Impact of valvular heart disease on activities of daily living of nonagenarians: the leiden 85-plus study a population based study

<p>Abstract</p> <p>Background</p> <p>Data on the prevalence of valvular heart disease in very old individuals are scarce and based mostly on in-hospital series. In addition, the potential detrimental effect of valvular heart disease on the activities of daily living is unknown. The present study evaluated the prevalence of significant valvular heart disease and the impact of valvular heart disease on the activities of daily living in community dwelling nonagenarians. Nested within the Leiden 85-plus study, a population based follow-up study of the oldest old, a sample of 81 nonagenarians was recruited.</p> <p>Methods</p> <p>The left ventricular (LV) dimensions, function and the presence and severity of heart valvular disease were evaluated by echocardiography. Significant valvular heart disease included any mitral or aortic stenosis severity, moderate or severe mitral regurgitation, moderate or severe aortic regurgitation and moderate or severe tricuspid regurgitation. Activities of daily living were assessed using the Groningen Activity Restriction Scale (GARS).</p> <p>Results</p> <p>LV cavity diameters (end-diastolic diameter 47 ± 8 mm, end-systolic diameter 30 ± 8 mm) and systolic LV function (LV ejection fraction 66 ± 13%) were within normal for the majority of the participants. Significant valvular disease was present in 57 (70%) individuals, with mitral regurgitation and aortic regurgitation as the most frequent valve diseases (49% and 28% respectively). The GARS score between individuals with and without significant valvular heart disease was similar (36.2 ± 9.2 vs. 34.4 ± 13.2, p = 0.5).</p> <p>Conclusions</p> <p>Nonagenarian, outpatient individuals have a high prevalence of significant valvular heart disease. However, no relation was observed between the presence of significant valvular heart disease and the ability to perform activities of daily living.</p

Noninvasive estimation of left ventricular filling pressures in patients with heart failure after surgical ventricular restoration and restrictive mitral annuloplasty

ObjectiveDoppler echocardiography, including tissue Doppler imaging, is widely applied to assess diastolic left ventricular function using early transmitral flow velocity combined with mitral annular velocity as a noninvasive estimate of left ventricular filling pressures. However, the accuracy of early transmitral flow velocity/mitral annular velocity in patients with heart failure, particularly after extensive cardiac surgery, is debated. Global diastolic strain rate during isovolumic relaxation obtained with 2-dimensional speckle-tracking analysis was recently proposed as an alternative approach to estimate left ventricular filling pressures.MethodsWe analyzed diastolic function in patients with heart failure after surgical ventricular restoration and/or restrictive mitral annuloplasty. Echocardiography, including tissue Doppler imaging and speckle-tracking analysis, was performed to determine early transmitral flow velocity/atrial transmitral flow velocity, isovolumetric relaxation time, deceleration time, early transmitral flow velocity/mean mitral annular velocity, strain rate during isovolumic relaxation, and early transmitral flow velocity/strain rate during isovolumic relaxation. These noninvasive indices were correlated with relaxation time constant Tau, peak rate of pressure decline, and left ventricular end-diastolic pressure obtained in the catheterization room using high-fidelity pressure catheters.ResultsTwenty-three patients were analyzed 6 months after restrictive mitral annuloplasty (n = 8), surgical ventricular restoration (n = 4), or a combined procedure (n = 11). The strongest correlation with invasive indices, in particular left ventricular end-diastolic pressure, was found for strain rate during isovolumic relaxation (r = −0.76, P < .001). Early transmitral flow velocity/mean mitral annular velocity did not correlate significantly with any of the invasive indices. Strain rate during isovolumic relaxation (cutoff value < 0.38 s−1) accurately predicted left ventricular end-diastolic pressure of 16 mm Hg or more with 100% sensitivity and 93% specificity.ConclusionsIn a group of patients with heart failure who were investigated 6 months after cardiac surgery, early transmitral flow velocity/mean mitral annular velocity correlated poorly with invasively obtained diastolic indexes. Global strain rate during isovolumic relaxation, however, correlated well with left ventricular end-diastolic pressure and peak rate of pressure decline. Our data suggest that global strain rate during isovolumic relaxation is a promising noninvasive index to assess left ventricular filling pressures in patients with heart failure after extensive cardiac surgery, including restrictive mitral annuloplasty and surgical ventricular restoration

