原位心脏移植肺动脉压及右心功能的彩色多普勒超声评价

目的 探讨终末期扩张型心肌病病人心脏移植术前和术后早期肺动脉压和右心功能的临床意义。方法 近2年6例心脏移植病人,术前和术后3～7d用彩色多普勒超声测量右心室前后径、右心室射血分数、肺动脉收缩压与舒张压、心包积液和三尖瓣反流程度。回顾分析术前肺动脉压和右心功能对术后早期右心功能和肺动脉压的影响。结果 术前肺动脉高压病人右心室前后径增加（r=0.8227,n=6）,右心室射血分数减少（r=-0.7361,n=6）。肺动脉压升高是引起右心扩大和衰竭的重要因素;术前肺动脉高压患者术后有明显下降,但仍处于高值;术前肺动脉压与术后右心室和肺动脉径和右心室射血分数改变不显著;术后三尖瓣反流和心包积液与术前和术后肺动脉压有关。结论 手术前后应用彩色多普勒超声评估肺动脉压对心脏移植术前受体选择和早期术后恢复具有重要的临床意义。彩色多普勒超声测量肺动脉压和右心功能简便易行,重复性较好。     

Cardiovascular calcification in patients with end-stage renal disease

Vascular calcifications are very frequent extraosseous calcifications in patients with chronic renal disease. They occur in the intima and in the media. They are associated with decreased arterial elasticity and increased mortality. The risk factors are: advanced age, duration of dialysis treatment, diabetes, increased phosphate concentration, the dose of Ca-containing phosphate binders and inflammation. It is now well established that vascular smooth muscle cells actively take up phosphate to form bioapatite. This process is associated with a phenotypic transformation of vascular smooth muscle cells during which they express osteoblast markers. Lipids and inflammatory cytokines also increase bioapatite formation. Calcification inhibitors are matrix Gla protein and fetuin-A. Decreased serum fetuin-A concentration is associated with a higher mortality rate in dialysis patients. An important preventive measure for vascular calcification is the substitution of Ca-containing by non-Ca-containing phosphate binders.     

Noninvasive diagnosis of coronary artery fistula by two-dimensional and Doppler echocardiography

Summary In a 48-year-old woman, the diagnosis of a right coronary arteriovenous fistula communicating with the coronary sinus was made noninvasively using two-dimensional, pulsed and color Doppler echocardiography.These noninvasive techniques were superior to angiography in delineating the cardiac chamber into which the fistula emptied.     

Dobutamine stress echocardiography and cardiac troponin T for the detection of significant coronary artery disease and predicting outcome in renal transplant candidates.

AIMS: Ischaemic heart disease is the leading cause of mortality and morbidity in patients with end-stage renal disease (ESRD) and after renal transplantation. However, the optimal non-invasive test for coronary artery disease (CAD) diagnosis in this population has yet to be established. The aim of this study was to assess the diagnostic accuracy of dobutamine stress echocardiography (DSE) and baseline plasma cardiac troponin T (cTnT) for detecting significant CAD and predicting adverse cardiac events in patients referred for renal transplantation. METHODS: Coronary angiography, DSE, and baseline cTnT measurements were performed in 118 consecutive patients (mean age 52+/-12 years, 75 male) with ESRD (mean creatinine 608+/-272 micromol/L) referred for renal transplantation. The mean follow-up period was 1.32+/-0.48 years. Significant CAD was defined as a reduction in luminal diameter >70% by visual estimation in at least one major epicardial vessel. An abnormal DSE result defined as the development of a new regional wall motion abnormality in one or more normal resting segments or a deterioration of wall motion in one or more resting hypokinetic segments. A baseline cTnT>0.1 microg/L was taken as positive. RESULTS: Significant CAD in at least one vessel was present in 35 patients (30%). The number of patients with significant 3 vessel and 2 vessel disease was 6 and 7, respectively. An abnormal DSE result was present in 36 (31%) patients. Thirty-one (26%) had cTnT>0.1 microg/L. Sixty-four (54%) patients were on dialysis and 46 (39%) were diabetic. The sensitivity, specificity, positive and negative predictive values for DSE in detecting significant coronary artery disease were 88%, 94%, 86% and 95%, respectively. The same values for a raised cTnT were 54%, 62%, 40% and 74%, respectively. The combination of an abnormal DSE result and raised cTnT gave values of 61%, 91%, 76%, and 80%, respectively. Over the follow-up period, mortality was significantly higher in those with a raised baseline cTnT but not those with an abnormal DSE result or significant CAD. CONCLUSION: DSE is an accurate technique for the detection of significant CAD in renal transplant candidates. An elevated cTnT does not predict significant CAD in this population and when used in conjunction with DSE, reduces the sensitivity of the combined tests. cTnT is an important marker of prognosis in renal transplant candidates.     

Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography

Pulsed Doppler echocardiography was used to examine the relation between pulmonary valve motion and pulmonary artery (PA) flow velocity patterns in 39 adults. In 16 patients with normal PA pressure (mean pressure less than 20 mm Hg), PA flow velocity accelerated slowly to a peak flow velocity at midsystole (time to peak flow velocity, or acceleration time = 134 +/- 20 ms [mean +/- standard deviation]), followed by a slow deceleration to the end of ejection, producing a "dome-like" appearance. In contrast, in 23 patients with elevated PA pressure (mean pressure 20 mm Hg or more), flow velocity accelerated rapidly to a peak flow velocity in early systole (acceleration time = 88 +/- 25 ms, p less than 0.01), followed by rapid flow velocity deceleration to a nadir in midsystole. In 13 of these patients, a transient increase in flow velocity occurred in late systole, producing a "spike and dome" appearance. In patients with an acceleration time of 120 ms or less, there was a negative linear correlation with mean PA pressure, expressed by the equation: mean PA pressure = 90 - (0.62 X acceleration time). The standard error of the estimate was 8.3 mm Hg. A similar negative linear correlation was found between PA acceleration time and total pulmonary resistance. Using a PA acceleration time of 100 ms or less resulted in a 78% sensitivity and a 100% specificity for detection of elevated PA pressure. Although this Doppler method cannot precisely estimate PA pressure, it can be helpful in separating patients with normal pressure from those with elevated PA pressure.     

Regular exercise as a part of treatment for patients with end-stage renal disease

Physical inactivity and its negative influence on health and the quality of life is a common problem generally, especially in patients with chronic illness and also in patients with end-stage renal disease. Motivation for regular physical exercise could be a problem. A supervised outpatient program in a rehabilitation center, a home exercise rehabilitation program and an exercise rehabilitation program during the first hours of the hemodialysis treatment with a bed bicycle ergometer in the renal unit could be carried out. Low intensity aerobic activity has a favorable effect on cardiovascular risk factor, and gymnastics to increase strength, flexibility and coordination, as well as relaxation techniques are very effective exercises in a rehabilitation program. The positive influence of individual regular exercise on health, quality of life, physical exercise capacity, endurance, muscle strength, social, professional and emotional status is also very high in patients. Side effects of exercise are very rare.     

Renovascular resistance assessed by color Doppler ultrasonography in patients with chronic liver diseases

BACKGROUND AND AIMS: Renal arterial vasoconstriction is known to be related to renal hemodynamic derangement in patients with liver cirrhosis. Using color Doppler ultrasonography in patients with chronic liver diseases, abnormal resistance in the renal artery was examined non-invasively both cross-sectionally and longitudinally to clarify the relationship between renal vascular resistance and liver function to neurohumoral factors. METHODS: The study comprised 118 patients with cirrhosis, 23 patients with chronic hepatitis, and 35 healthy controls. Pulsatility and resistive indices that were derived from renal artery velocity analysis were used as parameters of renal arterial resistance. RESULTS: Both the pulsatility and resistive indices were significantly higher in cirrhotic patients (1.29 +/- 0.37, P < 0.001 and 0.69 +/- 0.07, P < 0.001, respectively) compared to controls (1.00 +/- 0.12 and 0.62 +/- 0.05, respectively) and compared to patients with chronic hepatitis (0.97 +/- 0.13 and 0.60 +/- 0.05, respectively). Both indices showed significant correlation with increased Child-Pugh grade. Each correlated significantly with plasma renin activity and plasma aldosterone and norepinephrine levels. Multivariate analysis of the relationship between neurohumoral factors and renal arterial resistance disclosed that plasma renin activity was a significant independent predictor. The longitudinal change in pulsatility index, resistive index and neurohumoral factors were examined in the cirrhotic patients who were followed-up for longer than 6 months. Pulsatility and resistive indices increased according to the deterioration of liver function and the changes in both indices were closely related to the change in plasma renin activity. CONCLUSIONS: Pulsatility index and resistive index as measured by color Doppler ultrasonography were closely related to the severity of cirrhosis and to the levels of neurohumoral factors, especially plasma renin activity, in this cross-sectional and longitudinal study. Therefore, they are useful indices for assessing renal hemodynamics in patients with cirrhosis.     

