OBJECTIVES:The aim of this study was to examine the association between atherosclerosis risk factors, aortic atherosclerosis and aortic valve abnormalities in the general population.BACKGROUND:Clinical and experimental studies suggest that aortic valve sclerosis (AVS) is a manifestation of the atherosclerotic process.METHODS:Three hundred eighty-one subjects, a sample of the Olmsted County (Minnesota) population, were examined by transthoracic and transesophageal echocardiography. The presence of AVS (thickened valve leaflets), elevated transaortic flow velocities and aortic regurgitation (AR) was determined. The associations between atherosclerosis risk factors, aortic atherosclerosis (imaged by transesophageal echocardiography) and aortic valve abnormalities were examined.RESULTS:Age, male gender, body mass index (odds ratio [OR]: 1.07 per kg/m(2); 95% confidence interval [CI]: 1.02 to 1.12), antihypertensive treatment (OR: 1.93; CI: 1.12 to 3.32) and plasma homocysteine levels (OR: 1.89 per twofold increase; CI: 0.99 to 3.61) were independently associated with an increased risk of AVS. Age, body mass index and pulse pressure (OR: 1.21 per 10 mm Hg; CI: 1.00 to 1.46) were associated with elevated (upper quintile) transaortic velocities, whereas only age was independently associated with AR. Sinotubular junction sclerosis (p = 0.001) and atherosclerosis of the ascending aorta (p = 0.03) were independently associated with AVS and elevated transaortic velocities, respectively.CONCLUSIONS:Atherosclerosis risk factors and proximal aortic atherosclerosis are independently associated with aortic valve abnormalities in the general population. These observations suggest that AVS is an atherosclerosis-like process involving the aortic valve.

A patent foramen ovale was demonstrated by contrast transesophageal echocardiography in 24.6% of 345 subjects participating in a population-based study. This frequency was higher than that observed in patients with cerebral ischemic events (19.0% of 334 patients), suggesting that patent foramen ovale is underdiagnosed in routine clinical practice.

Objective: To examine the association between atrial fibrillation (AF) and aortic atherosclerosis in the general population,Subjects and Methods: Transesophageal echocardiography was performed in 581 subjects, a random sample of the adult Olmsted County, Minnesota, population (45 years of age or older) participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. The frequency of aortic atherosclerosis was determined in 42 subjects with AP and compared with that in 539 subjects without AP (non-AP group).Results: Subjects with AF were significantly older than non-AF subjects (mean +/- SD age, 82+/-10 vs 66+/-13 years, respectively; P<,001) and more commonly had hypertension (28 [66.7%] vs 288 [53,4%], respectively; P=,10), The 2 groups were similar in sex and frequency of diabetes mellitus, hyperlipidemia, or smoking history (P>.10). The odds of aortic atherosclerosis (of any degree) were 2.87 times greater (95% confidence interval [CI], 1.41-5.83; P=,004) and the odds of complex atherosclerosis (protruding atheroma 24 mm thick, mobile debris, or plaque ulceration) were 2.71 times greater (CI, 1.13-6.53; P=,03) in the AF group than in the non AF group. Age was a significant predictor of aortic atherosclerosis (P<,001), After adjusting for age, the odds of atherosclerosis and complex atherosclerosis were not significantly different between the 2 groups (P=,13 and P=.75, respectively).Conclusions: In the general population, AF is associated with aortic atherosclerosis, including complex atherosclerosis, This association is related to age since both AF and aortic atherosclerosis are more frequent in the elderly population.

Background —Atherosclerosis of the thoracic aorta is associated with stroke. The association between hypertension, a major risk factor for stroke, and aortic atherosclerosis has not been determined in the general population. Methods and Results —Transesophageal echocardiography was performed in 581 subjects, a random sample of the Olmsted County (Minnesota) population aged ≥45 years participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. Blood pressure was assessed by multiple office measurements and 24-hour ambulatory blood pressure monitoring. The association between blood pressure variables and aortic atherosclerosis was evaluated by multiple logistic regression, adjusting for other associated variables. Among subjects with atherosclerosis, blood pressure variables associated with complex aortic atherosclerosis (protruding plaques ≥4 mm thick, mobile debris, or ulceration) were determined. Age and smoking history were independently associated with aortic atherosclerosis of any degree ( P ≤0.001) and with complex atherosclerosis ( P =0.002), whereas sex, diabetes mellitus, and body mass index were not. Multiple systolic and pulse pressure variables (office and ambulatory), but none of the diastolic blood pressure variables, were associated with atherosclerosis and complex atherosclerosis, adjusting for age and smoking. Among subjects with atherosclerosis, the odds of complex atherosclerosis increased as ambulatory out-of-bed systolic blood pressure increased (odds ratio 1.43 per 10 mm Hg increase, 95% CI 1.10 to 1.87) and with hypertension treatment, adjusting for age and smoking history. Conclusions —High blood pressure is independently associated with aortic atherosclerosis. Among subjects with atherosclerosis, high blood pressure is associated with complex atherosclerosis.

