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Article: Aortic valve disease: a practical clinical approach.

Botkin, N F / Aurigemma, G P

2004 Volume 52, Issue 4, Page(s) 263–272

Abstract: The diagnosis and treatment of aortic valve disease can be challenging for the clinician. Aortic regurgitation (AR) may be evaluated with Doppler echocardiography or catheterization. Medical therapy consists of vasodilators. Surgery may be appropriate ... ...

Abstract	The diagnosis and treatment of aortic valve disease can be challenging for the clinician. Aortic regurgitation (AR) may be evaluated with Doppler echocardiography or catheterization. Medical therapy consists of vasodilators. Surgery may be appropriate for patients with symptoms, left ventricular dilatation or diminished left ventricle systolic function. Aortic stenosis (AS) can be evaluated with the same modalities as AR. There is evidence that statin therapy may slow the progression of AS. Contrary to conventional wisdom, vasodilators are safe and effective in certain patients. Surgical valve replacement is performed for symptoms and in certain asymptomatic patients.
MeSH term(s)	Aortic Valve Insufficiency/diagnosis ; Aortic Valve Insufficiency/drug therapy ; Aortic Valve Insufficiency/surgery ; Aortic Valve Insufficiency/therapy ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/drug therapy ; Aortic Valve Stenosis/surgery ; Aortic Valve Stenosis/therapy ; Heart Valve Prosthesis Implantation/methods ; Humans ; Treatment Outcome ; Vasodilator Agents/therapeutic use
Chemical Substances	Vasodilator Agents
Language	English
Publishing date	2004-08
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	123583-7
ISSN	1827-1618 ; 0026-4725
ISSN (online)	1827-1618
ISSN	0026-4725
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Zs.A 14: Show issues

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Article: Valve disease and diet pills--where do we stand?

Aurigemma, G P / Gaasch, W H

American family physician

1998 Volume 57, Issue 4, Page(s) 656, 659–60

MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Appetite Depressants/adverse effects ; Dopamine Agents/adverse effects ; Drug Therapy, Combination ; Echocardiography ; Endocarditis, Bacterial/etiology ; Endocarditis, Bacterial/prevention & control ; Fenfluramine/adverse effects ; Heart Valve Diseases/chemically induced ; Heart Valve Diseases/complications ; Heart Valve Diseases/diagnostic imaging ; Humans ; Middle Aged ; Obesity/drug therapy ; Phentermine/adverse effects ; Serotonin Agents/adverse effects
Chemical Substances	Appetite Depressants ; Dopamine Agents ; Serotonin Agents ; Fenfluramine (2DS058H2CF) ; Phentermine (C045TQL4WP)
Language	English
Publishing date	1998-02-15
Publishing country	United States
Document type	Editorial
ZDB-ID	412694-4
ISSN	0002-838X ; 0572-3612
ISSN	0002-838X ; 0572-3612
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Zs.B 848: Show issues

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Article: Gender differences in older patients with pressure-overload hypertrophy of the left ventricle.

Aurigemma, G P / Gaasch, W H

Cardiology

1995 Volume 86, Issue 4, Page(s) 310–317

Abstract: Left ventricular hypertrophy is an adaptive response to increased intraventricular pressure, and is consistently encountered in patients with hypertension or aortic stenosis. While it has long been appreciated that the extent of hypertrophy correlates ... ...

Abstract	Left ventricular hypertrophy is an adaptive response to increased intraventricular pressure, and is consistently encountered in patients with hypertension or aortic stenosis. While it has long been appreciated that the extent of hypertrophy correlates positively with the level of pressure, the age of the individual, and with indices of body size, recent evidence suggests that left ventricular structure and function also varies with gender. Elderly women with aortic stenosis, in several recent studies, have been shown to develop more marked concentric hypertrophy, lower levels of wall stress, and higher indices of systolic function. Similarly, in recent studies of extreme hypertensive hypertrophy, there is a strong female preponderance. The explanation for these findings is not clear at present, though it is possible that men with extensive hypertrophy have succumbed to complications of vascular disease at an earlier age. The syndrome of extreme hypertrophy complicating hypertension and aortic stenosis, more commonly seen in women, requires a carefully tailored clinical approach.
MeSH term(s)	Age Factors ; Aortic Valve Stenosis/complications ; Cardiomyopathy, Hypertrophic/complications ; Female ; Humans ; Hypertension/complications ; Hypertrophy, Left Ventricular/etiology ; Hypertrophy, Left Ventricular/pathology ; Hypertrophy, Left Ventricular/physiopathology ; Male ; Sex Factors ; Ventricular Pressure
Language	English
Publishing date	1995
Publishing country	Switzerland
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	80092-2
ISSN	1421-9751 ; 0008-6312
ISSN (online)	1421-9751
ISSN	0008-6312
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Ui IV Zs.31: Show issues

