El síndrome de apneas e hipopneas del sueño (SAHS) conlleva importantes repercusiones cardiacas q... more El síndrome de apneas e hipopneas del sueño (SAHS) conlleva importantes repercusiones cardiacas que se pueden evaluar mediante métodos no invasivos como la ecocardiografía transtorácica; sin embargo, está por dilucidar si se deben a la propia enfermedad o a la influencia de factores concomitants como la hipertensión arterial (HTA). El objetivo de este estudio es analizar las alteraciones ecocardiográficas en pacientes con SAHS y si se modifican en caso de HTA concomitante.Estudiamos a 103 pacientes consecutivos diagnosticados de SAHS e indicación de presión positive continua en la vía aérea (HTA, 49 pacientes; sin HTA, 54) frente a 24 controles ajustados por edad e índice de masa corporal. Realizamos ecocardiograma-Doppler por un observador para el que la asignación estaba enmascarada. Analizamos variables morfológicas (grosor de paredes y diámetros) y funcionales (fracción de eyección, velocidad máxima de ondas E y A, tiempo de deceleración mitral e índice Tei). Se compararon los resultados mediante ANOVA y test de Bonferroni.Los pacientes hipertensos tuvieron más alteraciones morfológicas tipo hipertrofia ventricular izquierda (mayor grosor de septo y pared posterior) que los no hipertensos, y éstos más que los controles. Grosor del septo: SAHS-HTA (1), 12 ± 2; SAHS sin HTA (2), 11 ± 2, y controles (3), 9,5 ± 5 mm (1 frente a 2, p = 0,038; 1 frente a 3, p = 0,0001, y 2 frente a 3, p = 0,034). Pared posterior: SAHS-HTA, 11 ± 2; SAHS sin HTA, 10 ± 1, y controles, 9 ± 1,5 mm (1 frente a 2, p = 0,5; 1 frente a 3, p = 0,0001, y 2 frente a 3, p = 0,001). También hubo más alteraciones en el patrón de llenado ventricular izquierdo (SAHS-HTA, 92%; SAHS sin HTA, 72%, y controles, 29%; p = 0,0001) y derecho (SAHS-HTA, 72%; SAHS sin HTA, 58%, y controles, 25%; p = 0,001). Los valores del índice Tei del VI tuvieron tendencia a incrementarse (SAHS-HTA, 0,56 ± 0,2; SAHS sin HTA, 0,54 ± 0,12, y controles, 0,5 ± 0,1; 1 frente a 2, p = 0,8; 1 frente a 3, p = 0,09; 2 frente a 3, p = 0,7).El SAHS presenta signos de hipertrofia ventricular izquierda y alteración del llenado biventricular aun en ausencia de HTA concomitante, y desde el momento de su diagnóstico. Las alteraciones detectadas son mayores cuando se asocia HTA.Sleep apnea-hypopnea syndrome (SAHS) is associated with significant effects on the heart, which can be assessed using noninvasive methods such as transthoracic echocardiography. However, it is not clear whether these effects are due to the condition itself or are influenced by associated factors, such as high blood pressure (HBP). The objective of this study was to investigate the echocardiographic alterations observed in SAHS patients and how they are affected by the presence of concomitant HBP.The study involved 103 consecutive patients (49 with HBP and 54 without) with SAHS and an indication for continuous positive airways pressure treatment and 24 controls matched for age and body mass index. Doppler echocardiography was performed in a blinded manner. Both morphology (i.e., wall thickness, and diameters) and function (i.e., ejection fraction, peak E and A wave velocities, mitral deceleration time, and Tei index) were assessed. Results were compared using ANOVA and Bonferroni's test.Hypertensive patients had larger morphological changes characteristic of left ventricular hypertrophy (i.e., increased septal and posterior wall thicknesses) than nonhypertensive patients, who in turn had larger changes than controls (septal thickness: HBP-SAHS, 12 [2] mm; non-HBP SAHS, 11 [2] mm, and controls, 9.5 [5] mm; 1 vs. 2, P=.038; 1 vs. 3, P=.0001, 2 vs. 3, P=.034) (posterior wall thickness: HBP-SAHS, 11 [2] mm; non-HBP SAHS, 10 [1] mm, and controls, 9 [1.5] mm; 1 vs. 2, P=.5; 