Aged ; Cardiomyopathy, Hypertrophic ; diagnosis ; Diagnostic Errors ; Female ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis

OBJECTIVETo determine the value of terminal force of P wave in V1 lead (Ptf-V1) in the diagnosis of coal-workers' pneumoconiosis with pulmonary heart disease complicated by left ventricular hypertrophy.

METHODSSelect the coal-worker with pneumoconiosis postmortem examination cases which were pathologically diagnosed as pulmonary heart disease complicated by left ventricular hypertrophy and can measure Ptf-V1. Select 14 cases with ECG left axis deviation, no deviation and right axis deviation. Measure and analyze the Ptf-V1 value, the thickness of left and right ventricular wall.

RESULTSThere's obvious discrepancy in ventricular wall thickness mean in ECG left axis deviation, no deviation and right axis deviation groups, the discrepancy have statistical significance (F1 = 32.18, P < 0.01, F2 = 8.02, P < 0.01). The left ventricular wall is thicker in ECG left axis deviation group [(1.81 +/- 0.18) cm] than in no deviation [(1.47 +/- 0.15) cm] and right axis deviation groups [(1.39 +/- 0.10) cm], the discrepancy have statistical significance with (P < 0.01). The right ventricular wall is thicker in ECG left axis deviation group [(0.79 +/- 0.14) cm] than in no deviation group [(0.58 +/- 0.14) cm], the discrepancy have statistical significance with (P < 0.01). The right ventricular wall is thicker in ECG right axis deviation group [(0.71 +/- 0.14) cm] than in no deviation group, the discrepancy have statistical significance with (P < 0.05). ECG left axis deviation Ptf-V1 relevance ratio 85.71% is higher than in no deviation (35.70%) and right axis deviation groups (28.57%), the discrepancy have statistical significance with (P < 0.01). The Ptf-V1 absolute value is positively related with left ventricular wall thickness in ECG left axis deviation and no deviation groups (r1 = 0.92, P < 0.01, r2 = 0.93, P < 0.01).

CONCLUSIONPft-V1 absolute value is the criterion index of left ventricular morphosis and function especially left atrium loading change. ECG Ptf-V1 combined with ECG left axis deviation is valuable to the diagnosis of coal-workers with pneumoconiosis complicated by left ventricular hypertrophy.

Aged ; Anthracosis ; complications ; physiopathology ; Electrocardiography ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis ; physiopathology ; Middle Aged ; Pulmonary Heart Disease ; complications ; diagnosis ; physiopathology

Asymmetric septal hypertrophy with systolic anterior motion of the mitral valve is frequently a phenotypic, but not pathognomonic, expression of genetic hypertrophic cardiomyopathy (HCM) with or without obstruction. It can, however, be associated nonspecifically with other forms of increased left ventricular (LV) afterload. We herein report the case of a young man with obesity cardiomyopathy and heart failure who presented with asymmetric septal hypertrophy and marked LV hypertrophy, and endomyocardial biopsy ruled out genetic HCM.
Adult ; Cardiomyopathy, Hypertrophic, Familial ; Diagnosis, Differential ; Echocardiography ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis ; Male ; Obesity, Morbid ; complications

OBJECTIVEThis thesis will discuss the value of RV(6) > RV(5) of ECG in diagnosis of pneumocardiac disease complicated by left ventricular hypertrophy in coal-workers with pneumoconiosis through the analysis of the ECG characteristics in the postmortem examination of coal-workers with pneumoconiosis.

METHODSThree data groups will be formed on the basis of the ECG data in the case 47 postmortem examination of coal-workers with pneumocardiac disease complicated by left ventricular hypertrophy, and they are right deviation group with ECG cardiac electric axis more than 90 degrees (case 16), no deviation group with ECG cardiac electric axis between 30 degrees and 90 degrees (case 16) and left deviation group with ECG cardiac electric axis between 30 degrees and -30 degrees (case 15). The method that this thesis adopted is to compare the thickness of the right and left ventricle walls of the three groups, their ratio and the detectable ratio of ECG RV(6) > RV(5).