The objectives of this study were to establish reference values and define the determinants of left atrial appendage (LAA) flow velocities in the general population. LAA flow velocities (contraction and filling velocities) were assessed by transesophageal echocardiography in 310 subjects aged ≥45 years, sampled from the population-based Stroke Prevention: Assessment of Risk in a Community study. All subjects were in sinus rhythm, with preserved left ventricular systolic function (ejection fraction ≥50%), and without valvular disease. Values of LAA contraction and filling velocities were established for various age groups in the population. Age was negatively associated with LAA contraction and filling velocities, which decreased by 4.1 cm/s (p <0.001) and 2.0 cm/s (p <0.01) for every 10 years of age, respectively. Contraction velocities were 5 cm/s higher in men than in women (p <0.05). After adjusting for age and sex, heart rate was independently associated with LAA contraction velocities (p <0.001; nonlinear association). Body surface area, left atrial size, left ventricular mass index, and a history of previous cardiac disease or hypertension showed no significant association with LAA flow velocities (p >0.05). Furthermore, detailed analysis of 24-hour ambulatory blood pressure data (available in 253 subjects) showed no association between various blood pressure parameters (systolic and diastolic blood pressure, out-of-bed and in-bed measurements) and LAA flow velocities (all p >0.05). In summary, the present study establishes the reference values for LAA flow velocities in a large sample of the general population. LAA flow velocities progressively decline with age in subjects with preserved left ventricular systolic function.

The effect of volume reduction on various diastolic Doppler parameters of left ventricular filling was assessed in 13 patients before and after hemodialysis. Volume reduction decreased early diastolic mitral annular velocities to a lesser extent than early diastolic mitral inflow velocities.

