Measurement of pulmonary arterial elastance in patients with systolic heart failure using Doppler echocardiography

Objective: A reliable and easy-to-perform method for measuring right ventricular (RV) afterload is desirable when scheduling patients with systolic heart failure to undergo heart transplantation. The present study aimed to investigate the accuracy of echocardiographically-derived pulmonary arterial elastance as a measurement of pulmonary vascular resistance by comparing it with invasive measures. Methods: Thirty-one patients with moderate to severe systolic heart failure, including 22 (71) male patients, with a mean age of 41.16±15.9 years were enrolled in the study. Right heart catheterization and comprehensive echocardiography during the first hour after completion of cardiac catheterization were performed in all the patients. The pulmonary artery elastance was estimated using the ratio of end-systolic pressure (Pes) over the stroke volume (SV) by both cardiac catheterization Ea (PV)-C and echocardiography Ea (PV)-E. Results: The mean Ea (PV)-C and Ea (PV)-E were estimated to be 0.73±0.49 mm Hg/mL and 0.67±0.44 mm Hg/mL, respectively. There was a significant relation between Ea (PV)-E and Ea (PV)-C (r=0.897, p<0.001). Agreement between echocardiography and catheterization methods for estimating Ea (PV), investigated by the Bland-Altman method, showed a mean bias of -0.06, with 95% limits of agreement from -0.36 mm Hg/mL to 0.48 mm Hg/mL. Conclusion: Doppler echocardiography is an easy, non-invasive, and inexpensive method for measuring pulmonary arterial elastance, which provides accurate and reliable estimation of RV afterload in patients with systolic heart failure. © 2016 by Turkish Society of Cardiology

Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration

Background: Cardiac resynchronization therapy (CRT) has been accepted as an established therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually evaluated to increase the percentage of CRT responders. We postulated that QRS notch can increase mechanical LV dyssynchrony independently of other known predictors such as left ventricular ejection fraction and QRS duration. Methods: A total of 87 consecutive patients with advanced systolic heart failure and QRS duration more than 120 ms with an LBBB-like pattern in V1 were prospectively evaluated. Twelve-lead electrocardiogram was used for detection of QRS notch. Complete echocardiographic examination including tissue Doppler imaging, pulse wave Doppler and M-mode echocardiography were done for all patients. Results: Eighty-seven patients, 65 male (75) and 22 female (25), with mean (SD) age of 56.7 (12.3) years were enrolled the study. Ischemic cardiomyopathy was the underlying heart disease in 58 of the subjects, and in the others it was idiopathic. Patients had a mean (SD) QRS duration of 155.13 (23.34) ms. QRS notch was seen in 49.4 of the patients in any of two precordial or limb leads. Interventricular mechanical delay was the only mechanical dyssynchrony index that was significantly longer in the group of patients with QRS notch. Multivariate analysis revealed that the observed association was actually caused by the effect of QRS duration, rather than the presence of notch per se. Conclusions: QRS notch was not an independent predictor of higher mechanical dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart failure; however, there was a borderline association between QRS notch and interventricular delay. © 2008 Via Medica

Can prodromal symptoms predict recurrence of vasovagal syncope?

Background: Vasovagal syncope (VVS) is a common symptom with empirical therapy and high recurrence rate. Our goal was to determine whether the pattern of presyncopal prodromal symptoms can predict the recurrence probability of vasovagal syncope. Methods: Seventy-nine consecutive patients (male/female: 53/26) with history of VVS and positive tilt table test (TTT) were enrolled in the study and completed the follow-up time for one year. They all had normal electrocardiograms and cardiac echocardiography without underlying disease. All of them were evaluated meticulously for prodromal symptoms (diaphoresis, nausea, palpitation and blurred vision) and frequency of syncopal spells in their past medical history. They received metoprolol at maximum tolerated dose and were taught tilt training as an empirical therapy after TTT. Results: Fifty-four patients (68.4) reported at least one of the four main prodromal symptoms. Median syncopal ± presyncopal spells were 4 episodes. Forty-two patients (53.2) experienced recurrence of syncope or presyncope during the follow-up period. In recurrent symptomatic patients, diaphoresis had been more significantly reported in their past medical history (p = 0.018) and they had more syncopal spells before TTT (p = 0.001). Age, gender and type of TTT response did not have any effect on the recurrence of VVS. Conclusions: Patients with a history of diaphoresis as a prodromal symptom and more pre-tilt syncopal attacks experience more syncopal or presyncopal spells during follow-up. Copyright © 2008 Via Medica

Relationship between icu nurses� working shifts and the time of endotracheal extubation after cardiac surgery