RESULTSThe detectable rate of the thickness of right ventricle front wall, the thickness of the left ventricle wall, the thickness of the left ventricle wall to the thickness of right ventricle wall and ECG RV(6) > RV(5) in left deviation group is obviously higher than those of the no deviation group and right deviation group. The differences between the three groups are of statistics significance (P < 0.01); the detectable rate of the thickness of right ventricle front wall, the thickness of the left ventricle wall, the thickness of the left ventricle wall to the thickness of right ventricle wall and ECG RV(6) > RV(5) in no deviation group is obviously higher than those of the right deviation group. The differences are of statistics significance (P < 0.01). In case 47 that pneumocardiac disease complicated by left ventricular hypertrophy in coal-workers with pneumoconiosis, the ECG shows 20 cases of ECG RV(6) > RV(5). There are altogether 3 kinds of ECG types: (1) 14 cases of ECG RV(6) > RV(5); (2) 4 cases of left ventricular hypertrophy; (3) 2 cases of right ventricular hypertrophy.

CONCLUSIONSThe left deviation of ECG cardiac electric axis and ECG RV(6) > RV(5) can be used as indications to diagnosis of pneumocardiac disease complicated by left ventricular hypertrophy in coal-workers with pneumoconiosis.

Adult ; Aged ; Electrocardiography ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis ; physiopathology ; Middle Aged ; Pneumoconiosis ; complications ; diagnosis ; Pulmonary Heart Disease ; complications ; diagnosis ; Retrospective Studies

OBJECTIVETo determine whether preoperative contrast delay-enhanced cardiovascular magnetic resonance imaging (DE-CMR) could help predict long-term survival of patients with severe chronic aortic regurgitation and extremely dilated left ventricular chamber after aortic valve replacement.

METHODSTotally 37 patients enrolled between February 2008 and November 2010 with severe chronic aortic regurgitation and extremely dilated left ventricular chamber, who met the echo criteria, that was left ventricular end diastolic dimension > 70 mm or left ventricular end systolic dimension > 55 mm, and were scheduled to the surgery. The 2-dimensional echocardiographic examinations and CMR with late gadolinium-enhancement (LGE) were performed routinely preoperatively. According to the results of CMR, the patients were divided into 2 groups: the LGE positive(+) group and LGE negative(-) group. The association of LGE with event free survival, postoperative cardiac function and postoperative hospital stay time was investigated. Fifteen patients had significant LGE signals in CMR films, while the other twenty-two were silent. All of them received the operative procedures, including aortic valve replacement in 28 cases, Bentall procedure in 3 cases, aortic valve replacement and ascending aorta replacement in 6 cases, and concomitant mitral valve repair in 11 cases.

RESULTSOver a follow-up of 33.6 months, 1-year, 2-year and 3-year event free survival rates in LGE(-) group were 94.7%, 88.4%, and 72.6%, respectively, compared to 80.0%, 48.9%, and 32.6%, respectively in LGE(+) group (χ(2) = 7.244, P = 0.007). The postoperative hospital stay time of LGE(-) group was (9 ± 2) days, which of LGE(+) group was (10 ± 3) days (t = 1.175, P = 0.248).

CONCLUSIONSLGE positive signal in CMR films is a potential predictor of persistent cardiac failure after aortic valve replacement for patients with severe chronic aortic regurgitation and extremely dilated left ventricular chamber. It has intimate relationship with malignant arrhythmia and sudden death, which makes it a valuable technique in preoperative evaluation and risk stratification.

Aortic Valve Insufficiency ; complications ; diagnosis ; surgery ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis ; surgery ; Magnetic Resonance Imaging ; methods ; Postoperative Period ; Prognosis

