Objective-To establish the time of onset of dilated cardiomyopathy (DCM) by review of annual chest x rays, which are obligatory in Hungary. Design-A retrospective survey of chest x rays of a cohort of confirmed cases of DCM, to assess time of onset of cardiomegaly. Clinical course was compared by follow up over a mean of six years from the time of diagnosis. Subjects-240 patients with DCM (31 familial, 209 non-familial). Diagnosis was made by echocardiography in all cases and confirmed by coronary angiography and heart biopsy in some cases. Main results-At diagnosis, the mean age of the patients was 31-8 years in the familial group and 39-6 years in the nonfamilial group (P < 0.05). The time between the onset of cardiomegaly (cardiothoracic ratio >0.45) and clinical diagnosis was 8-0 and 1041 years respectively (P < 0.05). The six year survival was 6% in the familial group and 23% in the non-familial group (P < 0.05).Conclusions-The familial form of DCM is the more malignant form: it occurs at an earlier age and progresses more rapidly than non-familial DCM. (Br Heart J 1995;74:171-173) Recent data'-3 show that familial dilated cardiomyopathy (DCM) is a not such a rare disease as was earlier believed. However, our knowledge about the age of onset of this form of cardiomegaly is limited as we only know the time of the onset of the clinical symptoms and signs of the disease. The clinical course of DCM is apparent only after the diagnosis has been made, while the real start of the disease before the onset of symptoms remains hidden. In Hungary, annual chest x ray screening is obligatory, and we are therefore in a position to acquire information retrospectively on the earlier "latent" period of the disease. The changes in heart size of DCM patients can be analysed by means of the cardiothoracic ratio, and the extent of cardiomegaly can be characterised by the increase in the ratio. For this study, we selected patients on whom previous annual cardiothoracic ratio data were available. These patients were examined and followed very thoroughly, allowing us not only to determine the onset of cardiomegaly, but also to follow up the progression of the disease. MethodsA comparison was made of 31 patients with familial DCM and 209 patients with sporadic DCM, for all of whom previous annual chest x ray pictures were available. The familial DCM group consisted of 12 females and 19 males, while the non-familial group consisted of 68 females and 141 males. The cardiothoracic ratio was measured by the method of Groedel and Danzer, and values of >0 45 were taken as pathological.6 We considered the disease to be of the familial form if we found at least two patients with frankly abnormal left ventricular function in the same family, and if at least two generations were involved. We recorded a detailed familial case history and examined all family members if possible. When relatives of DCM patients were not available for examination or were not alive, we asked for earlier medical reports, findings, and documentations. Th...
96 Stress echocardiography sured using 2D speckle tracking. Functional capacity was assessed with a treadmill stress test and expressed as metabolic equivalents (METs). We analyzed left atrial strain values with functional capacity through linear correlations (Bonferroni type adjustment). Results: In our group of patients, the relationship between left atrial ejection fraction and METs were not shown to be significant (r=0.11, p=0.34), but atrial strain values were significant predictors of functional capacity. Left atrial strain was significantly related to the diastolic patron, assessed by E/E' valor (r= -0.26, p=0.0269). We found a direct proportional relationship between peak atrial strain measured during the left atrial reservoir phase and METs (r=0.55, p<0.001) and an inverse relationship between the strain rate measured during the conduit phase and METs (r= -0.55, p<0.001). In our sample, we did not find any statistically significant association between E/E' rest with exercise capacity (r= -0.17, p=0.146). Conclusion: In our preserved left ventricular function group of patients, left atrial function assessed with speckle tracking was a significant predictor of functional capacity, better than left atrial ejection fraction or E/E' rest. Background: ST-segment elevation in lead aVR is an important predictor of acute left main (LM) coronary artery obstruction, but its predictive value in a setting of exercise treadmill testing is still unclear. Purpose: The aims of our study were to assess the incidence and predictors of LM/ostial left