Showing papers by "José Luis Zamorano published in 2005"

Comparison of left ventricular volumes and ejection fractions measured by three-dimensional echocardiography versus by two-dimensional echocardiography and cardiac magnetic resonance in patients with various cardiomyopathies

Abstract: End-diastolic volume and end-systolic volume were measured in 35 consecutive patients with cardiomyopathy using 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography (2, 4, and 8 planes) and cardiac magnetic resonance imaging Three-dimensional echocardiography correlates better with magnetic resonance imaging than does 2-D echocardiography Its accuracy improves with the increase in the number of planes used Two-dimensional echocardiography underestimates volumes, mainly in the subgroup with an ejection fraction of

Improved semiautomated quantification of left ventricular volumes and ejection fraction using 3-dimensional echocardiography with a full matrix-array transducer: comparison with magnetic resonance imaging.

Abstract: Our goals were to: (1) develop a technique for 3-dimensional (3D) direct, model-independent quantitative assessment of left ventricular (LV) volume and ejection fraction based on semiautomated detection of LV endocardial surface from transthoracic near real-time full matrix-array 3D echocardiographic (FM3DE) imaging; (2) evaluate the accuracy of LV volumes obtained with this technique, using cardiac magnetic resonance imaging (MRI) measurements as the reference for comparison; and (3) determine the effects of contrast enhancement on the accuracy of FM3DE measurements. A total of 46 patients underwent 2-dimensional echocardiography, FM3DE, and cardiac MRI. End-diastolic volume, end-systolic volume, and ejection fraction were derived from endocardial borders manually traced from 2-dimensional echocardiographic images and from semiautomatically detected LV cavity from FM3DE data. In 14 patients, FM3DE was also acquired with contrast. All measurements were compared with MRI values using linear regression and Bland-Altman analyses. FM3DE was feasible in 44 of 46 patients with LV volumes

Prevalence of Echocardiographically Detected Ventricular Asynchrony in Patients with Left Ventricular Systolic Dysfunction

Abstract: Objectives QRS complex width is not an accurate marker of cardiac asynchrony. Our aims were to determine the prevalence of cardiac asynchrony by Doppler echocardiography for patients with left ventricular (LV) dysfunction and to evaluate whether QRS width is a reliable method for detecting asynchrony. Methods In all, 316 consecutive patients with a LV ejection fraction less than 40% from 13 hospitals comprised the study group. Interventricular asynchrony was defined by the interventricular mechanical delay. Intraventricular asynchrony was evaluated using the calculation of the septal-to-posterior wall motion delay, the difference between time from Q wave to LV ejection end, and time from Q wave to the end of the systolic wave of the most delayed basal segment by Doppler tissue imaging, the SD of the time from the Q wave to the end of the systolic wave of 4 basal segments, and the maximum difference in the time from the Q wave to the end of the systolic wave of all 4 basal segments. Results Mean age was 62.14 ± 13.5 years (234 men; 74.1%). Interventricular asynchrony was present in 50 (26.2%) patients in the narrow QRS group and in 57 (55.3%) patients in the prolonged QRS group ( P Conclusions Cardiac asynchrony is highly prevalent for patients with LV dysfunction but there is a very poor agreement among the different methods used to detect it. Interventricular asynchrony is more prevalent for patients with prolonged QRS but intraventricular asynchrony is irrespective of the QRS duration. Further studies are needed to evaluate which method is the best to detect cardiac resynchronization therapy responders.

Proteolytic Regulation of Activated STAT6 by Calpains

Abstract: The transcription factor STAT6 plays an important role in cell responses to IL-4. Its activation is tightly regulated. STAT6 phosphorylation is associated with JAKs, whereas dephosphorylation is associated with specific phosphatases. Several studies indicate that proteases can also regulate STAT6. The aim of this study was to investigate the nature of these proteases in mouse T cell lines. We found that STAT6 was degraded in cell extracts by calcium-dependent proteases. This degradation was specifically prevented by calpain inhibitors, suggesting that STAT6 was a target for these proteases. This was supported by the cleavage of STAT6 by recombinant calpains. The proteolytic regulation of STAT6 was more complex in vivo. Calcium signaling was not sufficient to induce STAT6 degradation. However, treatment of IL-4-stimulated cells with calcium ionophores resulted in the absence of phosphorylated STAT6. This effect correlated with the loss of STAT6 protein and was prevented by calpain inhibitors. Cytoplasmic calpains seemed to be responsible for STAT6 degradation. Calpains can target signaling proteins; in this study we found that they can negatively regulate activated STAT6.

