T H Marwick

..We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables...

..This study sought to determine whether stress echocardiography using exercise (when feasible) or dobutamine echo could be used to predict mortality in patients with diabetes...

..Other tests that identify evidence of atheroma in the peripheral or coronary circulation may be useful to identify patients at risk...

..Thus, the results of stress echocardiography are an independent predictor of cardiac death in hypertensive patients with known or suspected coronary artery disease, incremental to clinical risks and exercise results...

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..Although no quantitative approach is in widespread clinical use, several alternative techniques are feasible, and this area warrants further study...

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..This study sought to define the value of dobutamine echocardiography (DbE) for cardiac risk stratification in patients with chronic renal failure (CRF)...

..The spironolactone group also exhibited reduction in posterior wall thickness (P=0.04) and a trend to reduced left atrial area (P=0.09). CONCLUSIONS: Aldosterone antagonism improves myocardial function in hypertensive heart disease...

..This study sought the accuracy of post-exercise heart-rate recovery in the diagnosis of cardiac autonomic neuropathy, which represents a serious, but often unrecognized complication of Type 2 diabetes...

..We also sought to determine if aortic stiffness was correlated with body size, independent of BP...

..Thus, use of MDV in all segments or MDV in all segments with wall motion scoring in the apex offers an improvement in sensitivity and accuracy with minimal compromise in specificity...

..Each of the techniques shows good correlation with each other, however, values for TAC-PPM are significantly lower. TAC-PPM and TAC-SVPP are comparable in determining differences between groups with and without cardiovascular risk...

..These results suggest that peak systolic velocity, timing of contraction and SRI reflect the underlying physiological characteristics of the regional myocardium during DbE, and may potentially allow objective analysis of wall motion...

..44, P = 0.01), independent of baseline functional capacity and clinical variables. Thus, change in peak VO2 following 16 weeks exercise training is related to myocardial function at baseline...

..Wall motion score at dobutamine stress echocardiography is an independent predictor of mortality. We sought to determine whether quantification of DSE by strain rate imaging was incremental to wall motion score for predicting outcome...

..In conclusion, a major determinant of subendocardial function is the wall thickness, as measured by the relative wall thickness, and not LV hypertrophy...

..This study sought to measure MBF, arterial stiffness and wave reflection in patients with CSF and controls...

..36, P=0.002), and em (beta=-0.41, P<0.001). CONCLUSIONS: Overweight subjects without overt heart disease have subclinical changes of LV structure and function even after adjustment for mean arterial pressure, age, gender, and LV mass...

..CONCLUSIONS: Myocardial contrast echo using harmonic power Doppler has greater accuracy than with grey scale imaging and digital subtraction. However, power Doppler appears to be less sensitive for mild perfusion defects...

..This study prospectively compared the incremental prognostic benefit of exercise echocardiography with that of exercise testing in a large cohort...

..Peak exercise BNP levels may identify exercise-induced elevation of filling pressures in DHF...

..001). The optimal cutoff values for predicting subsequent recovery of function at rest were an increment of peak velocity >1 cm/s, >5 mm of displacement, and a >5% improvement of ejection fraction with low-dose dobutamine...

..CONCLUSIONS: Brachial artery reactivity is lower in patients with events, but is not an independent predictor of cardiovascular outcomes in this cohort of patients...

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..This test may be particularly useful in patients with intermediate-risk Duke treadmill scores...

..This study sought to examine the prognostic importance of chronotropic incompetence among patients referred for stress echocardiography...

..Arterial compliance is an independent predictor of diastolic dysfunction in patients with hypertensive heart disease and should be considered a potential target for intervention in diastolic HF...

..We sought to assess the feasibility and accuracy of myocardial contrast echocardiography (MCE) using standard imaging approaches for the detection of perfusion defects in patients who had a myocardial infarction (MI)...

..CONCLUSION: Regional diastolic function is sensitive to ischemia. However, a number of practical limitations limit the applicability of diastolic parameters for the quantification of stress echocardiography...

..05). We conclude that an acute change in blood rheology improves ventricular-vascular interaction by enhanced LV systolic function and reduced light-exercise central BP...

..CONCLUSION: Although the absolute values show overlap between groups, the results of this study indicate that subtle changes of regional LV function may occur in the absence of infarction, in association with severe coronary stenoses...

..001). Neither SR (beta=0.12; P=0.18) nor heart rate-corrected SR (beta=0.02; P=0.72) was associated with AIx. We conclude that AIx is determined by chronotropic rather than inotropic effects, as well as factors other than wave reflection...

