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Elizabeth Goldmuntz - One of the best experts on this subject based on the ideXlab platform.
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longitudinal validation of the diastolic to systolic time velocity integral ratio as a doppler derived measure of pulmonary regurgitation in patients with repaired tetralogy of fallot
Pediatric Cardiology, 2017Co-Authors: Misha Bhat, Elizabeth Goldmuntz, Mark A Fogel, Jack Rychik, Laura MercerrosaAbstract:Pulmonary regurgitation (PR) is a common residual lesion and major determinant of outcome following surgical repair for tetralogy of Fallot. We sought to longitudinally study a previously described echocardiographic index as a correlate of PR measured by cardiac magnetic resonance imaging (CMR). We conducted a retrospective longitudinal study of patients with baseline and follow-up echocardiogram and CMR. The baseline studies were obtained as part of a research protocol, while the follow-up studies were performed for clinical purposes. On echocardiogram, the ratio of diastolic and systolic time–velocity integrals (DSTVI) in the main pulmonary artery was calculated. The Wilcoxon matched-pairs signed-rank test was used to test for individual changes in PR on echocardiogram and CMR. A linear regression of pulmonary valve Regurgitant Fraction (RF) was fit on DSTVI to identify clinically meaningful cut points of DSTVI. Thirty-five subjects were included, age at follow-up 18.3 ± 3.5 years. The follow-up between consecutive CMRs was a median time of 60 months (interquartile range 46–73). There was a moderate correlation between DSTVI and PR measured as RF by CMR (r = 0.62, p = 0.0001). A CMR RF of 20 and 40 % (the boundaries between mild/moderate and moderate/severe PR) corresponded with DSTVI of 0.52 and 0.79 (95 % CI 0.39; 0.66, and 0.69; 89), respectively. There was no significant change in either DSTVI (p = 0.61) or PR (p = 0.89) from baseline to follow-up. This study lends further credence to the DSTVI as an accurate reflection of PR. This index might become helpful in the routine echocardiographic assessment of PR. Further studies are needed to determine whether changes in RF by CMR result in changes in DSTVI.
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the impact of pulmonary insufficiency on the right ventricle a comparison of isolated valvar pulmonary stenosis and tetralogy of fallot
Pediatric Cardiology, 2015Co-Authors: Laura Mercerrosa, Mark A Fogel, Eitan Ingall, Xuemei Zhang, Michael G Mcbride, Stephen Kawut, Stephen M Paridon, Elizabeth GoldmuntzAbstract:Pulmonary insufficiency (PI) is associated with right ventricular (RV) dilation, dysfunction, and exercise intolerance in patients with tetralogy of fallot (TOF). We sought to compare RV function and exercise performance in patients with valvar pulmonary stenosis (VPS) following pulmonary balloon valvuloplasty to those with repaired TOF with similar degrees of PI. We performed a cross-sectional study of patients with VPS and TOF. Cardiac magnetic resonance (CMR) and exercise stress test were performed. Subjects were matched by time from initial procedure and severity of PI using propensity scores. After matching, there were 16 patients with VPS and 16 with TOF for comparison, with similar demographics. Time from initial procedure was 14 years (12–16), p = 0.92, and pulmonary Regurgitant Fraction was 19 % (6–31), p = 0.94, Patients with TOF had lower ejection Fraction [58 % (53–66) vs. 65 % (60–69), p = 0.04] and more RV hypertrophy [69 g/m2 (52–86) vs. 44 g/m2 (32–66), p = 0.04] compared to those with VPS. Aerobic capacity was worse in patients with TOF [68 ± 19 % mVO2 (56–84) vs. 82 ± 9.2 % (74–89) in VPS, p = 0.01], with a trend for less habitual physical activity [0.9 (0–12) vs. 8 h/week (4–12), p = 0.056], respectively. With similar degrees of PI, patients with TOF demonstrate worse RV function and aerobic capacity as compared to patients with just VPS. Habitual exercise may in part explain differences in exercise performance and should be further explored.