Usefulness of Real-Time 3-Dimensional Echocardiography in the Assessment of Infective Endocarditis Initial Experience

Abstract: Objective Our aim was to provide an initial description of the usefulness of real-time 3-dimensional (3D) echocardiography when evaluating patients with infective endocarditis. Methods For this purpose, we describe 3 cases in which the usefulness of real-time 3D echocardiography is shown. Results Better definition of the morphologic characteristics of the vegetation and valvular apparatus was achieved with real-time 3D echocardiography. Furthermore, the information provided by the real-time 3D echocardiogram to the surgical team was accurate and direct because it was not based on detailed verbal information for performing a 3D mental reconstruction but was a simple image similar to what would be found in the operating room. In all cases, the information provided by the real-time 3D echocardiography was confirmed during surgery. Conclusions Real-time 3D echocardiography is an important tool for aiding diagnosis or for fine tuning a suspected diagnosis when traditional echocardiography is not completely clear for both medical and surgical decision making.

Morphological determinants of subaortic stenosis in hypertrophic cardiomyopathy: insights from real-time 3-dimensional echocardiography.

Abstract: Real-time 3-dimensional echocardiography allows a comprehensive evaluation of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy. The anterior segment of the anterior mitral leaflet is essential in the development of the LVOT pressure gradient.

Prognostic influence of mitral regurgitation prior to a first myocardial infarction.

Abstract: Aims Mitral regurgitation (MR) following an acute myocardial infarction (AMI) confers an adverse prognosis during long-term follow-up. There are no studies evaluating the influence of pre-AMI MR in the short- and long-term prognosis of such patients. Our aim was to assess the prognostic value of pre-AMI MR in the short- and long-term follow-up of patients who suffered a first AMI and to assess its influence on left ventricular haemodynamics. Methods and results Sixty-eight consecutive patients with a first AMI and an echocardiographic study before AMI (<3 months) were included in the study. The pre-AMI echo was performed for various reasons. Of these 68 patients, 42 had pre-AMI MR (Group 1) and 26 showed no pre-AMI MR (Group 2). The presence of degenerative changes at the level of the mitral valve was confirmed in all cases. Patients with any other cause of MR were excluded. Clinical and echocardiographic variables for both phases (pre-AMI and post-AMI) were analysed and patients were followed up. Mean age was 75.5±9.5 years; there were 38 males (55.9%). There were no statistical differences in baseline clinical variables between the groups, except for the presence of pre-AMI atrial fibrillation, which was more frequent in Group 1 (21.4 vs. 0%; P =0.01). After AMI, only end-diastolic left ventricular diameter was significantly larger in Group 1 (54.9±4.7 vs. 48.1±5.6 mm; P <0.001). During long-term follow-up, median survival times were 912 days (interquartile range: 690 days) in Group 1 and 1423 days (interquartile range: 520 days) in Group 2 (Log-rank P =0.02). The multivariable analysis showed that the presence of pre-AMI MR relates to a statistically significant relationship with a worse post-AMI evolution [relative risk (95% confidence interval): 3.8 (1.1–13.1); P =0.037]. Conclusion The present study shows that the presence of pre-AMI MR is an independent prognostic marker among those patients suffering a first AMI.

Prognostic significance of ischemic mitral regurgitation after non-Q-wave acute myocardial infarction.

