Showing papers in "Journal of The American Society of Echocardiography in 2002"
2,056 citations
TL;DR: In this article, the authors proposed a standardization of the angles for cardiac planes, number of segments, slice display and thickness, nomenclature for segments and assignment of segments to coronary arterial territories.
Abstract: Nuclear cardiology, echocardiography, cardiovascular magnetic resonance (CMR), cardiac computed tomography (CT), positron emission computed tomography (PET), and coronary angiography are imaging modalities that have been used to measure myocardial perfusion, left ventricular function, and coronary anatomy for clinical management and research. Although there are technical differences between these modalities, all of them image the myocardium and the adjacent cavity. However, the orientation of the heart, angle selection for cardiac planes, number of segments, slice display and thickness, nomenclature for segments, and assignment of segments to coronary arterial territories have evolved independently within each field. This evolution has been based on the inherent strengths and weaknesses of the technique and the practical clinical application of these modalities as they are used for patient management. This independent evolution has resulted in a lack of standardization and has made accurate intra- and cross-modality comparisons for clinical patient management and research very difficult, if not, at times, impossible.
Attempts to standardize these options for all cardiac imaging modalities should be based on the sound principles that have evolved from cardiac anatomy and clinical needs.1–3⇓⇓ Selection of standardized methods must be based on the following criteria:
An earlier special report from the American Heart Association, American College of Cardiology, and Society of Nuclear Medicine4 defined standards for plane selection and display orientation for serial …
1,645 citations
TL;DR: The purpose of this report is not to define how to record a proper adult cardiac ultrasound examination or how to perform the measurements but, rather, to serve as a guideline to what measurements and descriptive items should be included in a transthoracic echocardiographic report.
Abstract: The American Society of Echocardiography has published guidelines relating to standards for training (and certification), performance, nomenclature and measurement, and quality improvement related to echocardiography.1-15 However, the Society has not previously made recommendations about what constitutes the core variables, ie, measurements and other elements, to be included in a transthoracic echocardiographic report. A document addressing this topic would be timely and could serve the following purposes: (1) Promote quality by defining the basic core of measurements and statements that constitute the report; (2) encourage the comparison of serial echocardiograms performed in patients at the same site or different sites; (3) improve communication by expediting development of structured report form software; and (4) facilitate multicenter research and analyses of cost-effectiveness. Because of these considerations, Dr Richard Kerber, President of the American Society of Echocardiography, appointed a task force in 1998 to develop recommendations for a standardized report for adult echocardiography.Various international societies have recently addressed this issue and recommended standards. The purpose of this report is not to define how to record a proper adult cardiac ultrasound examination or how to perform the measurements but, rather, to serve as a guideline to what measurements and descriptive items should be included. It is the hope of the Task Force that publication of this document will further our ongoing efforts to improve the overall quality of the practice of echocardiography.
327 citations
TL;DR: After intravenous injection and pulmonary passage, the microvascular rheology of Definity microbubbles is similar to that of red blood cells, which is important for establishing the safety of this agent.
Abstract: The microvascular rheology and extent of pulmonary retention of second-generation microbubble ultrasound contrast agents has not previously been well characterized. We assessed the microvascular behavior of Definity, a lipid-shelled microbubble agent containing perfluoropropane gas, using intravital microscopy of either rat spinotrapezius muscle or mouse cremaster muscle. Immediately after intra-arterial injection, which was performed to model pulmonary retention, larger microbubbles (> 5 μm) were entrapped within small arterioles and capillaries. The retention fraction of microbubbles was low (1.2% ± 0.1%) and entrapment was transient (85% dislodged by 10 minutes), resulting in no adverse hemodynamic effects. Leukocyte or platelet adhesion at the site of entrapment was not seen. After intravenous injection, no microbubble entrapment was observed and the velocities of microbubbles in arterioles, venules, and capillaries correlated well with those of red blood cells. We conclude that after intravenous injection and pulmonary passage, the microvascular rheology of Definity microbubbles is similar to that of red blood cells. Microbubble entrapment within the pulmonary microcirculation after venous injection should be negligible and transient. These findings are important for establishing the safety of this agent. (J Am Soc Echocardiogr 2002;15:396-403.)
263 citations
TL;DR: Ultrasound-based Strain SR/epsilon imaging is a practical, reproducible clinical technique, which allows the calculation of regional longitudinal and radial deformation from both LV and RV segments.
