Are changes in left ventricular volume as measured with the biplane Simpson's method predominantly related to changes in its area or long axis in the prognostic evaluation of remodelling following a myocardial infarction?
AIMS: Two-dimensional (2D) echocardiography has been widely applied to measure left ventricular volumes with the biplane Simpson's method in the assessment of left ventricular remodelling following an acute myocardial infarction. This volume formula is based upon tracings of endocardium and measurement of long axis on left ventricular images. In the present follow-up study of post-myocardial infarction patients we evaluated the prognostic impact of changes in left ventricular areas and geometry versus long axis to determine if only long-axis measurements may be used for prognostic purposes. METHODS AND RESULTS: Two-dimensional echocardiographic video recordings of the apical four-chamber and long-axis views were obtained in 756 patients 2--7 days and 3 months following an acute myocardial infarction. All videotapes were sent to a core laboratory and left ventricular volumes were measured with the biplane Simpson's method in end-diastole and end-systole. During the first 3 months 44 patients had suffered one of the following end-points and were excluded: cardiac death, recurrent myocardial infarction, heart failure or chronic arrhythmia. Over a period of 3--24 months 58 such end-points occurred. With the Cox proportional hazards model the increase in left ventricular systolic volume was the strongest predictor for such events (Chi-square 18.5, P
The value of exercise-redistribution thallium-201 perfusion scintigraphy (SPECT; single photon emission computed tomography) in the diagnosis of coronary artery disease was evaluated in 23 patients (one patient tested twice) who were subsequently submitted to coronary angiography. Reversible perfusion defects indicating myocardial ischemia were found in 22 patients, of whom 18 had angiographically significant coronary artery stenoses. Two patients had negative thallium scans, one had a normal angiogram and one had single vessel disease. Thus 18 of 19 patients with angiographically verified coronary heart disease had a positive thallium scan. The majority of patients with left main stenosis and triple vessel disease had scintigraphic evidence of double or triple vessel disease. The scintigraphic method identified the correct anatomical localization in 73% of the angiographically verified coronary artery stenoses. In conclusion, a positive exercise-redistribution thallium scan had a high predictive value in the diagnosis of coronary artery disease, whereas its value in estimating the number and localization of stenoses was more limited.
Comment In: Tidsskr Nor Laegeforen. 1994 Apr 20;114(10):12367748251
In the population of live born children in the County of Vestfold, Norway, during the seven-year period 1982-88 (N = 15,307), 138 cases of congenital heart defects were diagnosed (patent ductus arteriosus in preterm infants excluded), an incidence of 0.9%. In 114 infants (83%) the defect was diagnosed before discharge from hospital after birth (nursery, neonatal unit), in 20 infants (14%) it was diagnosed later during the first year of life, and in four (3%) during the second year of life. In 24 children (17%) congenital heart defect was associated with a syndrome (Down syndrome eight, Edwards syndrome three, other syndromes three), or other congenital malformations (single eight, multiple two). Diagnosis was made clinically only (including ECG, phonocardiography and X-ray pictures) in 15 patients (11%). 13 were classified as having ventricular septal defects, and two were unclassified. Echocardiography was performed in 120 children (87%), heart catheterization in 44 (32%), surgery in 47 (34%), and autopsy in 12 (9%). 15 children (11%) died, all during the first year after birth. 45 children (33%) are healthy after spontaneous closure of a ventricular (41 children) or atrial septal defect (four children), and 15 (11%) after surgical repair. 63 (46%) are alive with a defect. We found a tendency towards increasing incidence of congenital heart defects. This increase was explained by echocardiographic diagnosis of small muscular ventricular septal defects in the early neonatal period, with spontaneous closure of the defect during the first year of life.(ABSTRACT TRUNCATED AT 250 WORDS)
In the recently published CARE-study, 4,159 patients aged 21-75 years were included and randomised to treatment with pravastatin 40 mg once daily or placebo 3-20 months following a myocardial infarction. Inclusion criteria were a total cholesterol
In a population-based study of 35,218 infants born alive during the 15 years from 1982 to 1996, 353 (1%) were diagnosed as having a congenital heart defect, of whom 84 (24%) were diagnosed subsequent to discharge from hospital after birth (2.4/1000). Of these, 40 (48%) had a ventricular septal defect, 14 (17%) an atrial septal defect, 9 (11%) a patent arterial duct, 8 (10%) an aortic stenosis and 13 (15%) other defects. Compared with those in whom diagnosis was made before discharge, the group of patients with defects detected late had an increased prevalence of atrial septal defects, patent arterial duct and aortic stenosis, but less decreased prevalence of ventricular septal defects (p 0.05). A substantial proportion of congenital cardiac malformations are detected after discharge from hospital after birth. Some patients with these lesions present with cardiac decompensation and are in need of medication and surgery. One clinical examination of newborns detects congenital malformations of the heart as efficient as two.
