ble congestive heart failure. The results indicate that titration of hydralazine dose guided by specific clinical and hemodynamic end points permits the withdrawal of intravenous inotropic support in severely compromised patients who have become dependent on therapy with dobutamine. 1. Tuttle RR, Mills J. Dobutamine: development of a new catecholamine to selectively increase cardiac contractility. Circ Res 1975;35:185-196. 2. Leier CV, Webel J, Bush CA. The cardiovascular effects of the continuous infusion of dobutamine in patients with severe cardiac failure. Circulation 1977;56:468-472. 3. Leier CV, Unverferth DV. Drugs five years later: dobutamine. Annlntern Med 1983;99:490-496.
4. Leier CV, Heban P, Huss P, Bush CA, Lewis RP. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation 1977;58:466-475. 5. Packer M. Vasodilator and inotropic drugs for the treatment of chronic heart failure: distinguishing hype from hope. J Am CON Cwdiol 1988;12:1299-1317.
6. Magorien
he mitral valve “splitability” score has been devised as a composite index of valve mobility, thickening, calcium deposits and subvalvular disease. 1 The score is useful for selecting patients for mitral balloon valvuloplasty, and correlates with the immediate and long-term response to this procedure.2T3 These patients are often studied using transesophageal echocardiography (TEE) to further evaluate the severity of mitral regurgitation and the presence of left atria1 thrombi.4 The purpose of this study was to compare the results of the “splitability score” for transthoracic echocardiography (TTE) and TEE. Over a 2-year period, 45patients (40 women, mean age 48 f 13 years) undergoing mitral balloon valvuloplasty were studied by TTE and uniplane TEE. All had at least moderately severe mitral stenosis (meari mitral valve area 1.1 f 0.2 cm2), and none had >2+ (moderate) mitral regurgitation. The mitral valve area was calculated using the pressure half-time method, and conventional 2-dimensional views for TTE and TEE (including transgastric short-axis and transesophageal 4-chamber views) were obtained. Recording was made on ‘/z-inch VHS video tape, and results were interpreted later by
T
From the Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio. Dr. Marwick’s address is Service. de Cardiologie, University of Louvain Medical School, Cliniques Universitaires St. Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium. Manuscript received March 26,199l; revised manuscript received June 13,1991, and accepted June 14.
1106
THE AMERICAN
JOURNAL
OF CARDIOLOGY
VOLUME
68
DV, Leier CV. Hydralazine therapy in chronic and regional hemodynamic responses.
7. Leier CV, Desch CE, Magorien RD, Triffon DW, Unverferth DV, Boudoulas H, Lewis RP. Positive inotropic effects of hydralazine in human subjects comparison with prazosin in the setting of congestive heart failure. Am J Curdiol
1980461039-1044, , .
6. Binkley PF, VanFossen DB, Unverferth DV, Leier CV. The therapeutic efficacy of hydralazine: a positive inotropic component? (abstr) Chin Res 1989;37:247. 9. Gershwin ME, Smith NJ. Mode of action of hydralazine on guinea pig atria. Arch fnt Pharmacodyn 1967;170:108-116. 10. Khatri T, Mason DJ, Lee G. Direct inotropic effects of afterload reducing agents, hydralazine and prazosin, evaluated in isolated cat papillary muscle preparation (abstr). Am J Cardiol 1978;41:388. 11. Robinowitz B, Parmley WW, Har-Zakav Y, Elazar E, Blumlein S, Nerinsky R, Neufeld HN. Correlation between effects of hydralazine on force and on the adenyl cyclase system of bentricular myccardium in dogs and cats. Curdiouac Res 1986;20:215-220. 12. Binkley PF, Van Fossen DB, Nunziata E, Unverferth DV, Leier CV. Influence of positive inotropic therapy on pulsatile hydraulic load and ventricularvascular coupling in congestive heart failure. J Am CON Cardiol 1990;15: 1127-1135.
Assessment of the Mitral Valve Splitability and Transesophageal Echocardiography Thomas H. Marwick, MD, Julius Torelli, MD, Timothy and William J. Stewart, MD
RD, Unverferth
congestive failure: sustained central Anz J Medheart 198477:267-274,
Score by Transthoracic
Obarski, DO, Paul N. Casale, MD,
2 independent observers in a random sequence. The mitral splitability score was thus calculated separately for TTE and TEE in each patient, without knowledge of the results of the other technique. In situations of discrepancy, the score was determined by consensus. The total TTE score was 7.2 f 1.8, significantly higher (Figure 1) than that assessed in the same group using TEE (5.9 f 1.8, p = 0.002). Equal scores were present in 9 patients, and 2 had TEE scores greater than TTE. The remaining 34patients had TEE scores less than TTE; the difference was 1 point in 21 patients, 2 points in 7 patients, and >3 points in 6 patients. .. u m b e r
‘TE
i7.2d.8) (s.s+rE)
p
4. Leier CV, Heban P, Huss P, Bush CA, Lewis RP. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation 1977;58:466-475. 5. Packer M. Vasodilator and inotropic drugs for the treatment of chronic heart failure: distinguishing hype from hope. J Am CON Cwdiol 1988;12:1299-1317.