1 vs. 3,P=.034) (posterior wall thickness: HBP-SAHS, 11 [2] mm; non-HBP SAHS, 10 [1] mm, and controls, 9 [1.5] mm; 1 vs. 2, P=.5; 1 vs. 3, P=.0001; 2 vs. 3, P=.001). In addition, there were also greater changes in ventricular filling patterns on the left (HBP-SAHS, 92%; non-HBP SAHS, 72%, controls, 29%; P=.0001) and on the right (HBP-SAHS, 72%; non-HBP SAHS, 58%; controls, 25%; P=.001). There was a trend towards a larger left ventricular Tei index (HBP-SAHS, 0.56 [0.2]; non-HBP SAHS, 0.54 [0.12]; controls, 0.5 [0.1]; 1 vs. 2, P=.8; 1 vs. 3, P=.09; 2 vs. 3, P=.7).From the time of diagnosis, SAHS was associated with left ventricular hypertrophy and impaired biventricular filling, even in the absence of concomitant HBP. The abnormalities observed were more severe when HBP was present.
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2006
N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure ... more N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure (HF). LV two-dimensional cavity area from end-diastole (LVEDA) and end-systole (LVESA), and LV fractional area change (LVFAC) reflect changes in LV morphology and function without using geometric assumptions. In a multicenter study, we correlated LVEDA, LVESA and LVFAC with NT-proBNP, comparing patients with dilated and ischemic cardiomyopathy. We studied 106 HF patients. In the dilated group, NT-proBNP correlated with LVEDAI (r=0.6), LVESAI (r=0.7) and LVFAC (r=-0.6), all significant at p<0.001. In patients with ischemic cardiomyopathy we found LVESAI (r=0.3, p<0.05) and LVFAC (r=-0.4, p<0.01). After adjustment for age and BMI, LVFAC and LVESAI were associated in a multiple linear regression analysis with peptide levels (adjusted r(2)=0.5, p<0.001). In this study we found a good correlation of NT-proBNP with LV cavity areas and LVFAC. Multiple regression analysis showed that...
Revista espanola de cardiologia (English ed.), Jan 7, 2014
Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or... more Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or congenital pulmonary stenosis. Electrocardiographic variables have been correlated with parameters used to evaluate right ventricular function. We aimed to analyze the diagnostic value of the width and fragmentation of the electrocardiogram in the identification of patients with right ventricular dysfunction and/or dilation. We selected 107 consecutive patients diagnosed with severe pulmonary insufficiency after repair of pulmonary stenosis or tetralogy of Fallot. The tests included electrocardiography, echocardiography, and magnetic resonance. Each electrocardiogram was analyzed manually to measure QRS duration. We defined QRS fragmentation as the presence of low-voltage waves in the terminal portion of the QRS complex in at least 2 contiguous leads. We found a significant negative correlation between QRS width and right ventricular function, as well as a positive correlation with righ...
Aims The randomized NASPEAF study included non-valvular with prior embolism and mitral stenosis p... more Aims The randomized NASPEAF study included non-valvular with prior embolism and mitral stenosis patients in the same group. This is a sub-study to specially focus on the antithrombotic therapy in mitral stenosis. Methods and results We analysed 311 patients with mitral stenosis, compared with 175 non-valvular atrial fibrillation patients with prior embolism, stratified by a history of previous embolism and
Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms... more Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms had recently been included in the spectrum of arrhythmogenic cardiomyopathy. The aim of the study was to describe, using cardiovascular magnetic resonance, the patterns of ventricular involvement as well as late gadolinium enhancement in these conditions.