Abstract: Background: Noninvasive assessment of left (LV) and right (RV) ventricular function in children could benefit from a technique that would characterize local myocardial deformation. Color Doppler myocardial imaging (CDMI) allows the calculation of either local longitudinal or radial Strain Rate (SR) and Strain (e). To determine the clinical feasibility and reproducibility of longitudinal and radial SR and e, the following study was carried out. Methods: CDMI data were obtained from 33 healthy children (4-16 years). To quantify regional longitudinal and radial function SR and e data were obtained from apical and parasternal views respectively. From the extracted SR curves, peak values for systole, early diastole, and late diastole were calculated. From the extracted e curves the systolic, early and late diastolic e values were calculated. Results: LV longitudinal deformation were homogeneous for LV basal, mid and apical segments (peak systolic SR: –1.9 ± 0.7 s–1, systolic e –25% ± 7%). Longitudinal SR and e values were significantly higher and heterogeneous in the RV (compared with LV walls) and were maximal in the mid part of the RV free wall (peak systolic SR: –2.8 ± 0.7 s–1, systolic e –45% ± 13%). The RV inferior wall showed homogenous but lower longitudinal SR and e values. The LV systolic and diastolic SR and e values were higher for deformation in the radial direction compared with the longitudinal direction (radial peak systolic SR: 3.7 ± 0.9 s–1, radial systolic e 57% ± 11%; P < .0001). The interobserver variability for radial systolic e and SR was 10.3% and 13.1%, respectively. Conclusion: Ultrasound-based Strain SR/e imaging is a practical, reproducible clinical technique, which allows the calculation of regional longitudinal and radial deformation from both LV and RV segments. The combination of regional SR/e indices and the timing of specific systolic or diastolic regional events may offer a new noninvasive approach to quantifying regional myocardial function in congenital and acquired heart disease in children. (J Am
222 citations
TL;DR: In the multivariate model both RV end-diastolic diameter index and velocity of late diastolic filling were independent predictors of survival and a composite model combining these 2 measures provided the most powerful prognostic information.
Abstract: Right ventricular (RV) dysfunction determines prognosis in patients with chronic pulmonary disease. We examined the relative prognostic potential of measures of systolic, diastolic, and global RV function in 87 patients with chronic pulmonary disease. Systolic function was evaluated by measuring RV dimensions, diastolic function by pulsed wave Doppler of the tricuspid flow profile, and global function by the Tei index. After 15.5 months follow-up, 47 patients had died. Univariate analysis demonstrated that both clinical and echocardiographic variables predicted survival. In the multivariate model both RV end-diastolic diameter index and velocity of late diastolic filling were independent predictors of survival. Receiver operator characteristic analysis demonstrated that a composite model combining these 2 measures provided the most powerful prognostic information. Echocardiographic indices of RV function identify patients with pulmonary disease at high risk and provide incremental prognostic information over and above that supplied by clinical data. (J Am Soc Echocardiogr 2002;15:633-9.)
195 citations
TL;DR: The use of these findings on the management of patients with PPH should be tested in larger studies and the use of RAS, TR, and TR were independent risk factors of transplantation and death.
Abstract: Primary pulmonary hypertension (PPH) is a fatal illness. In advanced stages only transplantation is able to increase survival. Echocardiography is useful for the assessment of these patients, but there is limited information about its prognostic value. With this goal, 25 consecutive patients, age: 36.7 12.7 years, were studied and followed up for a mean period of 29 months (range: 0.2-84). Eleven echocardiographic parameters of cardiac anatomy, function, and hemodynamics were assessed. Age and sex were also analyzed. Death and heart-lung transplantation were considered end-points. Thirteen events (Death: 8; transplantation: 5) occurred in the follow-up (11 of 13 in the first year). Kaplan-Meier estimated survival free from transplantation at 5 years was 40% (95% CI: 23%-70%). In the univariate analysis, RAA (HR: 1.1, P .0004), TR (HR: 2.7, P .02), and RVET (HR: 0.98, P .02) showed statistically significant relation with survival free from transplantation. Multivariate analysis showed that RAS (HR: 1.10, 95% CI: 1.04-1.17, P .001) and TR (HR: 2.52, 95% CI: 1.01-6.3, P .047) were independent risk factors of transplantation and death. The use of these findings on the management of patients with PPH should be tested in larger studies. (J Am Soc Echocardiogr 2002;15:1160-4.)
179 citations
TL;DR: HCU will extend the concept of the "complete physical examination," allowing more rapid assessment of cardiovascular anatomy, function, and physiology, but appropriate user-specific training and assumption of responsibility are essential to ensure the most accurate acquisition, interpretation, and use of the data.
Abstract: The newest introduction to echocardiography is a hand-carried ultrasound (HCU) device It is a small echocardiographic machine that typically weighs less than 6 lb and can obtain echocardiographic images and data However, neither the device nor the context of the examination fulfills the criteria for a comprehensive or complete echocardiographic examination The American Society of Echocardiography believes that HCU will extend the concept of the "complete physical examination," allowing more rapid assessment of cardiovascular anatomy, function, and physiology However, appropriate user-specific training (Level 1 at a minimum) and assumption of responsibility are essential to ensure the most accurate acquisition, interpretation, and use of the data
174 citations
TL;DR: Both SR and epsilon can quantify the changes in myocardial function during a range of inotropic challenges and over the range of physiologic HRs encountered during clinical stress echocardiography.