Abstract: BACKGROUND AND AIM OF THE STUDY: The development of mitral regurgitation (MR) soon after acute myocardial infarction (AMI) is a recognized and frequent complication. Its negative impact on survival has been observed after Q-wave AMI, even when of a mild degree, and independently of left ventricular systolic function. Few data exist regarding MR after non-Q-wave AMI (nQ AMI), however. Hence, the study aim was to investigate the incidence, clinical predictors and prognostic implications of MR in the setting of nQ AMI. METHODS AND RESULTS: A total of 99 consecutive patients (37 men, 62 women; mean age 72 +/- 13 years) who suffered a nQ AMI was studied. All patients underwent echocardiography during the first week after the nQ AMI. MR was detected in 34 patients (17 men, 17 women; mean age 76 +/- 10 years). Events during follow up were coded as death, AMI, unstable angina, or heart failure. The in-hospital outcome was not significantly different between patients with and without MR. The mean follow up period was 663 +/- 574 days. In the univariate analysis, freedom from hospital survival was significantly greater in patients without MR. However, multivariate analysis showed that MR was not an independent predictor of cardiovascular hospitalization or death. CONCLUSION: The incidence of MR is high among patients with nQ AMI but, unlike results found with Q-wave AMI, its presence does not add any prognostic significance to other known negative factors in the setting of nQ AMI.

Infective endocarditis: mid-term prognosis in patients with good in-hospital outcome.

Abstract: Background and aim of the study The study aim was to analyze the mid-term prognosis of infective endocarditis (IE) in patients managed with medical therapy during the in-hospital phase and who had a good initial outcome. Comparison was made with the prognosis of patients treated surgically during this period. Methods A total of 151 patients diagnosed with IE was studied, and in-hospital outcome, clinical characteristics and mid-term follow up data were analyzed. The main end-point was a composite of death and need for surgical repair. Results Among 151 patients, 84 (56%) underwent surgery or died during the in-hospital phase, while 67 patients (44%) received medical treatment and were discharged clinically stable with a final diagnosis of healed infective endocarditis. A better baseline profile was seen in the medically treated group, but outcome in this group showed extensive mid-term morbidity/mortality. In total, 52.2% of patients underwent surgery to correct complications and 60% died as a consequence of the disease. The event-free survival rate was 20% at five years. Conclusion Despite a favorable in-hospital clinical course and successful medical treatment, patients with IE are at risk of late complications that result in a need for surgical repair, or in death. A close follow up should be made in order to treat late complications.

Long-term prognostic importance of transient left ventricular dilation during pharmacologic stress echocardiography

Abstract: Objectives We sought to evaluate the prognostic significance of left ventricular (LV) transient ischemic dilation (TID) for patients with a positive stress echocardiogram (SE). Background TID during SE has been related to the presence of extensive coronary artery disease, but its long-term prognostic implications have not been reported. Methods In all, 99 consecutive patients with a positive SE comprised the study group. LV volumes were evaluated according to the modified Simpson's rule. TID during SE was defined as the presence of an increase in LV end-diastolic volume during the stress test. A clinical history was fulfilled for each patient and all of them were followed up. Results Of 99 patients, 32 (32.3%) showed TID. Mean age was 65.8 ± 9.8 years for non-TID group and 70.2 ± 8.4 for TID group ( P = .048). Baseline characteristics and subsequent treatment were similar in both groups. Mean follow-up was 21.4 ± 15.8 months. In non-TID group the mean survival free of acute myocardial infarction was 47.28 months and 39.7 months in TID group (log rank=0.012). In the univariate and multivariate analysis only TID and the wall motion score index were found as independent predictors related to long-term prognosis (risk ratio=6.9; 95% confidence interval=0.8-59.6; P = .042; and risk ratio=0.4; 95% confidence interval=0.18-0.89; P = .047, respectively). Conclusions LV TID during SE is an easy and independent prognostic marker. It helps to select patients with increased risk.

Utilidad de la ecocardiografía de contraste miocárdico con cuantificación basada en imagen paramétrica para la predicción de la recuperación funcional de segmentos acinéticos en pacientes con infarto agudo de miocardio sometidos a angioplastia primaria

