Doppler echocardiographic indices in aortic coarctation: A comparison of profiles before and after stenting

Background: Diagnosis of aortic coarctation is important as it is a difficult condition to evaluate, especially in adults. A Doppler echocardiographic index could provide a simple tool to evaluate coarctation. This study was performed to compare Doppler echocardiographic profiles before and after stenting and to assess the diagnostic value of a complete list of echocardiographic indices for detecting aortic coarctation. Methods: This prospective study was conducted on 23 patients with a diagnosis of aortic coarctation based on angiography. Echocardiographic assessment was done twice for all patients before and after stenting. Each time, two-dimensional and Doppler echocardiographic imaging modalities were performed and complete lists of indices were recorded for each case. After comparing the values of indices before and after stenting, diagnostic values of each index were calculated in order to diagnose significant coarctation. Results: Twenty-three patients, including 16 males and seven females with a mean age of 26.14 ± 10.17 years, were enrolled in this study. Except for the mean velocity and mean pressure gradient of the abdominal aorta, the values of the other indices of the abdominal/descending aorta showed enough change after stenting to indicate significant diagnostic accuracy for detecting aortic coarctation. The velocity-time integral and the pressure half-time were among the indices with the highest accuracy rates for this purpose (all p < 0.001). Conclusion: Post-stenting echocardiographic profiles could provide a reliable reference value of the normal aortic haemodynamics as a unique identification of each patient and it is presumed that these indices could be used as reliable indicators of response to treatment

Global and regional left ventricular function improvement following successful percutaneous coronary intervention in patients with ischemic left ventricular dysfunction

This study assessed changes in global and regional systolic left ventricular function after successful percutaneous recanalization of coronary artery occlusions. A consecutive series of 110 patients with mean ± SD age of 53.6 ± 9.1 years, in whom a complete angiographic evaluation was available before angioplasty, underwent successful percutaneous recanalization of significant occlusions of coronary arteries. Left ventricular ejection fraction and wall motion score index were assessed by echocardiography at baseline, and 1, and 6 months after recanalization. Left ventricular ejection fraction increased from a mean ± SD of 40.7 ± 4.52 at baseline to 50 ± 8.3 after one month (P < 0.001) and to 50.9 ± 8.5 after 6 months. There was no significant difference between left ventricular ejection fraction at the end of the first and the sixth month of treatment (P = NS). The wall motion score index decreased from 1.3 ± 0.2 at baseline to 1.1 ± 0.2 after one month (P < 0.01). There was no significant difference between 1 and 6 months results. Six-month follow-up of all patients showed significant improvement in both angina severity and NYHA class. The restoration of coronary potency of occluded coronary arteries by successful percutaneous recanalization is associated with significant improvement in regional and global left ventricular function and clinical outcome

Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

<p>Abstract</p> <p>Objectives</p> <p>We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR).</p> <p>Background</p> <p>Functional mitral regurgitation (FMR) occurs as a consequence of systolic left ventricular (LV) dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one of the most controversial topic in surgery and proper repairing requires an understanding of its mechanisms, as the exact mechanism of FMR are not well defined.</p> <p>Methods</p> <p>136 consecutive patients mean age of 55 with systolic LV dysfunction and FMR underwent complete echocardiography and after assessing MR severity, LV volumes, Ejection Fraction, LV sphericity index, C-Septal distance, Mitral valve annulus, Interpapillary distance, Tenting distance and Tenting area were obtained.</p> <p>Results</p> <p>There was significant association between MR severity and echocardiogarphic indices (all p values < 0.001). Severe MR occurred more frequently in dilated cardiomyopathy (DCM) patients compared to ischemic patients, (p < 0.001). Based on the model, only Mitral valve tenting distance (TnD) (OR = 22.11, CI 95%: 14.18 – 36.86, p < 0.001) and Interpapillary muscle distance (IPMD), (OR = 6.53, CI 95%: 2.10 – 10.23, p = 0.001) had significant associations with MR severity.</p> <p>Mitral annular dimensions and area, C-septal distance and sphericity index, although greater in patients with severe regurgitation, did not significantly contribute to FMR severity.</p> <p>Conclusion</p> <p>Degree of LV enlargement and dysfunction were not primary determinants of FMR severity, therefore local LV remodeling and mitral valve apparatus deformation are the strongest predictors of functional MR severity.</p

A Novel Method to Harmonic Sources Placement

Abstract: This paper proposes on a new method for measurement placement of power system harmonic state estimation. Due to limitation in number of installed harmonic measurements, harmonic state estimation has been considered as one of the famous methods for measuring voltage and injection current of busbars and lines current and placement of these measurements with algorithm based on sequential elimination method. Also, after the algorithm find location of measurements in harmonical busbars, by minimization number of sites technique that collect harmonic data from measurement devices, optimal placement of these measurements will be done. This technique can find optimal place of measurement for identification location and intensity of harmonic sources. The proposed method have been performed on IEEE 14-bus with 69 possible locations to install these measurement in Matlab software. The simulation results depicts that the proposed system works correctly

Coronary flow reserve, strain and strain rate imaging during pharmacological stress before and after percutaneous coronary intervention: Comparison and correlation

Introduction: Coronary flow reserve (CFR) could apply reliable information about the coronary circulation, and strain (S) and strain rate imaging (SRI) are able to quantify the left ventricular myocardial performance. The aim of this study was to assess myocardial performance in relation to the function of the coronary circulation before and after successful percutaneous coronary intervention (PCI) of the left anterior descending artery. Material and Method: Fourteen patients (10 men, 4 women, mean age 53.2 ± 11.4 years) with severe left anterior descending stenosis who had a successful selective PCI were recruited into this study. CFR and myocardial deformity indices (S and SR) were recorded before and after percutaneous intervention, both at rest and during stress echo test. Results: CFR, S, and SR increased after intervention significantly. There was significant correlation between CFR ratio and poststress systolic strain (SS) ratio and early diastolic strain rate (ESR) ratio (P 0.6). Also CFR improvement had significant relationship with changes of poststress Systolic SR and poststress Systolic S (P 0.6). Based on regression analysis the amount of change in CFR was independently associated with change in SS during stress and systolic SR. Conclusion: PCI improves CFR (a marker of coronary perfusion), strain, and strain rate (markers of regional cardiac wall deformation). The independent association between CFR improvement and poststress systolic strain and strain rate means that SRI parameters can independently predict CFR changes after PCI. © 2011, Wiley Periodicals, Inc

RELATIONSHIP BETWEEN THE MANAGERIAL SKILLS WITH THE EFFECTIVENESS OF MANAGERS

Introduction: Each manager needs a set of skills for effective management. This study was conducted aimed to investigate Relationship between the managerial skills with the effectiveness of managers. Methods: this cross-sectional study was conducted with the participation of 190 employees of Kermanshah University of medical sciences in 2015. We used to questionnaire for data gathering including questionnaire of managerial skills and questionnaire of managers effectiveness. Data was analyzed using the software AMOS 22 as well as SPSS 21. Results: there were positive and direct relationships between managerial, technical, human, and perceptual skills with effectiveness of managers. The higher relationship with effectiveness belonged to technical skill (r=.965). Conclusion: Given that managers in medical sciences universities have expertise in medical sciences, academic qualifications, and sufficient experience we suggest that to be implemented training, practical, and complementary courses about management skills for them