Sensitivity and specificity of detection of mitral regurgitation was assessed by range-gated Doppler echocardiography. The degree of mitral regurgitation was also estimated by the depth and width of the regurgitant jet detected with Doppler and compared with that assessed by left ventriculography. Of 47 patients with an adequate Doppler study, 24 had no mitral regurgitation by ventriculography. All but one were also negative for mitral regurgitation by Doppler, for a specificity of 96%. Of 23 cases with mitral regurgitation documented by ventriculography, Doppler detected mitral regurgitation in 21, for a sensitivity of 92%. Two cases with mitral regurgitation undiagnosed by Doppler had mild mitral regurgitation due to papillary muscle dysfunction. All cases with rheumatic mitral regurgitation were detected. The degree of mitral regurgitation estimated with Doppler had a high correlation with that determined by ventriculography (r = 0.88, p less than 0.01).
SUMMARYAbnormal interventricular septal motion, with pre-ejection posterior motion and anterior motion away from the posterior left ventricular wall during ejection, was demonstrated by echocardiography in 14 out of 17 cases with complete left bundle branch block (LBBB). Two Patients with suspected or proven coronary artery disease were excluded from groups I, II, and III. Diagnoses were confirmed by cardiac catheterization and coronary arteriography in all cases in group I, and all but eight cases of uncomplicated hypertension in group II.The criteria for LBBB were those of the New York Heart Association: QRS _I~0.12 see; notching or slurring of the QRS which shows an initial R wave in I, aVL and left precordial leads; in these leads the peak of the R wave or one of its prominent notches occurs relatively late in the QRS interval; displacement of the S-T segment and usually the T wave in a direction opposite that of the principal QRS deflection.
The echocardiographic findings of eight patients with hypertrophic cardiomyopathy without outflow obstruction (HMC) and of 15 normal (Norm) individuals are presented.
The characteristic features in HMC were: (1) interventricular septal width much greater than normal (HMC = 2.5 ± 0.3 cm, Norm = 1.0 ± 0.2 cm,
P
< 0.005); (2) normal or only slightly increased posterior left ventricular wall thickness; (3) the ratio of interventricular septal to posterior wall thickness ≧2.0; (4) ejection fraction greater than normal (HMC = 0.76 ± 0.08, Norm = 0.68 ± 0.06,
P
< 0.025); (5) reduced velocity of the early diastolic closing motion of the anterior mitral leaflet (HMC = 60 ± 23 mm/sec, Norm = 124 ± 29 mm/sec,
P
< 0.005); (6) absence of abnormal systolic movement of the anterior mitral valve, as seen in hypertrophic obstructive cardiomyopathy. The diagnosis of hypertrophic cardiomyopathy can be made with echocardiography, even when outflow tract obstruction of the left ventricle is absent.
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