HomeCirculationVol. 99, No. 21Diastolic Mitral Regurgitation Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBDiastolic Mitral Regurgitation Yoram Agmon, William K. Freeman, Jae K. Oh and James B. Seward Yoram AgmonYoram Agmon From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn. , William K. FreemanWilliam K. Freeman From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn. , Jae K. OhJae K. Oh From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn. and James B. SewardJames B. Seward From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn. Originally published1 Jun 1999https://doi.org/10.1161/01.CIR.99.21.e13Circulation. 1999;99:e13A67-year-old man underwent transthoracic echocardiography for the evaluation of heart failure. The echocardiographic examination demonstrated significant dilatation of all cardiac chambers with marked global left ventricular (LV) systolic dysfunction (LV ejection fraction of 10% to 15%). Color flow imaging revealed a mild-to-moderate degree of mitral regurgitation (MR). Diastolic as well as systolic MR was detected by multiple Doppler modalities (Figures 1 to 3). Diastolic MR resulted from the combination of first-degree atrioventricular (AV) block and severe elevation of LV filling pressures.Effective ventricular contraction is mandatory for complete mitral valve closure. Diastolic MR is commonly observed during AV block of any degree, when atrial contraction is not followed by adequately synchronized LV contraction. Under these conditions, the AV pressure gradient reverses during atrial relaxation (ventricular pressures higher than atrial), resulting in diastolic MR in the presence of an incompletely closed mitral valve. Diastolic MR in the absence of AV block may occur secondary to significant elevation of LV end-diastolic filling pressures in the presence of restrictive ventric-ular hemodynamics or severe aortic regurgitation, primarily acute regurgitation. Diastolic tricuspid regurgitation, which commonly accompanies diastolic MR, may result from similar right-sided pathophysiological mechanisms.Diastolic MR has not been studied quantitatively. As a result of the low diastolic ventriculoatrial pressure gradient, diastolic regurgitant volume is probably small, despite a potentially large regurgitant orifice of the incompletely closed mitral valve. Diastolic MR due to AV block is, in general, a benign phenomenon devoid of diagnostic or therapeutic clinical implications. However, the presence of diastolic MR in patients with significant LV dysfunction (systolic and diastolic dysfunction), as in the patient described, highlights the significance of adequately timed AV synchrony in optimal diastolic filling of the failing ventricle. In the presence of first-degree AV block and severe LV dysfunction, dual-chamber pacing at a shorter AV interval may improve LV filling dynamics by optimization of mechanical atrial and ventricular synchrony, prolongation of the effective LV diastolic filling period, and elimination of diastolic MR. The combination of these effects may lower LV filling pressures and elevate cardiac output, thus offering an additional therapeutic option in a subset of patients with severe LV dysfunction. The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Pulsed-Doppler interrogation of mitral inflow from an apical transducer position. Fusion of mitral E and A waves is evident (arrow) as a result of combination of sinus tachycardia (heart rate of 100 bpm) and first-degree AV block (PR interval of 260 ms). Note that LV filling is extremely abbreviated, to ≈20% of total cardiac cycle length. Fused mitral inflow pattern does not allow evaluation of LV diastolic function. Doppler interrogation of pulmonary venous flow (not shown) was consistent with restrictive LV filling dynamics (low systolic and high diastolic velocities).Download figureDownload PowerPoint Figure 2. Color M-mode recording of flow through mitral valve from an apical transducer position. MR (encoded in blue) is clearly evident during majority of cardiac cycle, including second half of diastole (arrow) as well as systole. Fused earlier mitral inflow, corresponding to pulsed-Doppler inflow signal in Figure 1, is encoded in red (arrowhead).Download figureDownload PowerPoint Figure 3. Continuous-wave Doppler recording of transmitral flow from an apical transducer position. A lower-velocity signal of diastolic MR (arrow) precedes systolic regurgitant signal. Similar observations were evident on Doppler interrogation of tricuspid valve (not shown). Also note markedly delayed upstroke of systolic mitral regurgitant signal (arrowheads), representing slow rate of early systolic pressure rise (dP/dt) in failing left ventricle.FootnotesCorrespondence to Dr William K. Freeman, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Cabot R, Rosenberg E, Dudzinski D, Baggett M, Tran K, Sgroi D, Shepard J, McDonald E, Corpuz T, Paras M, Khurshid S, Foldyna B, Huang A, Hohmann E, Cooper L and Christensen B (2022) Case 13-2022: A 56-Year-Old Man with Myalgias, Fever, and Bradycardia, New England Journal of Medicine, 10.1056/NEJMcpc2201233, 386:17, (1647-1657), Online publication date: 28-Apr-2022. 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Noncompaction of the ventricular myocardium is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis, The characteristic echocardiographic findings consist of multiple, prominent myocardial trabeculations and deep intertrabecular recesses communicating with the left ventricular cavity. The disease uniformly affects the left ventricle, with or without concomitant right ventricular involvement, and results in systolic and diastolic ventricular dysfunction and clinical heart failure. Noncompaction was initially described in children. However, recent studies have characterized this disease in the adult population, in whom this process may be more prevalent than currently appreciated. We describe an illustrative case of isolated noncompaction of the ventricular myocardium in a 57-year-old woman with the typical clinical and echocardiographic features of the disease. The literature on the topic is reviewed.

The left atrial (LA) appendage is a common source of cardiac thrombus formation associated with systemic embolism. Transesophageal echocardiography allows a detailed evaluation of the structure and function of the appendage by two-dimensional imaging and Doppler interrogation of appendage flow. Specific flow patterns, reflecting appendage function, have been characterized for normal sinus rhythm and various abnormal cardiac rhythms. Appendage dysfunction has been associated with LA appendage spontaneous echocardiographic contrast, thrombus formation and thromboembolism. These associations have been studied extensively in patients with atrial fibrillation or atrial flutter, in patients undergoing cardioversion of atrial arrhythmias and in patients with mitral valve disease. The present review summarizes the literature on the echocardiographic assessment of LA appendage structure, function and dysfunction, which has become an integral part of the routine clinical transesophageal echocardiographic examination.