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abstract 18302 longitudinal evaluation of the diastolic to systolic time velocity integral ratio as a doppler derived measure of pulmonary Regurgitant Fraction in patients with surgically repaired tetralogy of fallot
Circulation, 2014Co-Authors: Misha Bhat, Elizabeth Goldmuntz, Laura MercerrosaAbstract:Background: [[Unable to Display Character: –]] Pulmonary regurgitation (PR) following surgical repair for tetralogy of Fallot (TOF) is a major determinant of outcome but can be difficult to q...
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quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of fallot a comparative analysis of echocardiography and magnetic resonance imaging
Circulation-cardiovascular Imaging, 2012Co-Authors: Laura Mercerrosa, Mark A Fogel, Jack Rychik, Wei Yang, Shelby Kutty, Elizabeth GoldmuntzAbstract:Background— Patients with repaired tetralogy of Fallot are monitored for pulmonary regurgitation (PR) and right ventricular (RV) function. We sought to compare measures of PR and RV function on echocardiogram to those on cardiac magnetic resonance (CMR) and to develop a new tool for assessing PR by echocardiogram. Methods and Results— Patients with repaired tetralogy of Fallot (n=143; 12.5±3.2 years) had an echocardiogram and CMR within 3 months of each other. On echocardiogram, RV function was assessed by (1) Doppler tissue imaging of the RV free wall and (2) myocardial performance index. The ratio of diastolic and systolic time-velocity integrals measured by Doppler of the main pulmonary artery was calculated. CMR variables included RV ejection Fraction, RV volumes, and pulmonary Regurgitant Fraction (RF). Pulmonary regurgitation was graded as mild (RF 40%). On CMR, RF was 34+17% and RV ejection Fraction was 61+8%. Echocardiography had good sensitivity identifying cases with RF>20% (sensitivity 97%; 95% CI: 92–99%) but overestimated the amount of PR when RF<20% (false-positive rate 36%; 95% CI: 18–57%). The diastolic and systolic time-velocity integrals on echocardiogram showed moderate correlation with RF on CMR ( R =0.60; P <0.0001). On CMR, RF of 20% and 40% corresponded with a diastolic and systolic time-velocity integral of 0.49 (95% CI: 0.44–0.56) and 0.72 (95% CI: 0.68–0.76), respectively. RV myocardial performance index correlated modestly with RV ejection Fraction ( r =−0.33; P <0.001). Conclusions— This study suggests that the diastolic and systolic time-velocity integrals ratio may make a modest contribution to the overall assessment of PR in patients with repaired tetralogy of Fallot and warrants further investigation. However, echocardiography continues to have a limited ability to quantify PR and RV function as compared with CMR.
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differential branch pulmonary artery Regurgitant Fraction is a function of differential pulmonary arterial anatomy and pulmonary vascular resistance
Jacc-cardiovascular Imaging, 2011Co-Authors: Matthew A Harris, Kevin K Whitehead, Matthew J Gillespie, Timothy Y Liu, Michael T Cosulich, David C Shin, Elizabeth GoldmuntzAbstract:Objectives We sought to investigate whether differential branch pulmonary artery (BPA) regurgitation correlates with differences in BPA anatomy and physiology. Background Patients with repaired conotruncal anomalies such as Tetralogy of Fallot frequently have residual BPA stenosis or BPA size differences. Previous reports have demonstrated an increased left pulmonary artery (LPA) Regurgitant Fraction (RF) in these patients. Methods We retrospectively reviewed 76 consecutive cardiac magnetic resonance (CMR) studies for BPA size and phase-contrast magnetic resonance data, including 13 consecutive patients who underwent both CMR and catheterization. Results Thirty of the 76 patients had either BPA stenosis or significant size discrepancy. Whereas previous studies had shown an increased RF in the LPA, patients with BPA stenosis or size discrepancy showed no significant difference between right and left BPA RF (30% vs. 30%, p = 0.985). However, there was a significantly increased RF of the larger versus smaller BPA (39% vs. 21%, p Conclusions BPA RF is a function of the relative PVR and the presence of BPA stenosis or size discrepancy. Contrary to prior reports, the LPA RF is only elevated in patients with relatively equal sized BPAs. In the setting of BPA stenosis or size discrepancy the larger BPA has a relatively increased RF and PVR. Therefore, the differential RF is an important tool for screening patients with unilateral stenosis for contralateral increases in PVR that cannot be identified with net flows alone. This can affect the indication and timing for BPA intervention.