Abstract: Background: We investigated the ability of ultrasonic strain rate (SR) and strain (ϵ) to quantify the changes in normal myocardial function at varying inotropic states and heart rates (HR) in an attempt to determine whether these new regional function indices are potentially robust enough to quantitate stress echocardiography. Methods and Results: Twenty closed-chest pigs underwent incremental atrial pacing (AP: 120-180/min, n=7), dobutamine infusion (DI: 2.5-20 μg/kg/min, n=7) or esmolol infusion with subsequent pacing (EI: 0.5 ± 0.15 mg/kg/min with pacing 120-180/min, n=6). Radial deformation of the left ventricular posterior wall was interrogated using the parasternal short-axis view to derive regional systolic SR and ϵ values. At baseline SR and ϵ averaged 5.0 ± 0.4 s −1 and 60% ± 4%, respectively. SR remained unchanged during AP and increased linearly with DI (at 2.5 μg/kg/min = 6.2 ± 0.3 s −1 , P −1 , P P MAX correlated linearly over the induced change in inotropic states and HR ( r = 0.82; P P P r = 0.87; P Conclusion: Both SR and ϵ can quantify the changes in myocardial function during a range of inotropic challenges and over the range of physiologic HRs encountered during clinical stress echocardiography. SR may reflect regional contractile function, whereas ϵ reflects changes in ventricular geometry. This study would suggest that for quantitative stress echocardiography SR is better in quantification of changes in contractile function being relatively independent of HR. (J Am Soc Echocardiogr 2002;15:416-24.)
150 citations
TL;DR: Prolonged TI (>1.14) is a powerful and independent predictor of poor clinical outcome in patients with symptomatic heart failure and severe LV systolic dysfunction.
Abstract: Background: The Tei index (TI) is a new echocardiographic/Doppler index of combined systolic and diastolic function, calculated as isovolumic relaxation time plus isovolumic contraction time divided by ejection time. This purpose of this study was to explore the prognostic value of TI in patients with heart failure from left ventricular (LV) systolic dysfunction. Methods: Of 105 randomly selected participants with LV ejection fraction less than 30% and at least 1 hospitalization for heart failure, we included 60 patients in whom assessment of the TI was technically feasible. Using the patients' medical records, we collected information on several clinical and echocardiographic variables. We monitored patients for a mean duration of 24 ± 19 months from the time of the echocardiogram. The study outcome was the composite of death from any cause or emergency heart transplant. Results: The median value (interquartile range) of TI was 0.79 (0.54, 1.14). Of 57 patients (95%) with complete follow-up, 28 (49%) died, and 2 (3.5%) underwent emergency heart transplant at a mean duration of 17 ± 14 months. Kaplan-Meier survival curves showed a higher cumulative incidence of the study end point among patients in the highest quartile of TI, compared with the other 3 quartiles (log rank P =.002). After adjustment for potential clinical confounders, TI in the highest quartile (TI > 1.14) was a significant independent predictor of the composite end point (odds ratio 5.3, 95% confidence interval 1.9 to 14.9, P =.0018). Conclusion: Prolonged TI (>1.14) is a powerful and independent predictor of poor clinical outcome in patients with symptomatic heart failure and severe LV systolic dysfunction. (J Am Soc Echocardiogr 2002;15:864-8.)
135 citations
TL;DR: The quantitation of regional deformation rather than motion would appear to be more appropriate in detecting and quantifying acute ischemic changes in myocardial function, especially in segments with pre-existing abnormal function.
Abstract: Ultrasound-derived natural strain rate and strain are new Doppler myocardial imaging (DMI) parameters, which can measure local deformation independently of overall heart motion and thus could better characterize local contractility than DMI velocities alone. This study was undertaken to evaluate the relative benefits of regional velocity, strain rate, and strain measurements in detecting the range of acute changes in regional myocardial function in the "at-risk" zone during coronary angioplasty. Sixty-one patients (aged 63 ± 12, 18 women) with stable angina pectoris were studied before, at the end of, and during recovery from a 60-second percutaneous transluminal coronary angioplasty (PTCA) balloon occlusion. High frame rate (147 fps) color DMI regional velocity data were derived from basal posterior (parasternal view) and mid, apical septal (apical view) "at-risk" segments as well as from the corresponding segments in healthy subjects and analyzed offline for velocity (VEL), strain rate (SR), and strain (ϵ) measurements. Coronary occlusion resulted in the reduction in VEL SYS , SR SYS , and ϵ SYS values for both radial (RCA/CX occlusion) and longitudinal data (LAD occlusion) in all segments analyzed. Velocity parameters alone failed to distinguish between baseline and occlusive measurements in the "at-risk" segments with visually abnormal baseline function. SR SYS and ϵ SYS had a higher diagnostic accuracy (sensitivity 75%, 80% and specificity 80%, 82%, respectively) than VEL SYS velocity alone (sensitivity 68%, specificity 65%,) for identifying acute ischemia in either baseline normal and abnormal segments. DMI-derived indexes can identify and quantify the spectrum of acute systolic and diastolic ischemic changes induced during clinical PTCA. The quantitation of regional deformation rather than motion would appear to be more appropriate in detecting and quantifying acute ischemic changes in myocardial function, especially in segments with pre-existing abnormal function. (J Am Soc Echocardiogr 2002;15:1-12.)