El síndrome de apneas e hipopneas del sueño (SAHS) conlleva importantes repercusiones cardiacas q... more El síndrome de apneas e hipopneas del sueño (SAHS) conlleva importantes repercusiones cardiacas que se pueden evaluar mediante métodos no invasivos como la ecocardiografía transtorácica; sin embargo, está por dilucidar si se deben a la propia enfermedad o a la influencia de factores concomitants como la hipertensión arterial (HTA). El objetivo de este estudio es analizar las alteraciones ecocardiográficas en pacientes con SAHS y si se modifican en caso de HTA concomitante.Estudiamos a 103 pacientes consecutivos diagnosticados de SAHS e indicación de presión positive continua en la vía aérea (HTA, 49 pacientes; sin HTA, 54) frente a 24 controles ajustados por edad e índice de masa corporal. Realizamos ecocardiograma-Doppler por un observador para el que la asignación estaba enmascarada. Analizamos variables morfológicas (grosor de paredes y diámetros) y funcionales (fracción de eyección, velocidad máxima de ondas E y A, tiempo de deceleración mitral e índice Tei). Se compararon los resultados mediante ANOVA y test de Bonferroni.Los pacientes hipertensos tuvieron más alteraciones morfológicas tipo hipertrofia ventricular izquierda (mayor grosor de septo y pared posterior) que los no hipertensos, y éstos más que los controles. Grosor del septo: SAHS-HTA (1), 12 ± 2; SAHS sin HTA (2), 11 ± 2, y controles (3), 9,5 ± 5 mm (1 frente a 2, p = 0,038; 1 frente a 3, p = 0,0001, y 2 frente a 3, p = 0,034). Pared posterior: SAHS-HTA, 11 ± 2; SAHS sin HTA, 10 ± 1, y controles, 9 ± 1,5 mm (1 frente a 2, p = 0,5; 1 frente a 3, p = 0,0001, y 2 frente a 3, p = 0,001). También hubo más alteraciones en el patrón de llenado ventricular izquierdo (SAHS-HTA, 92%; SAHS sin HTA, 72%, y controles, 29%; p = 0,0001) y derecho (SAHS-HTA, 72%; SAHS sin HTA, 58%, y controles, 25%; p = 0,001). Los valores del índice Tei del VI tuvieron tendencia a incrementarse (SAHS-HTA, 0,56 ± 0,2; SAHS sin HTA, 0,54 ± 0,12, y controles, 0,5 ± 0,1; 1 frente a 2, p = 0,8; 1 frente a 3, p = 0,09; 2 frente a 3, p = 0,7).El SAHS presenta signos de hipertrofia ventricular izquierda y alteración del llenado biventricular aun en ausencia de HTA concomitante, y desde el momento de su diagnóstico. Las alteraciones detectadas son mayores cuando se asocia HTA.Sleep apnea-hypopnea syndrome (SAHS) is associated with significant effects on the heart, which can be assessed using noninvasive methods such as transthoracic echocardiography. However, it is not clear whether these effects are due to the condition itself or are influenced by associated factors, such as high blood pressure (HBP). The objective of this study was to investigate the echocardiographic alterations observed in SAHS patients and how they are affected by the presence of concomitant HBP.The study involved 103 consecutive patients (49 with HBP and 54 without) with SAHS and an indication for continuous positive airways pressure treatment and 24 controls matched for age and body mass index. Doppler echocardiography was performed in a blinded manner. Both morphology (i.e., wall thickness, and diameters) and function (i.e., ejection fraction, peak E and A wave velocities, mitral deceleration time, and Tei index) were assessed. Results were compared using ANOVA and Bonferroni's test.Hypertensive patients had larger morphological changes characteristic of left ventricular hypertrophy (i.e., increased septal and posterior wall thicknesses) than nonhypertensive patients, who in turn had larger changes than controls (septal thickness: HBP-SAHS, 12 [2] mm; non-HBP SAHS, 11 [2] mm, and controls, 9.5 [5] mm; 1 vs. 2, P=.038; 1 vs. 3, P=.0001, 2 vs. 3, P=.034) (posterior wall thickness: HBP-SAHS, 11 [2] mm; non-HBP SAHS, 10 [1] mm, and controls, 9 [1.5] mm; 1 vs. 2, P=.5; 1 vs. 3,P=.034) (posterior