Multi-wavelength analysis of high energy electrons in solar flares: a case study of August 20, 2002 flare

A multi-wavelength spatial and temporal analysis of solar high energy electrons is conducted using the August 20, 2002 flare of an unusually flat (gamma=1.8) hard X-ray spectrum. The flare is studied using RHESSI, Halpha, radio, TRACE, and MDI observations with advanced methods and techniques never previously applied in the solar flare context. A new method to account for X-ray Compton backscattering in the photosphere (photospheric albedo) has been used to deduce the primary X-ray flare spectra. The mean electron flux distribution has been analysed using both forward fitting and model independent inversion methods of spectral analysis. We show that the contribution of the photospheric albedo to the photon spectrum modifies the calculated mean electron flux distribution, mainly at energies below 100 keV. The positions of the Halpha emission and hard X-ray sources with respect to the current-free extrapolation of the MDI photospheric magnetic field and the characteristics of the radio emission provide evidence of the closed geometry of the magnetic field structure and the flare process in low altitude magnetic loops. In agreement with the predictions of some solar flare models, the hard X-ray sources are located on the external edges of the Halpha emission and show chromospheric plasma heated by the non-thermal electrons. The fast changes of Halpha intensities are located not only inside the hard X-ray sources, as expected if they are the signatures of the chromospheric response to the electron bombardment, but also away from them.Comment: 26 pages, 9 figures, accepted to Solar Physic

Regularized energy-dependent solar flare hard x-ray spectral index

The deduction from solar flare X-ray photon spectroscopic data of the energy dependent model-independent spectral index is considered as an inverse problem. Using the well developed regularization approach we analyze the energy dependency of spectral index for a high resolution energy spectrum provided by Ramaty High Energy Solar Spectroscopic Imager (RHESSI). The regularization technique produces much smoother derivatives while avoiding additional errors typical of finite differences. It is shown that observations imply a spectral index varying significantly with energy, in a way that also varies with time as the flare progresses. The implications of these findings are discussed in the solar flare context.Comment: 13 pages; 5 figures, Solar Physics in pres

Reduced Left Ventricular Torsion Early After Myocardial Infarction Is Related to Left Ventricular Remodeling

Background— Left ventricular (LV) torsion is emerging as a sensitive parameter of LV systolic myocardial performance. The aim of the present study was to explore the effects of acute myocardial infarction (AMI) on LV torsion and to determine the value of LV torsion early after AMI in predicting LV remodeling at 6-month follow-up. Methods and Results— A total of 120 patients with a first ST-segment elevation AMI (mean±SD age, 59±10 years; 73% male) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, speckle-tracking echocardiography was performed to assess LV torsion; infarct size was assessed by myocardial contrast echocardiography. At 6-month follow-up, LV volumes and LV ejection fraction were reassessed to identity patients with LV remodeling (defined as a ≥15% increase in LV end-systolic volume). Compared with control subjects, peak LV torsion in AMI patients was significantly impaired (1.54±0.64°/cm vs 2.07±0.27°/cm, P <0.001). By multivariate analysis, only LV ejection fraction ( β =0.36, P <0.001) and infarct size ( β =−0.47, P <0.001) were independently associated with peak LV torsion. At 6-month follow-up, 19 patients showed LV remodeling. By multivariate analysis, only peak LV torsion (odds ratio=0.77; 95% CI, 0.65–0.92; P =0.003) and infarct size (odds ratio=1.04; 95% CI, 1.01–1.07; P =0.021) were independently related to LV remodeling. Peak LV torsion provided modest but significant incremental value over clinical, echocardiographic, and myocardial contrast echocardiography variables in predicting LV remodeling. By receiver-operating characteristics curve analysis, peak LV torsion ≤1.44°/cm provided the highest sensitivity (95%) and specificity (77%) to predict LV remodeling. Conclusions— LV torsion is significantly impaired early after AMI. The amount of impairment of LV torsion predicts LV remodeling at 6-month follow-up

Left Ventricular Dyssynchrony Acutely After Myocardial Infarction Predicts Left Ventricular Remodeling