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Article: Worsening of mitral regurgitation secondary to ventricular pacing.

Hanna, S R / Chung, E S / Aurigemma, G P / Meyer, T E

The Journal of heart valve disease

2000 Volume 9, Issue 2, Page(s) 273–275

Abstract: A 68-year-old woman was admitted to hospital for possible mitral valve surgery for severe mitral regurgitation (MR). Six months before admission, a DDD pacemaker was implanted for symptomatic bradycardia. She developed atrial fibrillation and the pacer ... ...

Abstract	A 68-year-old woman was admitted to hospital for possible mitral valve surgery for severe mitral regurgitation (MR). Six months before admission, a DDD pacemaker was implanted for symptomatic bradycardia. She developed atrial fibrillation and the pacer was changed to a VVI mode. At cardiac catheterization, the pulmonary artery and wedge pressures were elevated; coronary angiography showed non-obstructive coronary artery disease. 2-D echocardiography confirmed preserved left ventricular function, severe MR and moderate tricuspid regurgitation. The change in pacing had a dramatic effect on MR severity; ventricular pacing was associated with a MR jet that occupied a larger area of the left atrium than with the unpaced rhythm, the continuous-wave mitral regurgitant Doppler profile was 'dagger'-shaped, and the signal intensity stronger compared with the unpaced rhythm. These findings are consistent with severe MR. The pacer was reprogrammed to reduce the pacing rate from 70 to 45 beats/min, allowing an unpaced rhythm for the most part. The patient improved and was discharged two days later. Six months later she was asymptomatic; repeat echocardiography confirmed mild to moderate MR.
MeSH term(s)	Aged ; Disease Progression ; Echocardiography, Doppler, Color ; Female ; Follow-Up Studies ; Heart Rate/physiology ; Hemodynamics/physiology ; Humans ; Mitral Valve/diagnostic imaging ; Mitral Valve/physiopathology ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/physiopathology ; Pacemaker, Artificial
Language	English
Publishing date	2000-03
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1205265-6
ISSN	2053-2644 ; 0966-8519
ISSN (online)	2053-2644
ISSN	0966-8519
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Zs.A 4109: Show issues

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Article: Managing asymptomatic patients with chronic mitral regurgitation.

Gaasch, W H / John, R M / Aurigemma, G P

Chest

1995 Volume 108, Issue 3, Page(s) 842–847

MeSH term(s)	Atrial Fibrillation/etiology ; Chronic Disease ; Heart Valve Prosthesis ; Humans ; Hypertrophy, Left Ventricular/etiology ; Mitral Valve/surgery ; Mitral Valve Insufficiency/complications ; Mitral Valve Insufficiency/physiopathology ; Mitral Valve Insufficiency/therapy ; Vasodilator Agents/therapeutic use ; Ventricular Dysfunction, Left/etiology
Chemical Substances	Vasodilator Agents
Language	English
Publishing date	1995-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1378/chest.108.3.842
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Ui III Zs.45: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 349: Show issues

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Article: Left ventricular length-force-shortening relations before and after surgical correction of chronic mitral regurgitation.

Goldfine, H / Aurigemma, G P / Zile, M R / Gaasch, W H

Journal of the American College of Cardiology

1998 Volume 31, Issue 1, Page(s) 180–185

Abstract: Objectives: We tested the hypothesis that postoperative left ventricular (LV) systolic wall stress can be predicted from the change in LV diastolic dimension and ejection fraction (EF) after surgical correction of chronic mitral regurgitation (MR). We ... ...