Mark A Fogel - One of the best experts on this subject based on the ideXlab platform.
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longitudinal validation of the diastolic to systolic time velocity integral ratio as a doppler derived measure of pulmonary regurgitation in patients with repaired tetralogy of fallot
Pediatric Cardiology, 2017Co-Authors: Misha Bhat, Elizabeth Goldmuntz, Mark A Fogel, Jack Rychik, Laura MercerrosaAbstract:Pulmonary regurgitation (PR) is a common residual lesion and major determinant of outcome following surgical repair for tetralogy of Fallot. We sought to longitudinally study a previously described echocardiographic index as a correlate of PR measured by cardiac magnetic resonance imaging (CMR). We conducted a retrospective longitudinal study of patients with baseline and follow-up echocardiogram and CMR. The baseline studies were obtained as part of a research protocol, while the follow-up studies were performed for clinical purposes. On echocardiogram, the ratio of diastolic and systolic time–velocity integrals (DSTVI) in the main pulmonary artery was calculated. The Wilcoxon matched-pairs signed-rank test was used to test for individual changes in PR on echocardiogram and CMR. A linear regression of pulmonary valve Regurgitant Fraction (RF) was fit on DSTVI to identify clinically meaningful cut points of DSTVI. Thirty-five subjects were included, age at follow-up 18.3 ± 3.5 years. The follow-up between consecutive CMRs was a median time of 60 months (interquartile range 46–73). There was a moderate correlation between DSTVI and PR measured as RF by CMR (r = 0.62, p = 0.0001). A CMR RF of 20 and 40 % (the boundaries between mild/moderate and moderate/severe PR) corresponded with DSTVI of 0.52 and 0.79 (95 % CI 0.39; 0.66, and 0.69; 89), respectively. There was no significant change in either DSTVI (p = 0.61) or PR (p = 0.89) from baseline to follow-up. This study lends further credence to the DSTVI as an accurate reflection of PR. This index might become helpful in the routine echocardiographic assessment of PR. Further studies are needed to determine whether changes in RF by CMR result in changes in DSTVI.
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the impact of pulmonary insufficiency on the right ventricle a comparison of isolated valvar pulmonary stenosis and tetralogy of fallot
Pediatric Cardiology, 2015Co-Authors: Laura Mercerrosa, Mark A Fogel, Eitan Ingall, Xuemei Zhang, Michael G Mcbride, Stephen Kawut, Stephen M Paridon, Elizabeth GoldmuntzAbstract:Pulmonary insufficiency (PI) is associated with right ventricular (RV) dilation, dysfunction, and exercise intolerance in patients with tetralogy of fallot (TOF). We sought to compare RV function and exercise performance in patients with valvar pulmonary stenosis (VPS) following pulmonary balloon valvuloplasty to those with repaired TOF with similar degrees of PI. We performed a cross-sectional study of patients with VPS and TOF. Cardiac magnetic resonance (CMR) and exercise stress test were performed. Subjects were matched by time from initial procedure and severity of PI using propensity scores. After matching, there were 16 patients with VPS and 16 with TOF for comparison, with similar demographics. Time from initial procedure was 14 years (12–16), p = 0.92, and pulmonary Regurgitant Fraction was 19 % (6–31), p = 0.94, Patients with TOF had lower ejection Fraction [58 % (53–66) vs. 65 % (60–69), p = 0.04] and more RV hypertrophy [69 g/m2 (52–86) vs. 44 g/m2 (32–66), p = 0.04] compared to those with VPS. Aerobic capacity was worse in patients with TOF [68 ± 19 % mVO2 (56–84) vs. 82 ± 9.2 % (74–89) in VPS, p = 0.01], with a trend for less habitual physical activity [0.9 (0–12) vs. 8 h/week (4–12), p = 0.056], respectively. With similar degrees of PI, patients with TOF demonstrate worse RV function and aerobic capacity as compared to patients with just VPS. Habitual exercise may in part explain differences in exercise performance and should be further explored.