TL;DR: MV repair was successful in 91% of patients, and independent predictors of unsuccessful repair were central jet of mitral regurgitation, calcification or severe dilatation of the mitral annulus, and extensive leaflet disease with involvement of at least 3 segments.
Abstract: Mitral valve (MV) repair is the procedure of choice for MV prolapse or flail. However, valve repair is more technically demanding and requires a precise definition of MV morphology to determine the timing, complexity, and feasibility of repair. We prospectively examined 170 consecutive patients with MV prolapse or flail referred for MV repair. The MV valve was systematically assessed by intraoperative transesophageal echocardiography. MV anatomy was independently assessed at the time of operation. Accuracy of transesophageal echocardiography in identifying MV segments ranged from 90% to 97%, and was best for the middle segment/scallop of either anterior or posterior leaflet. MV repair was successful in 91% of patients. Success rate was the lowest (78%) in the presence of extensive bileaflet disease involving at least 2 segments of each leaflet. Independent predictors of unsuccessful repair were central jet of mitral regurgitation, calcification or severe dilatation of the mitral annulus, and extensive leaflet disease with involvement of at least 3 segments.
TL;DR: A joint task force was appointed to delineate guidelines for training in perioperative echocardiography including the prerequisite medical knowledge and training, eChocardiographic knowledge and skills, training components and duration, training environment and supervision, and equivalence requirements for postgraduate physicians already in practice.
Abstract: When expertly utilized, perioperative echocardiography can lead to improved outcome in patients requiring cardiovascular surgery and in those suffering perioperative cardiovascular instability. However, prior publications have not specified the requisite training for perioperative echocardiography. Therefore, the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists (SCA) appointed a joint task force to delineate guidelines for training in perioperative echocardiography including the prerequisite medical knowledge and training, echocardiographic knowledge and skills, training components and duration, training environment and supervision, and equivalence requirements for postgraduate physicians already in practice. This document is the result of the task force’s deliberations and recommendations.
TL;DR: Testing the hypothesis that targeted disruption of cationic microbubble-linked plasmid DNA, using diagnostic ultrasound, may aid transfection of large animal myocardium found it to be correct.
Abstract: We tested the hypothesis that targeted disruption of cationic microbubble-linked plasmid DNA, using diagnostic ultrasound, may aid transfection of large animal myocardium. Plasmid DNA encoding for CAT (pCAT, chloramphenicol acetyltransferase) was bound to a novel cationic microbubble containing MRX-225 for intravenous administration, and 16 dogs in 4 groups variously received this conjugate or plasmid only, or were exposed to ultrasound. Histochemical staining and enzyme-linked immunosorbent assay analysis showed CAT activity in the myocardium of only those animals that received microbubble-linked DNA and were exposed to ultrasound. Thus, disruption of cationic-linked, low-dose plasmid systems by diagnostic ultrasound may facilitate transfection of large animal hearts. (J Am Soc Echocardiogr 2002;15:214-8.)
TL;DR: Echocardiography is an accurate noninvasive tool for determination of infarct size and quantitative characterization of postinfarct remodeling in the mouse model of MI and Alterations in cardiac structure and function after coronary ligation in mice closely resemble pathophysiologic changes in human ischemic heart disease.
Abstract: Gene-targeting in mice is a powerful tool to define molecular mechanisms of ischemic heart disease that determine infarct size, postinfarct left ventricular (LV) remodeling, and arrhythmogenesis. Coronary ligation in mice is becoming a widely used model of myocardial infarction (MI), but the pathophysiologic consequences of MI in mice and its relevance to human MI have not been fully elucidated. To characterize structural and functional changes during evolving MI, we analyzed 2-dimensional-based reconstruction of the left ventricle by noninvasive echocardiography obtained 1 day and 1 week after surgical ligation of the left anterior descending coronary artery in mice. Sequential 2-dimensional short-axis cineloops of the left ventricle were used to measure LV mass, and LV volumes at end-diastole and end-systole. Echocardiographic infarct size was estimated by measuring the volume of akinetic LV segments. Histologic infarct size was measured by planimetry of 9 transverse sections of each heart. There was close correlation between the 2 methods (31% +/- 20% of LV mass and 34% +/- 17% of LV area, respectively; y =.83x + 7.9, r = 0.96, P <.01). LV volumes at end diastole increased significantly between 1 day and 1 week (51 +/- 17 microL vs 78 +/- 46 microL, respectively, P <.05). The relative change in LV volumes at end diastole varied as a function of infarct size (r = 0.93, P <.01). LV mass and the extent of hypertrophy of noninfarcted segments also varied with infarct size (r = 0.92, P <.01; r = 0.90, P <.01, respectively). Thus, echocardiography is an accurate noninvasive tool for determination of infarct size and quantitative characterization of postinfarct remodeling in the mouse model of MI. Alterations in cardiac structure and function after coronary ligation in mice closely resemble pathophysiologic changes in human ischemic heart disease.
TL;DR: Strain rate and strain can better assess segmental dysfunction severity than myocardial velocities alone after an acute MI.