This study was undertaken to characterise patients without overt heart failure and with a left ventricular ejection fraction > or = 40% 2-7 days following an acute myocardial infarction. Patients with an ejection fraction > or = 40% (n = 868) had a lower prevalence of anterior myocardial infarction (p or = 40% had smaller left ventricular volume and mass (p or = 40%. Pro-ANP levels were not correlated with the ejection fraction or left ventricular volume. Approximately two thirds of the patients received thrombolytic treatment.
In a population-based study in children born alive during the 10-year period from 1982 to 1991 (n = 22,810), ventricular septal defects (VSDs) were diagnosed in 127 cases, an incidence of 5.6 per 1000. The incidence was significantly higher in the cohort of children born during the 6-year period from 1986 to 1991 than among those born in the preceding 4-year period, 1982-1985 (6.5 and 4.0 per 1000 respectively; p 0.05). More children born in 1986-1991 had spontaneous closure of their VSDs (75.5%) than those born in 1982-1985 (51.5%) (p
An isolated ventricular septal defect (VSD) was diagnosed in 70 patients (39 men and 31 women, mean age 29 years, range 10-64 years). Surgery was judged unnecessary. The follow-up period was at least 10 years, or until death or 31 December 1988, comprising a mean duration of 21 (range 6-29) years. The mortality was 11/69 (one lost to follow-up), and was not significantly higher than in a matched 'normal' group. Six deaths were cardiac, four of which could probably be related to the VSD. The follow-up study revealed that: (1) 14 (22%) subjects had major, VSD-related complications, and cardiac surgery was indicated in eight patients; (2) six (10%) had minor complications. By the end of 1988, 24% of subjects had significant dyspnoea, 22% had chest pain and 19% used cardioactive drugs. Only 33% were receiving regular cardiac control in a hospital. Thus unoperated adults with a small VSD should be monitored closely, since this condition is far from benign.
A series of 125 consecutive patients with isolated ventricular septal defect (VSD) aged 10 or over, were followed until death or beyond the age of 30 (31-73) years. A prospective restudy was performed after a mean follow-up of 15 (3-21) years. Forty-one patients (group 1) were treated with surgical repair of VSD at a mean age of 23 (10-51) years, and early mortality was 10%, i.e. 3 with severe aortic insufficiency and one with systemic pulmonary artery pressure. Surgery was initially not regarded indicated in 70 patients with small defects (group 2). A further 14 patients were judged inoperable (group 3). Long-term mortality was 5% in group 1, 9% in group 2 and 71% in group 3. When restudied, group 2 patients had significantly higher (p less than 0.01) and group 1, lower (p less than 0.01) pulmonary artery pressures than initially. A moderate deterioration in NYHA-rating was noted in group 2 (p less than 0.05) vs. a slight improvement in group 1 (p less than 0.05). The non-operated patients had a higher incidence of valvular lesions (19% vs. 13%) and bacterial endocarditis (4.3% vs. 2.7%) than the operated but not to a statistically significant level. Spontaneous closure was 6% in group 2 whereas mostly small residual defects were found in 34% of the operated. Patients with uncomplicated VSDs (absence of valvular lesions or coronary heart disease) had subnormal exercise tolerance as judged from a standardized ergometer bicycle test. These patients also had impaired left ventricular function based upon haemodynamic studies during moderate supine exercise. No major differences were noted between groups 1 and 2, but operated patients with residual VSDs tended to have the poorest cardiac performance. Non-cardiac disease represented only a minor problem and no significant differences in psychosocial function were observed between groups 1 and 2. Only 50% in group 1 and 60% in group 2 attended a regular medical clinic. Antibiotic prophylaxis had only been practiced by 50% in both groups. Although small, but differences between groups 1 and 2 favour surgery. This must be regarded as a positive result of surgical treatment since those operated on had basically larger and thus more severe defects than the others. In view of the very low operative risk associated with modern surgical technique one should direct patients with significant shunts to operative treatment.
In order to assess M-mode echocardiographic recordings in a normal Norwegian population, 190 apparently healthy subjects (95 women and 95 men) aged 21-69 years were examined with an Irex Meridian system. Measurements were performed according to criteria recommended by the American Society of Echocardiography. Absolute values for all parameters except for left ventricular (LV) shortening fraction (SF) were greater in men (P less than 0.001). When corrected for body surface area (BSA), the differences between the two genders were far less pronounced. Women had greater left atrium (LA) (P less than 0.01) and LV end-diastolic diameter (EDD) (P less than 0.001), whereas the interventricular septum in end-diastole (IVS-ED) (P less than 0.05) and LV posterior wall (PW) in ED (P less than 0.001) were thicker in men. Only weak correlations between age and the various echocardiographic parameters with r-values less than or equal to 0.30 were observed. It is recommended that BSA corrected values should be preferred since the differences between men and women are negligible. When absolute values are used, different normal ranges for both sexes should be applied.