Incorporation of pulmonary vascular resistance measurement into standard echocardiography: implications for assessment of pulmonary hypertension

Doppler estimation of pulmonary artery systolic pressure (PASP) from tricuspid regurgitation velocity is a simple approach to the detection of pulmonary hypertension but may be influenced by right ventricular stroke volume. We sought the clinical utility of incorporating Doppler calculation of pulmonary vascular resistance (PVR) into determination of pulmonary hypertension in 578 consecutive patients with tricuspid regurgitation. Right atrial pressure was estimated from vena caval dimensions and collapsibility. Pulmonary hypertension was classified on the basis of a) PASP >35 mmHg, b) age-/gender normalized PASP, c) PVR >2 Wood units. The mean PASP was 40 +/- 13 mmHg and PVR was 1.9 +/- 0.8 Wood units. Standard PASP identified pulmonary hypertension in 58%, compared with 36% by age-/gender normalized PASP (P < 0.0001), and 31% by PVR (P < 0.0001). Of patients who had pulmonary hypertension by PASP, 33% were reclassified as normal on the basis of PVR and 6% were reclassified from normal to pulmonary hypertension. PVR is easy to incorporate into a standard echo exam, and identifies a small group with normal PASP as having PAH, and a larger group of apparently increased PASP as normal.     

Pulmonary artery diastolic pressure: a simultaneous Doppler echocardiography and catheterization study

Pulmonary hypertension is an important determinant of the clinical presentation of and surgical approach to patients with heart disease. To confirm the utility of continuous wave Doppler echocardiography in assessing the pulmonary artery diastolic pressure in patients with pulmonary regurgitation, 51 patients representing the wide hemodynamic spectrum of pulmonary artery pressure underwent simultaneous determination of pulmonary artery diastolic pressure by continuous wave Doppler echocardiography and cardiac catheterization. Pulmonary artery diastolic pressure was estimated from the Doppler recordings by the end-diastolic pressure gradient obtained by the modified Bernoulli equation plus the estimated right atrial pressure. A correlation was observed (r = 0.935, SEE = 7.4 mmHg) between Doppler and catheterization pulmonary artery diastolic pressure. In addition, comparison between the mean diastolic pressure gradient across the pulmonary valve by Doppler and pulmonary artery diastolic pressure at catheterization yielded a high correlation (r = 0.947, SEE = 5.1 mmHg). These data demonstrate that continuous wave Doppler echocardiography is a useful noninvasive technique for evaluating the pulmonary artery diastolic pressure in patients with pulmonary regurgitation.     

Estimation of pulmonary vascular resistance: correlation between echocardiography and catheterization data in patients with congenital heart disease

Background: The ratio of peak tricuspid regurgitation velocity (TRV) and right ventricular outflow time–velocity integral (TVI RVOT) has been described as a good correlate of pulmonary vascular resistance (PVR). However, this method has not been well studied in congenital heart disease. Method: Twenty patients with post‐tricuspid shunt lesions who were planned to undergo cardiac catheterization were enrolled for the study. The ratio of TRV/TVI_RVOT was measured via transthoracic echocardiography and correlated with invasively derived PVR (PVR_CATH). PVR_CATH was measured by cardiac catheterization. Fick's principle was used to calculate the pulmonary blood flow and oxygen consumption was assumed. Linear regression analysis was done to find the correlation between TRV/TVI_RVOT and PVR_CATH. Results: There was a significant correlation between the two variables, r = 0.635(P = 0.003). Subgroup analysis revealed that this correlation was better at lower values of PVR_CATH (r = 0.817 for PVR < 6 Wood units (WU)) than higher values (r = 0.659 for PVR > 6 WU). TRV/TVI_RVOT ratio of greater than 0.145 predicted with 80% sensitivity and specificity a PVR > 6 WU. Conclusions: There is modest correlation between TRV/TVI_RVOT ratio and invasively derived PVR in congenital shunt lesions, especially in PVR < 6 WU. TRV/TVI_RVOT ratio could be useful in identifying patients with congenital shunts whose PVR is likely to be <6 WU, and hence, do not need cardiac catheterization. (Echocardiography 2012;29:478‐483)     

