جستجوی مقالات مرتبط با کلیدواژه « echocardiography » در نشریات گروه « پزشکی »

Right ventricle failure is a well-known complication following pulmonary thromboembolism. Although Computed Tomography Pulmonary Angiography (CTPA) findings are supposed to be a surrogate for patients’ outcome, investigations based on this issue is not still elucidated. Thus, in the current study, we assessed patients’ CTPA findings and compared the result with echocardiographic findings.

A total of 36 patients with proven pulmonary thromboembolism were enrolled and a comparison was made between indices in CTPA (interventricular septal deviation to the right side, inferior vena cava contrast reflux, and right ventricle diameter to left ventricle diameter ratio) and echocardiographic findings for detecting right ventricular failure. Also, the reliability of the aforementioned indices was sought for predicting mortality.

No significant correlation was found between CTPA indices and echocardiographic findings. The highest sensitivity and positive predictive value in CT pulmonary angiography for detecting right ventricle dysfunction were revealed to be for Right Ventricle Diameter (RVD) / Left Ventricle Diameter (LVD) > 1 (63.64%), abnormal septal deviation (75.00%), respectively.

Our results revealed that CTPA indices can reliably predict the upcoming mortality risk. On the other hand, these indices were not well-correlated with echocardiographic findings.

Aortic valve stenosis (AS) is the most common valvular heart disease in developed countries, with its prevalence on the rise due to aging populations. While severe AS has long been recognized as high-risk, recent studies have shed light on the significant association between moderate AS and cardiovascular morbidity and mortality. Yet, the data are still inconclusive. With noninvasive multi-modality imaging techniques advancing rapidly, we now have more insight into the underlying biology of AS. Echocardiography continues to serve as the primary noninvasive imaging modality for diagnosing and grading AS. This comprehensive review delves into the role of echocardiography in diagnosing moderate AS and how the findings can support clinicians in making well-informed decisions that impact patients’ prognoses.

A 72-year-old man presenting with progressive dyspnea was evaluated. Transthoracic and consequently transesophageal echocardiography verified severe mitral regurgitation (MR) caused by hypoplasia of the posterior mitral leaflet (PML) and flail of A2 scallop. Areview of reported cases reveals that PML hypoplasia is an uncommon diagnosis among the adult population which can be tolerated relatively well and carries a good prognosis. Our patient had a unique course of the disease. Previously presenting with a bicuspid aortic valve and a nonsignificant MR in spite of the severely hypoplastic PML. Eventually, he became symptomatic years later as severe MR developed due to chordal rupture and flail of the anterior mitral leaflet.

Assessing right ventricular performance using twodimensional (2D) echocardiography has been difficult due to its complex shape. Tissue Doppler imaging was used as a noninvasive method in this study to evaluate right ventricular function in patients with acute inferior wall ST-elevation myocardial infarction (IWMI) treated with primary percutaneous coronary intervention (PCI).

Forty patients with IWMI admitted to a tertiary care hospital in India were included in this prospective, observational study. The patient’s detailed history, physical examination along with laboratory parameters, electrocardiogram, echocardiogram, and coronary angiogram profile were recorded from which the decision for PCI was made. The followup period for each patient was 6 weeks, during which 2D color Doppler and pulse-wave echocardiographic parameters were assessed.

This study comprised 40 patients, among which 16 patients had right ventricular myocardial infarction (RVMI), and the mean age of RVMI patients was 56.65 ± 12.03 years. In RVMI patients, tricuspid annular plane systolic excursion (mm) and RV FAC (%) values were lower than in IWMI patients, and a surge in its respective value to 15.66 ± 1.20 and 32.64 ± 3.17 (P = 0.03) was observed post-PCIs. Furthermore, an inclination in tissue annular systolic velocity (Sm; cm/s) to 11.24 ± 1.55, P = 0.02, and early diastolic tissue annular velocity (Em; cm/s) to 10.98 ± 1.27, P = 0.003, from the baseline was observed after revascularization. The myocardial performance index value accounted to be higher in RVMI patients; however, after PCI, a change from 0.73 ± 0.06 to 0.61 ± 0.12 was noted (P = 0.002).

