J.D. Barbetseas

Partial Thrombosis of a Bileaflet Mitral Prosthetic Valve: Diagnosis by Transesophageal Echocardiography

We describe the contribution of transesophageal echocardiography in the diagnosis of acute thrombosis of a bileaflet mechanical prosthetic valve in the mitral position. The thrombus had immobilized one hemidisc without affecting the function of the other. These findings were confirmed at surgery.

Role of Transesophageal Echocardiography in the Diagnosis of Infected Retained Pacing Lead

A 68‐year‐old woman had a tronsvenous pacemaker implanted 6 years ago. One year after the procedure the pulse generator was removed due to generator site infection. Efforts to remove the lead resulted in fracture of the tip, which was abandoned in the right cardiac cavities. After this the patient suffered intermittent episodes of fever and chills, which responded to antibiotic therapy. At her recent admission, transesophageal echocardiography revealed a large mass attached to the free end of the fractured lead suggestive of the existence of a vegetation on the pacing lead. The diagnosis was confirmed at surgery.

Microalbuminuria and global myocardial function in patients with essential hypertensive

INTRODUCTION The myocardial performance index, Tei index, is a relatively new echocardiography indice which is related to parameters which express both the systolic and diastolic myocardial function. The purpose of the present study was to investigate the possible correlation of Tei index to microalbuminuria, which is an indice of kidney target-organ damage in hypertensive patients. MATERIALS AND METHODS We evaluated 9680 consecutive patients (mean age 55.2 years, 5144 male and 4536 female) with chronic uncomplicated essential hypertension and the correlation between Tei index, defined as the sum of the isovolumetric relaxation and contraction time divided by the ejection time, and kidney target damage (microalbuminuria) was evaluated. RESULTS In univariate analysis we noticed a positive correlation of Tei index with microalbuminuria (r=0.353 p<0.001). Furthermore, a significant difference was found in each Tei quartile for microalbumin levels (p<0.001). In multivariate analysis with Tei index as a dependent variable (high versus low quartile) and independent variables gender, age, body mass index, plasma glucose, heart rate, blood pressure, kidney function indices and lipids, the independent prognostic correlation to microalbuminuria was noticed (OR: 1.002 p<0.001). CONCLUSIONS In the present study we found that Tei index correlates with microalbuminuria in essential hypertensive patients. Thus we can assume that this index could be used not only for the evaluation of the global myocardial performance of hypertensive patients but also for the assessment of the cardiovascular risk in arterial hypertension since it correlates with kidney damage.

OR-10: Left atrial dimension depends on 24 hour ambulatory blood pressure dipping pattern and left ventricular geometry in arterial hypertension

Left ventricle hypertrophy (LVH) is a common and powerful risk factor in arterial hypertension, while concentric LVH is considered the most dangerous. It is well known that LV geometry and the dipping status according to 24h ambulatory blood pressure provide independent prognostic informations in hypertensive patients. On the other hand left atrial dilation is associated with increased cardiovascular risk in arterial hypertension. The aim of this study was to evaluate the possible relationship between LA enlargement and LVH, LV, geometry and dipping status. We studied 5175 consecutive untreated patients with essential hypertension. Dippers were 2976 and LVH had 2907 (1087 patients with eccentric and 1820 with concentric LVH), while 1236 patients had concentric remodeling. LA was measured from 2D derived M-mode tracings and LA index was calculated after correction with body surface area. The LA/aortic root ratio was obtained as well. Non-dippers had larger LA in comparison to dippers (35 vs 32 mm, p 0.00001), as did patients with LVH compared to those without LVH (35 vs 31 mm, p 0.00001). LV geometry differentiated LA size (normal geometry 31mm, concentric remodeling 32mm, eccentric LVH 36 mm, concentric LVH 34 mm, F 294, p 0.00001). Dippers without LVH had smaller LA compared to non dippers with LVH 34 mm, F 294, p 0.00001). Dippers without LVH had smaller LA compared to non dippers with LVH (31 vs 36 mm, p 0.00001). Overall, dippers with normal geometry had the smallest LA (30.7 mm) and the non dippers with eccentric LVH had the largest LA (37.4 mm). These findings held true after correcting LA dimension for body surface area or aortic root diameter. It is concluded that LA dimension is related to LV hypertrophy and geometry while 24 h ambulatory blood pressure dipping pattern adds to prognosis.