炎症诱导低密度脂蛋白受体表达失调在终末期肾病患者桡动脉泡沫细胞形成中的作用

目的 观察微炎症状态下低密度脂蛋白受体(LDLr)途径在终末期肾病(ESRD)患者泡沫细胞形成及动脉粥样硬化(AS)进展中的作用,并初步探讨雷帕霉素靶蛋白(mTOR)通路激活在炎症致LDLr途径失调中的作用机制.方法 根据血清C反应蛋白(CRP)水平将30例ESRD患者分为对照组(16例)和炎症组(14例),取动-静脉内瘘手术时部分切除的桡动脉组织,观察脂质沉积情况;免疫组化检测肿瘤坏死因子α(TNFα)及单核细胞趋化因子-1(MCP-1),同时检测mTOR、LDLr及其基因转录调节相关因子的表达,如固醇调节元件结合蛋白-2(SREBP-2)及SREBP裂解激活蛋白(SCAP);免疫荧光染色检测SCAP与高尔基体的共转位情况.结果 两组患者在病因、年龄、体重、血红蛋白、总蛋白、白蛋白、血糖、血脂谱等指标之间差异无统计学意义(P值均＞0.05);炎症组患者桡动脉TNFα及MCP-1表达增加,并伴随大量泡沫细胞形成和脂质沉积;炎症组患者桡动脉LDLr表达及SCAP由内质网膜向高尔基体的转位显著增加(P＜0.05).进一步分析显示,炎症组LDLr表达增加与mTOR表达上调具有较高的相关性(r=0.733,P＜0.05);且炎症组mTOR与SREBP-2共表达明显高于对照组(P＜0.05).结论 微炎症状态下,ESRD患者AS进展加速,其机制可能与炎症诱导mTOR通路激活,破坏LDLr负反馈调节,导致泡沫细胞形成增加有关.     

Value of tissue Doppler imaging to predict left ventricular filling pressure in patients with coronary artery disease

Assessment of left ventricular (LV) diastolic filling pressure provides important information on the hemodynamic status in the general population. The aim of our study was to investigate the reliability of tissue Doppler imaging (TDI) in estimating left ventricular filling pressure in patients with coronary artery disease (CAD). We prospectively studied 32 consecutive CAD-patients, mean age 64 +/- 12 years, in sinus rhythm. All patients underwent cardiac catheterization and echocardiography within the same hour. Catheterization investigated pre-A-wave pressure (preA) and LV ejection fraction (LVEF). Echocardiographic LVEF was calculated using wall motion indexes (WMI) with segmental division of LV wall. The following Doppler parameters were assessed: (1) PW Doppler signals from the mitral inflow (E), (2) PW TDI of the mitral annulus (E'), thus allowing to obtain the mitral inflow to annulus ratio (E/E'). The best correlation between invasive and echocardiographic LVEF was observed using WMI (r = 0.91). The correlations between preA and E, E', and E/E' were significant (r = 0.36, r = 0.38, and r = 0.60, respectively). In patients with LVEF >50%, no correlation between E/E' and preA was found (r = 0.18, P = 0.44), whereas with LVEF <50%, this correlation was strong (r = 0.76, P < 0.001). In patients with myocardial infarction, the correlation between E/E' and preA was significant whatever the localization of myocardial infarction (r > 0.71, P < 0.05). ROC curve analysis identified an E/E'>9 to be the best cut-off value related to preA > 15 mmHg. We conclude that the mitral inflow-to-annulus ratio is a reliable method in CAD patients and allows determination of LV filling pressure when LVEF <50%.     

A simple Doppler echocardiography method to evaluate pulmonary capillary wedge pressure in patients with atrial fibrillation

OBJECTIVE: The accuracy of E/E' ratio has not been validated in atrial fibrillation (AF). The objective of this study is to compare the accuracy of the E/E' ratio averaged over a sample of 10 cardiac cycles and E/E' ratio obtained in the cycle with the longest RR interval for the estimation of wedge pressure in patients with AF using a simultaneous pulmonary artery occlusive pressure measured with a Swan-Ganz catheter. DESIGN: Twenty-four consecutive patients with AF with a Swan-Ganz catheter were recruited in this study. The majority of patients (92%) were in the early postoperative phase of cardiac surgery. RESULTS: The best sensitivity and specificity was reached with E/E' ratio in the medial position using the one-beat method; E/E' ratio > or = 16 with one beat predicts a wedge pressure >15 mmHg with a sensitivity and specificity of 91% and 85%, respectively. CONCLUSIONS: Measuring E/E' ratio using the one-beat method is a simple and clinically accurate way to estimate wedge pressure in patients with AF.     