Abstract	Objectives: We tested the hypothesis that postoperative left ventricular (LV) systolic wall stress can be predicted from the change in LV diastolic dimension and ejection fraction (EF) after surgical correction of chronic mitral regurgitation (MR). We used a simple mathematic model to predict postoperative systolic stress from end-diastolic dimension and EF. The validity of this model was assessed using data from 21 patients undergoing mitral valve replacement (MVR) for chronic MR. Background: The decline in EF after MVR for chronic MR is traditionally thought to be a consequence of a postoperative increase in afterload, caused by closure of a low resistance runoff into the left atrium. However, consideration of the Laplace relation suggests that afterload does not necessarily increase after the operation. Methods: A spherical mathematical model of the left ventricle was used to define the relations between LV end-diastolic dimension, systolic wall stress and EF. To test the validity of this model, clinical and echocardiographic data were obtained from 21 patients with chronic MR before and 10 to 14 days after MVR. These echocardiographic data were examined with reference to plots derived from the mathematical model. Results: Patients were categorized as those in whom end-diastolic dimension declined after the operation (group I, n = 15) and those with no reduction in end-diastolic dimension (group II, n = 6). Group I patients were subclassified into those undergoing MVR with chordal preservation (group Ia) and those undergoing MVR with chordal transection (group Ib). In groups Ib and II, there were significant reductions in EF (56 +/- 3% to 48 +/- 3% in group Ib and 50 +/- 2% to 40 +/- 3% in group II, both p < 0.05), but the changes in end-diastolic dimension and wall stress differed. In group Ib, end-diastolic dimension decreased and systolic wall stress was unchanged; in group II, end-diastolic dimension was unchanged and wall stress increased. In contrast, group Ia patients experienced a substantial reduction in end-diastolic dimension, no change in EF and a reduction in stress. The corresponding length-force-shortening coordinates closely approximate those predicted from a mathematic model relating end-diastolic dimension to EF and systolic wall stress. Conclusions: Concordant echocardiographic and mathematical model results indicate that postoperative changes in systolic stress are directly related to changes in chamber size and that LV afterload may fall when chordal preservation techniques are used in combination with MVR.
MeSH term(s)	Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/physiopathology ; Mitral Valve Insufficiency/surgery ; Models, Cardiovascular ; Myocardial Contraction ; Postoperative Period ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	1998-01
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/s0735-1097(97)00453-1
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Which indexes of filling behavior should be used to characterize left ventricular diastolic function when changes in heart rate and atrioventricular delay occur?

Meyer, T E / Casadei, B / Aurigemma, G P / Gaasch, W H

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

1997 Volume 10, Issue 7, Page(s) 689–698

Abstract: The routine use of the peak early-to-peak atrial velocity, early velocity integral-to-atrial velocity integral, and early velocity integral-to-the total filling velocity integral ratios are limited because they are influenced by heart rate and ... ...