In this study, a significant difference in the echocardiographic parameters assessing RV function in RVMI and IWMI patients was noted, and hence, it can be considered a reliable diagnostic tool to predict the RV performance.

The relationship between diastolic function parameters and the severity of coronary artery disease (CAD) is controversial. This study aimed to determine the relationship between left ventricular diastolic function and the severity of CAD. This cross-sectional study included 63 patients with Ischemic heart disease (IHD) or those suspected of having IHD, who underwent angiography. The study was conducted in Shafa Hospital, Kerman, Iran, from 2021 to 2022. Two-dimensional (2D) strain echocardiography was used to assess left ventricular (LV) function parameters, followed by coronary angiography. Based on the severity of the disease, patients with significant CAD were placed in the case group, and patients with insignificant CAD were placed in the control group. The correlation between the CAD severity and the severity of LV diastolic dysfunction was computed. Descriptive tests, independent t tests, and Spearman correlation coefficients were used. P<0.05 was considered statistically significant. The results indicated that there was no correlation between E/e′ (P=0.103), left atrial volume index (LAVI) (P=0.168), tricuspid regurgitation velocity (TRV) (P=0.217), myocardial performance index (MPI) (P=0.106), E wave deceleration time (dt) (P=0.644), and late diastolic strain rate (P=0.502) with CAD severity based on SYNTAX score. However, there was a correlation between left atrial (LA) strain (P=0.017), global longitudinal strain (GLS) (P<0.001), early diastolic strain rate (P<0.001), and systolic strain rate (P=0.047) with SYNTAX score. Besides, there was a correlation between LA strain (P=0.017), GLS (P<0.001), early diastolic strain rate (P<0.001), and late diastolic strain rate (P=0.035) with numbers of epicardial coronary arteries with significant lesions. In contrast with 2D strain echocardiography, this study showed that conventional echocardiography parameters had no significant relationship with CAD severity. GLS had the strongest correlation with CAD severity, and diastolic strain rates had a weaker correlation with CAD severity.

Hydatid disease is a parasitic infestation caused by larvae of the Echinococcus tapeworm. It mainly affects the liver and lungs. Cardiac hydatid cyst is uncommon and involvement of the interventricular septum is even rarer. It may lead to various complications because of rupture and embolization. We report the case of a 24-year-old man who was diagnosed to have a large interventricular hydatid cyst associated with cysts in the liver which mimics like acute coronary syndrome. This case is of particular interest because of the rarity of septal localization of a hydatid cyst, and concurrent involvement of the liver and cardiac is uncommon.

 Previous studies have investigated the potential influence of prior aspirin use on cardiac function in patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). However, the results from these studies have been conflicting. This study aimed to investigate whether prior aspirin use affects left ventricular (LV) function in these patients using echocardiography.

 The study included 260 consecutive STEMI patients, who were divided into two groups based on the presence or absence of prior aspirin use. Echocardiographic parameters, such as maximal left atrial (LA) size, LV ejection fraction (LVEF), early diastolic velocity (e’), E/A ratio, and E/e’ ratio, were assessed within 72 hours of admission.

 Aspirin users had an older age compared to non-users, as well as lower body mass index and renal function. They also had a greater history of hypertension and were more likely to be taking statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and calcium channel blockers. There were no significant differences in LVEF, maximal LA size, E/A ratio, E/e’ ratio, and deceleration time between aspirin users and non-users. e’ wave was marginally lower in aspirin users (P=0.054). After controlling for confounding variables, the previous use of aspirin did not show a significant impact.

 Prior aspirin use in STEMI patients does not have a significant impact on LV echocardiographic parameters. Our conclusions remained consistent even after adjusting for potential confounders.

