Conard Failinger

Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome

•  What is the central question of this study? Metabolic syndrome (MetS) is associated with a threefold increase in risk of cardiovascular disease mortality, which may be mediated, in part, by impaired left ventricular systolic function. The severity of left ventricular and arterial dysfunction during dynamic exercise in individuals with MetS without diabetes and/or overt cardiovascular disease has not previously been explored. •  What is the main finding and its importance? Cardiovascular function was characterized at rest and during peak exercise using echocardiography and gas exchange. During exercise, individuals with MetS displayed impaired left ventricular contractility, a blunted arterial–ventricular coupling reserve and limited aerobic capacity. These findings provide insight into the pathophysiological changes that may occur to predispose individuals with MetS to an increased risk of cardiovascular disease.

Comparison of left atrial dimensions by transesophageal and transthoracic echocardiography.

Transesophageal echocardiography (TEE) is an established cardiovascular diagnostic technique. Left atrial (LA) size, as measured by transthoracic echocardiography (TTE), is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke, death, and the success of cardioversion. Assessment of LA size has not been as well validated on TEE as on TTE. We determined LA size measurements in four standard views in 122 patients undergoing TEE and TTE at the same setting. In this study, we found that measurement of LA dimensions by TEE suffers from significant limitations in all views except the basal long‐axis view (mid‐esophageal level) with transducer plane at 120–150 degrees. This view had the best correlation with transthoracic LA measurements: r = 0.79 for TEE long axis (CI 0.71–0.85), P <.0001. (ECHOCARDIOGRAPHY, Volume 22, November 2005)

ORIGINAL INVESTIGATIONS: Comparison of Left Atrial Dimensions by Transesophageal and Transthoracic Echocardiography

Transesophageal echocardiography (TEE) is an established cardiovascular diagnostic technique. Left atrial (LA) size, as measured by transthoracic echocardiography (TTE), is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke, death, and the success of cardioversion. Assessment of LA size has not been as well validated on TEE as on TTE. We determined LA size measurements in four standard views in 122 patients undergoing TEE and TTE at the same setting. In this study, we found that measurement of LA dimensions by TEE suffers from significant limitations in all views except the basal long‐axis view (mid‐esophageal level) with transducer plane at 120–150 degrees. This view had the best correlation with transthoracic LA measurements: r = 0.79 for TEE long axis (CI 0.71–0.85), P <.0001. (ECHOCARDIOGRAPHY, Volume 22, November 2005)

A Quadricuspid Aortic Valve with Atrial Septal Defect

A quadricuspid aortic valve (QAV) is a rare congenital heart defect, previously described as an incidental finding at the time of surgery or postmortem, which is now being increasingly detected by 2D transthoracic or transesophageal echocardiogram. With advances in echocardiography, secondary cardiac anomalies are also being described in association with QAV. Herein we describe a patient with QAV with a secundum atrial septal defect.

Emotional Stress and Reversible Myocardial Dysfunction

A growing body of clinical and experimental literature supports a strong association between emotional stress and adverse outcomes from CVD. Effects of emotional stress on coronary blood flow and cardiac arrhythmias provide only a partial explanation. A direct impact of emotional stress on myocardial function has recently received attention as a result of reports of patients presenting with new onset of unexplained reversible heart failure following episodes of emotional stress. Potential mechanisms responsible for myocardial dysfunction following emotional stress remain to be elucidated. This review will explore potential pathophysiologic mechanisms linking emotional stress to adverse cardiovascular outcomes beginning with primary and secondary risk factors and leading to direct effects of emotional stress on reversible myocardial dysfunction.

Ruptured Sinus of Valsalva Aneurysm in a Turner's Syndrome Patient

The patient is a 29-year-old female with a past medical history of Turner’s syndrome. Prior to this admission, she had presented to the emergency department with a chief complaint of cough and shortness of breath. She was diagnosed with an upper respiratory infection and treated as an outpatient with a course of antibiotics. She presented again 11 days later with worsening symptoms. She was then admitted with a diagnosis of community-acquired pneumonia. Empiric antibiotics were started.

Two-Dimensional Echocardiographic Findings of Pulmonary Valve Cyst Secondary to Pulmonary Valvuloplasty

Real time two‐dimensional transthoracic and transesophageal echocardiography demonstrated a mobile echolucent mass attached to the pulmonary valve in a 25‐year‐old adult, 20 years following balloon pulmonary valvuloplasty. The mass was surgically excised and pathology showed it to be a cyst.

ORIGINAL INVESTIGATIONS: Comparison of Left Atrial Dimensions by Transesophageal and Transthoracic Echocardiography: COMPARISON OF LA SIZE WITH TEE AND TTE

Transesophageal echocardiography (TEE) is an established cardiovascular diagnostic technique. Left atrial (LA) size, as measured by transthoracic echocardiography (TTE), is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke, death, and the success of cardioversion. Assessment of LA size has not been as well validated on TEE as on TTE. We determined LA size measurements in four standard views in 122 patients undergoing TEE and TTE at the same setting. In this study, we found that measurement of LA dimensions by TEE suffers from significant limitations in all views except the basal long‐axis view (mid‐esophageal level) with transducer plane at 120–150 degrees. This view had the best correlation with transthoracic LA measurements: r = 0.79 for TEE long axis (CI 0.71–0.85), P <.0001. (ECHOCARDIOGRAPHY, Volume 22, November 2005)