Diagnostic superiority of a combined assessment of the systolic and early diastolic mitral annular velocities by tissue Doppler imaging for the differentiation of restrictive cardiomyopathy from constrictive pericarditis

Background and aims  

Echocardiographic tissue Doppler imaging (TDI) has been proposed as diagnostic tool for the differentiation between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). The aim of this study was a comprehensive TDI analysis of systolic (S′) and early diastolic (E′) velocities of the septal and lateral mitral annulus (MA) in patients (pts) with severe diastolic dysfunction caused either by CP or RCM.     

Plötzlicher Herztod und Rhythmusstörungen bei Sportlern

Sports-related acute cardiovascular events and sudden cardiac death in athletes <35 years old are mainly caused by hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia and coronary anomalies. In athletes >35 years old coronary heart disease is the main cause of sudden cardiac death. In Europe preparticipation screening for competitive sports and mass screening programs including 12-lead electrocardiography (ECG) are recommended for the prevention of sudden cardiac death in athletes. Up to 20% of cases of sudden death in athletes show no tangible structural cardiac disease. The causes in these athletes are mostly congenital cardiac arrhythmia (e.g. Wolff-Parkinson-White syndrome), ion channel disorders (e.g. Brugada syndrome) or acquired cardiac arrhythmia (e.g. Long Q-T syndrome). These diseases necessitate that athletes be advised about the individual risk and further sports activities. Moreover, an improvement of the emergency management in sport arenas with availability of automatic cardioverter defibrillators and standardized emergency programs seems to be necessary.     

Sustained High Quality of Life in a 5-Year Long Term Follow-up after Successful Ablation for Supra-Ventricular Tachycardia. Results from a large Retrospective Patient Cohort

Introduction: The ablation of supraventricular tachycardias (SVT) using radiofrequency energy (RF) is a procedure with a high primary success rate. However, there is a scarcity of data regarding the long term outcome, particularly with respect to quality of life (QoL).     

Alterations of left ventricular function in women with insulin-dependent diabetes mellitus during pregnancy

AIMS/HYPOTHESIS: During pregnancy, eminent cardiovascular changes occur. The aim of the following study was to investigate the course of haemodynamic parameters under the increased volume load during pregnancy and delivery in women with insulin-dependent diabetes mellitus. METHODS: We examined 51 pregnant diabetic women and 51 healthy pregnant women. The control group consisted of 51 healthy non-pregnant women. In all women, left ventricular mass and fractional shortening were calculated. To evaluate left ventricular diastolic function, mitral inflow and pulmonary venous flow profiles were analysed. RESULTS: During pregnancy left ventricular mass increased, fractional shortening decreased and diastolic dysfunction was found. While the healthy pregnant women developed signs of disturbed relaxation during pregnancy, pregnant diabetic women showed signs of a disturbed relaxation at the beginning of gestation. Of the pregnant diabetic women, 29 developed a restrictive filling pattern at the 24th week of gestation. The remaining 22 diabetic women had a comparable restrictive filling pattern only during vaginal delivery. In 10 of the 29 pregnant diabetic women dangerous complications were documented, while there were no complications in the healthy pregnant women and the other 22 diabetic pregnant women. CONCLUSION/INTERPRETATION: In healthy women pregnancy results in a reversible physiologic left ventricular hypertrophy, a disturbed relaxation pattern and a temporary decrease of left ventricular systolic function. In contrast, pregnant diabetic women showed a delayed relaxation at the beginning of pregnancy and developed a restrictive filling pattern. The early development of a restrictive filling pattern could indicate complications during delivery in pregnant diabetic women.     

Pericardial pseudotumor. Echocardiographic observation of juxtacardiac pulmonary collapse

Despite its value in the diagnosis of pericardial disease, two-dimensional echocardiography also is known to produce confounding results. Ten patients had juxtacardiac masses simulating pericardial tumor implants on echocardiographic examination ("pericardial pseudotumor") caused by juxtacardiac pulmonary atelectasis or lobar collapse. The atelectatic nature of these masses was based on echocardiographic delineation of pericardial and pleural anatomy, combined with ancillary radiographic and CT studies. Drainage of pleural fluid also led to disappearance of the masses on echocardiographic examination, suggesting that the masses were an ultrasonic manifestation of pulmonary atelectasis resulting from surrounding compressive effusive fluid. Finally, clinical follow-up failed to show development of malignant disease in any patient. The possibility of pericardial pseudotumor should be considered when ultrasound studies show juxtacardiac masses within large collections of pleural fluid, especially in the clinical absence of malignant disease.     

Determinants of Doppler indexes of left ventricular diastolic function in normal subjects (the Framingham Heart Study).

Normative Doppler values and determinants of left ventricular (LV) diastolic function in healthy subjects have not been fully elucidated. Subjects from the Framingham Heart Study were examined to describe reference values and determinants of echocardiographic Doppler indexes of diastolic function. One hundred twenty-seven randomly selected, rigorously defined, normal subjects, approximately evenly distributed by sex and age from the third through the eighth decades were studied by Doppler echocardiography. Normative values for 7 frequently used Doppler indexes of LV diastolic function are presented. Doppler indexes of LV diastolic function change dramatically with age; the peak velocity of early filling divided by late filling (peak velocity E/A) ranges from a mean of 2.08 +/- 0.55 for subjects in their third decade to 0.84 +/- 0.29 for those in their eighth decade. A peak velocity E/A ratio less than 1 is abnormal in subjects aged less than 40 years, but occurs in most subjects aged greater than or equal to 70 years. The high correlations between age and Doppler indexes of LV diastolic function are not greatly attenuated after adjustment for other clinical parameters associated with diastolic function; the multivariate partial correlation coefficient between age and peak velocity E/A is -0.80 (p less than 0.0001). Heart rate, PR interval, LV systolic function, sex and systolic blood pressure are minor determinants of Doppler indexes of diastolic function. Body mass index, left atrial diameter, and LV wall thickness, internal dimension and mass have little or no association with Doppler indexes in healthy subjects.(ABSTRACT TRUNCATED AT 250 WORDS)