The staging of Heart Failure (HF) in the population at risk of progression emphasizes early identification and prevention of HF. Therefore, this study aims to evaluate the prevalence of various stages of HF in individuals over 40 years old within a large population of Iranian adults. In this descriptive cross-sectional study, a random sub sample of Yazd Health Study (YaHS) participants aged 40-70 years was evaluated. History and clinical examination of the patients was conducted by a cardiologist and then, the participants underwent echocardiography to determine the stages of heart failure. Among 410 Yazd population -the representative sample with mean age 58.0±9.2 years, 183 patients (44.6%) were in stage 0, 121 (29.5%) in stage A, 77(18.8%) in stage B, and 29 (7.1%) in stage C heart failure. No individuals were in stage D. There was a significant difference between the frequency of individuals with different stages of HF in terms of diabetes, hypertension, obesity, and history of ischemic heart disease (p<0.05). In addition, the frequency of HF increased in the age group >60 years and the obesity group (p<0.05).  According to these, about half of the patients with HF were in stage A and B. Therefore, appropriate measures are needed to identify these groups of patients, especially individuals with risk factors of diabetes, hypertension, obesity and those over 60 years to prevent the progression of the disease to higher stages which lead to poorer outcome.

Type 2 myocardial infarction (MI) is caused by myocardial ischemia resulting from an imbalance between oxygen supply and demand in the heart. This study aimed to assess the incidence, variations in clinical characteristics, current therapeutic approaches, and overall prognosis in patients with type 2 MI compared to those with type 1 MI.
 
This prospective, cross-sectional study involved 350 Egyptian patients presenting with MI. Participants were categorized into type 1 MI (n = 262) and type 2 MI (n = 88) groups based on standard diagnostic criteria. Data regarding demographic characteristics, clinical presentations, management strategies, and outcomes, including in-hospital, 30-day, and 6-month mortality rates; major adverse cardiovascular events (MACE); and hospitalization for heart failure, were collected and analyzed.
 
Coronary angiography was performed more frequently in patients with type 2 MI than in those with type 1 MI. Primary percutaneous coronary intervention and coronary artery bypass grafting were more commonly performed in type 1 MI patients. A statistically significant difference was observed between type 1 MI and type 2 MI concerning echocardiographic findings and hospital stays. However, there was no significant difference in MACE at 1-month and 6-month follow-ups, except for mortality and stroke, where a statistically significant difference was found.
 
Type 1 MI is more common than type 2 MI. Nonetheless, type 2 MI is associated with higher mortality rates and longer hospital stays. Patients with type 1 MI typically present with chest pain, while those with type 2 MI predominantly present with dyspnea, syncope, and hemodynamic instability. Cardiac interventions are primarily performed in patients with type 1 MI. (Iranian Heart Journal 2024; 25(4): 51-58)

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease predominantly affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract, and the eyes. 1 The diagnosis of leprosy is based on the presence of at least 1 of 3 cardinal signs: definite loss of sensation in a pale or reddish skin patch, a thickened or enlarged peripheral nerve with loss of sensation, and/or weakness of the muscles supplied by the nerve, and the presence of acid-fast bacilli in a slit-skin smear. However, there are no reports that describe the link between leprosy and pulmonary hypertension (PH). Here, we describe a 22-year-old man who was first diagnosed with leprosy and subsequently developed PH, confirmed by echocardiography. To our knowledge, this is the first case of leprosy associated with PH with a detailed clinical description. We recommend that physicians be aware of this rare comorbidity in patients with leprosy. Early echocardiographic screening is necessary for symptomatic patients. (Iranian Heart Journal 2024; 25(4): 100-104)

Various extracardiac disorders are associated with congenital heart defect (CHD) at varying prevalence rates (7%–50%). Over the years, numerous studies worldwide have investigated these associations. This study aimed to examine the prevalence of extracardiac anomalies in children with CHD in Isfahan, one of Iran’s largest cities. 

This cross-sectional study was conducted in Isfahan, Iran, from 2020 through 2022, involving 750 infants under 1 year old diagnosed with CHD. Pediatric cardiologists performed echocardiography to evaluate the cardiovascular system and detect CHD. Most participants were referred for cardiac examinations due to abnormalities detected during physical examinations of skin, cerebral, spinal cord, abdominal, and urinary tract regions. Patients exhibiting signs of a syndromic disorder were also referred for CHD evaluation. 