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quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of fallot a comparative analysis of echocardiography and magnetic resonance imaging
Circulation-cardiovascular Imaging, 2012Co-Authors: Laura Mercerrosa, Mark A Fogel, Jack Rychik, Wei Yang, Shelby Kutty, Elizabeth GoldmuntzAbstract:Background— Patients with repaired tetralogy of Fallot are monitored for pulmonary regurgitation (PR) and right ventricular (RV) function. We sought to compare measures of PR and RV function on echocardiogram to those on cardiac magnetic resonance (CMR) and to develop a new tool for assessing PR by echocardiogram. Methods and Results— Patients with repaired tetralogy of Fallot (n=143; 12.5±3.2 years) had an echocardiogram and CMR within 3 months of each other. On echocardiogram, RV function was assessed by (1) Doppler tissue imaging of the RV free wall and (2) myocardial performance index. The ratio of diastolic and systolic time-velocity integrals measured by Doppler of the main pulmonary artery was calculated. CMR variables included RV ejection Fraction, RV volumes, and pulmonary Regurgitant Fraction (RF). Pulmonary regurgitation was graded as mild (RF 40%). On CMR, RF was 34+17% and RV ejection Fraction was 61+8%. Echocardiography had good sensitivity identifying cases with RF>20% (sensitivity 97%; 95% CI: 92–99%) but overestimated the amount of PR when RF<20% (false-positive rate 36%; 95% CI: 18–57%). The diastolic and systolic time-velocity integrals on echocardiogram showed moderate correlation with RF on CMR ( R =0.60; P <0.0001). On CMR, RF of 20% and 40% corresponded with a diastolic and systolic time-velocity integral of 0.49 (95% CI: 0.44–0.56) and 0.72 (95% CI: 0.68–0.76), respectively. RV myocardial performance index correlated modestly with RV ejection Fraction ( r =−0.33; P <0.001). Conclusions— This study suggests that the diastolic and systolic time-velocity integrals ratio may make a modest contribution to the overall assessment of PR in patients with repaired tetralogy of Fallot and warrants further investigation. However, echocardiography continues to have a limited ability to quantify PR and RV function as compared with CMR.
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abstract 20997 in postoperative conotruncal anomalies patients differential branch pulmonary artery Regurgitant Fraction is a function of differential pulmonary vascular resistance and pulmonary arterial properties
Circulation, 2010Co-Authors: Matthew A Harris, Kevin K Whitehead, Matthew J Gillespie, Michael T Cosulich, David C Shin, Elizabeth Goldmuntz, Paul M Weinberg, Timothy I Liu, Mark A FogelAbstract:Introduction: Repaired conotruncal anomaly patients frequently have residual branch pulmonary artery (BPA) stenosis or size differences associated with differential BPA regurgitation. Hypothesis: I...
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usefulness of branch pulmonary artery Regurgitant Fraction to estimate the relative right and left pulmonary vascular resistances in congenital heart disease
American Journal of Cardiology, 2005Co-Authors: Matthew A Harris, Kevin K Whitehead, Paul M Weinberg, Mark A FogelAbstract:In postoperative congenital heart patients with pulmonary regurgitation, individual branch pulmonary artery Regurgitant Fractions estimate relative pulmonary vascular resistance independent of pulmonary blood flow distribution.
Michael A Gatzoulis - One of the best experts on this subject based on the ideXlab platform.
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physiologic determinants of exercise capacity in patients with different types of right sided Regurgitant lesions ebstein s malformation with tricuspid regurgitation and repaired tetralogy of fallot with pulmonary regurgitation
International Journal of Cardiology, 2016Co-Authors: Sylvia S M Chen, Michael A Gatzoulis, Konstantinos Dimopoulos, Florence H Sheehan, Philip J KilnerAbstract:Abstract Background Exercise capacity relates to right ventricular (RV) volume overload in congenital heart disease and may improve after surgery. We herewith investigate the relation between exercise capacity, cardiac index, and RV volume overload due to tricuspid regurgitation (TR) in Ebstein's malformation and pulmonary regurgitation (PR) after repair of tetralogy of Fallot (rToF). Methods We measured cardiac index and tricuspid/pulmonary Regurgitant Fraction by cardiovascular magnetic resonance in patients with Ebstein's malformation (n=40) or rTOF (n=53) with at least moderate TR/PR and 24 healthy controls. Exercise tolerance was determined by peak oxygen consumption (peak VO 2 ) during cardiopulmonary exercise testing. Results TR and PR Fraction were similar in Ebstein and rTOF patients (43±17% versus 39±12%, respectively). Cardiac index was reduced in Ebstein (2.7±0.6L/min/m 2 compared to controls 3.5±0.9L/min/m 2 , p 2 ). Multiple regression analysis revealed a significant correlation between peak VO 2 and cardiac index in Ebstein. Furthermore, peak VO 2 correlated with peak heart rate in both groups but not with regurgitation Fraction. Conclusions Despite comparable amounts of regurgitation from a right sided heart valve in patients with Ebstein and rToF, reduction of cardiac index was observed only in the former group. Greater physiologic complexity and adverse ventricular interaction with chronotropic incompetence in Ebstein's malformation may account for this.