Abstract: Introduccion y objetivos La ecocardiografia de contraste miocardico (ECM) es util para predecir la recuperacion funcional de los segmentos acineticos en pacientes que reciben una angioplastia coronaria transluminal percutanea primaria. Se ha desarrollado recientemente la imagen parametrica para la cuantificacion de la perfusion. Los objetivos son: a) valorar de forma cuantitativa la perfusion de los segmentos acineticos en pacientes que reciben angioplastia primaria, y b) evaluar la utilidad de la cuantificacion con imagen parametrica para predecir la recuperacion funcional de los segmentos acineticos. Pacientes y metodo Se analizo a 49 pacientes con infarto agudo de miocardio (IAM) que recibieron angioplastia primaria. Se realizo ecocardiograma estandar y ECM entre los 2 y 5 dias posteriores al IAM. Se realizaron ecocardiograma estandar y cateterismo a los 6 meses. La evaluacion cualitativa y cuantitativa fue realizada off-line por 2 investigadores independientes. Resultados La edad media fue de 62,3 ± 14,5 anos (39 varones). En el estudio basal se detectaron 170 segmentos acineticos. La recuperacion funcional fue observada en 105 segmentos. El mejor parametro cuantitativo para predecir la recuperacion funcional fue la velocidad del flujo sanguineo (β): el area bajo la curva ROC fue 0,96 (intervalo de confianza del 95%, 0,92-0,99). Para un punto de corte de 31dB/s, la sensibilidad fue del 87,62%, la especificidad del 95,31%, el valor predictivo positivo del 96,8% y el valor predictivo negativo del 82,43%. Estos resultados son mejores que los obtenidos con el metodo cualitativo. Conclusiones La cuantificacion de la perfusion con imagen parametrica es una herramienta util para predecir la recuperacion funcional de los segmentos acineticos en pacientes que reciben angioplastia coronaria transluminal percutanea primaria y es mejor que la valoracion cualitativa.

Usefulness of Real Time 3D echocardiography in assessment of rheumatic mitral stenosis

Abstract: To date, the assessment of rheumatic mitral stenosis has been based on Doppler methods, which have a high dependence on the hemodinamic conditions and on the planimetry obtained from 2D echo images. Real Time 3D echocardiography has been implemented in the daily clinical practice. It provides high quality 3D images and the acquisition time is very short. In the present work, we try to show the "state of the art" of Real Time 3D echocardiography in the assessment of rheumatic mitral stenosis. These findings are based on the experience of our "Unidad de Imagen Cardiovascular" at the Hospital Clinico San Carlos de Madrid.

Identification of Stunned Myocardium With Parametric Imaging-Based, Quantitative Myocardial Contrast Echocardiography After Acute Myocardial Infarction

Abstract: Microvascular integrity demonstrated by myocardial contrast echocardiography (MCE) predicts functional recovery after an acute myocardial infarction (AMI). Recently, parametric imaging-based quantitative MCE has been developed. Our aim was to assess the usefulness of parametric imaging-based quantitative MCE parameters to predict the functional recovery of akinetic segments after primary percutaneous transluminal coronary angioplasty (PTCA). Fifty-three consecutive patients with a first AMI were enrolled. They underwent primary PTCA. Standard echocardiography and real-time MCE were performed. Qualitative analysis and parametric imaging-based quantitative parameters were measured offline by different blinded investigators. Dobutamine stress echocardiography was performed 1 month later. A new standard echocardiogram to assess the functional status of the akinetic segments and coronary angiography to evaluate the presence of restenosis at the level of the culprit lesion were performed 6 months later. The mean patient age was 62.9 ± 14 years, and 42 were men (79%); 170 segments were akinetic. Of these, 105 (62%) recovered their function. The best parameter to predict functional recovery was the myocardial blood flow velocity (β). These results were better than those obtained using dobutamine stress echocardiography and qualitative MCE to predict functional recovery. In conclusion, parametric imaging-based quantitative MCE is an accurate diagnostic tool to detect stunned myocardium after AMI. Its diagnostic accuracy in predicting the functional recovery of akinetic segments after primary PTCA is better than the accuracy of dobutamine stress echocardiography and qualitative MCE.

Valoración ecocardiográfica de la asincronía

Abstract: La terapia de resincronizacion cardiaca ha logrado beneficios tanto a corto como a largo plazo en determinados pacientes con insuficiencia cardiaca. Los criterios actuales de seleccion para la implantacion de un marcapasos bicameral son: a) insuficiencia cardiaca en clase funcional III-IV de la NYHA (New York Heart Association) a pesar de un tratamiento optimo; b) funcion ventricular izquierda deprimida (FEVI 130 ms. Pero estos criterios estan en revision. Si consideramos como criterio para la resincronizacion un complejo QRS > 130 ms, aproximadamente un 30% de los pacientes no responden de manera favorable a la terapia. Se sabe que hasta un 51% de los pacientes con un complejo QRS

Adolescent and adult congenital heart disease assessed by real-time three-dimensional echocardiography: an initial experience.