Out of 750 infants with confirmed CHD, 241 (32.13%) presented at least 1 extracardiac malformation. Ninety (37.7%) had craniofacial malformations, with 66.7% having cleft palate with or without cleft lip. Forty-eight patients (19.9%) had genetic syndromes, most commonly Down syndrome (56.5%), and 46 (19.8%) had gastrointestinal abnormalities, including intestinal or esophageal atresia. 

The prevalence of extracardiac anomalies in patients with CHD is significant, and these patients are at an increased risk of mortality and morbidity throughout their lives. Implementing a screening program could effectively prevent further complications associated with the late diagnosis of these anomalies. (Iranian Heart Journal 2024; 25(3): 6-12)

Obesity is a prevalent health issue associated with an increased risk of cardiovascular diseases. While obesity's link to various cardiovascular conditions is well-documented, its specific impact on global longitudinal strain (GLS) requires further investigation. This study aims to explore the relationship between obesity and GLS in an adult population.

This cross-sectional study included 91 adult participants, categorized into obese (n=59) and non-obese (n=32) groups based on body mass index (BMI). GLS was measured using speckle-tracking echocardiography. Chi-square tests and odds ratios (OR) were used to assess the association between obesity and abnormal GLS.

Among the non-obese group, 25.0% had abnormal GLS compared to 20.3% in the obese group. The chi-square test indicated no significant difference in the prevalence of abnormal GLS between the groups (p = 0.60). The odds ratio for abnormal GLS in obese versus non-obese participants was 1.3 (95% CI: 0.4-3.6), indicating no significant association.

The study found no significant association between obesity and abnormal GLS, suggesting that BMI alone may not be a reliable predictor of subclinical myocardial dysfunction. These findings highlight the need for a comprehensive approach to cardiovascular risk assessment that includes multiple factors beyond BMI.

Aging is a physiological process that affects heart function. Training is known as a factor accelerating heart output, especially in aged individuals. In the present experimental study, the authors aimed to evaluate how high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) affect autophagy, cardiac remodeling, and cardiac function. 

Twenty-four male Wistar rats, approximately 20 months old, were divided into three groups of control, HIIT, and MICT. The training programs lasted for eight weeks. Aerobic power and training capacity were also assessed. Two-dimensional echocardiography was also applied to assess cardiac indices. At the end of the experiment, tissue sampling of cardiac tissue was applied, and gene expression was assessed using the qRT-PCR technique. Data were analyzed using SPSS software, version 19.

After HIIT and MICT, no significant changes were detected regarding the animal weight. Also, mTORC1, Atg16, and Atg7 gene expression and ejection fraction (EF) and fractional shortening (FS) were accelerated in HIIT and MICT groups compared to control animals. Besides, the collagen type 3 (COLIII) gene expression, left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD) showed a significant increase (p<0.05) in HIIT and MICT animals than control.

Training can potentially improve cardiac output in older adults. Besides, HIIT seems more effective than MICT.

Breast cancer is the most common cancer and the leading cause of cancer-related death among women worldwide. Breast cancer treatment has been improved by the development of targeted chemotherapies such as antibodies against HER2 receptors and now Trastuzumab is the standard treatment for HER2 positive breast cancer. Cardiotoxicity is the most prominent adverse effect of Trastuzumab that restricts the usage of this drug. This study is designed to assess cardiomyopathy in patients with breast cancer under Trastuzumab chemotherapy with special respect to both right and left ventricles. A total number of 38 cases were evaluated. Echocardiography was done at the baseline and three to six months after the initiation of Trastuzumab chemotherapy. According to the second echocardiography 24 cases (63.8%) developed cardiotoxicity based on decrease in ejection fraction or decrease in the absolute value of the left and/or right ventricular Global Longitudinal Strain (LV and/or RV GLS). There was a significant difference between the mean values of echocardiographic indices including RVSm, RV Tei-index, LV Tei-index, RV GLS, LV GLS, LVEF, MAPSE, and TAPSE before and after chemotherapy (the p-value for comparison of MAPSE was 0.006, and the p-value for comparison of other parameters was <0.001). There was no significant difference in terms of cardiotoxicity between the group that received radiotherapy in addition to chemotherapy and the group that did not receive radiotherapy. In conclusion, the best way to minimize Trastuzumab-induced cardiotoxicity is intensive follow-up by echocardiography to detect cardiac impairments in the early stages. Also, the study demonstrated the uniqueness of longitudinal strain especially LV-GLS for early detection of cardiotoxicity.