anterior descending (LAD) coronary artery and/or ostial circumflex (Cx) artery stenosis in patients referred to exercise testing presenting with exercise-induced ST segment elevation in lead aVR. Methods: Out of 9052 patients who underwent stress echocardiography testing from 2012 to 2016 in our laboratory, we identified 76 patients (55 men; mean age of 61±8.4 years), presenting with ST segment elevation in lead aVR during exercise. All the patients underwent coronary angiography. Significant LM/ostial LAD or ostial Cx stenosis was defined as narrowing ≥50% of diameter stenosis. We analyzed baseline clinical characteristics, hemodynamic response to exercise, rest and stress electrocardiograms as well as baseline and peak exercise echocardiography images in all patients. We calculated Duke treadmill score and changes in wall motion score index (delta WMSI). Results: Significant LM/ostial LAD or ostial Cx stenosis was present in 26/76 patients (34%) with exercise-induced ST segment elevation in lead aVR. There were no statistically significant differences in majority of baseline clinical characteristics and hemodynamic response between patients with and without significant LM/ostial LAD or ostial Cx stenosis. However, patients with LM/ostial LAD and ostial Cx stenosis were older (63±8 years vs. 60±9 years, p=0.19), with a lower Duke treadmill score (-7±6 vs. -3±4, p=.004) in comparison to those without significant LM/ostial LAD or ostial Cx stenosis, and the showed more severe w...
0.009). Overall mean Plax LA diameter was 44.5 (±5.4) mm. Three months after the ablation all patients were in sinus rhythm. The improvement in LA function from both interventions are shown in Figure 1. There were significant improvements in reduction of LA size in both groups (p value= <0.05) with no significant difference in LA function three months' post ablation using both volume based function and strain function as shown in graphs. LA function -Volume and Strain analysisConclusion: TSA improves LA function to the same degree as CA with no evidence that mechanical LAA exclusion adversely impacts LA function assessed by volume and strain analysis. Background: Recently, simple renal cysts have been linked to an increased risk of aortic aneurysm. In Autosomal Dominant Polycystic Kidney Disease (ADPKD), there is a higher prevalence of intracranial aneurisms but little evidence regarding aortic root dilatation. Purpose: The aim of this study was to compare Sinuses of Valsalva (SoV) diameters in ADPKD patients and matched controls. Population and methods: All consecutive ADPKD patients who had an echocardiography in our institution were included and matched 1:1 with non-ADPKD patients for sex, age, blood pressure and beta-blocker therapy. SoV were measured according to guidelines, by 2 echographers blinded to the clinical status of patients. The results were analyzed using paired-t tests for quantitative variables and Mc Nemar tests for qualitative variables. Results: From 2008 to 2016, 60 ADPKD patients were included and matched with 60 controls. Mean age was 56±12 years, 54% were men, 35% under beta-blocker therapy, mean body surface area was 1.8±0.2 m 2 and mean systolic/diastolic BP were 136±24 and 79±16 mmHg, respectively (p>0.10 with matched controls for all parameters). Mean SoV diameters were significantly higher in ADPKD patients than in controls (36.3±4.1 versus 34.1±3.7 mm, p<0.0001). The Campens Z-scores (normalized Histogram of the Z scores on sex, age and body surface area) were higher in ADPKD patients (1.2±1.2 versus 0.4±1.0, p<0.0001). More importantly, aortic aneurysms, as defined by a Z score>2 Standard Deviations, were present in 15 ADPKD patients (25%) versus 4 controls (7%), p<0.01. Conclusion: There is an increased prevalence of aortic aneurysms in ADPKD patients as compared with controls, matched for common confounding factors for aortic dilatation. Systematic echocardiography is currently not recommended in ADPKD patients, however, our results strongly support aortic aneurysms echocardiographic screening and follow-up in this population. Background: Deep vein thrombosis (DVT) develops after major orthopedic surgery despite use of current prophylactic techniques. Incidence of DVT has been shown to be higher in patients who underwent total knee arthroplasty (TKA) than in patients who underwent total hip arthroplasty (THA). Most DVTs are developed in the soleal vein (SV) and SV diameter determined by ultrasonography is applicable for prediction of the DVT after the major orthopedic surgery. ...
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