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doppler echocardiographic assessment of pulmonary regurgitation in adults with repaired tetralogy of fallot comparison with cardiovascular magnetic resonance imaging
American Heart Journal, 2004Co-Authors: Wei Li, Periklis Davlouros, Philip J Kilner, Dudley J Pennell, Derek G Gibson, Michael Y Henein, Michael A GatzoulisAbstract:Abstract Aims The purpose of this study was to compare the noninvasive assessment of severity of pulmonary regurgitation with Doppler echocardiography versus cardiovascular magnetic resonance imaging (CMR) in adult patients with repaired tetralogy of Fallot (rTOF). Methods We studied 52 (22 females) consecutive patients (aged 32 ± 2 years, 23 ± 5 years after rTOF) using Doppler echocardiography and compared these findings with CMR. From the continuous-wave Doppler trace, the duration of pulmonary regurgitation and of total diastole was measured and the ratio between the 2 was defined as pulmonary regurgitation index (PRi). Pulmonary Regurgitant Fraction (PRF) was assessed with flow phase velocity mapping with CMR. Results Patients were divided into 2 groups according to the median value (24.5%) of PRF measured by CMR: Group I (26 patients) with PRF ≤24.5% and Group II with PRF >24.5%. There was no difference between patients' age, sex, or age at repair between the 2 groups. More patients from Group II had a right ventricular outflow or transannular patch repair compared to Group I (12/26 [46%] vs 6/26 [23%], P P = .001) and PRi was lower (0.61 ± 0.11 vs 0.91 ± 0.11, P P r = −0.82, P r = −0.66, P r = 0.72, P 24.5%, with a predictive accuracy of 95%. Furthermore, echocardiographically-assessed right ventricular end-diastolic dimensions correlated with CMR end-diastolic volume index ( r = 0.49, P Conclusions Pulmonary regurgitation is common in asymptomatic adults with rTOF. Severity of pulmonary regurgitation and its effects on right ventricular dimensions in these patients can be assessed noninvasively by Doppler echocardiography and CMR, with reasonable agreement between the 2 techniques.
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right ventricular function in adults with repaired tetralogy of fallot assessed with cardiovascular magnetic resonance imaging detrimental role of right ventricular outflow aneurysms or akinesia and adverse right to left ventricular interaction
Journal of the American College of Cardiology, 2002Co-Authors: Periklis Davlouros, Philip J Kilner, Tim S Hornung, Jane M Francis, Wei Li, Dudley J Pennell, Gillian C Smith, James C Moon, Michael A GatzoulisAbstract:Abstract Objectives We examined the relationship among biventricular hemodynamics, pulmonary Regurgitant Fraction (PRF), right ventricular outflow tract (RVOT) aneurysm or akinesia, and baseline and surgical characteristics in adults with repaired tetralogy of Fallot (rTOF). Background The precise relationship of pulmonary regurgitation with biventricular hemodynamics has been hampered by limitations of right ventricular (RV) imaging. Methods We assessed 85 consecutive adults with rTOF and 26 matched healthy controls using cardiovascular magnetic resonance imaging. Results Patients had higher right ventricular end-diastolic volume index (RVEDVi) (p Conclusions Pulmonary regurgitation and RVOT aneurysm/akinesia were independently associated with RV dilation and the latter with RV hypertrophy late after rTOF. The RVOT aneurysm/akinesia was common but related only in part to RVOT or transannular patching. Both RV hypertrophy and RVOT aneurysm/akinesia were associated with lower RVEF. Left ventricular systolic dysfunction correlated with RV dysfunction, suggesting an unfavorable ventricular-ventricular interaction. Measures to maintain or restore pulmonary valve function and avoid RVOT aneurysm/akinesia are mandatory for preserving biventricular function late after rTOF.