Abstract: Real-time three-dimensional (3D) echocardiography has enormous diagnostic potential, enabling acquisition of full-volume three-dimensional images in real time, which can be sliced in several planes and rotated in order to achieve a more accurate study of the target cardiac structures. It is particularly useful because it enables the heart to be visualized from multiple perspectives in the same way a surgeon would see it during an operation. We describe our echocardiographic laboratory's experience with real-time 3D ultrasound study of adolescent and adult congenital heart disease.

Left Ventricular Geometric Patterns After 1 Year of Antihypertensive Treatment

Abstract: Left ventricular hypertrophy increases the risk for cardiovascular target organ damage, myocardial infarction, and stroke. The authors assessed the patterns of ventricular adaptation in 107 essential hypertensives whose treatment had been withdrawn and its modification after 1 year of hypertension treatment. Blood pressure decreased from 158+17/96+12 mm Hg to 137+15/83+10 mm Hg (mean + SD; p 0.05). Left ventricular mass geometry improved in 31% of the patients, remained unaffected in 51%, and worsened in 18%. The data suggest that even while suboptimal antihypertensive treatment reduces left ventricular mass index, either left ventricular hypertrophy or concentric remodeling remains present in a significant number of patients at the end of a 1-year treatment period. The authors conclude that these patients should be considered as a subgroup at high risk and should be treated more aggressively.

Usefulness of Parametric Imaging-Based Quantitative Myocardial Contrast Echocardiography in Predicting the Functional Recovery of Akinetic Segments Following Primary Angioplasty in Acute Myocardial Infarction Patients

Abstract: Introduction and objectives Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a ) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE, and b ) to assess the usefulness of these measurements in predicting functional recovery of these segments. Patients and Method The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images. Results The patients' mean age was 62.3±14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (?): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion. Conclusions Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods.

Utilidad de la ecocardiografía tridimensional en tiempo real en la valoración de la estenosis mitral reumática

Abstract: Los metodos no invasivos actuales para valorar la estenosis mitral reumatica presentan una serie de limitaciones. Recientemente, la ecocardiografia tridimensional ha ampliado las posibilidades diagnosticas. Su utilidad en la valoracion de la estenosis mitral aun no esta bien establecida. HIPOTESIS La ecocardiografia tridimensional en tiempo real es una tecnica no invasiva, mas precisa que las actuales, para la valoracion del area valvular en pacientes con estenosis mitral. MATERIAL Y METODOS A todos los pacientes se les realizo un estudio Eco-Doppler bidimensional y tridimensional. Los pacientes que fueron sometidos a valvuloplastia mitral percutanea fueron sometidos a dos estudios, el primero dentro de las 24 horas previas a la valvuloplastia y el segundo dentro de las 24 horas siguientes ala valvuloplastia. Se determino el score de Wilkins empleando ecocardiografia bidimensional y ecocardiografia 3DTR. RESULTADOS Fueron incluidos en el estudio de valoracion del area valvular mitral un total de 80 pacientes con estenosis mitral. La comparacion de los diferentes metodos, mostro que el area valvular mitral determinada mediante el metodo de Gorilin tiene mejor correlacion con la obtenida por planimetria 3DTR que son la determinada por los otros metodos no invasivos. La valoracion del "score" valvular mediante ecocardiografia tridimensional en tiempo real, mostro un mejor acuerdo interobservador que la determinada por ecocardiografia bidimensional. La valvuloplastia mitral percutanea fue realizada en 29 pacientes. En este grupo el AVM obtenida de forma invasiva empleando el metodo de Gorlin presentaba un mejor acuerdo con los resultados de la planimetria 3DTR que con los resultados del THP o la planimetria 2D. Tras la valvuloplastia, la mejor precision de la planimetria 3DTR se mantuvo. CONCLUSIONES La ecocardiografia 3DTR es una herramienta util, precisa y muy reproducible para estimar el