Abstract: Objectives: The aim of this study was to evaluate the additional value of ultrasonic strain rate and strain to myocardial velocity in the identification and quantification of regional asynergy after an acute myocardial infarction (MI). Methods: Forty patients (59 ± 13 years) were investigated 3 ± 2 days after a first infarction and compared with 14 age-matched controls with normally contracting segments (group A, n=146). Longitudinal myocardial velocities, strain rate (SR) and strain (ϵ) were postprocessed from basal, mid, and apical segments interrogated using apical views. In a subset of patients with coronary angiograms (n = 24), myocardial segments were divided into 3 groups: normally contracting segments supplied by a normal coronary artery (group B1), normally contracting segments supplied by a diseased coronary artery (group B2), and segments with abnormal motion (group B3). Velocities were decreased in patients with myocardial infarction (MI) ( P −1 and −13%, respectively). Conclusion: Strain rate and strain can better assess segmental dysfunction severity than myocardial velocities alone after an acute MI. (J Am Soc Echocardiogr 2002;15:723-30.)
TL;DR: Patients with ventricular noncompaction who were echocardiographically identified at this institution since 1991 clearly represent the clinical and morphological spectrum of this disorder.
Abstract: We report 12 patients with ventricular noncompaction who were echocardiographically identified at our institution since 1991. The mean age at presentation was 3.5 years. Five patients had isolated noncompaction. Three of them had subnormal left ventricular systolic function at presentation. Noncompaction was associated with complex congenital heart defect in 3 patients. Four patients had simple congenital heart defects: pulmonary stenosis, coarctation of aorta with aberrant origin of right subclavian artery, ventricular septal defect, and partial anomalous pulmonary venous return. The observed rhythm abnormalities were Wolff-Parkinson-White syndrome and paroxysmal supraventricular tachycardia, bigemini ventricular extrasystoles, and left bundle branch block. A transvenous pacemaker was implanted in a patient because of complete heart block. Noncompaction of the ventricular myocardium is rare. Our patients clearly represent the clinical and morphological spectrum of this disorder. Distinct morphological features can be diagnosed on 2-dimensional echocardiography. (J Am Soc Echocardiogr 2002;15:1523-8.) Noncompaction of the ventricular myocardium is a recently described anomaly. It is a result of an arrest in myocardial morphogenesis and is characterized by prominent and excessive trabeculations in a ventricular wall segment, with deep intertrabecular spaces perfused from the ventricular cavity. 1 It has been described in association with other congenital heart defects such as severe obstruction of right or left ventricular outflow tracts and anomalous origin of the left coronary artery from the pulmonary trunk. 2 It can also exist as an isolated lesion. 2-5 We describe the entity of ventricular noncompaction and present a series of patients in a childhood population with this rare disorder.
TL;DR: Interobserver and intraobserver agreements for the diagnosis of PFO and ASA by transesophageal echocardiography are not perfect and need to be improved, particularly for ASA.
Abstract: Background: An accurate diagnosis of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) may be of decisional importance in the management of patients with ischemic stroke. Very few studies have been devoted to observer agreement in the diagnosis of these atrial septum abnormalities using contrast transesophageal echocardiography, which is considered as the method of choice for the diagnosis. The aim of this study was to assess interobserver and intraobserver variability in the diagnosis of PFO and ASA with contrast echocardiography. Methods: Three sonographers independently reviewed 100 contrast studies stored on videotape on 2 occasions each. The interobserver and intraobserver variability was assessed by calculating κ statistics. Results: The overall interobserver and intraobserver κ values for the assessment of degree of shunting through a PFO were 0.77 (first and second reading) and 0.82, respectively. The best κ statistics were obtained when no and small shunts (less than 10 microbubbles) were pooled and compared with larger shunts. For the diagnosis of ASA, the overall interobserver κ value was 0.45 for the first reading and 0.71 for the second reading, whereas the overall intraobserver κ value was 0.74. Conclusion: Interobserver and intraobserver agreements for the diagnosis of PFO and ASA by transesophageal echocardiography are not perfect and need to be improved, particularly for ASA. This variability has to be taken into account when deciding on a potential risky treatment to prevent recurrent strokes. (J Am Soc Echocardiogr 2002;15:441-6.)
TL;DR: AcuNav UC with Doppler and color flow imaging has significant use, especially during left heart ablation, and uses include guidance of transseptal and mapping/ablation catheters and closure devices, and prompt diagnosis of cardiac complications.