J P Lesbre - One of the best experts on this subject based on the ideXlab platform.
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non invasive measurement of the Regurgitant Fraction by pulsed doppler echocardiography in isolated pure mitral regurgitation
Heart, 1991Co-Authors: C Tribouilloy, M A Slama, H Dufosse, W F Shen, D Choquet, A Marek, J P LesbreAbstract:OBJECTIVE--To assess the usefulness of pulsed Doppler echocardiography as a method of measuring the Regurgitant Fraction in patients with mitral regurgitation. PATIENTS AND METHODS--Twenty controls and 27 patients with isolated mitral regurgitation underwent Doppler studies. In the patients the study was performed within 48 hours of cardiac catheterisation. Aortic outflow was measured in the centre of the aortic annulus, and mitral inflow was derived from the flow velocity at the tip of the leaflets and the area of the elliptical mitral opening. The Regurgitant Fraction was calculated as the difference between the two flows divided by the mtiral inflow. RESULTS--In the 20 controls the two flows were almost identical (mitral inflow, 4.44 (SD 0.88) l/min; aortic outflow, 4.58 (SD 0.84) l/min), with a mean Regurgitant Fraction of 4.2 (SD 8.4)%. In patients with mitral regurgitation, the mitral inflow was significantly higher than the aortic outflow (8.8 (3.6) v 4.3 (1.1) l/min). In most patients the Doppler-derived Regurgitant Fraction (45.8 (19.2)%) accorded closely with the Regurgitant Fraction (41.3 (SD 17.8)%) determined by the haemodynamic technique. CONCLUSION--Pulsed Doppler echocardiography, with an instantaneous velocity-valve area method for calculating mitral inflow, reliably measured the severity of regurgitation in patients with mitral regurgitation.
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pulsed echo doppler evaluation of Regurgitant Fraction in mitral valve insufficiency
Archives Des Maladies Du Coeur Et Des Vaisseaux, 1991Co-Authors: C Tribouilloy, M A Slama, H Kugener, H Dufosse, J L Rey, J P LesbreAbstract:The aim of this study was to evaluate the validity of Doppler echocardiographic evaluation of the Regurgitant Fraction in pure mitral insufficiency. The Doppler echocardiographic measurement of systemic flow was made at the level of the aortic ring, and the mitral flow by the method of integration of instantaneous flow proposed by Touche. In a preliminary study, we demonstrated a close correlation between forward aortic and mitral flow in 20 normal subjects (r = 0.94; SD = 0.31 l/mn; y = 0.98 x -0.004). We then studied a group of 38 patients with pure isolated mitral regurgitation. Five patients were excluded because of the poor quality of the echocardiographic documents. The hemodynamic Regurgitant Fraction was determined by measuring pulmonary flow by thermodilution and the left ventricular outflow by digitised angiography. The average Doppler and hemodynamic Regurgitant Fractions were 46.6 +/- 18% and 42 +/- 17% respectively. There was a close correlation between the Doppler and hemodynamic values (r = 0.91; SD = 7.8%; y = 0.97 x + 5.7). The correlations were also good between Doppler Regurgitant Fraction and the four angiographic grades of regurgitation (r = 0.88). A statistically significant difference was observed between the Doppler Regurgitant Fractions of Grades I and II and of Grades III and IV (p less than 0.001). In addition, the ratio of mitral VTI/aortic VTI gave a useful index of regurgitation in pure mitral insufficiency. When the ratio was greater than 1.3 the Regurgitant Fraction was over 40% with a sensitivity of 79% and a specificity of 86%. Finally, this study shows that pure, isolated mitral regurgitation can be evaluated by Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