Pulmonary embolism (PE) is challenging to diagnose due to nonspecific symptoms. While computed tomography pulmonary angiography (CTPA) is the gold standard, transthoracic echocardiography (TTE) is frequently used first. This study aimed to evaluate the accuracy of TTE findings in predicting the severity of CTPA-confirmed PE. 

This retrospective study in 2023, analyzed 124 patients who underwent CTPA for suspected PE at Seyed Al Shohada Hospital of Urmia, Iran. The Pulmonary Embolism Severity Index (PESI), as a risk stratification tool for pulmonary embolism, was measured in the first hours of hospitalization. TTE was performed 48 hours following hospital admission, with an emphasis on Key TTE parameters, including McConnell’s sign, D-shape septum sign, right ventricular (RV) dimensions, left ventricular dimensions, pulmonary artery (PA) diameter, tricuspid regurgitation gradient (TRG), Tricuspid annular plane systolic excursion (TAPSE)  and PA acceleration time (PaACT). Sensitivity, specificity and predictive value were all calculated. 

Most patients were women (53.23%) over 60 (38.71%). Several TTE measures showed promise for predicting PE: RV dilation (sensitivity 84%, specificity 77%), PA diameter (84% and 28%), TRG (66% and 58%), and PA acceleration time (92% and 62%). However, McConnell’s sign had low accuracy (area under ROC curve 0.62). Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time showed the best predictive performance (AUC 0.95-0.92) and can be used as screening tools for life-threatening massive PE.PESI index test, when compared to the gold standard CT scan (which shows lung involvement), does not provide additional valuable information and accurate predictions about the severity of PE. 

TAPSE and PaACT showed excellent predictive ability to CTPA-detected PE. RV dilation and PA diameter also showed good predictive capability. Findings support using some TTE indices to screen for PE severity and risk assessment before CTPA when access is limited.

Pulmonary hypertension (PH) is a known complication of hemodialysis (HD) but its pathogenesis and etiology is not completely clear. The purpose of the current study is to determine the prevalence and possible causes of PH among hemodialysis patients.
Demographic, clinical and laboratory data of 40 patients referred to hemodialysis ward of Masih Daneshvari Hospital during 12 months were recorded. Detailed echocardiography was performed for each patient within 24 hours of hemodialysis. PH was defined as systolic pulmonary artery pressure (SPAP) above 35 mmHg.
12 of 40 HD patients had PH (prevalence = 30%). The hemodialysis vintage in PH group was longer than patients without PH (No PH group) . Also, left atrium size, right ventricle size, left ventricle end diastolic diameter (LVEDD) and left ventricular mass index (LV mass index) were significantly higher in PH group; but ejection fraction (EF) was lower than No PH group. Left ventricle diastolic dysfunction and pericardial effusion were significantly associated with PH. The crude mortality rate was relatively similar in PH group and No PH group.
PH is prevalent in HD patients with multifactorial etiology. Increased pulmonary capillary wedge pressure (PCWP) is a very important factor to induce PH in these patients; on the other hand, chronic volume overload and left ventricle systolic and diastolic dysfunction are some of the predominant causes of increased PCWP in this population.

The establishment of pneumoperitoneum has impacts on patient’s cardiovascular function. In this study, the  respiratory variation of inferior vena cava (IVC), stroke volume (SV) index, and other parameters was monitored to determine how the pneumoperitoneum affects the patient’s hemodynamic and acknowledge how to resolve it.

