Left ventricular hypertrophy: Effect on survival

The diagnostic value of transesophageal echocardiography in monitoring the clinical course has been evaluated in 83 patients with echocardiographic evidence of infective endocarditis. A total of 103 vegetations attached to the aortic or mitral valves were detected by use of the transesophageal approach. The patients were monitored for a mean of 74 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations. Group A included patients with increasing or remaining constant size of vegetation (8.2 ± 1.5 to 11.2 mm, p p p p p p Staphylococcus aureus was the most frequent organism isolated in group A (44% versus 11% in B, p p

Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size.

Ten-year clinical laboratory follow-up after application of a symptom-based therapeutic strategy to patients with severe chronic aortic regurgitation of predominant rheumatic etiology.

Coronary flow and resistance reserve in patients with chronic aortic regurgitation, angina pectoris and normal coronary arteries

Thirty three consecutive patients with clinically suspected endocarditis were studiedbybothprecordial crosssectional echocardiography and transoesophagealechocardiography. The diagnostic value ofbothtechniques wasassessed.Thedatawere comparedwithfindings at operation in 25 patients. In 21 patients withnative valve endocarditis precordial echo-cardiographyshowedevidenceof vegeta- tions in six patients andsuggested their presence in nine. Transoesophagealechocardiography identified vegetationsin 18 patients.Complications wereseen infour patients at precordial echocardio-graphyandinninepatients attransoeso- phageal echocardiography. Precordialechocardiography did not show vegeta- tions in any of the 12 patients withprosthetic valve endocarditis whereastransoesophageal echocardiographyshowed vegetations in four. Complica-tions were seen in four patients at precordial echocardiography and in 10at transoesophageal echocardiography.Echocardiographic findings were con- firmed at operation

Enhanced morphological diagnosis ininfective endocarditis bytransoesophageal echocardiography

The timing of surgery in chronic aortic regurgitation remains a difficult problem. To identify variables predictive of postoperative haemodynamic improvement, changes in left ventricular mass, volume, morphology, and histochemistry were analysed in 67 patients undergoing surgery for chronic aortic regurgitation. Patients were divided into two groups: those in whom the left ventricular echo diameters returned to normal after operation (51 patients, group A), and those with postoperative dilatation (16 patients, group B). A preoperative biopsy was obtained in all patients; postoperative tissue samples were available in 13 patients (five from group A, eight from group B). Data were correlated with the postoperative clinical, haemodynamic state over a follow-up period of three years. Regression of hypertrophy was usually incomplete. Echocardiographic and angiographic data could not define the type and degree of dysfunction which was irreversible. Massive fibre hypertrophy (mean 34.1 micrometers), moderately or severely increased interstitial fibrous tissue, reduced levels of the myofibrillar and mitochondrial enzymes adenosine triphosphates and succinate dehydrogenase in pre- and post-operative tissue samples correlated with persistent dilation, cardiac failure, and early death (group B). Irreversible morphological and functional changes contributed to a depressed cardiac function after operation. Preoperative ventricular biopsies are thus of prognostic importance in volume overload.

https://heart.bmj.com/content/heartjnl/48/6/589.full.pdf

Irreversible morphological changes contributing to depressed cardiac function after surgery for chronic aortic regurgitation.

We evaluated the clinical application of echocardiography (M and 2D modes) in the assessment of cardiac patients with fever and an underlying valvular abnormality in whom the diagnosis of infective endocarditis was suspected.

One or more of the clasiic clinical features of the disease were present in 50 patients (group A). Vegetations were detected by echocardiography in 17 (47%) out of the 36 patients within this group A who had positive blood cultures. Four (28·5%) of the remaining 14 patients with unequivocal endocarditis clinically and negative blood cultures had demonstrable vegetations on ultrasound. Anatomical complications resulting from the septic process (valve destruction or detachment, aortic root abscess) were visualized in 18 (36%) of the 50 patients in group A.

The clinical features of endocarditis were lacking in the other 53 patients with fever and a murmur (group B). This group included 12 patients with other sources of bacteraemia besides endocarditis. Unsuspected vegetations were detected only in 2 (3·7%) out of the 53 cases.

Thus echocardiography is useful in confirming the clinical diagnosis of infective endocarditis, but only rarely detects vegetations in patients who lack the characteristic clinical features of endocarditis, regardless of whether they have positive or negative blood cultures.

The role of echocardiography in suspected bacterial endocarditis

The electrophysiological and mechanical events that follow transient therapeutic coronary artery balloon occlusion were analyzed in five patients. A marked (mean, 60 msec) decrease in the repolarization time of the left ventricular ischemic zone (assessed indirectly from endocardial monophasic action potential [MAP] recordings) ensued within 6 to 10 beats of occlusion. Abnormalities in left ventricular relaxation occurred almost simultaneously and preceded contraction abnormalities. A shift in the ST segment in the electrocardiogram (ECG) usually followed within the next 5 to 10 beats. An increase in heart rate (approximately 10 beats per minute) appeared last in the sequence of events. Angina was a variable parameter, frequently absent. Thus, intracavitary recordings of the electrical and mechanical changes are sensitive indicators of the early ischemic changes that follow coronary occlusion, and may be used to assess the effects of therapeutic interventions on events resulting from a myocardial perfusion deficit.

Study of electrophysiological ischemic events during coronary angioplasty.

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Irreversible morphological changes contributing to depressed cardiac function after surgery for chronic aortic regurgitation.

The role of echocardiography in suspected bacterial endocarditis

Study of electrophysiological ischemic events during coronary angioplasty.