..4 +/- 1.0 vs 4.5 +/- 2.8, p = 0.003). In conclusion, DM significantly influenced the quantitative, but not the qualitative, assessment of MCE, with a marked reduction in specificity in patients with DM...

..This study sought to determine the relative contributions of exercise E/e' and ischemia to outcomes in patients referred for exercise echocardiography...

..However, screening approaches, including BNP, do not appear to be sufficiently sensitive to identify subclinical dysfunction, which requires sophisticated echocardiographic analysis...

..54).(abstract truncated at 250 words)..

..CONCLUSIONS: Evaluation of CR by exercise echocardiography may be useful for risk stratification and may help to optimise the timing of surgery in asymptomatic severe MR...

..Functional capacity appears related not only to diastolic function, but also to systolic function and filling pressure, and is most closely associated with a combination of these factors...

..We sought the comparative influence of reversible and irreversible risk factors on TAC in a large primary prevention group...

..We sought to examine the accuracy of non-contrast (NC) and CE-2DE and 3DE for calculation of LV volumes and ejection fraction (EF), relative to cardiac magnetic resonance imaging (MRI)...

..However, the variability of peptide levels within individuals may pose a problem to the interpretation of sequential data in response to exercise or therapies...

..044), and eccentric hypertrophy (p = 0.012) were significant predictors of both false-negative and false-positive results for DSE. CONCLUSIONS: The accuracy of DSE is influenced by the LV geometric pattern and peak wall stress...

..Combined analysis of longitudinal and radial velocities allows the derivation of a composite velocity, which is homogeneous in all segments and may allow better separation of normal and abnormal myocardium...

..Although elevated in the presence of diastolic dysfunction, the BNP level mostly is in the normal range and, therefore, has limited diagnostic value in stable patients with suspected diastolic HF...

..The extremes of age may influence peak systolic Doppler velocities. These results suggest that peak systolic velocity may be a robust quantitative measure during dobutamine echocardiography across most patient subgroups...

..The normal response to stress suggests that ischemia due to small-vessel disease may not be important in early diabetic heart muscle disease...

..Comparison of myocardial tissue-velocity imaging (TVI) and speckle-tracking echocardiography (STE) for prediction of viability at dobutamine echocardiography (DbE)...

..However, no single test has a perfect, or near perfect, sensitivity and specificity, and thus, a combination of tests are usually needed. Algorithms are developed to integrate these tests in clinical decision making...

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..9). CONCLUSION: Aggressive risk factor modification in CKD does not limit the development of new ischaemia or reduce cardiac events in patients with an abnormal DSE...

..CONCLUSION: While traditional cardiovascular risk factors are strong predictors of ischaemia on stress echocardiography, TAC is an independent predictor of the extent of ischaemia...

..Diastolic dysfunction (DD) is highly prevalent and associated with increased morbidity and mortality, but its natural history remains poorly defined...

..To identify the effects of a 1-year exercise intervention on myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM)...

..Strain (SI) and strain rate (SR) measure regional myocardial deformation and may be a new technique to assess phasic atrial function...

..Correlates of abnormal function are age, diabetes mellitus, hypertension, and LV mass, rather than ESRD alone, dialysis adequacy, or abnormal endothelial function...

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..CONCLUSIONS: Telemonitoring is feasible for following adherence to home ExT. Ongoing adherence is critical in obtaining sustained benefit from ExT in heart failure...

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..48, p < 0.0001), with less strong correlations by global parameters. The extent of dysfunctional myocardium, rather than its nature determines BNP levels...

..Subjects with MS who also have subclinical myocardial abnormalities and reduced cardiorespiratory fitness may have a higher risk of cardiovascular disease events and heart failure...

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..0001) and peak end-diastolic volume (P <.0001); the model r(2) was 0.93 (P <.001). CONCLUSION: In the absence of regional LV dysfunction, measurement of longitudinal axis function by DTI may be a marker of CR...

..A stepwise strategy of combining clinical risk scores with DSE for CAD screening in CKD reduces the number of tests required and identifies a high-risk subgroup among whom DSE results more effectively stratify high and low risk...

..Perhexiline improves functional capacity in heart failure, but the mechanisms are undefined. We sought its effects on myocardial deformation in patients with viable myocardium...

..The aim of this study was to compare global longitudinal speckle strain (GLS), an automated technique for measurement of long-axis function, with EF and WMSI for the prediction of mortality...

..Due to several inter-related biological processes, hypertension is often associated with diabetes, and accelerates these morbid conditions. These points are outlined below...

