Showing papers by "Jens-Uwe Voigt published in 2015"

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Abstract: The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.

Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging

Abstract: Recognizing the critical need for standardization in strain imaging, in 2010, the European Association of Echocardiography (now the European Association of Cardiovascular Imaging, EACVI) and the American Society of Echocardiography (ASE) invited technical representatives from all interested vendors to participate in a concerted effort to reduce intervendor variability of strain measurement. As an initial product of the work of the EACVI/ASE/Industry initiative to standardize deformation imaging, we prepared this technical document which is intended to provide definitions, names, abbreviations, formulas, and procedures for calculation of physical quantities derived from speckle tracking echocardiography and thus create a common standard.

Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors: The EACVI/ASE Inter-Vendor Comparison Study.

Abstract: Background This study was planned by the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging to (1) test the variability of speckle-tracking global longitudinal strain (GLS) measurements among different vendors and (2) compare GLS measurement variability with conventional echocardiographic parameters. Methods Sixty-two volunteers were studied using ultrasound systems from seven manufacturers. Each volunteer was examined by the same sonographer on all machines. Inter- and intraobserver variability was determined in a true test-retest setting. Conventional echocardiographic parameters were acquired for comparison. Using the software packages of the respective manufacturer and of two software-only vendors, endocardial GLS was measured because it was the only GLS parameter that could be provided by all manufactures. We compared GLS AV (the average from the three apical views) and GLS 4CH (measured in the four-chamber view) measurements among vendors and with the conventional echocardiographic parameters. Results Absolute values of GLS AV ranged from 18.0% to 21.5%, while GLS 4CH ranged from 17.9% to 21.4%. The absolute difference between vendors for GLS AV was up to 3.7% strain units ( P AV and 6.2% to 11.0% for GLS 4CH , while the intraobserver relative mean errors were 4.9% to 7.3% and 7.2% to 11.3%, respectively. These errors were lower than for left ventricular ejection fraction and most other conventional echocardiographic parameters. Conclusion Reproducibility of GLS measurements was good and in many cases superior to conventional echocardiographic measurements. The small but statistically significant variation among vendors should be considered in performing serial studies and reflects a reference point for ongoing standardization efforts.

Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy

Abstract: BackgroundData on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking. MethodsIn this multicenter case–control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months. ResultsA total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%)...

Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study

Abstract: Aims Reference values for Doppler parameters according to age and gender are recommended for the assessment of heart physiology, specifically for left ventricular (LV) diastolic function. In this study, we report normal reference ranges for Doppler parameters obtained in a large group of healthy volunteers. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following Doppler acquisition and measurement protocols approved by the European Association of Cardiovascular Imaging. Methods and results A total of 449 (mean age: 45.8 ± 13.7 years) healthy volunteers (198 men and 251 women) were enrolled at the collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was obtained from all subjects following predefined protocols. The majority of the Doppler diastolic parameters ( e ′, E / e ′) as well as right ventricle systolic s ′ wave velocity were similar in men and women. Left ventricle s ′ wave velocity was higher in men than in women. E wave and e ′ were higher in younger subjects and decreased progressively in the older ones. E / e ′ ratio increased with ageing. Septal e ′ <8 cm/s was present in 19.7% of the subjects in the 40–60 year group and in 55% of those in the ≥60 year group. However, the cut-off value of average E / e ′ or lateral E / e ′ remained <15 or 13, respectively, in the majority of patients. Conclusion The NORRE study provides the reference values for the most useful Doppler parameters in the evaluation of heart physiology. These data highlight the need of using age-specific reference values especially for the diagnosis of LV systolic and diastolic dysfunction and for the estimation of LV filling pressures.

Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes

Abstract: Aims Intense exercise places disproportionate strain on the right ventricle (RV) which may promote pro-arrhythmic remodelling in some athletes. RV exercise imaging may enable early identification of athletes at risk of arrhythmias. Methods and results Exercise imaging was performed in 17 athletes with RV ventricular arrhythmias (EA-VAs), of which eight (47%) had an implantable cardiac defibrillator (ICD), 10 healthy endurance athletes (EAs), and seven non-athletes (NAs). Echocardiographic measures included the RV end-systolic pressure–area ratio (ESPAR), RV fractional area change (RVFAC), and systolic tricuspid annular velocity (RV S′). Cardiac magnetic resonance (CMR) measures combined with invasive measurements of pulmonary and systemic artery pressures provided left-ventricular (LV) and RV end-systolic pressure–volume ratios (SP/ESV), biventricular volumes, and ejection fraction (EF) at rest and during intense exercise. Resting measures of cardiac function were similar in all groups, as was LV function during exercise. In contrast, exercise-induced increases in RVFAC, RV S′, and RVESPAR were attenuated in EA-VAs during exercise when compared with EAs and NAs ( P < 0.0001 for interaction group × workload). During exercise-CMR, decreases in RVESV and augmentation of both RVEF and RV SP/ESV were significantly less in EA-VAs relative to EAs and NAs ( P < 0.01 for the respective interactions). Receiver-operator characteristic curves demonstrated that RV exercise measures could accurately differentiate EA-VAs from subjects without arrhythmias [AUC for ΔRVESPAR = 0.96 (0.89–1.00), P < 0.0001]. Conclusion Among athletes with normal cardiac function at rest, exercise testing reveals RV contractile dysfunction among athletes with RV arrhythmias. RV stress testing shows promise as a non-invasive means of risk-stratifying athletes.

