Daytime Ambulatory Blood Pressure Correlates Strongly with the Echocardiographic Diameter of Aortic Coarctation

Objective - To relate the echocardiographic aortic arch-diameter to ambulatory and clinic blood pressure (BP) in patients with aortic coarctation. Design - Eighteen adult patients (50% men) were recruited from the coarctation registry of the Linkoping Heart Centre. Biplane-trans-oesophageal echocardiography (TEE) was performed with Acuson XP 128/10, ambulatory BP was recorded with Spacelab models 90202/90205. Results - Systolic clinic and ambulatory BP levels were higher in patients than in the 36 controls (clinic BP: 146 &#45 25 mmHg vs 119 &#45 10 mmHg, p = 0.0009, ambulatory BP: 140 &#45 18 mmHg vs 124 &#45 11 mmHg, p = 0.009). The differences in diastolic BP levels were less obvious (clinic BP: 87 &#45 16 mmHg vs 76 &#45 8 mmHg, p = 0.02, ambulatory BP: 84 &#45 13 mmHg vs 77 &#45 9 mmHg, p = 0.052). Daytime ambulatory BP was more strongly related than clinic BP to the coarctation diameter (AD) (systolic BP r = -0.73, p = 0.0006 and r = -0.61, p = 0.007, respectively). In surgically corrected patients ( n = 14) only the correlations between ambulatory systolic daytime ( r = -0.61, p = 0.02) and night-time ( r = -0.58, p = 0.03) BP to AD was statistically significant. Conclusion - Ambulatory BP correlates strongly with aortic coarctation measured by TEE and would thus be the preferred technique for evaluating BP in this patient category.     

Prevalence of rheumatic heart disease in patients with recurrent tonsillitis and elevated anti-streptolysin O titers

IntroductionPatients with elevated anti-streptolysin O (ASO) titers (ASOT) and recurrent tonsillitis episodes are known to be at higher risk for rheumatic heart disease (RHD). However, there is no data regarding prevalence of RHD in this high risk population. In this study, we aimed to screen ambulatory patients with elevated ASOT and recurrent tonsillitis episodes using echocardiography for identification of RHD. We hypothesized that prevalence of RHD is higher in this patient group compared to general population.Methods102 patients (10.33 ± 4.01 years, 50.98% female) who were diagnosed with recurrent tonsillitis and had elevated ASOT were included this study. Echocardiographic evaluation was performed by an experienced cardiologist.ResultsEchocardiographic examination revealed definite RHD in 2/102 (1.96%) patients and borderline RHD in 3/102 (2.94%) patients.ConclusionOur study demonstrates a high prevalence of RHD in patients with recurrent tonsillitis episodes and high ASOT. Screening with echocardiography is beneficial to improve the detection rates of subclinical RHD in such high-risk populations.     

Characteristic Echocardiographic Manifestations of Behçet's Disease

The objective of this study was to determine the characteristic echocardiographic manifestations of Behçet's disease. Ninety-seven Behçet's patients admitted to our hospital from January 2002 to December 2016 were retrospectively analyzed. There were 63 patients (64.9%) with cardiac involvement; these included 47 men (74.6%) and 16 women (25.4%). Of these 63 patients, most (74.6%) exhibited valvular lesions, especially aortic regurgitation. The primary characteristic manifestations of valves were cusp prolapse with aneurysmal changes, vegetation-like lesions and echo-free spaces within the annulus. Second (30.0%) were aortic lesions, including aortic dilation or aneurysm formation, aortic pseudoaneurysm and coronary sinus aneurysm. Other manifestations, such as cardiac thrombosis, coronary arterial pseudoaneurysm, pulmonary aneurysm and pericardial effusion, were rare. Cardiac involvement is not uncommon in Behçet's patients, especially in males, and it is characterized by valvular disease, especially aortic regurgitation. The diagnosis of Behçet's disease should be considered when evaluating patients with these characteristic echocardiographic manifestations.     

Oversizing in transcatheter aortic valve replacement,a commonly used term but a poorly understood one: Dependency on definition and geometrical measurements

BackgroundIn transcatheter aortic valve replacement, prosthesis oversizing is essential to prevent paravalvular regurgitation. However, the estimated extent of oversizing strongly depends on the measurement used for annular sizing.PurposeThe aim was to investigate the influence of geometrical parameters for calculation of relative oversizing in transcatheter aortic valve replacement, reported as percentage in relation to the native annulus size, to standardize reporting.MethodsElectrocardiogram-gated cardiac dual-source CT data of 130 consecutive patients with severe aortic stenosis (mean age, 81 ± 8 years; 56 men; mean aortic valve area, 0.67 ± 0.18 cm²) were included. Aortic annulus dimensions were quantified by means of planimetry that yielded area and perimeter at the level of the basal attachment points of the aortic cusps during systole. Area- and perimeter-derived diameters were calculated as D_A = 2 × √(A/π) and D_P = P/π. Hypothetical prosthesis sizing was based on D_A (23-mm prosthesis for 19–22 mm; 26-mm prosthesis for 22–25 mm; 29-mm prosthesis for 25–28 mm). Relative oversizing for hypothetical prosthesis selection was calculated as percentage in relation to the native annulus size.ResultsMean annulus area was 492.12 ± 94.9 mm² and mean perimeter was 80.1 ± 7.6 mm. D_P was significantly larger than D_A (25.5 ± 2.4 mm vs 24.9 ± 2.4 mm; P < .001). Mean maximum diameter was 28.1 ± 3.0 mm and mean minimal diameter was 22.8 ± 2.4 mm. Calculated eccentricity index [EI = 1 − minimal diameter/maximum diameter)] was 0.19 ± 0.06. Difference between D_P and D_A correlated significantly with EI (r = 0.67; P < .001). Relative oversizing was 10.2% ± 3.8% and 21.6% ± 8.4% by D_A and area, and 7.8% ± 3.9% by both D_P and perimeter.ConclusionFor planimetric assessment of aortic annulus dimensions with CT, the percentage oversizing calculated strongly depends on the geometrical variable used for quantifying annular dimensions. Standardized nomenclature seems warranted for comparison of future studies.