Abstract: Background: AcuNav ultrasound catheter (UC) (10F, 5.5-10 MHz) has unique advantages for left heart imaging with its 4-way tip flexible maneuverability, maximal 16-cm intracardiac imaging depth, and Doppler and color flow imaging capability. Methods: We assessed the initial use of this UC in 40 consecutive patients (34 men; age 53 ± 11 years old). All patients were also undergoing transseptal catheterization for percutaneous catheter mapping and ablation of either left atrium (focal initiated atrial arrhythmia/fibrillation, n=32) or left ventricle (ventricular tachycardia, n=4), or transcatheter atrial septal defect closure (n = 4) procedures. During each procedure, the UC was placed in the right atrium, superior vena cava, or right ventricular inflow/outflow tract. Results: In all patients, UC successfully guided transseptal catheterization and provided imaging of normal or aberrant anatomy of the right/left atrial (interatrial septum, fossa ovalis, appendages, 4 pulmonary vein ostia) and right/left ventricular (valves and papillary muscles) structures. UC was important in early identification procedure complications, including pericardial effusion (n = 2, detected before systematic hemodynamic deterioration) and thrombus formation on sheaths deployed in the right atrium (n = 9) and left atrium (n = 2, early elimination with management of the sheath). With Doppler and color flow imaging, UC provided effective monitoring of increased flow velocity of all ablated pulmonary vein ostia and detection of patent foramen ovale (n = 6) or residual trivial/small atrial septal defect posttransseptal catheterization (n = 2). UC was also used to successfully image and guide transcatheter closure of atrial septal defect with positioning of the cardioseal septal occluder (Nitinol Medical Technologies Inc, Boston, Mass) and color Doppler imaging of no significant residual shunt. Conclusion: AcuNav UC with Doppler and color flow imaging has significant use, especially during left heart ablation. Uses include guidance of transseptal and mapping/ablation catheters and closure devices, and prompt diagnosis of cardiac complications. (J Am Soc Echocardiogr 2002;15:1301-8.)
TL;DR: It is concluded that the propagation velocities of left ventricular lengthening waves are dependent on preload changes and increase with increasing preload.
Abstract: Background: Strain rate imaging is a new and intriguing way of displaying myocardial deformation properties by means of echocardiography. With high frame rate strain rate imaging we observed a spatial inhomogeneity in diastolic longitudinal strain rates in healthy persons. A base-to-apex time delay in diastolic lengthening could be seen both in early diastole and at atrial contraction. Methods and Results: We investigated this consistent finding and its dependence on loading conditions in 20 healthy volunteers. Propagation velocities of lengthening of 91 ± 31 cm/s (E-wave) and 203 ± 11 cm/s (A-wave) at rest (equal to time delays of 104 ± 29 ms and 56 ± 24 ms, respectively) increased significantly to 101 ± 27 cm/s (E) and 283 ± 17 cm/s (A) with lifting the volunteers' legs. Applying nitroglycerine sublingually and sitting upright significantly decreased propagation velocities (E-wave 76 ± 20 cm/s, A-wave 172 ± 93 cm/s and E-wave 66 ± 17 cm/s, A-wave 150 ± 64 cm/s, respectively). Free lateral walls showed a lower propagation velocity than septal walls. Conclusion: We conclude that the propagation velocities of left ventricular lengthening waves are dependent on preload changes and increase with increasing preload. (J Am Soc Echocardiogr 2002;15:13-9.)
TL;DR: The color M-mode-derived index was the most accurate in patients with normal systolic function, and the best correlations with PCWP were found for indices that combined isovolumic relaxation time with flow propagation velocity.
Abstract: To overcome the limitations of mitral inflow parameters for predicting pulmonary capillary wedge pressure (PCWP), combined indices (with Doppler tissue imaging or color M-mode Doppler) have been developed. This study was aimed to compare the accuracy of these indices to predict PCWP. Sixty-one patients were studied. The best correlations with PCWP were found for indices that combined isovolumic relaxation time with flow propagation velocity (color M-mode) or early diastolic velocity of the lateral mitral annulus (Doppler tissue). Both closely tracked changes in PCWP. The color M-mode-derived index was the most accurate in patients with normal systolic function. (J Am Soc Echocardiogr 2002;15:1245-50.)
TL;DR: When the respiratory variation in Doppler E velocity is blunted or absent during the evaluation of suspected CP in patients with restrictive mitral inflow velocity, preserved E' velocity shown by DTE should support the diagnosis of CP over a primary myocardial disease.
Abstract: Respiratory variation of 25% or more in transmitral early diastolic filling (E) velocity is a well-recognized diagnostic feature of constrictive pericarditis (CP) that is useful for distinguishing it from restrictive cardiomyopathy. However, a subset of patients with CP do not exhibit the typical respiratory change. Recent data showed that mitral annular (E') velocity measured by Doppler tissue echocardiography (DTE) is markedly reduced in patients with restrictive cardiomyopathy whereas E' velocity is well-preserved in CP. This study evaluated the role of DTE for the diagnosis of CP when there is no characteristic respiratory variation of E velocity. From September 1999 to March 2001, 19 patients (17 men, 2 women; mean age, 57 +/- 13 years) with surgically confirmed CP underwent comprehensive echocardiography preoperatively, including pulsed wave and DTE examination with simultaneous recording of respiration. Nine (47%) of the 19 patients had less than 25% respiratory variation in E velocity. There was no significant difference in mitral inflow peak velocity, deceleration time, early-to-late ventricular filling ratio, and E' velocity between patients with and patients without respiratory variation of E velocity of 25% or more. Regardless of the presence or absence of a significant respiratory variation of E velocity, E' velocity was relatively normal (mean, 12 +/- 4 cm/s) in all patients with CP. In conclusion, E' velocity is well preserved in patients with isolated CP even when there is no characteristic respiratory variation of E velocity. Thus, when the respiratory variation in Doppler E velocity is blunted or absent during the evaluation of suspected CP in patients with restrictive mitral inflow velocity, preserved E' velocity shown by DTE should support the diagnosis of CP over a primary myocardial disease.