How to Define End-Diastole and End-Systole?: Impact of Timing on Strain Measurements

Abstract: Objectives This study aimed to investigate to what extent timing definitions influence strain measurements and which surrogates are reliable and feasible to define end-diastole (ED) and end-systole (ES) during speckle-tracking (STI) analysis. Background Current STI-based strain measurements are highly automated. It remains unclear when a particular analysis software defines the zero baseline and the systolic strain measurement position. Methods A total of 60 subjects (20 healthy volunteers, 20 patients with coronary artery disease, and 20 patients with typical left bundle-branch block) underwent a complete echocardiographic examination. In one-half of them, a real M-mode through the mitral valve was acquired for each electrocardiographic (ECG) lead of the echo machine. Timing of peak R and automatic ECG trigger were compared with mitral valve closure for every electrode. Mitral and aortic valve closure, as observed in the apical 3-chamber view, served as reference for ED and ES. With the use of these references, end-systolic global longitudinal strain (ES-GLS) and end-systolic segmental longitudinal strain (ES-SLS) longitudinal end-systolic strain were measured at baseline and after changing the definition of either ED or ES by ±4 frames. Furthermore, strain and volume curves derived from the same tracking, as well as the Doppler interrogation of the valves, were compared with the references. Results Depending on the selected lead, timing of the ECG-derived time markers changed considerably compared with mitral valve closure. Changing the definition of ED and ES resulted in significantly different ES-GLS and ES-SLS values in all subjects. ES-SLS in dyssynchronous hearts showed the highest sensitivity to timing definition. From all methods, spectral Doppler was the most reliable time marker in all subjects (p > 0.05). Conclusions Exact temporal definition of ED and ES has a major impact on the accuracy of strain measurements. After direct observation of the valves, Doppler evaluation is the best means for characterizing ED and ES for STI analysis.

A large-scale magnetic shield with 106 damping at millihertz frequencies

Abstract: We present a magnetically shielded environment with a damping factor larger than 1 × 106 at the mHz frequency regime and an extremely low field and gradient over an extended volume. This extraordinary shielding performance represents an improvement of the state-of-the-art in the difficult regime of damping very low-frequency distortions by more than an order of magnitude. This technology enables a new generation of high-precision measurements in fundamental physics and metrology, including searches for new physics far beyond the reach of accelerator-based experiments. We discuss the technical realization of the shield with its improvements in design.

Urinary Proteome and Systolic Blood Pressure as Predictors of 5-Year Cardiovascular and Cardiac Outcomes in a General Population

Abstract: In a previous cross-sectional study, we identified a multidimensional urinary classifier (HF1), which was associated with left ventricular dysfunction. We investigated whether HF1 predicts cardiovascular end points over and beyond traditional risk factors. In 791 randomly recruited Flemish (mean age, 51.2 years; 50.6% women), we quantified HF1 by capillary electrophoresis coupled with mass spectrometry. In addition, we measured cardiovascular risk factors. HF1 averaged −0.97 U (range, −3.26 to 2.60). Over 6.1 years (median), 35 participants died and 63, 45, and 22 experienced fatal or nonfatal cardiovascular, cardiac, or coronary events, respectively. The incidence of fatal combined with nonfatal cardiovascular and cardiac end points, standardized for sex and age, increased across thirds of the HF1 distribution ( P ≤0.014), whereas trends for all-cause mortality and coronary events were nonsignificant ( P ≥0.10). The multivariable-adjusted hazard ratios (+1-SD) were 1.30 (95% confidence interval, 1.03–1.65; P =0.029) and 1.39 (1.06–1.84; P =0.018) for cardiovascular and cardiac events in relation to HF1. For systolic pressure, the corresponding estimates were 0.97 (0.74–1.28; P =0.85) and 0.93 (0.67–1.29; P =0.66), respectively. The HF1 upper thresholds optimized by maximizing Younden’s index were −0.50 and −0.36 U for cardiovascular and cardiac end points, respectively. Prognostic accuracy significantly ( P ≤0.006) improved by adding HF1 to Cox models already including the other baseline predictors. Sensitivity analyses, from which we excluded 71 participants with previous cardiovascular disease, were confirmatory. In conclusion, over a 6-year period, the urinary proteome, but not systolic pressure, predicted cardiovascular and cardiac disease.

