10 research outputs found
Transthoracic echocardiography for the diagnosis of left ventricular thrombosis in the postoperative care unit
Transthoracic echocardiography for the diagnosis of left ventricular thrombosis in the postoperative care unit
Introduction: Transthoracic echocardiography (TTE) is a reliable,
noninvasive imaging method that is useful in the evaluation of
cardiovascular thrombosis. We conducted a retrospective study of all the
echocardiograms from patients in the postoperative care unit to assess
the role of TTE in thrombus identification in the left ventricle.
Methods: This retrospective database evaluation included all
echocardiograms during a 14-month period. The echocardiographic
examination protocol included the subcostal four-chamber view, the
apical four-chamber view, the apical two-chamber view and the
parasternal view, along the long and short axes in both spontaneously
and mechanically ventilated patients. All echocardiograms were obtained
within the 48 hours immediately following surgery.
Results: In total, 160 postoperative echocardiograms were obtained from
160 patients and resulted in the detection of five cases of left
ventricular thrombosis. Subgroup analysis showed that 21 and 35 of the
160 patients examined had either dilated or ischemic cardiomyopathy,
respectively. In these patients, preoperative echocardiograms had been
obtained recently prior to surgery and were negative for left
ventricular thrombus. In three of 35 patients with ischemic
cardiomyopathy and two of 21 patients with dilated cardiomyopathy,
thrombus was identified in the left ventricle. The thrombi were mobile,
uncalcified and pedunculated and were located in the apex of the left
ventricle. In addition, no clinical consequences of the left ventricular
thrombi were recorded.
Conclusions: Low-flow conditions in heart chambers due to ischemic or
dilated cardiomyopathy in conjunction with the hypercoagulability caused
by perioperative prothrombotic factors may lead to thrombotic events in
the left ventricle
Effects of darbepoetin-alpha on quality of life and emotional stress in anemic patients with chronic heart failure
Objective Anemia is a frequent comorbidity in chronic heart failure
(CHF) adversely affecting patients’ prognosis. Erythropoietin seems to
improve exercise capacity in CHF patients. This study investigates the
effects of recombinant human erythropoietin analog darbepoetin-alpha on
quality of life and emotional stress, evaluated by relevant
questionnaires in patients with CHIF and anemia.
Methods Forty-one CHF patients [New York Heart Association class:
II-III; left ventricular (LV) ejection fraction (EF) < 40%; hemoglobin
< 12.5 g/dl; serum creatinine < 2.5 mg/dl] were randomized (1 : 1) to
receive either 3-month darbepoietin-alpha at 1.5 mu g/Kg every 20 days
plus iron orally (n = 21) or placebo plus iron orally (n = 20).
Echocardiographic LVEF, questionnaires addressing quality of life
(Kansas City Cardiomyopathy Questionnaire, functional and overall,
Duke’s Activity Status Index) and emotional stress [Zung self-rating
depression scale (SDS), Beck Depression Inventory], as well as plasma
b-type natriuretic peptide and 6-min walking distance (6MWT as a marker
of exercise capacity) were assessed at baseline and posttreatment.
Results A significant improvement in LVEF (32 +/- 6 from 26 +/- 6%, P <
0.001), 6MWT (274 +/- 97 from 201 +/- 113m, P < 0.01), hemoglobin (12.8
+/- 1.4 from 10.9 +/- 1.0g/dl, P < 0.001) and plasma b-type natriuretic
peptide (517 +/- 579 from 829 +/- 858 pg/ml, P=0.002) was observed
posttreatment only in darbepoetin-treated group. Kansas City
Cardiomyopathy Questionnaire functional (78 +/- 14 from 57 +/- 24%, P <
0.01) and overall (68 +/- 20 from 47 +/- 22, P < 0.001), Duke’s Activity
Status Index (19 +/- 11 from 14 +/- 9, P < 0.05), Zung SDS (38 +/- 10
from 47 +/- 11, P < 0.05) and Beck Depression Inventory (11 +/- 9 from
16 +/- 10, P < 0.05) scores also improved in darbepoeti n -treated
patients, whereas they remain unchanged in the placebo group except for
the Zung SDS which worsened (P < 0.05). A significant correlation
between drug-induced percent changes in 6MWT and Zung SDS (r= - 0.627, P
< 0.05) was also observed.