TL;DR: Diastolic filling patterns in 520 consecutive patients referred to the authors' laboratory for transthoracic echocardiograms retrospectively were evaluated and standard guidelines used to characterize left ventricular (LV) diastolic function were applied.
Abstract: We evaluated diastolic filling patterns using Doppler echocardiography in 520 consecutive patients referred to our laboratory for transthoracic echocardiograms retrospectively and applied the standard guidelines used to characterize left ventricular (LV) diastolic function Patients were classified by the Canadian consensus guidelines using transmitral and pulmonary venous Doppler echocardiographic parameters to have normal diastolic function or mild (abnormal relaxation), mild-to-moderate, moderate (pseudonormal), or severe (restrictive) diastolic dysfunction LV diastolic dysfunction was present in 290 (56%) patients, whereas 167 (45%) patients with a normal LV ejection fraction had abnormal diastolic function Patients with progressively more abnormal diastolic patterns had greater structural abnormalities with larger left atrial and LV size and lower LV ejection fractions In the subset of patients with clinical evidence of congestive heart failure (99 patients), the prevalence of primary diastolic heart failure was 38% and most patients had underlying coronary or hypertensive heart disease Standard guidelines of Doppler echocardiographic parameters allow semiquantitation of diastolic function and can be applied to studying large number of patients in a large clinical practice (J Am Soc Echocardiogr 2002;15:1237-44)
TL;DR: It is concluded that the acoustic power for maximizing acoustic signal without destroying microbubbles during low mechanical index imaging varies according to shell characteristics.
Abstract: Low mechanical index perfusion imaging relies on the detection of signals produced by microbubble oscillation at low acoustic powers that results in minimal microbubble destruction. We hypothesized that the optimal acoustic power for real-time imaging would differ for microbubbles with different shell characteristics. Three microbubble agents with varying shell elastic properties according to their polymer composition were studied. Differences in the elastic properties of these microbubbles was demonstrated by: (1) measurement of their bulk modulus and (2) evaluation of their acoustic lability by microscopic visualization of microbubble destruction during insonification at incremental acoustic powers. The ultrasound signal generated by these microbubbles at various mechanical indexes and the degree of microbubble destruction during continuous imaging was determined both in an in vitro flow system and during in vivo imaging in an open-chest canine model. Both studies indicated that optimal power for achieving maximal signal intensity with minimal microbubble destruction was influenced by the shell elastic properties. We conclude that the acoustic power for maximizing acoustic signal without destroying microbubbles during low mechanical index imaging varies according to shell characteristics. (J Am Soc Echocardiogr 2002;15:1269-76.)
TL;DR: Among women who had recently delivered infants with congenital heart disease, those who had had fetal echocardiography during the pregnancy felt less responsible for their infants' defects and tended to have improved their relationships with the infants' fathers after the prenatal diagnosis of congenitalHeart disease.
Abstract: The maternal psychological impact of fetal echocardiography may be deleterious in the face of newly diagnosed congenital heart disease. This questionnaire-based study prospectively examined the psychological impact of both normal and abnormal fetal echocardiography. Normal fetal echocardiography decreased maternal anxiety, increased happiness, and increased the closeness women felt toward their unborn children. In contrast, when fetal echocardiography detected congenital heart disease, maternal anxiety typically increased, and mothers commonly felt less happy about being pregnant. However, among women who had recently delivered infants with congenital heart disease, those who had had fetal echocardiography during the pregnancy felt less responsible for their infants' defects and tended to have improved their relationships with the infants' fathers after the prenatal diagnosis of congenital heart disease. Further study of the psychological and medical impact of fetal echocardiography will be necessary to define and optimize the clinical value of this powerful diagnostic tool. (J Am Soc Echocardiogr 2002;15:159-66.)
TL;DR: The SonoHeart device allows rapid and accurate diagnosis, whenever needed in the outpatient clinic, and identified hypertrophic cardiomyopathy, pericardial effusion, and abnormalities of valves.
Abstract: Background: To test the diagnostic potential of the SonoHeart, a battery-powered hand-held ultrasound imaging device, in an outpatient clinic setting. Methods: A total of 114 patients with a variety of cardiac diseases were examined by 2 independent cardiologists with the hand-held device using the standard echocardiographic system (SE) as a reference. Global right ventricular (RV) and left ventricular (LV) function (scored as normal, mildly to moderately, or severely reduced) and internal cavity dimensions were assessed. Regional wall motion of 6 segments using a 2-point score (1 = normal wall motion, 2=abnormal wall motion) was evaluated in 34 patients on-line. Results: There was a good agreement between the 2 imaging devices for evaluation of global LV (93%) and RV function (99%), regional wall motion (90%), dimensions of the LV (99%) and the RV (99%), and the left (96%) and right atria (99%). Furthermore, SonoHeart identified hypertrophic cardiomyopathy, pericardial effusion, and abnormalities of valves. Conclusion: The SonoHeart device allows rapid and accurate diagnosis, whenever needed in the outpatient clinic. (J Am Soc Echocardiogr 2002;15:80-5.)