6. Magorien
he mitral valve “splitability” score has been devised as a composite index of valve mobility, thickening, calcium deposits and subvalvular disease. 1 The score is useful for selecting patients for mitral balloon valvuloplasty, and correlates with the immediate and long-term response to this procedure.2T3 These patients are often studied using transesophageal echocardiography (TEE) to further evaluate the severity of mitral regurgitation and the presence of left atria1 thrombi.4 The purpose of this study was to compare the results of the “splitability score” for transthoracic echocardiography (TTE) and TEE. Over a 2-year period, 45patients (40 women, mean age 48 f 13 years) undergoing mitral balloon valvuloplasty were studied by TTE and uniplane TEE. All had at least moderately severe mitral stenosis (meari mitral valve area 1.1 f 0.2 cm2), and none had >2+ (moderate) mitral regurgitation. The mitral valve area was calculated using the pressure half-time method, and conventional 2-dimensional views for TTE and TEE (including transgastric short-axis and transesophageal 4-chamber views) were obtained. Recording was made on ‘/z-inch VHS video tape, and results were interpreted later by
T
From the Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio. Dr. Marwick’s address is Service. de Cardiologie, University of Louvain Medical School, Cliniques Universitaires St. Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium. Manuscript received March 26,199l; revised manuscript received June 13,1991, and accepted June 14.
1106
THE AMERICAN
JOURNAL
OF CARDIOLOGY
VOLUME
68
DV, Leier CV. Hydralazine therapy in chronic and regional hemodynamic responses.
7. Leier CV, Desch CE, Magorien RD, Triffon DW, Unverferth DV, Boudoulas H, Lewis RP. Positive inotropic effects of hydralazine in human subjects comparison with prazosin in the setting of congestive heart failure. Am J Curdiol
1980461039-1044, , .
6. Binkley PF, VanFossen DB, Unverferth DV, Leier CV. The therapeutic efficacy of hydralazine: a positive inotropic component? (abstr) Chin Res 1989;37:247. 9. Gershwin ME, Smith NJ. Mode of action of hydralazine on guinea pig atria. Arch fnt Pharmacodyn 1967;170:108-116. 10. Khatri T, Mason DJ, Lee G. Direct inotropic effects of afterload reducing agents, hydralazine and prazosin, evaluated in isolated cat papillary muscle preparation (abstr). Am J Cardiol 1978;41:388. 11. Robinowitz B, Parmley WW, Har-Zakav Y, Elazar E, Blumlein S, Nerinsky R, Neufeld HN. Correlation between effects of hydralazine on force and on the adenyl cyclase system of bentricular myccardium in dogs and cats. Curdiouac Res 1986;20:215-220. 12. Binkley PF, Van Fossen DB, Nunziata E, Unverferth DV, Leier CV. Influence of positive inotropic therapy on pulsatile hydraulic load and ventricularvascular coupling in congestive heart failure. J Am CON Cardiol 1990;15: 1127-1135.
Assessment of the Mitral Valve Splitability and Transesophageal Echocardiography Thomas H. Marwick, MD, Julius Torelli, MD, Timothy and William J. Stewart, MD
RD, Unverferth
congestive failure: sustained central Anz J Medheart 198477:267-274,
Score by Transthoracic
Obarski, DO, Paul N. Casale, MD,
2 independent observers in a random sequence. The mitral splitability score was thus calculated separately for TTE and TEE in each patient, without knowledge of the results of the other technique. In situations of discrepancy, the score was determined by consensus. The total TTE score was 7.2 f 1.8, significantly higher (Figure 1) than that assessed in the same group using TEE (5.9 f 1.8, p = 0.002). Equal scores were present in 9 patients, and 2 had TEE scores greater than TTE. The remaining 34patients had TEE scores less than TTE; the difference was 1 point in 21 patients, 2 points in 7 patients, and >3 points in 6 patients. .. u m b e r
‘TE
i7.2d.8) (s.s+rE)
p