Fifty?five patients were randomly divided into Group A (8 mmHg), Group B (10 mmHg), Group C (12 mmHg), Group D (14 mmHg), andGroup E (12 mmHg, infusion with 7 mL/kg crystalloid solution). The parameters including IVC variability, SV index, mean artery pressure (MAP), heart rate (HR), cardiac output index (CI), and airway pressure were measured, to compare the changes before and after pneumoperitoneum.

Among Group A, Group B, Group C, and Group D, there were no significant differences in patients’ prepneumoperitoneum information. Compare with prepneumoperitoneum, the difference in IVC variability, SV index, MAP, HR, CI, and airway pressure was statistically significant (P < 0.05). After the establishment of pneumoperitoneum, the difference in IVC variability, SV index, and airway pressure among Group A, Group B, Group C, and Group D was statistically significant (P < 0.05). Compare with Group C, the change rates of IVC variability, SV index, MAP, HR, and CI were smaller in Group E (P < 0.05).

The establishment of pneumoperitoneum could increase the patient’s IVC variability and reduce SV index, and with the increase of pressure, IVC variability had an increasing trend, SV index had a decreasing trend. Fluid transfusion could reduce the relative influence of the pneumoperitoneum.

Appendage is the growth of the left atrium, which is different in terms of shape and size. This research aimed to investigate the relationship between the shape of the left atrium appendage and atrial fibrillation incidence.

In a cross-sectional study, using the census method, 25 patients diagnosed with atrial fibrillation and a candidate for cardioversion were examined for the shape of the left atrial fibrillation in Farshchian Heart Hospital in Hamedan from 2021 to 2022. Three-dimensional echocardiography with an esophageal probe was used to detect LAA morphology. Data, after recording in the checklist, were analyzed with SPSS software (version 26).

Patients had a mean age of 56.64±12.31 years. Males accounted for 32% of the patients and females for 68%. The frequency of chicken-wing, cactus, cauliflower, and windsock in the left atrium was 52%, 40%, 4%, and 4%, respectively. The mean and standard deviation of blood flow velocity in chicken-wing, cactus, cauliflower, and windsock forms were 14.92±3.90, 40.70±9.62, 23.00, and 32.00 cm/s, respectively (P˂0.001).  Shape of the left atrial appendage had no significant difference with the type of atrial fibrillation regarding age, gender, diabetes, and blood pressure (P<0.05 for all).

In patients with atrial fibrillation, the frequency of left atrial appendage morphology is different. Chicken-wing and cactus forms were the most common forms of left atrial appendage in patients diagnosed with atrial fibrillation. The shape of the left atrium was significantly related to the flow rate, which seems to help predict thrombosis and atrial fibrillation.

The administration of antenatal corticosteroid is a standard treatment to reduce the rate of perinatal mortality and morbidity; however, there is limited evidence regarding the potential effects of betamethasone on the constriction of the ductus arteriosus (DA).

This study aimed to investigate the short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status.

This quasi-experimental observational (before-after) study was conducted on 32 singleton fetuses. The participants were healthy pregnant women with a diagnosis of placenta accreta spectrum who were eligible for 2 doses of betamethasone and referred to prenatal care clinic, Vali-E-Asr hospital, Tehran, Iran from January 2021-May 2022. The results of fetal echocardiography and Doppler sonography were compared before and after the administration of antenatal corticosteroid therapy.

Following betamethasone injection, significant increases were observed in peak systolic and diastolic velocity of the DA without constriction of the DA (p < 0.001, p = 0.002 respectively). However, no significant changes were observed in right ventricular function, tricuspid valve function, Doppler of ductus venous, and peak systolic velocity of the aortic isthmus (p > 0.05). Doppler examination of the uterine, umbilical, and middle cerebral arteries also showed no significant changes (p > 0.05).

Considering the benefits of antenatal corticosteroid therapy, its administration seems reasonable in preterm births. The transient changes in ductal blood flow are not prohibitive.