Abstract	The routine use of the peak early-to-peak atrial velocity, early velocity integral-to-atrial velocity integral, and early velocity integral-to-the total filling velocity integral ratios are limited because they are influenced by heart rate and atrioventricular delay. Hence, we sought to establish whether these ratios could be normalized to account for the differences in cycle length (RR interval) and diastolic filling period when heart rate and atrioventricular delay were altered in 18 patients with programmable dual-chamber pacemakers. We further explored whether these and other parameters of the mitral velocity profile could be used to characterize the mitral filling pattern during isoproterenol and methoxamine infusions-interventions that are likely to change both heart rate and left ventricular filling. The early velocity integral-to-atrial velocity integral and early velocity integral-to-the total filling velocity integral ratios were more sensitive to minor variations in heart rate and atrioventricular delay than the peak early-to-peak atrial velocity ratio. The early velocity integral-to-atrial velocity integral and early velocity integral-to-total filling velocity integral ratios could not be normalized to account for differences in RR interval or diastolic filling period, whereas the peak early-to-peak atrial velocity ratio became less sensitive to changes in heart rate when it was divided by the RR interval, or diastolic filling period, or square root of diastolic filling period. Because the diastolic filling period is affected by atrioventricular delay independent of changes in the RR interval, these ratios were also corrected for the functional cycle length, defined as the interval from R-wave of the electrocardiogram to the end of the diastolic filling period. When corrected for either the functional cycle length or diastolic filling period or square root of diastolic filling period, only the peak early-to-peak atrial velocity ratio became less sensitive to variations in the atrioventricular delay. The ratio of diastolic filling period expressed as a proportion of RR interval or functional cycle length changed significantly when heart rate and atrioventricular delay were altered and did not improve when diastolic filling period was divided by the square root of RR or square root of functional cycle length. However, when the square root of diastolic filling period was divided by the RR interval or functional cycle length, the effects of heart rate and atrioventricular delay were not apparent. Of all the ratios, the ratio of square root of diastolic filling period expressed as a proportion of RR interval or functional cycle length was the most useful to differentiate the confounding effects of heart rate (+/-atrioventricular delay) from the effects of isoproterenol and methoxamine on left ventricular filling. Hence, this ratio appeared to be a heart rate- and atrioventricular delay-independent index of left ventricular diastolic function.
MeSH term(s)	Aged ; Atrial Function/drug effects ; Atrial Function/physiology ; Atrioventricular Node/drug effects ; Atrioventricular Node/physiology ; Blood Flow Velocity/drug effects ; Blood Flow Velocity/physiology ; Blood Pressure/drug effects ; Cardiac Output/drug effects ; Cardiac Output/physiology ; Cardiac Pacing, Artificial ; Cardiotonic Agents/pharmacology ; Diastole/drug effects ; Diastole/physiology ; Echocardiography, Doppler ; Electrocardiography/drug effects ; Female ; Heart Block/physiopathology ; Heart Block/therapy ; Heart Rate/drug effects ; Heart Rate/physiology ; Humans ; Isoproterenol/pharmacology ; Male ; Methoxamine/pharmacology ; Middle Aged ; Mitral Valve/drug effects ; Mitral Valve/physiology ; Pacemaker, Artificial ; Sick Sinus Syndrome/physiopathology ; Sick Sinus Syndrome/therapy ; Vasoconstrictor Agents/pharmacology ; Ventricular Function, Left/drug effects ; Ventricular Function, Left/physiology
Chemical Substances	Cardiotonic Agents ; Vasoconstrictor Agents ; Methoxamine (HUQ1KC1YLI) ; Isoproterenol (L628TT009W)
Language	English
Publishing date	1997-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/s0894-7317(97)70110-x
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Zs.A 2638: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MG 55: Show issues

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Article: Measurement of left ventricular mass: methodology and expertise.

Devereux, R B / Pini, R / Aurigemma, G P / Roman, M J

Journal of hypertension

1997 Volume 15, Issue 8, Page(s) 801–809

Abstract: The strong relation between increased left ventricular mass and cardiovascular events makes accurate measurement of left ventricular mass a high priority, especially in patients with hypertension. M-mode echocardiography is used most widely to measure ... ...

Abstract	The strong relation between increased left ventricular mass and cardiovascular events makes accurate measurement of left ventricular mass a high priority, especially in patients with hypertension. M-mode echocardiography is used most widely to measure left ventricular mass because of its wide availability, moderate expense, anatomic and prognostic validation and lack of radiation or claustrophobia; however, this technique is expertise-dependent and may give erroneous results in distorted ventricles. Two-dimensional and especially three-dimensional echocardiography increase the precision with which left ventricular mass is measured but they are more time-consuming and difficult to perform on a large scale. Magnetic resonance imaging provides highly accurate left ventricular mass measurements and permits tissue imaging but its use is limited by expensive, fixed facilities and claustrophobia. Cine computed X-ray tomography also measures left ventricular mass accurately and permits perfusion assessment with contrast injection but it involves radiation and the use of fixed facilities of limited availability. Understanding the strengths and limitations of available techniques can facilitate selection of the most appropriate method to measure left ventricular mass in a particular setting.
MeSH term(s)	Animals ; Diagnostic Imaging/methods ; Echocardiography ; Heart Ventricles/pathology ; Humans ; Hypertension/pathology ; Hypertrophy, Left Ventricular/diagnosis ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed
Language	English
Publishing date	1997-08
Publishing country	England
Document type	Editorial ; Research Support, U.S. Gov't, P.H.S. ; Review
ZDB-ID	605532-1
ISSN	1473-5598 ; 0263-6352 ; 0952-1178
ISSN (online)	1473-5598
ISSN	0263-6352 ; 0952-1178
DOI	10.1097/00004872-199715080-00002
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Zs.A 1885: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 614: Show issues

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Article: Radiation-associated valvular heart disease in Hodgkin's disease is associated with characteristic thickening and fibrosis of the aortic-mitral curtain.

