The assessment of flow velocity (FV) in the left atrial appendage (LAA) by transesophageal echocardiography (TEE) has been reported to be a useful tool as a high risk marker for systemic emboli. The analysis of FV in LAA by transthoracic echocardiography (TTE) has not yet been validated. The purpose of this study was to compare FV measurements in the LAA by TEE and TTE in 30 consecutive patients (age 19-87 years, mean = 55) sent for echocardiographic study with the following diagnosis: stroke (11 patients), mitral stenosis (6 patients), congenital heart disease (4 patients), mitral prosthetic function assessment (2 patients), and other pathologies (7 patients). FV was measured at the outlet and mid-portion of the LAA with TTE, from the apical two-chamber view and with biplane TEE, from the longitudinal two-chamber view. Satisfactory measurements were obtained with TTE from the outlet of the LAA in 96.7% and from the mid-portion of the LAA in 90% of patients. One third of patients were in atrial fibrillation (AF) during the study. The mean FV in the outlet of the LAA was 32.7 +/- 2.5 (SE) cm/sec with TTE and was 33.7 +/- 3.04 (SE) cm/sec with TEE (r = 0.95). The mean FV in the mid-portion of the LAA was 40.9 +/- 3.3 and 42.7 +/- 3.9 with TTE and TEE respectively (P = NS) (r = 0.95). There was no difference in the LAA FV determination by TTE and TEE in the subgroup with AF. TTE was able to detect FV < 30 cm/sec with a sensitivity of 88% and specificity of 81% and a positive predictive value of 84% compared with TEE.
Abreviaciones utilizadas: Enfermedad cardiovascular (ECV); Infarto Al Miocardio (IAM); Factores de riesgo cardiovascular (FRCV); Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR); Hipertensión arterial (HTA); Encuesta Nacional de Salud (ENS); GEMI (Registro de Estudios Multicéntricos del IAM en Chile); Acceso Universal a Garantías Explícitas en Salud (AUGE); Inhibidores de enzima convertidora (IECA); Receptores de angiotensina II (ARA II); Organización Mundial de la Salud (OMS); Accidente Vascular Encefálico (AVE); Riesgo relativo (RR); Odds Ratio (OR); Hazard ratio (HR); Años De Vida Ajustado Por Calidad (AVAC).
Results of intraventricular resynchronization in patients with severe cardiac failure Background: Intraventricular resynchronization with pacemakers is a promising therapy for patients with refractory cardiac failure and intraventricular conductions delay. However its long term effects are not well known. Aim: To report the results of this therapy in patients with cardiac failure. Patients and methods: Fourteen patients (11 male), whose mean age was 68 years, with a severe and refractory cardiac failure, have been treated in our unit using intraventricular resynchronization with pacemakers. Eight had a coronary heart disease and six a dilated myocardiopathy. The pacemaker was implanted transvenously, with conventional stimulation in atrium and right ventricle. The left ventricle was stimulated through an epicardial vein, accessed through the coronary sinus. Results: In one patient the high thresholds did not allow a left ventricular stimulation. In the other 13 patients, a clinical improvement was observed in 11 (85%), that has been sustained for a mean of 8.2 months. The ejection fraction improved form 23.5 to 32.4% (p <0.001), the 6 min walking test improved from 347 to 437 m (p=0.003) and the functional capacity changes from 3.3 to 2.7 (p <0.001). Three patients died during follow up. One was the patient in whom the stimulation failed and two had a sudden death. No complications of the procedure were observed. Conclusions: In this series, intraventricular resynchronization with pacemakers was effective in 11 of 13 patients, improving functional capacity and ejection fraction. Sudden death could be avoided adding a defibrillator to the pacemaker system (
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