Additional tricuspid annuloplasty in mitral valve surgery results in better clinical outcome

Abstract: Objective The clinical benefit of tricuspid annuloplasty (TA) in patients undergoing mitral valve surgery (MVS) is still debated. We evaluated the immediate surgical success, postoperative outcome and the medium-term effect of TA in MVS. Methods Patients were included between September 2003 and December 2009 and followed until September 2013 to achieve a median follow-up time of 5 years (IQR 3.7–6.9). The end point of mortality due to cardiac causes and combined end point of cardiac mortality or hospitalisation for heart failure were evaluated. Propensity score adjusted Cox regression was used to evaluate the clinical benefit of TA at the time of MVS. Results Of 150 patients (84 female; 67±12 years), 82 presented with tricuspid regurgitation (TR) Conclusions Additional TA is an effective surgical measure to reduce functional TR severity. This approach results in a decreased risk of cardiac mortality and hospitalisation in patients with preoperative TR≥2/4.

Artículo especial Guía ESC 2015 sobre el diagnóstico y tratamiento de las enfermedades del pericardio: Grupo de Trabajo de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de las enfermedades del pericardio

Abstract: Otras entidades de la ESC que han participado en la elaboracion de este documento: Asociaciones: Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention and Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA). Consejos: Council for Cardiology Practice (CCP), Council on Cardiovascular Nursing and Allied Professions (CCNAP), Council on Cardiovascular Primary Care (CCPC). Grupos de Trabajo: Farmacoterapia Cardiovascular, Cirugia Cardiovascular, Cardiopatias Congenitas en el Adulto, Enfermedades del Miocardio y del Pericardio, Circulacion Pulmonar y Funcion Ventricular Derecha, Valvulopatias. El contenido de esta Guia de Practica Clinica de la Sociedad Europea de Cardiologia (ESC) se publica exclusivamente para uso personal y educativo. No se autoriza su uso comercial. No se autoriza la traduccion o reproduccion de ningun fragmento de esta guia sin la autorizacion escrita de la ESC. La autorizacion se solicitara por escrito a Oxford University Press, editorial de European Heart Journal y representante autorizado de la ESC para gestionar tales permisos. Descargo de responsabilidad. Esta guia recoge la opinion de la ESC y se ha elaborado tras el estudio minucioso de los datos y la evidencia disponibles hasta la fecha. La ESC no es responsable en caso de que haya alguna contradiccion, discrepancia o ambiguedad entre la guia de practica clinica (GPC) de la ESC y cualquier otra recomendacion oficial o GPC publicada por autoridades relevantes de la sanidad publica, particularmente en lo que se refiere al buen uso de la atencion sanitaria y las estrategias terapeuticas. Se espera que los profesionales de la salud tengan en consideracion esta GPC a la hora de tomar decisiones clinicas, asi como al implementar estrategias medicas preventivas, diagnosticas o terapeuticas. No obstante, esta guia no anula la responsabilidad individual de cada profesional al tomar las decisiones oportunas relativas a cada paciente, de acuerdo con dicho paciente y, cuando fuera necesario, con su tutor o representante legal. Ademas, las GPC de la ESC no eximen al profesional medico de su obligacion etica y profesional de consultar y considerar atentamente las recomendaciones y las GPC actualizadas emitidas por autoridades sanitarias competentes. Es tambien responsabilidad del profesional verificar la normativa y la legislacion sobre farmacos y dispositivos medicos a la hora de prescribirlos. Los formularios de autorizacion de todos los autores y revisores se encuentran en la pagina web de la ESC: www.escardio.org/guidelines

Development of a vector-tensor system to measure the absolute magnetic flux density and its gradient in magnetically shielded rooms

Abstract: Several experiments in fundamental physics demand an environment of very low, homogeneous, and stable magnetic fields. For the magnetic characterization of such environments, we present a portable SQUID system that measures the absolute magnetic flux density vector and the gradient tensor. This vector-tensor system contains 13 integrated low-critical temperature (LTc) superconducting quantum interference devices (SQUIDs) inside a small cylindrical liquid helium Dewar with a height of 31 cm and 37 cm in diameter. The achievable resolution depends on the flux density of the field under investigation and its temporal drift. Inside a seven-layer mu-metal shield, an accuracy better than ±23 pT for the components of the static magnetic field vector and ±2 pT/cm for each of the nine components of the gradient tensor is reached by using the shifting method.

Partial volume correction of doubly-gated cardiac datasets using anatomical and edge-preserving priors

Abstract: Positron emission tomography (PET) images suffer from partial volume (PV) effects due to the poor spatial resolution of the PET system. In cardiac imaging, additional blurring is caused by the breathing motion and the beating of the heart. Dual gating of the cardiac datasets is one possible approach to remove the motion blur [1], but it dramatically reduces the statistics of the dataset and leads to extremely noisy reconstructions (still to be corrected for PV).