Members of the Chamber Quantification Writing Group are: Roberto M. Lang, MD, FASE, Michelle Bierig, MPH, RDCS, FASE, Richard B. Devereux, MD, Frank A. Flachskampf, MD, Elyse Foster, MD, Patricia A. Pellikka, MD, Michael H. Picard, MD, Mary J. Roman, MD, James Seward, MD, Jack S. Shanewise, MD, FASE, Scott D. Solomon, MD, Kirk T. Spencer, MD, FASE, Martin St John Sutton, MD, FASE, and William J. Stewart, MD

http://www.botonimarco.it/files/chamberquantification.pdf

Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.

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It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

/pdf/acc-aha-2006-guidelines-for-the-management-of-patients-with-27qfh9fc7i.pdf

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

We have presented recommendations for the optimum acquisition of quantitative two-dimensional data in the current echocardiographic environment. It is likely that advances in imaging may enhance or supplement these approaches. For example, three-dimensional reconstruction methods may greatly augment the accuracy of volume determination if they become more efficient. The development of three-dimensional methods will depend in turn on vastly improved transthoracic resolution similar to that now obtainable by transesophageal echocardiography. Better resolution will also make the use of more direct methods of measuring myocardial mass practical. For example, if the epicardium were well resolved in the long-axis apical views, the myocardial shell volume could be measured directly by the biplane method of discs rather than extrapolating myocardial thickness from a single short-axis view. At present, it is our opinion that current technology justifies the clinical use of the quantitative two-dimensional methods described in this article. When technically feasible, and if resources permit, we recommend the routine reporting of left ventricular ejection fraction, diastolic volume, mass, and wall motion score.

Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms.

on Statement: Society of Echocardiography is accreditedby theAccreditationCouncil for edical Education to provide continuingmedical education for physicians. n Society of Echocardiography designates this educational activity for of 1.0 AMA PRA Category 1 Credits . Physicians should only claim credit te with the extent of their participation in the activity. CCI recognize ASE’s certificates and have agreed to honor the credit hours registry requirements for sonographers. Society of Echocardiography is committed to ensuring that its educational ll sponsored educational programs are not influencedby the special interests ation or individual, and itsmandate is to retain only those authors whose fists canbeeffectively resolved tomaintain thegoals andeducational integrity y. While a monetary or professional affiliation with a corporation does not fluence an author’s presentation, the Essential Areas and policies of the ire that any relationships that could possibly conflict with the educational activity be resolved prior to publication and disclosed to the audience. f faculty and commercial support relationships, if any, have been indicated. ience: is designed for all cardiovascular physicians and cardiac sonographers with erest and knowledge base in the field of echocardiography; in addition, reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.

https://www.nationaljewish.org/getattachment/programs/directory/cardiology/pulmonary-hypertension-center/Echo-Guidelines-for-RV-JASE-2010.pdf.aspx

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography

The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines was formed to make recommendations regarding the diagnosis and treatment of patients with known or suspected cardiovascular disease. Coronary artery disease (CAD) is the leading cause of death in the United States. Unstable angina (UA) and the closely related condition non–ST-segment elevation myocardial infarction (NSTEMI) are very common manifestations of this disease. These life-threatening disorders are a major cause of emergency medical care and hospitalizations in the United States. In 1996, the National Center for Health Statistics reported 1 433 000 hospitalizations for UA or NSTEMI. In recognition of the importance of the management of this common entity and of the rapid advances in the management of this condition, the need to revise guidelines published by the Agency for Health Care Policy and Research (AHCPR) and the National Heart, Lung and Blood Institute in 1994 was evident. This Task Force therefore formed the current committee to develop guidelines for the management of UA and NSTEMI. The present guidelines supersede the 1994 guidelines.

The customary ACC/AHA classifications I, II, and III summarize both the evidence and expert opinion and provide final recommendations for both patient evaluation and therapy:

Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective .

Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. 

Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy. 

Class IIb: Usefulness/efficacy is less well established by evidence/opinion. 

Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful. 

The weight of the evidence was ranked highest (A) if the data …

/pdf/acc-aha-guidelines-for-the-management-of-patients-with-4ru5c6nutz.pdf

ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on the management of patients with unstable angina)

An echocardiographic index for separation of right ventricular volume and pressure overload.