ObjectivesWe sought to identify predictors of left ventricular (LV) remodeling after acute myocardial infarction.BackgroundLeft ventricular remodeling after myocardial infarction is associated with an adverse long-term prognosis. Early identification of patients prone to LV remodeling is needed to optimize therapeutic management.MethodsA total of 178 consecutive patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention were included. Within 48 h of intervention, 2-dimensional echocardiography was performed to assess LV volumes, LV ejection fraction (LVEF), wall motion score index, left atrial dimension, E/E′ ratio, and severity of mitral regurgitation. Left ventricular dyssynchrony was determined using speckle-tracking radial strain analysis. At 6-month follow-up, LV volumes, LVEF, and severity of mitral regurgitation were reassessed.ResultsPatients showing LV remodeling at 6-month follow-up (20%) had comparable baseline characteristics to patients without LV remodeling (80%), except for higher peak troponin T levels (p < 0.001), peak creatine phosphokinase levels (p < 0.001), wall motion score index (p < 0.05), E/E′ ratio (p < 0.05), and a larger extent of LV dyssynchrony (p < 0.001). Multivariable analysis demonstrated that LV dyssynchrony was superior in predicting LV remodeling. Receiver-operating characteristic curve analysis demonstrated that a cutoff value of 130 ms for LV dyssynchrony yields a sensitivity of 82% and a specificity of 95% to predict LV remodeling at 6-month follow-up.ConclusionsLeft ventricular dyssynchrony immediately after acute myocardial infarction predicts LV remodeling at 6-month follow-up

Determination Of Electron Flux Spectra In A Solar Flare With An Augmented Regularization Method: Application To Rhessi Data

Kontar et al. (2004) have shown how to recover mean source electron spectra in solar flares through a physical constraint regularization analysis of the bremsstrahlung photon spectra that they produce. They emphasize the use of non-square inversion techniques, and preconditioning combined with physical properties of the spectra to achieve the most meaningful solution to the problem. Higher-order regularization techniques may be used to generate ${overline F}(E)$ forms with certain desirable properties (e.g., higher order derivatives). They further note that such analyses may be used to infer properties of the electron energy spectra at energies well above the maximum photon energy observed. In this paper we apply these techniques to data from a solar flare observed by RHESSI on 26 February, 2002. Results using different orders of regularization are presented and compared for various time intervals. Clear evidence is presented for a change in the value of the high-energy cutoff in the mean source electron spectrum with time. We also show how the construction of the injected (accelerated) electron spectrum $F_0(E_0)$ (assuming that Coulomb collisions in a cold target dominate the electron energetics) is facilitated by the use of higher-order regularization methods.Comment: 10 pages, 7 figures, accepted to Solar Physic

Right ventricular peak systolic longitudinal strain is a sensitive marker for right ventricular deterioration in adult patients with tetralogy of Fallot

The aim of this study was to evaluate the feasibility of right ventricular (RV) longitudinal peak systolic strain (LPSS) assessment for the follow-up of adult patients with corrected tetralogy of Fallot (TOF). Adult patients (n = 18) with corrected TOF underwent echocardiography and CMR twice with a time interval of 4.2 ± 1.7 years. RV performance was derived from CMR, and included RV volumes and ejection fraction (EF). LPSS was calculated globally (GLPSS) and in the RV free wall (LPSS FW), with echocardiographic speckle-tracking strain-analysis. Baseline (G)LPSS values were compared between patients and healthy controls; the relation between (G)LPSS and CMR parameters was evaluated and the changes in (G)LPSS and CMR parameters during follow-up were compared. GLPSS and LPSS FW were significantly reduced in patients as compared to controls (−14.9 ± 0.7% vs. −21.6 ± 0.9% and −15.5 ± 0.9% vs. −22.7 ± 1.5%, P < 0.01). Moderate agreement between LPSS and CMR parameters was observed. RV EF remained unchanged during follow-up, whereas GLPSS and LPSS FW demonstrated a significant reduction. RVEF showed a 1% increase, whereas GLPSS decreased by 14%, and LPSS FW by 27%. RV LPSS is reduced in TOF patients as compared to controls; during follow-up RV EF remained unchanged whereas LPSS decreased suggesting that RV LPSS may be a sensitive marker to detect early deterioration in RV performance