Brand, M D / Abadi, C A / Aurigemma, G P / Dauerman, H L / Meyer, T E

The Journal of heart valve disease

2001 Volume 10, Issue 5, Page(s) 681–685

Abstract: Radiation-associated valvular dysfunction is characterized by variable aortic and mitral valve thickening. A review of three patients assessed echocardiographically revealed that radiation-associated valvular dysfunction after radiation treatment for ... ...

Abstract	Radiation-associated valvular dysfunction is characterized by variable aortic and mitral valve thickening. A review of three patients assessed echocardiographically revealed that radiation-associated valvular dysfunction after radiation treatment for Hodgkin's disease may be characterized by a unique and consistent pattern of thickening of the aortic and mitral valves involving the aortic-mitral curtain.
MeSH term(s)	Aortic Valve/radiation effects ; Female ; Heart Valve Diseases/etiology ; Heart Valve Diseases/mortality ; Hodgkin Disease/complications ; Hodgkin Disease/mortality ; Hodgkin Disease/radiotherapy ; Humans ; Male ; Middle Aged ; Mitral Valve/radiation effects ; Radiation Pneumonitis/complications ; Radiation Pneumonitis/mortality ; Treatment Failure
Language	English
Publishing date	2001-09
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1205265-6
ISSN	2053-2644 ; 0966-8519
ISSN (online)	2053-2644
ISSN	0966-8519
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Zs.A 4109: Show issues

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Article: Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study.

Aurigemma, G P / Gottdiener, J S / Shemanski, L / Gardin, J / Kitzman, D

Journal of the American College of Cardiology

2001 Volume 37, Issue 4, Page(s) 1042–1048

Abstract: Objectives: We sought to assess the ability of echocardiographic indices of systolic and diastolic function to predict incident congestive heart failure (CHF).: Background: Noninvasive indices of subclinical systolic and/or diastolic dysfunction that ...

Abstract	Objectives: We sought to assess the ability of echocardiographic indices of systolic and diastolic function to predict incident congestive heart failure (CHF). Background: Noninvasive indices of subclinical systolic and/or diastolic dysfunction that can be used to identify patients in a transition phase between normal cardiac function and clinical CHF would be valuable. Though midwall shortening and Doppler mitral inflow patterns are seemingly well suited to predict subsequent CHF, the predictive value of these indices has not been investigated. Methods: We studied 2,671 participants in the Cardiovascular Health Study who were free of coronary heart disease, CHF or atrial fibrillation. Clinical and quantitative echocardiographic data were obtained in all participants. Results: At a mean follow-up of 5.2 years (range 0 to 6 years), 170 participants (6.4% of the cohort) developed CHF. Although 96% of these participants had normal or borderline ejection fraction (EF) at baseline, only 57% had normal or borderline EF at the time of hospitalization. In multivariate modeling, fractional shortening at the endocardium (relative risk [RR] 1.85 per 10-unit decrease, confidence interval [CI] 1.27 to 2.39), fractional shortening at the midwall (RR 1.29 per five-unit decrease, 95% CI 1.11-1.51) and peak Doppler peak E (RR 1.15 for each 0.1 M/s increment; CI 1.02 to 1.21) independently predicted incident CHF. Both high and low Doppler E/A ratios were predictive of incident CHF. Conclusions: Roughly half the occurrences of CHF in this population are associated with normal or borderline EF. Echocardiographic findings suggestive of subclinical contractile dysfunction and diastolic filling abnormalities are both predictive of subsequent CHF. The standard (FSendo) and refined (FSmw) parameters of systolic function performed similarly in this regard, though subjects with left ventricular hypertrophy and depressed FSmw are at particularly high risk for subsequent CHF.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Diastole ; Echocardiography ; Female ; Follow-Up Studies ; Heart Failure/diagnostic imaging ; Heart Failure/physiopathology ; Humans ; Male ; Multivariate Analysis ; Myocardial Contraction ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Risk Factors ; Systole
Language	English
Publishing date	2001-03-15
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/s0735-1097(01)01110-x
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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