Conclusions Darbepoetin-a improves quality of life and emotional stress
in CHIF patients with anemia, with a parallel increase in exercise
capacity
Effects of darbepoetin-alpha on plasma pro-inflammatory cytokines, anti-inflammatory cytokine interleukin-10 and soluble Fas/Fas ligand system in anemic patients with chronic heart failure
Pro-inflammatory cytokine over-expression may be implicated to the
pathogenesis of anemia in chronic heart failure (CHF) through the
suppression of bone marrow erythropoiesis. Erythropoietin administration
has anti-inflammatory and anti-apoptotic properties in experimental CHF
models and improves exercise capacity in anemic CHF patients. The
present study investigates the effects of recombinant human
erythropoietin analogue darbepoetin-alpha on circulating
pro-inflammatory cytokines and soluble Fas/soluble Fas ligand system in
patients with CHF and anemia. Forty-one CHF patients (NYHA class:
II-III; left ventricular (LV) ejection fraction (EF) <40%; hemoglobin
<12.5 g/dl; serum creatinine <2.5 mg/dl) were randomized to receive
either 3-month darbepoietin-alpha at 1.5 mu g/kg every 20 days plus iron
orally (n = 21) or placebo plus iron orally (n = 20). LV systolic
function, plasma B-type natriuretic peptide (BNP), inflammatory markers
(TNF-alpha, IL-6, CRP), anti-inflammatory cytokine IL-10, endothelial
adhesion molecules (soluble ICAM-1 and VCAM-1) and soluble apoptosis
mediators (soluble Fas, soluble Fas ligand), and 6-min walking distance
were assessed at baseline and 3 months post-treatment. In
darbepoetin-alpha treated patients, plasma BNP (451 (62-2770) from 802
(476-4440) pg/ml,p = 0.002), IL-6 (6.5 +/- 4.7 from 10.5 +/- 7.8 pg/ml,
p, = 0.013) and soluble Fas ligand (53.2 +/- 16.6 from 59.2 +/- 17.9
pg/ml, p = 0.023) decreased significantly, while LVEF (32 +/- 6 from 26
+/- 6%, p < 0.001), hemoglobin (12.8 +/- 1.4 from 10.9 +/- 1.0 g/dl, p
< 0.001) and 6-min walked distance (274 +/- 97 from 201 +/- 113 m, p <
0.01) increased significantly. No significant changes were observed in
the placebo arm, except for a worsening in 6-min walked distance (p =
0.044). In conclusion, darbepoetin-alpha reduces circulating
pro-inflammatory cytokine IL-6 and apoptotic mediator soluble Fas ligand
in CHF patients with anemia, with a parallel improvement of cardiac
performance and exercise capacity. (C) 2007 Elsevier Ireland Ltd. All
rights reserved
Effects of darbepoetin alpha on right and left ventricular systolic and diastolic function in anemic patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy
Background Anemia is a frequent condition in chronic heart failure (CHF)
that affects adversely long-term cardiac outcomes. We sought to
investigate the effects of recombinant human erythropoietin analogue
darbepoetin alpha on left (LV) and right ventricular (RV) function and
neurohormonal activation in patients with CHF and anemia.
Methods Thirty-two CHF patients (New York Heart Association class
II-III, LV ejection fraction [EF] <40%, hemoglobin level < 12.5 9/dL,
serum creatinine level <2.5 mg/dL) were randomized (2: 1) to receive
either a 3-month darbepoetin alpha regimen at 1.5 mu g/kg every 20 days
plus oral iron (n = 2 1) or placebo plus oral iron (n = 11).
Echocardiographic indices of LV systolic and diastolic function and RV
function, plasma B-type natriuretic peptide (BNP) and 6-minute walked
distance were assessed at baseline and posttreatment.