..The response to GIK is observed in areas of normal and abnormal perfusion assessed by contrast echocardiography...

..A desirable next step in the development of BAR and IMT as useful clinical tools would be to show an association of improvement in response to treatment with improvement in prognosis...

..Chronotropic incompetence, an attenuated heart rate response to exercise, is a predictor of all-cause mortality in healthy populations. This association may be independent of exercise-induced myocardial perfusion defects...

..We sought to find out the independent and incremental prognostic value of exercise thallium-201 single-photon-emission computed tomography (SPECT) for prediction of death and non-fatal myocardial infarction (MI) in these patients...

..CONCLUSION: Remodeling appears to occur independent of the presence of regional contractile reserve but does correlate with the volume response to low-dose dobutamine...

..Obese women with polycystic ovary syndrome (PCO), characterized by hormonal and metabolic abnormalities, are thought to be at particularly increased cardiovascular risk...

..We compared their feasibility and accuracy in 150 patients undergoing dobutamine stress echocardiography (DSE) and coronary angiography...

..CONCLUSIONS: Both contractile reserve and perfusion are sensitive to the extent of scar. However, contractile reserve may be impaired in the face of no or minor scar, and thickening may still occur with extensive scar...

..Although these changes are similar to those caused by LVH, they are independent and incremental to the effects of LVH...

..SRI quality can be improved with harmonic imaging and higher temporal resolution but optimisation of spatial resolution is critical...

..Newer measurements were no better than LVEF in detecting changes in clinical status. Sequential LV assessment should be interpreted with caution, and more robust measurements are needed...

..This study aimed to determine the association between LV tissue velocity and LV size in healthy controls and in those with type 2 diabetes (T2DM)...

..CONCLUSION: Patients with symptomatic coronary artery disease who are treated with aggressive lipid lowering have improvement of symptom status and ischemia that appears to reflect improved vascular function but not atheroma burden...

..In conclusion, increased central pulse pressure, possibly due to amplified pressure wave reflections, is independently associated with abnormal LV diastolic function in patients with type 2 DM...

..The displacements in the basal segments had a sensitivity and specificity of 83% and 78%, respectively (p = NS). Regional myocardial displacement during DBE is feasible and offers a fast and accurate method for the diagnosis of CAD...

..6 vs 3.7 +/- 1.9, P = .01). CONCLUSION: Quantitative MCE is feasible for the diagnosis of CAD with dipyridamole/exercise stress. Dipyridamole prolongs postexercise hyperemia, augmenting the degree of hyperemia at the time of imaging...

..01). Thus, assessment of CVIB from the apical views is a feasible and accurate tool for detecting CR and predicting myocardial viability in chronic LV dysfunction...

..013), and A1C (P = 0.0007) were independent predictors of exercise capacity. CONCLUSIONS: Reduced exercise capacity in patients with type 2 diabetes is associated with diabetes control, subclinical LV dysfunction, and impaired HRR...

..CONCLUSIONS: Increasing BMI is associated with increasing severity of RV dysfunction in overweight and obese subjects without overt heart disease, independent of sleep apnea...

..Patients with known or suspected coronary disease are often investigated to facilitate risk assessment. We sought to examine the cost-effectiveness of strategies based on exercise echocardiography and exercise electrocardiography...

..Use of additional views and longer clips may be indicated to minimize discordance with video in patients with complex problems. Digital interpretation offers a significant reduction in reading times and the cost of archiving...

..Radial artery dP/dt max has been proposed as a possible marker of LV systolic function and we sought to test this hypothesis...

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..CONCLUSIONS: Online measurement of LV volumes is feasible and more accurate than with 2-dimensional echocardiography. Although the offline approach is more accurate, it is also more time-consuming...

..9 +/- 0.3 s(-1) respectively; all P< or =0.001). Thus radial contractility appears to compensate for reduced longitudinal contractility in subclinical LV dysfunction occurring in the absence of ischaemia or LV hypertrophy...

..In conclusion, baseline myocardial tissue deformation, but not evolution, is associated with LV geometry in treated hypertensive patients...

..We sought to determine whether real-time three-dimensional echocardiography (RT3DE) is superior to two-dimensional echocardiography (2DE) for the follow-up of RV function by validation vs cardiac MRI...

..In conclusion, if sequential measurement of LV volumes is used to guide management decisions, 3DE appears preferable to 2DE...

..Telehealth promises cost reductions in service delivery, although there is a need for properly controlled cost-effectiveness trials to underpin telehealth with a firm evidence base...

..Care must be taken to ensure that the same segments are measured between observers and serially...