No abstract

No abstract

Objective: Right ventricular (RV) dysfunction in acute pulmonary embolism (APE) has been associated with increased mortality and morbidity. The aim of the present study was to assess the timing and magnitude of regional RV functions using speckle-tracking echocardiography (STE) and their relationship to early hospital mortality in patients with APE. Methods: One hundred forty-two patients were prospectively studied at the onset of an acute episode and after a median follow-up period of 30 days. Their clinical and laboratory characteristics were recorded. For all patients, conventional two-dimensional echocardiography and STE were performed within 24 h after the diagnosis of APE. Results: Twenty-eight (19.7%) patients died during the hospitalization follow-up. Patients who died during hospitalization were older and had higher high sensitivity cardiac troponin T levels, and a higher percentage of patients had simplified Pulmonary Embolism Severity Indexes. In STE analyses, they had lower RV free wall peak longitudinal systolic strain (PLSS) and higher RV peak systolic strain dispersion indexes. The time to PLSS difference between RV free wall and LV lateral was longer in patients who died during hospitalization than in those who survived, and this was an independent predictor of early hospital mortality with 85.7% sensitivity and 75.0% specificity in patients with APE. Conclusion: APE was associated with RV electromechanical delay and dispersion. Electromechanical delay index might be useful to predict early hospital mortality in patients with APE.

The authors investigated the prognostic relevance of serum carbohydrate antigen 125 (CA125) levels in nonischemic dilated cardiomyopathy (NICMP) and assessed whether increased levels relate to the degree of functional mitral regurgitation (FMR). Seventy-seven patients with NICMP were enrolled and followed-up for 10 ± 2 months in this prospective study. Receiver-operating characteristic analysis established a cutoff CA125 value of 25 U/mL for predicting mortality. Patients were divided into two groups according to their CA125 levels (CA125 <25 U/mL [n=58] and CA125 ≥ 25 U/mL [n=19]). Patients with high CA125 values had statistically worse functional status, higher B-type natriuretic peptide (BNP) levels, higher left ventricular volumes, lower ejection fraction, higher E/Em ratio, higher pulmonary artery systolic pressure, and more severe FMR. On the multivariate analysis, serum CA125 (P=.002) and severe FMR (P=.04) were identified as the independent predictors of mortality. Serum CA125 levels also correlated with BNP levels and FMR severity (P<.001). Serum CA125 is a powerful prognostic biomarker that is associated with the severity of heart failure, serum BNP levels and several echocardiographic parameters including left ventricular volumes, systolic and diastolic functions, pulmonary artery pressure, and the degree of FMR. Serum CA125 was also shown as an independent predictor of mortality during 10 ± 2 months of follow-up.

Purpose Right ventricular (RV) dysfunction is a common condition that is related to increased adverse outcomes in patients with acute pulmonary embolism (APE). Our aim was to assess timing and magnitude of regional RV function using speckle tracking echocardiography (STE) and to evaluate their relationship to long‐term mortality in patients after APE. Methods In total, 147 patients were enrolled at the onset of an APE episode and followed for 12 ± 1.1 months. For all patients, the clinical, laboratory, and echocardiography examinations were performed at the diagnosis of APE and at the end of the 1‐year follow‐up. Results Of the 147 patients, 44 (29.9%) died during the 1‐year follow‐up after APE. The patients who died had lower RV free wall peak longitudinal systolic strains (PLSS) and left ventricular (LV) PLSS and higher RV peak systolic strain dispersion (PSSD) index which means the electromechanical dispersion when compared with the survivors. The difference in time to PLSS between the RV free wall and LV lateral wall (RVF–LVL) which means the electromechanical delay was longer in patients who died than in those who survived during follow‐up, and this difference was an independent predictor of mortality at 1 year of follow‐up after APE, with 86.4% sensitivity and 81.7% specificity. At the end of 1‐year follow‐up, the RV free wall PLSS and the LV global PLSS increased, whereas the RV PSSD index and the difference in time to PLSS between the RVF and LVL decreased. Conclusions Acute pulmonary embolism was associated with RV dysfunction and RV electromechanical delay and dispersion. These parameters improved at the end of 1‐year follow‐up. The electromechanical delay index might be a useful predictor of mortality in patients after APE.

No abstract

Background: In patients (pts) with sick sinus syndrome (SSS), right ventricular apical (RVA) pacing increased the risk of developing atrial fibrillation (AF). However, the mechanism of proarrhythmic effect of RVA pacing remains unclear. Methods: We performed detailed echocardiograhic examination with Tissue Doppler Imaging in 60 pts with SSS (mean age 73A9 years, 42 F) who implanted with DDD pacemakers during atrial and ventricular pacing with atrioventricular interval programmed at 120-150 mesc (ApVp mode) and AAI mode with (ApVs mode) at 70 bpm. Echo measurements were taken after 15 mins of pacing in each mode. The myocardial atrial contraction velocity was measured at annulus of right free wall (Ra), septal (Sa) and lateral free wall (La) respectively. Results: As expected, the AV interval was significantly shorter (118A25 vs.163A45 ms, P=0.002), and QRS duration was longer (146A33 vs.97A26 ms, P,0.001) during ApVp mode as compared with ApVs mode. Although there was no significant difference in left ventricular ejection fraction, left atrial (LA) ejection fraction (50A14 vs.55A14%, P=0.005), LA active emptying fraction (32A17 vs.37A16%, P=0.018) and LA filling fraction (43A13 vs. 48A13%, P=0.007) were all significant improved by 18%, 54% and 18%, respectively during ApVs mode as compared with ApVp mode. Furthermore, atrial myocardial contraction velocities among Ra (14.0A3.8 vs.15.2A4.6cm/s, P=0.026), Sa (7.8A2.6 vs. 8.8A2.8cm/s, P=0.001), and La (8.9A3.2 vs.9.7A2.7cm/s, P=0.020) were also significantly increased during ApVs mode by 12%, 19% and 21%, respectively as compared with ApVp mode (Figure). Conclusions: In pts with SSS, avoidance of RVA pacing during ApVs mode improves LA haemodynamic and mechanical function, which might contribute to a lower risk of development of AF after pacemaker implantation. P773Qualitative and quantitative assessment of 3 novel post-processing methods for enhancing echocardiographic images. Echocardiography, while a prevalent tool for assessing cardiac morphology and function, suffers from a range of artefacts that reduce its diagnostic value. This work qualitatively and quantitatively evaluates 3 novel post-processing methods for enhancing echocardiographic images. Data enhancement is achieved by utilising multiple partially decorrelated instances of a cardiac cycle acquired through a single acoustic window. Such information has until now been largely disregarded during data post-processing. Moreover, unlike past approaches, data enhancement is achieved without filtering out information based on static or adaptive selection criteria. Qualitative assessment using 32 clinical datasets demonstrated (i) suppression of cavity noise, (ii) increase in tissue/cavity contrast, and (iii) visual enhancement of tissue structures previously masked-out by various artefacts (Figure 1). The effect of each post-processing method on the diagnostic value of cardiac ultrasound data was quantitatively assessed by examining the repeatability coefficient variations (via Bland-Altman plots) in clini...

No abstract