Background: The aim of this study was to determine the relationship between nurses� work shifts in the intensive care unit (ICU) and the time of endotracheal extubation after cardiac surgery. Methods: The present study enrolled 210 patients that underwent cardiac surgery in a university referral cardiovascular center in 2018. Samples were selected via the convenience sampling method from adult patients that underwent elective cardiac surgery. The study samples were divided into 3 groups based on their admission time in the ICU: before 2 pm (morning shift), between 2 and 7 pm (evening shift), and after 7 pm (night shift). The patients� demographic characteristics, risk factors, and intraoperative and postoperative clinical variables were collected. Information regarding the time of admission into the ICU, the time of readiness for extubation, and the actual time of extubation was recorded. Finally, these times were compared between the patients admitted into ICU in the 3 abovementioned work shifts. Results: The study population was comprised of 210 patients, 142 (67.6) male and 68 (32.4) female, at an average age of 55 years old (44�63). According to the findings, tracheal extubation was usually performed in the work shift after the patients� admission time. There was a significant difference between the time of readiness for extubation and the actual time of tracheal tube removal on the different shifts, with the time being about 1 hour longer on the night shift than on the evening or morning shift (P < 0.05). Conclusions: Our cardiac surgery patients who were admitted into the ICU on the morning and evening shifts were ready for extubation earlier than those admitted on the night shift. © 2020, Iranian Heart Association. All rights reserved

Echocardiographic evaluation of chronic thromboembolic pulmonary hypertension before and after pulmonary artery endarterectomy: A case series

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and under diagnosed disorder with significant morbidity and mortality. For reasons that are still unclear, the lyses of blood clots does not occur in some survivors with acute pulmonary thromboemboli, which then evolve into the organization of the clot inside the pulmonary artery and CTEPH. Obstruction of the pulmonary artery results in increased vascular resistance and thereafter right heart strain and remodeling. Pulmonary artery endarterectomy is the treatment of choice with good outcome in these patients. Objectives: The aim of the present study was to evaluate right ventricular function and pulmonary artery pressure before and then after pulmonary thrombo-endarterectomy for a preoperative classification system and risk stratification to aid in patient selection. Methods: In this study, all clinical and paraclinical data such as echocardiographic data of patients with CTEPH were obtained before and after pulmonary thrombo-endarterectomy. Results: Pulmonary thrombo-endarterectomy was associated with significant improvement in right ventricular size (p value = 0.024), systolic pulmonary arterial pressure (p value = 0.012), and functional exercise capacity (p value = 0.007), but right ventricular systolic function did not show significant improvement after that. Conclusion: Pulmonary endarterectomy by well-experienced surgical and medical teams is the method of choice for the treatment of CTEPH with good long-term results and acceptable mortality and morbidity

Assessment of pulmonary regurgitation severity in tetralogy of fallot total correction: Comparison between doppler echocardiography and cardiac MRI

Background: Pulmonary regurgitation is a common finding in patients after tetralogy of Fallot total correction (TFTC). Right ventricular enlargement and dysfunction have been ascribed to pulmonary insufficiency (PI), which is an important issue in the follow-up of patients with TFTC. We sought to compare PI measured by echocardiography with data provided by cardiac magnetic resonance imaging (CMR). Methods: We studied 155 selected patients (91 male; median age = 25.65 y, range = 15-55 y) after TFTC. To quantify the pulmonary regurgitant fraction (PRF) by CMR, we performed flow velocity mapping. On Doppler echocardiography, the length, width, and localization of the regurgitant flow, no-flow time, and pressure half-time were measured. The severity of PI on echocardiography was categorized as nonsignificant and significant and was thereafter compared to the data obtained by CMR. Results: In all 155 patients, the measurement of the flow and volume was possible by CMR, and the measurement of PI was possible by Doppler echocardiography. The mean PRF, as determined by CMR, was 33 ± 16.4. Pulmonary regurgitation has been reported to be a causative factor in right ventricular volume enlargement. A PRF > 20 was considered significant and was compared with echocardiographic parameters and also right ventricular size and function and other indices resulted from CMR. The regression analysis showed a significant correlation between PI severity on CMR and right ventricular enlargement on MRI at end diastole (r = 0.746; P < 0.001) and also at end systole (r = 0.71; P < 0.05). Conclusions: There was no significant correlation between right ventricular ejection fraction and PI severity on CMR (r=0.553; P=0.45). On echocardiography, the semiquantitative estimation of pulmonary regurgitation showed that there were 26 patients with mild-to-moderate PI and 99 patients with severe PI. A right ventricular end-diastolic volume index (RVEDVI) of 121 mL/m² was 87 sensitive and 54 specific for severe PI, and an RVEDVI of 180 mL/m² was 90 specific for severe PI. © 2016, Iranian Heart Association. All rights reserved