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[Echocardiographic features of small heart]
Insights
Individuals with a small cardiac silhouette on chest X-rays have smaller heart dimensions, but normal hemodynamics when corrected for body size. Some experience cardiovascular symptoms, and mitral valve prolapse is common.
Area of Science:
- Cardiology
- Radiology
- Echocardiography
Background:
- A small cardiac silhouette on chest radiography (cardiothoracic ratio ≤ 40%) may have unclear clinical significance.
- Associated physical characteristics include straight spines and decreased chest anteroposterior diameters.
- Patients with small hearts often report cardiovascular complaints like chest pain, palpitations, dyspnea, and dizziness.
Purpose of the Study:
- To investigate the clinical significance of a small heart (cardiac silhouette) using echocardiography.
- To compare echocardiographic and hemodynamic parameters between individuals with small hearts and normal controls.
Main Methods:
- Echocardiographic study involving 60 individuals with small hearts (cardiothoracic ratio ≤ 40%) and 23 matched controls (cardiothoracic ratio 42%-50%).
- Two-dimensional and M-mode echocardiography were performed to assess cardiac dimensions and function.
- Hemodynamic indices at rest were calculated and compared between groups.
Main Results:
- The small heart group had significantly lower body weight and body surface area (BSA).
- Cardiac dimensions (left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial dimension, left ventricular mass) were smaller in the small heart group but normalized when corrected for BSA.
- No significant differences in resting hemodynamic indices (heart rate, stroke volume, ejection fraction, cardiac output) were observed between the groups.
- Mitral valve prolapse (MVP) was diagnosed in 32% of the small heart group.
Conclusions:
- A small cardiac silhouette is associated with smaller body size and cardiac dimensions, but not with impaired cardiac function or hemodynamics when adjusted for body size.
- Mitral valve prolapse is a frequent finding in individuals with small hearts.
- Further investigation may be warranted for symptomatic individuals with small hearts, particularly those with MVP.
Abstract:
To clarify the clinical significance of a small heart; i.e., a small cardiac silhouette on chest radiography, an echocardiographic study was performed. Sixty persons with small heart according to cardiothoracic ratios less than or equal to 40%, and 23 age- and sex-matched normal controls (42% less than cardiothoracic ratio less than or equal to 50%) received two-dimensional and M-mode echocardiography. The body weights and body surface areas (BSA) in the small heart group were significantly less than those in the control group. On the lateral chest radiographs, numerous cases with small heart had straight spines and chests with decreased anteroposterior diameters. More than half of the small heart group had a variety of cardiovascular complaints, including chest pain, palpitation, dyspnea, and dizziness. Echocardiographic measurements were performed and hemodynamic indices were calculated. The results were as follows: Left ventricular dimension at end-diastole (LVDd), left ventricular dimension at end-systole (LVDs), left atrial dimension (LAD), and left ventricular mass (LV mass) of the small heart group were significantly less than those of the control group. There were, however, no differences in the values corrected by BSA (LVDd/BSA, LVDs/BSA, LAD/BSA and LV mass/BSA) between the two groups. We found no differences in hemodynamic indices (heart rate, stroke volume, ejection fraction, and cardiac output) at rest between the small heart and control groups. Nineteen cases (32%) had mitral valve prolapse (MVP) on echocardiography in the small heart group. Characteristic phonocardiographic findings were found in 11 cases with MVP (systolic click in four, mitral regurgitant murmur in three, and both in four).(ABSTRACT TRUNCATED AT 250 WORDS)