Noninvasive assessment of elevated pulmonary vascular resistance in children with pulmonary hypertension secondary to congenital heart disease: A comparative study between five different Doppler indices

Background

Pulmonary vascular resistance (PVR) is an important hemodynamic parameter in patients with congenital heart disease (CHD). Noninvasive estimation of PVR represents an attractive alternative to invasive measurements.

Methods

The study included 175 patients with pulmonary hypertension (PH) secondary to CHD. All patients underwent full echocardiographic study and invasive hemodynamic measurements. The study population was then subdivided into four subgroups. Each of the following Doppler indices was measured in one of these four subgroups: peak tricuspid regurgitant velocity (TRV), the ratio of the TRV to the velocity time integral of the right ventricular outflow tract (TRV/TVI_RVOT), peak velocity of tricuspid annular systolic motion (TSm), heart rate corrected acceleration time and infliction time of the proximal left pulmonary artery (ATc, InTc). The data obtained was correlated with invasive PVR measurement. An ROC curve analysis was done to generate cutoff points with the highest balanced sensitivity and specificity to predict PVR > 6WU/m². The receiver operating characteristics (ROC) curves were compared with each other to determine the most reliable cutoff point in predicting elevated PVR > 6WU/m².

Results

There was a significant correlation between both the TRV and TSm and invasive measurement of PVR (r = −0.511, 0.387 and P value = 0.0002, 0.006 respectively). The TSm and TRV cutoff values were the most reliable to predict elevated PVR > 6 WU/m². A TSm cutoff value of ⩽16.16 cm/s provided the best balanced sensitivity (85.7%) and specificity (66.7%) to determine PVR_CATH > 6 WU/m². A cutoff value less than 7.62 cm/s had 100% specificity to predict PVR_CATH > 6 WU/m². A TRV cutoff value of >3.96 m/s provided the best balanced sensitivity (66.7%) and specificity (100%) to determine PVR_CATH > 6 WU/m². Both TRV and TSm had the highest area under the ROC curve among the 5 DOPPLER indices studied.

Conclusion

Prediction of elevated PVR in children with PH secondary to CHD could be achieved noninvasively using a number of Doppler indices. Among the five Doppler indices examined in the current study, the peak TRV and the TSm of the lateral tricuspid annulus had the highest balanced sensitivity and specificity to predict PVRI > 6 WU/m².Abbreviations: AcT, acceleration time; AcTc, acceleration time corrected to heart rate; BSA, body surface area; CHD, congenital heart disease; DTI, Doppler tissue imaging; InT, inflection time; InTc, inflection time corrected to heart rate; MPAP, mean pulmonary artery pressure; PA, pulmonary artery; PCWP, pulmonary capillary wedge pressure; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; Qp, pulmonary blood flow; ROC, receiver operating characteristics curves; RVSP, right ventricular systolic pressure; TRV, peak tricuspid regurgitant velocity; TSm, peak velocity of tricuspid annular systolic motion; TVI_RVOT, right ventricular outflow tract time–velocity integral     

Assessment of congenital coronary artery fistulas by transesophageal color Doppler echocardiography

PURPOSE: Coronary angiography is the gold standard for imaging the coronary tree, but the relation of coronary artery fistulas to other structures, and their origin and course, may not be apparent. We evaluated the ability of multiplane color Doppler transesophageal echocardiography to identify coronary fistulas. PATIENTS AND METHODS: Twenty-one patients with angiographically confirmed coronary artery fistulas were investigated by transesophageal echocardiography in four Italian hospitals between January 1997 and May 2001. RESULTS: Transesophageal echocardiography correctly diagnosed fistulous connection in all 21 patients. This included 6 patients with connections from the left circumflex artery (into the right chambers of the heart in 5 patients, and into the left ventricle in 1 patient), 10 patients with a fistula arising from the left anterior descending artery or left main coronary artery (with drainage into the right ventricle or main pulmonary artery), and 5 patients with a fistula from the right coronary artery (with drainage sites in the lateral aspect of the right ventricle, the low posterior right atrium, or the superior vena cava). In 4 of the 21 patients, angiography did not identify the precise site of a fistula into the coronary sinus or right ventricle. CONCLUSION: Color Doppler transesophageal echocardiography is useful in the diagnosis and in the precise localization of coronary artery fistulas.     