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end diastolic flow velocity just beneath the aortic isthmus assessed by pulsed doppler echocardiography a new predictor of the aortic Regurgitant Fraction
Heart, 1991Co-Authors: C Tribouilloy, M A Slama, J L Rey, W F Shen, P Avinee, J P LesbreAbstract:End diastolic flow velocity just beneath the aortic isthmus was measured within 72 hours of cardiac catheterisation by pulsed Doppler echocardiography in 30 controls and 61 patients with aortic regurgitation. The end diastolic flow velocity was determined at the peak R wave on a simultaneously recorded electrocardiogram. In all controls there was no reverse flow at the end diastole beneath the aortic isthmus. In patients with aortic regurgitation the end diastolic flow velocity correlated well with the angiographic grade of regurgitation (r = 0.81) and Regurgitant Fraction (r = 0.82). The mean (SD) values were 6.3 (5.2), 12.2 (4.3), 22.1 (5.7), and 34.3 (9.3) cm/s for patients with Regurgitant Fraction of less than 20%, between 20% and 40%, between 41% and 60%, and greater than 60%, respectively. An end diastolic flow velocity of greater than 18 cm/s predicted a Regurgitant Fraction of greater than or equal to 40% with a sensitivity of 88.5% and a specificity of 96%. The study suggests that the pulsed Doppler derived end diastolic flow velocity is a useful index in the routine non-invasive assessment of the severity of aortic regurgitation.
C Tribouilloy - One of the best experts on this subject based on the ideXlab platform.
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Pathophysiologic determinants of third heart sounds: a prospective clinical and Doppler echocardiographic study
The American Journal of Medicine, 2001Co-Authors: C Tribouilloy, Maurice Enriquez-sarano, Dania Mohty, Robin A. Horn, Kent R. Bailey, James B. Seward, Arnold M. Weissler, A. Jamil TajikAbstract:Abstract PURPOSE: We sought to determine the importance of a third heart sound (S 3 ) and its relation to hemodynamic and valvular dysfunction. SUBJECTS AND METHODS: We prospectively enrolled 580 patients who had isolated valvular regurgitation (mitral, n=299; aortic, n=121) or primary left ventricular dysfunction with or without functional mitral regurgitation (n = 160). We analyzed the associations between the clinical finding of an audible S 3 (as noted in routine clinical practice by internal medicine physicians) and hemodynamic alterations measured by comprehensive quantitative Doppler echocardiography. RESULTS: S 3 was more prevalent in patients with primary left ventricular dysfunction (46%, n=73) than in organic mitral (16%, n=47) or aortic (12%, n=14) regurgitation ( P 3 were more likely to have class III–IV symptoms (55% [74 of 137] vs. 18% [80 of 443] of those without an S 3 , P P 3 was also related to a higher early filling velocity due to a greater filling volume, restrictive filling, or both. An S 3 was a marker of severe regurgitation (Regurgitant Fraction ≥40%) in patients with primary left ventricular dysfunction (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.1 to 5.5), mitral regurgitation (OR = 17; 95% CI: 5.8 to 52), and aortic regurgitation (OR = 7.1; 95% CI: 1.8–28). An S 3 was also associated with restrictive filling in primary left ventricular dysfunction (OR = 3.0; 95% CI, 1.6 to 5.9), marked dilatation in mitral regurgitation (OR = 20; 95% CI: 6.8 to 58), and an ejection Fraction ( CONCLUSION: An audible S 3 is an important clinical finding, indicating severe hemodynamic alterations, and should lead to a comprehensive assessment and consideration of vigorous medical or surgical treatment.
