Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ecause of the rapid increase in cases of calcific aortic stenosis (AS) in industrialized countries, there are increasing numbers of symptomatic elderly patients who do not undergo aortic valve surgery because the surgical intervention poses significant risks related to coexisting comorbidities. 1,2 As a result, there are growing concerns regarding the poor prognosis of these patients and the increased associated medical costs. 3 Transcatheter aortic valve implantation (TAVI) has recently emerged as an alternative to surgery in high-risk patients with AS. 4-7 Detailed anatomical information regarding the aortic root geometry is important for selecting candidates for successful TAVI while avoiding associated complications. Recent studies have reported that multidetector computed tomography (MDCT) provides 3-dimensional (D) morphological information on the geometry of the aortic root, as well as the spatial relationship between the aortic annulus and the ostia of the left and right coronary arteries (LCA and RCA, respectively). 8-11 However, because of its known limitations, MDCT cannot be performed in all patients.Real-time 3D transesophageal echocardiography (3DTEE) has the potential to provide 3D information regarding aortic root morphology. We hypothesized that real-time 3DTEE could be a useful alternative for assessing aortic root geometry. Accordingly, the aims of this study were: (1) to validate 3DTEE measurements of aortic root using MDCT measurements as a reference, and (2) to examine whether the aortic root geometry differs between patients with and without AS.
Methods
Study PopulationProtocol 1 We retrospectively enrolled 35 patients referred for MDCT coronary angiography who underwent Background: Precise evaluation of the aortic root geometry prior to transcatheter aortic valve implantation is important for procedural success in patients with aortic stenosis (AS). To determine the potential for 3-dimensional transesophageal echocardiography (3DTEE), the aims of the present study were: (1) to assess the accuracy of 3DTEE measurements of the aortic root using multidetector computed tomography (MDCT) as a reference, and (2) to examine whether aortic root geometry differs between patients with and without AS.
Sex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.
AimsThe aim of this study was to determine differences in the acute and chronic impact of adaptive servo-ventilation (ASV) on left chamber geometry and function in patients with chronic heart failure (CHF).
Methods and resultsAn acute ASV study was performed to measure echocardiographic parameters before and 30 min after the initiation of ASV therapy in 30 CHF patients (mean age: 69 years, 23 male). The chronic effects of ASV therapy were also evaluated in 26 of these 30 patients over a mean follow-up period of 24 weeks. Patients were divided into two groups according to the status of ASV therapy [ASV group (n ¼ 15) and withdrawal group (n ¼ 11)]. In the acute study, heart rate and blood pressure were significantly decreased 30 min after the ASV therapy compared with baseline. Stroke volume and cardiac output were significantly increased in conjunction with a reduction in systemic vascular resistance. Multivariate regression analysis revealed baseline E/e ′ to be an independent predictor for absolute increase in cardiac output. In the chronic study, a significant reduction of left ventricular (LV)/left atrial (LA) volumes and the severity of mitral regurgitation (MR), and improved LV diastolic function parameters were noted in the ASV group. These beneficial effects were not observed in the withdrawal group.
ConclusionThe acute beneficial impact of ASV is mainly associated with the reduction of afterload resulting in an increase in stroke volume and cardiac output. In contrast, chronic ASV therapy produces LV and LA reverse remodelling resulting in an improvement in LV function and the severity of MR in patients with CHF.--
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