TL;DR: Doppler tissue imaging proved to be useful in early detection of RV dysfunction in Chagas' disease, with potential use in risk stratification of these patients.
Abstract: Background: The involvement of the right ventricle (RV) in Chagas' disease is frequent. Although echocardiography plays an important role in noninvasive assessment of cardiac function, evaluation of RV is challenging because of the anatomic and functional complexity of this chamber. Methods: To study early functional abnormalities in the RV, we selected 18 patients with Chagas' disease, no other disease, and a normal echocardiogram; and 12 normal individuals as a control group. All participants were submitted to Doppler tissue imaging and the parameters of systolic (systolic wave and regional isovolumic contraction time) and diastolic (early and late expansion waves) function were analyzed at the level of the interventricular septum and free wall of the RV. Results: Regional isovolumic contraction time values showed a statistically significant difference between the 2 groups both in the RV free ( P = .0003) and septal ( P = .003) walls. With respect to diastolic function, we observed a significant difference between groups involving the early expansion wave ( P = .014) and e/a ratio ( P = .004) of the RV free wall. Conclusion: Doppler tissue imaging proved to be useful in early detection of RV dysfunction in Chagas' disease, with potential use in risk stratification of these patients. (J Am Soc Echocardiogr 2002;15:1197-1201.)
TL;DR: Testing if the correlation between IVCD and RAP measurement in patients who are critically ill depends on the transthoracic echocardiography (TTE) methodology used confirmed that variation of correlation between TTE IVCD measurement and R AP depends onThe ultrasonographic methodology used and the timing of measurement during the cardiac cycle.
Abstract: cava. All measurements were taken in the supine position. IVCD at end-expiration and end-diastole, with ECG synchronization, using the M-mode, and IVCD at end-expiration, without ECG synchronization, using the 2-dimensional long-axis view, correlate linearly with RAP (0.81, P < .0001 and 0.71, P .0004). Mean bias between the 2 TTE methods (Bland-Altman analysis) was 1.6 mm (SD 2.03 mm). In conclusion, this study confirms that variation of correlation between TTE IVCD measurement and RAP depends on the ultrasonographic methodology used and the timing of measurement during the cardiac cycle. IVCD at end-expiration and enddiastole, with ECG synchronization, using the Mmode (IVCD-MM) correlates more satisfactory with RAP than with IVCD at end-expiration, without ECG synchronization, using the 2-dimensional long-axis view, in patients during mechanical ventilation. (J Am Soc Echocardiogr 2002;15:944-9.)
TL;DR: The usefulness of PWDTI in the assessment of functional properties of "athlete's heart" and differentiation from pathologic cardiac conditions is suggested.
Abstract: We studied the relationship between left ventricular (LV) function and the increased LV mass in 18 highly trained rowing athletes (14 men, 4 women; mean age 20.7 ± 4.5 years) using pulsed wave Doppler tissue imaging (PWDTI). Thirteen untrained volunteers, matched for age and body mass index, acted as control participants. Peak systolic, early diastolic (Ev), and late diastolic (Av) myocardial velocities (cm/s); Ev/Av ratio; and isovolumic relaxation time (ms) were measured at the level of basal lateral wall and basal posterior interventricular septum (bas-IVS) segments. In comparison with control participants, athletes showed a greater LV cavity size ( P P P P P r = 0.66, P r = 0.71, P P P P (J Am Soc Echocardiogr 2002;15:900-5.)
TL;DR: Results suggest that the threshold value of Ea used to identify diastolic dysfunction should be approximately 12.5 cm/s and should be interpreted in light of the other Doppler parameters and the use of Valsalva's maneuver.
Abstract: Because it appears to be less affected by changes in preload, mitral annulus Doppler tissue imaging (DTI) has been proposed as an alternate mean of identifying pseudonormal patterns of left ventricular filling. We thus studied the practical implications of DTI in 40 patients classified according to the Canadian Consensus on Diastolic Function (9 control participants, 9 with impaired relaxation, and 22 pseudonormal participants). Using DTI, the early diastolic velocity (Ea) was the most reproducible parameter whereas the late diastolic velocity (Aa) and Ea/Aa ratio varied significantly. Nonetheless, Ea missed 23% of pseudonormal participants and its sensitivity, specificity, and positive and negative predictive values to identify diastolic dysfunction were 81%, 89%, 96%, and 57%, respectively; improving to 94%, 89%, 97%, and 80%, respectively, if used during Valsalva's maneuver. Thus, DTI is not totally preload independent and should be interpreted in light of the other Doppler parameters and the use of Valsalva's maneuver. Moreover, consistent with recent studies, these results suggest that the threshold value of Ea used to identify diastolic dysfunction should be approximately 12.5 cm/s.