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non invasive measurement of the Regurgitant Fraction by pulsed doppler echocardiography in isolated pure mitral regurgitation
Heart, 1991Co-Authors: C Tribouilloy, M A Slama, H Dufosse, W F Shen, D Choquet, A Marek, J P LesbreAbstract:OBJECTIVE--To assess the usefulness of pulsed Doppler echocardiography as a method of measuring the Regurgitant Fraction in patients with mitral regurgitation. PATIENTS AND METHODS--Twenty controls and 27 patients with isolated mitral regurgitation underwent Doppler studies. In the patients the study was performed within 48 hours of cardiac catheterisation. Aortic outflow was measured in the centre of the aortic annulus, and mitral inflow was derived from the flow velocity at the tip of the leaflets and the area of the elliptical mitral opening. The Regurgitant Fraction was calculated as the difference between the two flows divided by the mtiral inflow. RESULTS--In the 20 controls the two flows were almost identical (mitral inflow, 4.44 (SD 0.88) l/min; aortic outflow, 4.58 (SD 0.84) l/min), with a mean Regurgitant Fraction of 4.2 (SD 8.4)%. In patients with mitral regurgitation, the mitral inflow was significantly higher than the aortic outflow (8.8 (3.6) v 4.3 (1.1) l/min). In most patients the Doppler-derived Regurgitant Fraction (45.8 (19.2)%) accorded closely with the Regurgitant Fraction (41.3 (SD 17.8)%) determined by the haemodynamic technique. CONCLUSION--Pulsed Doppler echocardiography, with an instantaneous velocity-valve area method for calculating mitral inflow, reliably measured the severity of regurgitation in patients with mitral regurgitation.
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pulsed echo doppler evaluation of Regurgitant Fraction in mitral valve insufficiency
Archives Des Maladies Du Coeur Et Des Vaisseaux, 1991Co-Authors: C Tribouilloy, M A Slama, H Kugener, H Dufosse, J L Rey, J P LesbreAbstract:The aim of this study was to evaluate the validity of Doppler echocardiographic evaluation of the Regurgitant Fraction in pure mitral insufficiency. The Doppler echocardiographic measurement of systemic flow was made at the level of the aortic ring, and the mitral flow by the method of integration of instantaneous flow proposed by Touche. In a preliminary study, we demonstrated a close correlation between forward aortic and mitral flow in 20 normal subjects (r = 0.94; SD = 0.31 l/mn; y = 0.98 x -0.004). We then studied a group of 38 patients with pure isolated mitral regurgitation. Five patients were excluded because of the poor quality of the echocardiographic documents. The hemodynamic Regurgitant Fraction was determined by measuring pulmonary flow by thermodilution and the left ventricular outflow by digitised angiography. The average Doppler and hemodynamic Regurgitant Fractions were 46.6 +/- 18% and 42 +/- 17% respectively. There was a close correlation between the Doppler and hemodynamic values (r = 0.91; SD = 7.8%; y = 0.97 x + 5.7). The correlations were also good between Doppler Regurgitant Fraction and the four angiographic grades of regurgitation (r = 0.88). A statistically significant difference was observed between the Doppler Regurgitant Fractions of Grades I and II and of Grades III and IV (p less than 0.001). In addition, the ratio of mitral VTI/aortic VTI gave a useful index of regurgitation in pure mitral insufficiency. When the ratio was greater than 1.3 the Regurgitant Fraction was over 40% with a sensitivity of 79% and a specificity of 86%. Finally, this study shows that pure, isolated mitral regurgitation can be evaluated by Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
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end diastolic flow velocity just beneath the aortic isthmus assessed by pulsed doppler echocardiography a new predictor of the aortic Regurgitant Fraction
Heart, 1991Co-Authors: C Tribouilloy, M A Slama, J L Rey, W F Shen, P Avinee, J P LesbreAbstract:End diastolic flow velocity just beneath the aortic isthmus was measured within 72 hours of cardiac catheterisation by pulsed Doppler echocardiography in 30 controls and 61 patients with aortic regurgitation. The end diastolic flow velocity was determined at the peak R wave on a simultaneously recorded electrocardiogram. In all controls there was no reverse flow at the end diastole beneath the aortic isthmus. In patients with aortic regurgitation the end diastolic flow velocity correlated well with the angiographic grade of regurgitation (r = 0.81) and Regurgitant Fraction (r = 0.82). The mean (SD) values were 6.3 (5.2), 12.2 (4.3), 22.1 (5.7), and 34.3 (9.3) cm/s for patients with Regurgitant Fraction of less than 20%, between 20% and 40%, between 41% and 60%, and greater than 60%, respectively. An end diastolic flow velocity of greater than 18 cm/s predicted a Regurgitant Fraction of greater than or equal to 40% with a sensitivity of 88.5% and a specificity of 96%. The study suggests that the pulsed Doppler derived end diastolic flow velocity is a useful index in the routine non-invasive assessment of the severity of aortic regurgitation.