Echocardiographic manifestations of valvular vegetations

Cross-sectional echocardiography was used to study left ventricular wall motion in 44 patients with myocardial infarction, and the extent of observed asynergy was correlated with left ventricular function. Echocardiographic studies were performed in short and long axes of the ventricle and nine segments were identified for analysis. Wall motion in each segment was classified as normal, hyperkinetic, hypokinetic, akinetic or dyskinetic. Based on this analysis a wall motion index was derived as an overall assessment of left ventricular asynergy. Left ventricular function was measured by clinical and hemodynamic parameters to note the presence of pulmonary congestion or peripheral hypoperfusion or both.Segmental asynergy was detected in all patients with acute myocardial infarction. Patients with uncomplicated infarction had a wall motion index of 3.2 ± 2.4, which was significantly less than that in patients with pulmonary congestion (9.7 ± 3.1, p < 0.001) or with both pulmonary congestion and hypoperfusion (10.6 ± 4.8, p < 0.001).In nine patients with acute ventricular septal defect or acute mitral regurgitation, wall motion index was 6.7 ± 1.9, significantly less than with other complicated infarcts (p < 0.001) but greater than with uncomplicated infarcts (p < 0.005). Wall motion index also discriminated complicated from uncomplicated infarction when death was used as the end point.Cross-sectional echocardiography provides a method of measuring the extent of left ventricular asynergy during acute myocardial infarction that correlates well with hemodynamic parameters of left ventricular function.

Cross-sectional echocardiographic analysis of the extent of left ventricular asynergy in acute myocardial infarction.

Left ventricular asynergy associated with acute myocardial infarction was evaluated by crosssectional echocardiography. Patients with acute infarction were studied within 48 hours of admission, and a segmental analysis of left ventricular wall motion was performed using nine segments obtained by short- and long-axis recordings of the left ventricle. By this segmental approach, analysis of wall motion in the entire left ventricle was possible. Complete studies were recorded in 37 of 44 original patients. Segmental wall motion abnormalities were recorded and localized in each of the 37 study patients. Asynergy was detected in 142 segments, and 29 patients had multiple segment involvement. Asynergy was most common in the apical segments of the left ventricle, but the cross-sectional scans permitted detection of asynergy in all segments. Correlation between the ECG and the cross-sectional echocardiogram revealed that 19 of 20 patients with inferior infarction had asynergy in posterior segments, 14 of 14 patients with anterior infarction had asynergy in anterior segments, and three of three patients with anteroinferior infarction had asynergy both anterior and posterior segments. In addition, the location of segmental asynergy followed specific patterns for each ECG subgroup of infarction. In four patients with postmortem examination, 21 of 22 segments that had asynergy by cross-sectional echocardiography also had pathologic evidence of infarction. Therefore, the cross-sectional echocardiogram provides a reliable method for detecting the presence and location of regional asynergy associated with acute myocardial infarction.

Cross-sectional echocardiography in acute myocardial infarction: detection and localization of regional left ventricular asynergy.

Echocardiographic studies were performed on 39 adult patients with atrial septal defects. Findings were compared with those from normal subjects, patients with other congenital left-to-right shunts (ventricular septal defect and patent ductus arteriosus), patients with uncomplicated right ventricular pressure overload (pulmonic stenosis and pulmonary hypertension), and patients with pulmonary hypertension complicated by tricuspid regurgitation. Two echocardiographic features were assessed: 1) a right ventricular dimension, or RVD Index, representing the distance between the right ventricular epicardial echoes and echoes from the right side of the interventricular septum divided by the patient's body surface area, and 2) motion of the interventricular septum. The increased RVD Index and abnormal septal motion observed in the patients with atrial septal defects provided an ultrasound complex that could clearly separate these patients from normal individuals, those with ventricular septal defect and patent d...

James C. Dillon

Papers

An echocardiographic index for separation of right ventricular volume and pressure overload.

Echocardiographic manifestations of valvular vegetations

Cross-sectional echocardiographic analysis of the extent of left ventricular asynergy in acute myocardial infarction.

Cross-sectional echocardiography in acute myocardial infarction: detection and localization of regional left ventricular asynergy.

Echocardiographic Features of Atrial Septal Defect