Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.

No abstract

These data indicate that in patients without intraventricular conduction defects and cardiac dysfunction, QTc prolongation measured from the standard electrocardiogram is a risk factor for sudden death independent of age, history of myocardial infarction, heart rate, and drug use. In patients with cardiac dysfunction, QTc duration is not related to the risk for sudden death.

Large numbers of patients referred for evaluation of chest pain are unable to perform adequate, diagnostic exercise testing. In these patients, dobutamine stress echocardiography (DSE) represents an alternative, exercise-independent stress modality. Apart from the approximately 5% of patients with an inadequate acoustic window, 10% of patients referred for this test have nondiagnostic (submaximal negative) test results. Serious side effects during or shortly after DSE are uncommon, with ventricular fibrillation or myocardial infarction occurring in approximately 1 of 2,000 studies. No deaths have been reported. On the basis of a total number of 2,246 patients, reported in 28 studies, the sensitivity, specificity and accuracy of the test for the detection of coronary artery disease (CAD) were 80%, 84% and 81%, respectively. Mean sensitivities for one-, two- and three-vessel disease were 74%, 86% and 92%, respectively. The sensitivity for detection of disease in the left circumflex coronary artery (55%) was lower, both compared with that for left anterior descending (72%) and right coronary artery disease (76%). The sensitivity of predicting multivessel disease by multiregion echocardiographic abnormalities varied widely, from 8% to 71%. In direct comparisons, DSE was superior to exercise electrocardiography and dipyridamole echocardiography and comparable to exercise echocardiography and radionuclide imaging. DSE is a useful, feasible and safe exercise-independent stress modality for assessing the presence, localization and extent of CAD.

Patients with substantial viability on DSE demonstrated improvement in LVEF and NYHA functional class after revascularization; viability was also associated with a favorable prognosis after revascularization.

The feasibility of assessing arterial wall configuration with an intravascular 40 MHz ultrasound imaging device was investigated in an in vitro study of 11 autopsy specimens of human arteries. The system consists of a single element transducer, rotated with a motor mounted on an 8F catheter tip. Cross sections obtained with ultrasound were matched with the corresponding histologic sections. The arterial specimens were histologically classified as of the muscular or elastic type. Muscular arteries interrogated with ultrasound presented with a hypoechoic media, coinciding with the smooth muscle cells. In contrast, the media of an elastic artery densely packed with elastin fibers was as echogenic as the intima and the adventitia. On the basis of the cross-sectional image, it was possible to determine the nature of the atherosclerotic plaque. The location and thickness of the lesion measured from the histologic sections correlated well with the data derived from the corresponding ultrasound images. This study indicates that characterization of the type of artery and detection of arterial wall disease are possible with use of an intravascular ultrasound imaging technique.

This document was developed by a consensus conference initiated by Kristian Thygesen, MD, and Joseph S. Alpert, MD, after formal approval by Lars Rydén, MD, President of the European Society of Cardiology (ESC), and Arthur Garson, MD, President of the American College of Cardiology (ACC). All of the participants were selected for their expertise in the field they represented, with approximately one-half of the participants selected from each organization. Participants were instructed to review the scientific evidence in their area of expertise and to attend the consensus conference with prepared remarks. The first draft of the document was prepared during the consensus conference itself. Sources of funding appear in Appendix A. The recommendations made in this document represent the attitudes and opinions of the participants at the time of the conference, and these recommendations were revised subsequently. The conclusions reached will undoubtedly need to be revised as new scientific evidence becomes available. This document has been reviewed by members of the ESC Committee for Scientific and Clinical Initiatives and by members of the Board of the ESC who approved the document on April 15, 2000.*

These findings support the theory that patients with low parasympathetic activity (low short-term RR interval variability) have an increased risk for sudden death independent of other risk factors.