Evaluation of fetal arrhythmias from simultaneous pulsed wave Doppler in pulmonary artery and vein

Objective

To evaluate the clinical application of simultaneous recordings of pulsed wave Doppler (PWD) signals in pulmonary artery and vein as alternative sampling site for assessment of arrhythmias in the fetus.

Design

Prospective, cross‐sectional study.

Setting

Tertiary referral centre for fetal cardiology.

Patients and methods

From July 1999 to July 2005 PWD was used in pulmonary vessels to assess fetal arrhythmias at 15–40 weeks'' gestation. Sample volume placement in the peripheral lung vessels was guided by colour flow mapping on a four‐chamber section of the fetal heart. Atrial and ventricular systoles were identified from the pulmonary venous and arterial signals respectively. M‐mode recordings were used for comparison.

Outcome measures

Diagnosis of fetal arrhythmias.

Results

Of 129 cases, 15 had supraventricular tachycardia, 12 with 1:1 atrioventricular conduction and 3 with atrial flutter and 2:1 block. There were 96 cases of atrial and 7 of ventricular premature beats, 2 of sinus bradycardia, 8 of variable degree heart block and 1 of ventricular tachycardia. PWD was diagnostic in 119 cases. PWD was better than M mode for diagnosis of premature beats and added information about mechanisms of tachycardia. Both methods facilitated interpretation of all arrhythmia patterns, although PWD was of less practical value in cases of complete heart block.

Conclusion

Simultaneous PWD recording of pulmonary vessels in the fetus allows accurate diagnosis of arrhythmias. It is easily obtained with standard ultrasound equipment and adds to the armamentarium of diagnostic techniques for assessment of rhythm abnormalities prenatally.     

心脏超声估测肺动脉压对于评估肺栓塞预后的作用

目的 探讨多普勒超声估测肺动脉压力对于评估肺栓塞预后的作用.方法 对66例肺动脉栓塞住院患者进行回顾性分析.根据2008年欧洲心脏病协会颁布的急性肺栓塞诊治指南对肺栓塞患者进行危险分层,根据心脏多普勒超声检查,对于存在三尖瓣反流的患者估测肺动脉收缩压,＞40 mm Hg为肺动脉高压组,≤40 mm Hg为肺动脉压正常组.比较两组间临床指标和危险分层的差异.结果 肺动脉收缩压与肺栓塞患者的危险度分层关系密切(P＜0.05),肺动脉高压组的氨基端前脑钠肽值较肺动脉压正常组明显增高(P＜0.01),但其肌钙蛋白T值与肺动脉压正常组相比差异无统计学意义(P＞0.05).结论 多普勒超声估测肺动脉压力对于肺栓塞预后有一定的评估意义.     

Effects of the sibutramine therapy on pulmonary artery pressure in obese patients

Aim: Obesity is a major global public health problem. Previous drugs (dexfenfluramine and fenfluramine) used for the treatment of obesity have been withdrawn due to various cardiac side effects. Sibutramine is an anti‐obesity agent. The purpose of this study was to assess cardiac valve disease and pulmonary artery pressure (PAP) of the patients who used once daily doses of sibutramine. Methods: One hundred and six obese patients (51 men and 55 women) determined to have minimal tricuspid regurgitation (TR) on echocardiographic examination were included in the study. All patients had a complete physical examination, complete blood count and measurement of lipid parameters, and echocardiography was performed by which cardiac valves and PAP were evaluated. After the mean duration of 24‐week of follow up, all examinations were repeated for each patient. Results: The drug was well tolerated by all patients for the follow‐up period. A significant weight loss was recorded in all patients compared to the baseline values (93.1 ± 9.6 kg vs. 85.8 ± 7.7 kg, p < 0.001). Blood pressures and heart rate of the patients increased compared to the baseline measurements (systolic 122.3 ± 8.5 vs. 124 ± 10.2 mmHg, p = 0.128, diastolic 79.3 ± 4.7 vs. 80 ± 5.7 mmHg, p = 0.42 and heart rate 79.5 ± 6.5 vs. 85 ± 5.7 beats/min, p < 0.001). Echocardiographically determined aortic or mitral valve dysfunction appeared in none of the patients. PAP lightly increased after the treatment but the difference between pre and post‐treatment values was not found statistically significant (14.7 ± 1.8 vs. 16.3 ± 1.6 mmHg, p = 0.06). Conclusions: A 24‐week treatment with sibutramine does not affect heart valves and pulmonary artery pressure.