Pui-Kee Lee

Left Ventricular Filling Patterns and Pulmonary Artery Pressures in Patients Aged 90 to 100 Years With Normal Echocardiography Results

Left ventricular filling and pulmonary artery pressure (PAP) have not been well described in patients > or = 90 years old. We reviewed our database to obtain echocardiograms with normal findings in this age group. The peak early and late mitral filling velocities, the early and late velocity-time integral (VTI), the mitral deceleration time, and the atrial filling fraction (late VTI/total VTI) were measured. PAP was obtained from the peak tricuspid regurgitation velocity. Of 252 echocardiograms performed on patients > or = 90 years old, 47 (19%) were normal. The mean +/- SD values were: ratio of peak early and late mitral filling velocities, 0.69 +/- 0.16; deceleration time, 240 milliseconds +/- 31; ratio of early and late VTI, 1.0 +/- 0.3; atrial filling fraction, 47% +/- 7; and PAP, 31 mm Hg +/- 6. Left ventricular filling in patients aged 90 to 100 years demonstrates increasingly impaired left ventricular relaxation from patients in their eighth and ninth decades. PAP continues to increase with age and PAP < or = 40 mm Hg in the elderly could be considered normal.

Symptomatic sinus node dysfunction associated with the use of propafenone

Propafenone is an investigational antiarrhythmic agent with demonstrated effectiveness against a variety of supraventricular and ventricular arrhythmias.1 In vitro and in vivo studies have confirmed its class I activity in suppressing the rate of rise of phase 0 of the action potential by blocking the fast inward sodium current.2 In addition, propafenone has a mild β-blocking effect. Clinically the drug has been shown to slow sinus rate3 and prolong the sinus node recovery time.4 However, advanced sinus node dysfunction leading to symptomatic bradycardia associated with the use of propafenone has been rarely reported. Herein, we report 6 such cases presenting over 3 years.

Multimodality imaging of a pulmonary artery sarcoma

Pulmonary artery sarcoma is a rare malignant neoplasm. Here, we describe a patient with a pulmonary artery sarcoma, which was only subtly visible and therefore not fully appreciated on initial transthoracic echocardiogram. Characterization of the tumor was aided by the use of multimodality imaging that included computed tomography, magnetic resonance imaging, and positron emission tomography. Familiarity with its appearance on multiple imaging modalities including echocardiography is important to ensure timely diagnosis, although the optimal treatment strategy is still unknown, and the prognosis remains poor.

NATURAL HISTORY OF MITRAL ANNULUS REMODELING IN PERMANENT ATRIAL FIBRILLATION

Atrial fibrillation (AF) is associated with progressive atrial enlargement, and mitral annular diameter (MAD) is closely related to the left atrial size. The natural history of mitral annulus remodeling in the context of AF has not been assessed. We aimed to determine the rate of change in MAD over