Implanting a valve that will reduce left ventricular mass is critical in aortic stenosis. Regression of left ventricular hypertrophy in 46 aortic valve replacement (AVR) patients receiving a St. Jude Medical (SJM) valve was assessed by serial electrocardiographic and echocardiographic studies during the preoperative, immediate, and late postoperative periods. The patients were divided into three groups according to valve size; 19 mm group (n=9), 21 mm group (n=20), and 23+mm group (n=17). There was no surgical mortality. The NYHA functional class improved from an average of 2.2+/-0.8 preoperatively to 1.3+/-0.5 post-operatively. Left ventricular muscle mass index (LVMI) regression failed to reach statistical significance in the 19 mm group, whereas in the other two groups a steady decrease in the LVMI occurred with follow up. ECG findings were less remarkable showing insignificant differences in voltage among the three groups (p=0.000). In conclusion, the current data suggest that the 19 mm SJM valve may not result in satisfactory left ventricular muscle mass regression despite adequate function, even in small patients. Therefore, additional procedures to accommodate a larger valve may be warranted in the aortic annulus smaller than 21 mm.
Adult ; Aged ; Aortic Valve/ultrasonography ; Aortic Valve Stenosis/surgery* ; Aortic Valve Stenosis/complications ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Valve Prosthesis* ; Human ; Hypertrophy, Left Ventricular/prevention & control* ; Hypertrophy, Left Ventricular/etiology ; Hypertrophy, Left Ventricular/diagnosis ; Male ; Middle Age ; Multivariate Analysis ; Postoperative Period ; Remission Induction ; Risk Factors ; Treatment Outcome

Among the congenital coronary artery fistulae, multiple coronary artery microfistulae arising from the left and right coronary artery and emptying into the left ventricle are very rare and little is known of their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. A 67-year- old woman was referred for the evaluation of chest pain at exertion, and shortness of breath. Electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic color Doppler echocardiography, using a high frequency transducer with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.
Aged ; Cardiomyopathy, Hypertrophic/*complications/diagnosis ; Coronary Angiography ; Coronary Vessel Anomalies/*complications/diagnosis/*ultrasonography ; Echocardiography ; Electrocardiography ; Female ; Heart Defects, Congenital/*complications/diagnosis/*ultrasonography ; Heart Ventricles ; Human ; Hypertrophy, Left Ventricular/complications/diagnosis

Idiopathic peripartum cardiomyopathy is an uncommon malady disease. Making the diagnosis is often difficult and it is always necessary to exclude other prior heart disease and other causes of left ventricular dysfunction in pregnant women. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are further amplified when the common complications of pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy. This may be aggravated by making a late diagnosis and providing inappropriate treatment. We experienced a 38-year-primigravida who has diagnosed with idiopathic peripartum cardiomyopathy and underwent elective cesarean section with general anesthesia.
Anesthesia ; Anesthesia, General ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cesarean Section ; Delayed Diagnosis ; Female ; Heart Diseases ; Heart Failure ; Humans ; Hypertrophy ; Peripartum Period ; Pregnancy ; Pregnancy Complications ; Pregnant Women ; Ventricular Dysfunction, Left

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid- ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.
Cardiomyopathy, Hypertrophic/complications/*diagnosis ; Coronary Angiography ; Echocardiography, Doppler ; Heart Aneurysm/*diagnosis/etiology ; Humans ; Hypertrophy, Left Ventricular/complications/*diagnosis ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Myocardial Ischemia/complications/diagnosis

It is known that blood pressure variability (BPV) can independently affect target organ damage (TOD), even with normal blood pressure. There have been few studieson chronic kidney disease (CKD) patients. We evaluated the relationship between BPV and TOD in a cross-sectional, multicenter study on hypertensive CKD patients. We evaluated 1,173 patients using 24-hr ambulatory blood pressure monitoring. BPV was defined as the average real variability, with a mean value of the absolute differences between consecutive readings of systolic blood pressure. TOD was defined as left ventricular hypertrophy (LVH) (by the Romhilt-Estes score > or =4 in electrocardiography) and kidney injury (as determined from an estimated glomerular filtration rate [eGFR]<30 mL/min/1.73 m2 and proteinuria).The mean BPV of the subjects was 15.9+/-4.63 mmHg. BPV displayed a positive relationship with LVH in a univariate analysis and after adjustment for multi-variables (odds ratio per 1 mmHg increase in BPV: 1.053, P=0.006). In contrast, BPV had no relationship with kidney injury. These data suggest that BPV may be positively associated with LVH in hypertensive CKD patients.
Adult ; Aged ; Blood Pressure/*physiology ; Blood Pressure Monitoring, Ambulatory ; Cross-Sectional Studies ; Electrocardiography ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension/*complications/*diagnosis ; Hypertrophy, Left Ventricular/*physiopathology ; Kidney/injuries ; Male ; Middle Aged ; Odds Ratio ; Proteinuria/complications ; Renal Insufficiency, Chronic/*complications/*diagnosis