Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine evaluation of patients presenting with symptoms of dyspnea or heart failure. The 2009 American Society of Echocardiography (ASE) and European Association of Echocardiography (now European Association of Cardiovascular Imaging [EACVI]) guidelines for diastolic function assessment were comprehensive, including several two-dimensional (2D) and Doppler parameters to grade diastolic dysfunction and to estimate LV filling pressures.1 Notwithstanding, the inclusion of many parameters in the guidelines was perceived to render diastolic function assessment too complex, because several readers have interpreted the guidelines as mandating all the listed parameters in the document to fall within specified values before assigning a specific grade. The primary goal of this update is to simplify the approach and thus increase the utility of the guidelines in daily clinical practice.
LV diastolic dysfunction is usually the result of impaired LV relaxation with or without …
Surveys of houses in South Africa have shown that dust mites and mite-derived antigens are more common along the eastern and southern coastal lowlands than on the central Highveld plateau. The present study extended this research to hospitals in the three major coastal cities, to determine whether or not dust mites were present in ward furnishings and on foors, and if so, at what densities. Sampling, over 22 months, in provincial and private hospitals in Durban, Port Elizabeth and Cape Town recovered 10 mite species, including the cosmopolitan pyroglyphids, Dermatophagoides farinae, D. pteronyssinus, Euroglyphus maynei and Malayoglyphus intermedius. Mites were found in all sampled habitats without any apparent preferences, but mean densities were mostly below 10/m2, lower than found previously in houses along the coast. To characterise mite habitats in these coastal hospitals, preliminary environmental data were collected in wards and from inside mattresses. These showed nearly constant environments, with moderate temperatures and relative humidity and narrow annual ranges. Temperature and relative humidity levels decreased with increasing latitude from Durban to Cape Town.
Background Conventional cardiac catheterization criteria for the diagnosis of constrictive pericarditis (CP) rely on equalization of intracardiac pressures and have many recognized limitations. Recently, Doppler echocardiographic methods have been used to examine dynamic respiratory changes of increased ventricular interdependence and dissociation of intrathoracic and intracardiac pressures for the diagnosis of CP. These pathophysiological features may be best delineated by cardiac catheterization. Therefore, we studied the accuracy of these dynamic respiratory changes in left ventricular and right ventricular pressure for the diagnosis of CP at cardiac catheterization. Methods and Results High-fidelity manometric catheters and respirometry were used to study 36 patients: 15 patients with surgically proven CP (group 1) and 21 patients with other causes of heart failure (group 2). Conventional cardiac catheterization variables used to establish the diagnosis of CP lacked sensitivity and specificity and failed to distinguish between these groups. However, the finding of discordance between right ventricular and left ventricular pressures during inspiration, a sign of increased ventricular interdependence, accurately distinguished patients in group 1 from those in group 2 ( P <.05). Conclusions Examination of dynamic respiratory changes indicating increased ventricular interdependence may be helpful in the diagnosis of CP in the cardiac catheterization laboratory.
