Assessment of left atrial function after percutaneous closure of patent foramen ovale

Background The influence of atrial septal occluders in left atrial (LA) function after percutaneous closure of patent foramen ovale (PFO) has not been thoroughly studied. Methods Twenty-five patients (mean age 40.7 ± 12 years) undergoing percutaneous PFO closure were enrolled in this study. Transthoracic echocardiogram (TTE) was performed 3 and 6 months before the procedure. Volumetric indices (active emptying fraction: LA AEF, expansion index: LA EI, and passive emptying fraction: LA PEF), strain and strain rate (SR), were calculated during the contractile, reservoir, and conduit LA phases for the lateral, anterior, and inferior LA walls with TTE. Results After 3 months, a decrease in the SR of the LA anterior wall was observed (from 2.12 ± 0.22 to 1.66 ± 0.26, P < 0.045), while the LA lateral wall strain was found to be increased (from 0.708 ± 0.15 to 0.783 ± 0.159, P < 0.001). Moreover, simultaneously LA AEF was greater compared with baseline (from 31.0 ± 1.6 to 34.0 ± 1.6, P < 0.004). However, all these alterations reversed at 6 months. Conclusions Segmental LA function is altered transiently after percutaneous PFO closure with a septal occlude. The LA anterior wall SR decreases, while the lateral wall strain increases. The impact of these alterations needs further clarification. © 2013, Wiley Periodicals, Inc

Exaggerated exercise blood pressure response is related to tissue Doppler imaging estimated diastolic dysfunction in the early stages of hypertension

We investigated the plausible interrelationship of exaggerated blood pressure response (EBPR) during exercise with left ventricular (LV) diastolic dysfunction, both associated with adverse cardiovascular outcomes, in the early stages of essential hypertension (EH). Sixty-five consecutive patients (aged 54 years, 56 males) with stage I to II EH underwent 24-hour ambulatory blood pressure (BP) recording and treadmill exercise testing and were classified as subjects with (n = 21) and without EBPR (n = 44) based on the systolic BP elevation at peak exercise (≥210 mm Hg for men and ≥190 mm Hg for women). LV diastolic function was estimated by pulsed tissue Doppler imaging (TDI), averaging diastolic mitral annular velocities (Em, Am) from four separate sites (LV lateral, septal, anterior, and inferior wall). Hypertensives with EBPR, compared with those without EBPR, exhibited increased 24-hour pulse pressure by 4.8 mm Hg (P < .05) and significantly lower values of Em/Am ratio by 0.07 (P < .05). Univariate logistic regression analysis revealed that only 24-hour pulse pressure (odds ratio [OR] = 1.069; P = .043) and Em/Am (OR = 0.041; P = .049) were independent predictors of EBPR. Hypertensives with EBPR compared to their counterparts without EBPR are characterized by more pronounced LV diastolic dysfunction - assessed by TDI. Moreover, the increased pulsatile load seems to be a common denominator of these hypertension-linked states. © 2008 American Society of Hypertension

Relation of left ventricular concentric remodeling to levels of C-reactive protein and serum amyloid A in patients with essential hypertension

In this study, we investigated possible relations between left ventricular (LV) concentric remodeling and plasma levels of high-sensitivity C-reactive protein (hs-CRP) and serum amyloid-A (SAA) in subjects who had essential hypertension; 65 consecutive subjects who had hypertension, did not have diabetes, and had normal LV mass were categorized as those whose LV relative wall thickness was < 0.44 (n = 41) and those whose relative wall thickness was >= 0.44. Venous blood samples were collected for determination of metabolic profile and plasma levels of hs-CRP and SAA. Subjects whose relative LV wall thickness was >= 0.44 compared with those whose relative LV wall thickness was < 0.44 had significantly increased systolic blood pressure by 4.5 mm Hg (p = 0.015) and higher levels of plasma hs-CRP (1.80 vs 1.39 mg/L, p = 0.001) and SAA (10.22 vs 4.86 mg/dl, p = 0.000), although the 2 groups did not differ with regard to age, gender, waist-to-hip ratio, and diastolic blood pressure (p = NS for all). In the entire study population, log hs-CRP and SAA exhibited positive relations with systolic blood pressure (r = 0.21 and r = 0.29, respectively; p < 0.05 for the 2 markers) and relative wall thickness (r = 0.26 and r = 0.81, respectively; p < 0.05 for the 2 markers). Multiple linear regression analysis showed that age, gender, and diastolic blood pressure were significantly associated with LV mass index (p < 0.05), whereas gender, body mass index, log hs-CRP, and SAA were significantly associated with relative wall thickness (p < 0.003). By analysis of covariance, log hs-CRP and SAA were significantly different between subjects whose relative LV wall thickness was >= 0.44 and those whose relative LV wall thickness was < 0.44 after the adjustment for age, gender, body mass index, and systolic/diastolic blood pressure (p < 0.005 for the 2 markers). In conclusion, alterations in LV geometry are associated with increased serum CRP and SAA levels in patients who are newly diagnosed with essential hypertension. (c) 2005 Elsevier Inc. All rights reserved

Cardiac echo-lab productivity in times of economic austerity

The present study attempts to offer insight into the volume, cost, and productivity of the operation of a cardiac echocardiographic laboratory (echo-lab) in a major public hospital of Greece and thus to contribute, on a practical level, to the widening of knowledge in the strategic field of secondary and tertiary healthcare management. The conducted research includes the basic step of the deployment of a primary data registry in the echo-lab and unfolds in three levels, i.e. the variability measurement of the quantity and cost of medical services provided to different patient populations, the assessment of operating costs and the development of productivity indexes. The results show that the mean costs of provision do change among distinct patient populations. The most important, from a financial standpoint, population cluster appears to be the one corresponding to outpatients. Productivity indices presented in this analysis constitute an essential piece of information which the public healthcare system is currently largely lacking, and which, combined with the pricing and the diagnosis-related group coding system of hospitals, can be used to improve efficiency in the management of secondary and tertiary care. © 2014, Katsi et al.; licensee Springer