to non-RFP at stress in 24(EA), but persisted in 18(EE); 27 of 69 had non-RFP at rest and peak stress(AA). In EA, IVRT and EDT lengthened(by 43 ms and 46 ms), and tricuspid regurgitation(TR) decreased(by 26 mm Hg, p< 0.01), suggesting a fall in left atrial(LA) pressure. The stress response in AA was similar to EA. In EE, IVRT and EDT shortened(by 21 ms) and TR increased(by 13 mm Hg, p< 0.01), suggesting a rise in LA pressure. Peak aortic acceleration(LV inotropy)increased by 0.8 g in EA but only by 0.2 g in EE(difference p< 0.001). Median follow-up(interquartile range) was 34(20 to 57) months. Three-year survival for EE, EA, and AA was 49%, 79%, and 89%, respectively(p< 0.001). Compared with AA, the hazard ratio for EE was 9.5(p< 0.001) and for EA was 1.9(p=0.30). CONCLUSIONS: In ischemic cardiomyopathy, persistence of restrictive filling during stress implies a striking rise in LA pressure, greatly attenuated LV inotropic response, and markedly reduced survival. Stress echocardiography uniquely identifies these high-risk patients.展开更多
Background: Left ventricular(LV) thrombus is a frequent and potentially dangerous complication of ischemic heart disease(IHD). We evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus...Background: Left ventricular(LV) thrombus is a frequent and potentially dangerous complication of ischemic heart disease(IHD). We evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus and compared the diagnostic value of contrast-enhanced magnetic resonance imaging(MRI) with transthoracic(TTE) and transesophageal echocardiography(TEE) for the diagnosis of LV thrombi. Methods: Between November 1997 and December 2003, 361 patients with IHD had surgical and/or pathological confirmation of presence or absence of LV thrombus. Clinical information and preoperative imaging study reports were retrospectively reviewed regarding detection of thrombus. Comparisons were made between clinical and imaging characteristics of patients with and without confirmed thrombus. Results: Left ventricular thrombus was present in 106(29%) of 361 patients in this study. Patients with thrombus had a higher incidence of recent embolic events(6.1%vs 0.8%, P< .005). In 160 patients with all 3 imaging modalities performed within 30 days of surgical or pathological confirmation, contrast-enhanced MRI showed the highest sensitivity and specificity(88%±9%and 99%±2%, respectively) compared with TTE(23%±12%and 96%±3.6%, respectively) and TEE(40%±14%and 96%±3.6%, respectively) for thrombus detection. Conclusions: Left ventricular thrombus occurs frequently in patients with IHD and is associated with risk of systemic embolization. Contrast-enhanced MRI provided the highest sensitivity and specificity for LV thrombus when compared to TTE and TEE, and should be considered in the care of patients at high risk of LV thrombus formation.展开更多
文摘OBJECTIVES: The purpose of this research was to study the effect of dobutamine on left ventricular(LV) filling in ischemic cardiomyopathy(ICM) and to determine whether restrictive filling pattern(RFP) at peak stress has prognostic value. BACKGROUND: The prognostic value of RFP at peak stress in ICM is unknown. METHODS: A total of 69 patients with ICM were studied by Doppler echocardiography at rest and stress; RFP was defined as transmitral E∶A ratio ≥1.0, isovolumic relaxation time(IVRT)< 80 ms, and E-wave deceleration time(EDT)< 120 ms. RESULTS:A total of 42 of 69 had RFP at rest, which reverted to non-RFP at stress in 24(EA), but persisted in 18(EE); 27 of 69 had non-RFP at rest and peak stress(AA). In EA, IVRT and EDT lengthened(by 43 ms and 46 ms), and tricuspid regurgitation(TR) decreased(by 26 mm Hg, p< 0.01), suggesting a fall in left atrial(LA) pressure. The stress response in AA was similar to EA. In EE, IVRT and EDT shortened(by 21 ms) and TR increased(by 13 mm Hg, p< 0.01), suggesting a rise in LA pressure. Peak aortic acceleration(LV inotropy)increased by 0.8 g in EA but only by 0.2 g in EE(difference p< 0.001). Median follow-up(interquartile range) was 34(20 to 57) months. Three-year survival for EE, EA, and AA was 49%, 79%, and 89%, respectively(p< 0.001). Compared with AA, the hazard ratio for EE was 9.5(p< 0.001) and for EA was 1.9(p=0.30). CONCLUSIONS: In ischemic cardiomyopathy, persistence of restrictive filling during stress implies a striking rise in LA pressure, greatly attenuated LV inotropic response, and markedly reduced survival. Stress echocardiography uniquely identifies these high-risk patients.
文摘Background: Left ventricular(LV) thrombus is a frequent and potentially dangerous complication of ischemic heart disease(IHD). We evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus and compared the diagnostic value of contrast-enhanced magnetic resonance imaging(MRI) with transthoracic(TTE) and transesophageal echocardiography(TEE) for the diagnosis of LV thrombi. Methods: Between November 1997 and December 2003, 361 patients with IHD had surgical and/or pathological confirmation of presence or absence of LV thrombus. Clinical information and preoperative imaging study reports were retrospectively reviewed regarding detection of thrombus. Comparisons were made between clinical and imaging characteristics of patients with and without confirmed thrombus. Results: Left ventricular thrombus was present in 106(29%) of 361 patients in this study. Patients with thrombus had a higher incidence of recent embolic events(6.1%vs 0.8%, P< .005). In 160 patients with all 3 imaging modalities performed within 30 days of surgical or pathological confirmation, contrast-enhanced MRI showed the highest sensitivity and specificity(88%±9%and 99%±2%, respectively) compared with TTE(23%±12%and 96%±3.6%, respectively) and TEE(40%±14%and 96%±3.6%, respectively) for thrombus detection. Conclusions: Left ventricular thrombus occurs frequently in patients with IHD and is associated with risk of systemic embolization. Contrast-enhanced MRI provided the highest sensitivity and specificity for LV thrombus when compared to TTE and TEE, and should be considered in the care of patients at high risk of LV thrombus formation.