Results Regarding LV function, only treatment with darbepoetin a caused
a significant improvement in LVEF (F = 22.001, P<.001), end-systolic
wall stress (F = 4.934, P =.03A), mitral annulus systolic displacement
(F = 6.710, P<.015), isovolumic relaxation time (F = 4.909, P =.035),
and E/e ratio (F = 7.833, P =.009). The RV systolic pressure (F = 7.715,
P =.009) as well as tricuspid annulus systolic displacement and RVEF (F
= 9.264, P =.005) were significantly improved only in the darbepoetin a
group. Darbepoetin a had also a beneficial effect on New York Heart
Association class (F = 14,586, P =.001), plasma BNP (F = 14.781, P
=.001), and 6-minute walk test (F = 19.926, P <.001), whereas these
parameters did not significantly change in the placebo-treated patients.
Conclusion Darbepoetin a improves both LV and RV performance and
exercise capacity and counteracts neurohormonal activation in CHF
patients with anemia. The drug effects on LV diastolic function, RV
function, and LV end-systolic wall stress, in particular, are novel
findings, with a potential important contribution to patients’
symptomatic improvement
Effects of levosimendan on right ventricular function in patients with advanced heart failure
Right ventricular (RV) dysfunction frequently complicates advanced left
ventricular heart failure and contributes to an unfavorable prognosis.
Levosimendan is a novel inodilator that beneficially affects
hemodynamics and left ventricular systolic and diastolic function in
patients with advanced heart failure. However, its effects on RV
function have not yet been properly assessed in these patients. In this
randomized trial, the impact of levosimendan or placebo on various
echocardiographic parameters of RV systolic and diastolic function was
investigated in 54 patients with advanced heart failure due to left
ventricular systolic dysfunction. Tissue Doppler imaging maximal,
systolic tricuspid annular velocity (S wave) increased significantly
only in the levosimendan group (8.2 +/- 3.2 vs 9.0 +/- 3.0 cm/s, p <
0.03). Tissue Doppler imaging RV early diastolic velocity (E wave) and
the, ratio of early to late diastolic velocities (E/A) also increased
significantly after levosimendan administration (p < 0.01 and p < 0.05,
respectively). Systolic pulmonary arterial pressure decreased
significantly (54 +/- 11 vs 43 +/- 11 mm Hg, p < 0.01) in the
levosimendan-treated patients. Levosimendan beneficially modulated
neurohormonal and inflammatory status by decreasing B-type natriuretic
peptide levels (p < 0.05) and by altering the ratio of interleukin-6 to
interleukin-10 in favor of the latter (p < 0.05). In conclusion,
levosimendan could offer further therapeutic advantages in patients with
advanced heart failure by improving systolic and diastolic RV function.
(c) 2006 Elsevier Inc. All rights reserved
Diastolic stress echocardiography detects coronary artery disease in patients with asymptomatic type II diabetes
Objectives Diabetes mellitus is considered as an equivalent of coronary
artery disease (CAD). Aim of the study was to investigate whether in
asymptomatic patients with type II diabetes, diastolic stress
echocardiography may represent an alternative tool for the detection of
CAD.
Methods The study population consisted of 105 patients with diabetes
mellitus (age 61 +/- 9 years, 26% female, duration of diabetes 37 +/-
14 months). We performed an exercise stress test, followed by an
echo-study and a single-positron emission tomography. Coronary
angiography was performed within 1 month.
Results Coronary angiography revealed a coronary artery stenosis of at
least 70% in 72 patients (69%, CAD group), while the remaining formed
the non-CAD group. Exercise induced an increase of both E/E’ lateral and
septal ratios as well as their average in the CAD group and on the
contrary a decrease of these ratios in the non-CAD group. Receiver
operating curve analysis for discrimination between patients with and
without obstructive CAD showed an optimal cut-off value of - 0.0708 for
the exercise-induced change of E/E’ average (area under curve 0.892, P <
0.001). Sensitivities of scintigraphy and of diastolic stress
echocardiography for detection of CAD were 75.0 and 93.1%,
respectively; specificity was 78.8% for both methods. In asymptomatic
patients, sensitivities of scintigraphy and diastolic stress
echocardiography were 76.9 and 92.3%; specificity of both was 80%.
Conclusion In patients with type II diabetes, diastolic stress
echocardiography, by means of E/E’ ratio exercise-induced changes, can
be used for the diagnosis and severity of CAD and for the detection of
occult myocardial ischemia. Coron Artery Dis 21:104-112 (C) 2010 Wolters
Kluwer Health vertical bar Lippincott Williams & Wilkins