[Show abstract][Hide abstract] ABSTRACT: Background
Right ventricular (RV) function is significantly impaired in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Two-dimensional speckle tracking RV strain and strain rate are novel methods to assess regional RV systolic function in CTEPH patients before and after pulmonary thromboendarterectomy (PTE). Our goal was to (1) assess baseline longitudinal strain and strain rate of the basal RV free wall in CTEPH and (2) measure early changes in RV strain and strain rate after PTE.Methods
We performed echocardiography on 30 consecutive patients with CTEPH referred for PTE with adequate pre- and post-PTE strain imaging. Strain and strain rate were assessed 6.4 ± 4.5 days before and 9.1 ± 3.9 after PTE.ResultsBasal RV free wall strain and time to peak strain—but not basal RV strain rate and time to peak strain rate—changed significantly after PTE. Unexpectedly, basal RV strain became less negative, from −24.3% to −18.9% after PTE (P = 0.005). Time to peak strain decreased from 356 to 287 msec after PTE (P < 0.001). Preoperatively, RV strain correlated with pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (mPAP) but this relationship was not evident postoperatively. Furthermore, the change in RV strain did not correlate with the change in mPAP or PVR.Conclusions
In patients with CTEPH, RV basal strain paradoxically became less negative (i.e., relative systolic shortening decreased) following PTE. This change in RV strain could be due to intraoperative RV ischemia and/or postoperative stunning. Thus, RV basal strain cannot be used as a surrogate marker for surgical success early after PTE.
[Show abstract][Hide abstract] ABSTRACT: Background: Impaired left ventricular diastolic filling is common in chronic thromboembolic pulmonary hypertension (CTEPH), and recent studies support left ventricular underfilling as a cause. To investigate this further, we assessed left atrial volume index (LAVI) in patients with CTEPH before and after pulmonary thromboendarterectomy (PTE).
[Show abstract][Hide abstract] ABSTRACT: Impaired left ventricular diastolic filling is common in chronic thromboembolic pulmonary hypertension (CTEPH), and recent studies support left ventricular underfilling as a cause. To investigate this further, we assessed left atrial volume index (LAVI) in patients with CTEPH before and after pulmonary thromboendarterectomy (PTE).
Journal of the American College of Cardiology 04/2014; 63(12_S). · 14.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To assess the safety and efficacy of extracorporeal shockwave myocardial revascularization (ESMR) therapy in treating patients with refractory angina pectoris.
Patients and Methods
A single-arm multicenter prospective trial to assess safety and efficacy of the ESMR therapy in patients with refractory angina (class III/IV angina) was performed. Screening exercise treadmill tests and pharmacological single-photon emission computed tomography (SPECT) were performed for all patients to assess exercise capacity and ischemic burden. Patients were treated with 9 sessions of ESMR to ischemic areas over 9 weeks. Efficacy end points were exercise capacity by using treadmill test as well as ischemic burden on pharmacological SPECT at 4 months after the last ESMR treatment. Safety measures included electrocardiography, echocardiography, troponin, creatine kinase, and brain natriuretic peptide testing, and pain questionnaires.
Fifteen patients with medically refractory angina and no revascularization options were enrolled. There was a statistically significant mean increase of 122.3±156.9 seconds (38% increase compared with baseline; P=.01) in exercise treadmill time from baseline (319.8±157.2 seconds) to last follow-up after the ESMR treatment (422.1±183.3 seconds). There was no improvement in the summed stress perfusion scores after pharmacologically induced stress SPECT at 4 months after the last ESMR treatment in comparison to that at screening; however, SPECT summed stress score revealed that untreated areas had greater progression in ischemic burden vs treated areas (3.69±6.2 vs 0.31±4.5; P=.03). There was no significant change in the mean summed echo score from baseline to posttreatment (0.4±5.1; P=.70). The ESMR therapy was performed safely without any adverse events in electrocardiography, echocardiography, troponins, creatine kinase, or brain natriuretic peptide. Pain during the ESMR treatment was minimal (a score of 0.5±1.2 to 1.1±1.2 out of 10).
In this multicenter feasibility study, ESMR seems to be a safe and efficacious treatment for patients with refractory angina pectoris. However, larger sham-controlled trials will be required to confirm these findings.
Mayo Clinic Proceedings 01/2014; 89(3):346–354. · 5.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To analyze left ventricular (LV) obstruction in hypertrophic cardiomyopathy (HCM) during exercise echocardiography.
Despite the association of symptoms with LV outflow tract obstruction in HCM, there exist paradoxical situations in which significant intraventricular gradients (>50 mmHg) at rest occur in conjunction with excellent exercise tolerance.
To examine this phenomenon we performed exercise echocardiography and analyzed the clinical status in 107 HCM patients with and without resting obstruction.
At rest, 69 patients had no obstruction while 38 exhibited an intraventricular gradient, 9 of whom exhibited a decrease in gradient of at least 30 mmHg (99±35 to 30±14 mmHg, p<0.001) during exercise (paradoxical response to exercise or PRE). PRE patients presented a significantly lower NYHA clinical class and higher left ventricular volumes and arterial pressure both at rest and during exercise than HCM patients in whom the gradient increased or did not change during stress echocardiography. Finally, PRE patients exhibited a trend toward a reduced rate of cardiac events.
Our study reports a subgroup of HCM patients, designated PRE, based on a decreased intraventricular gradient during exercise. The reduced exertional obstruction may account for the better functional class and trend to less clinical events in PRE patients.
Journal of the American College of Cardiology 06/2013; · 14.09 Impact Factor