wall thickness: HBP-SAHS, 11 [2] mm; non-HBP SAHS, 10 [1] mm, and controls, 9 [1.5] mm; 1 vs. 2, P=.5; 1 vs. 3, P=.0001; 2 vs. 3, P=.001). In addition, there were also greater changes in ventricular filling patterns on the left (HBP-SAHS, 92%; non-HBP SAHS, 72%, controls, 29%; P=.0001) and on the right (HBP-SAHS, 72%; non-HBP SAHS, 58%; controls, 25%; P=.001). There was a trend towards a larger left ventricular Tei index (HBP-SAHS, 0.56 [0.2]; non-HBP SAHS, 0.54 [0.12]; controls, 0.5 [0.1]; 1 vs. 2, P=.8; 1 vs. 3, P=.09; 2 vs. 3, P=.7).From the time of diagnosis, SAHS was associated with left ventricular hypertrophy and impaired biventricular filling, even in the absence of concomitant HBP. The abnormalities observed were more severe when HBP was present.
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2006
N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure ... more N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure (HF). LV two-dimensional cavity area from end-diastole (LVEDA) and end-systole (LVESA), and LV fractional area change (LVFAC) reflect changes in LV morphology and function without using geometric assumptions. In a multicenter study, we correlated LVEDA, LVESA and LVFAC with NT-proBNP, comparing patients with dilated and ischemic cardiomyopathy. We studied 106 HF patients. In the dilated group, NT-proBNP correlated with LVEDAI (r=0.6), LVESAI (r=0.7) and LVFAC (r=-0.6), all significant at p<0.001. In patients with ischemic cardiomyopathy we found LVESAI (r=0.3, p<0.05) and LVFAC (r=-0.4, p<0.01). After adjustment for age and BMI, LVFAC and LVESAI were associated in a multiple linear regression analysis with peptide levels (adjusted r(2)=0.5, p<0.001). In this study we found a good correlation of NT-proBNP with LV cavity areas and LVFAC. Multiple regression analysis showed that...
Revista espanola de cardiologia (English ed.), Jan 7, 2014
Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or... more Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or congenital pulmonary stenosis. Electrocardiographic variables have been correlated with parameters used to evaluate right ventricular function. We aimed to analyze the diagnostic value of the width and fragmentation of the electrocardiogram in the identification of patients with right ventricular dysfunction and/or dilation. We selected 107 consecutive patients diagnosed with severe pulmonary insufficiency after repair of pulmonary stenosis or tetralogy of Fallot. The tests included electrocardiography, echocardiography, and magnetic resonance. Each electrocardiogram was analyzed manually to measure QRS duration. We defined QRS fragmentation as the presence of low-voltage waves in the terminal portion of the QRS complex in at least 2 contiguous leads. We found a significant negative correlation between QRS width and right ventricular function, as well as a positive correlation with righ...
Aims The randomized NASPEAF study included non-valvular with prior embolism and mitral stenosis p... more Aims The randomized NASPEAF study included non-valvular with prior embolism and mitral stenosis patients in the same group. This is a sub-study to specially focus on the antithrombotic therapy in mitral stenosis. Methods and results We analysed 311 patients with mitral stenosis, compared with 175 non-valvular atrial fibrillation patients with prior embolism, stratified by a history of previous embolism and
Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms... more Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms had recently been included in the spectrum of arrhythmogenic cardiomyopathy. The aim of the study was to describe, using cardiovascular magnetic resonance, the patterns of ventricular involvement as well as late gadolinium enhancement in these conditions.
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