Showing papers in "Journal of The American Society of Echocardiography in 2005"
TL;DR: 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 and Elyse Foster, MD.
Abstract: 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
10,834 citations
TL;DR: The 2DSE demonstrated good overall correlation and agreement with sonomicrometry for the tested in vitro and in vivo values, and some caution is needed for combinations of low strains and strain rates.
Abstract: Background A new 2-dimensional strain echocardiography (2DSE) method has been introduced that measures myocardial deformations by tracking localized acoustic markers. We compared strains measured in vitro and in vivo by 2DSE with those obtained by sonomicrometry. Methods For the in vitro study, a tissue-mimicking gelatin block was cyclically compressed and longitudinal strains obtained by 2DSE and sonomicrometry crystals. For the in vivo study, arrays of crystals were implanted into the apical anteroseptal (test region) and midposterior (control region) in 16 open-chest pigs and strains measured by 2DSE and crystals at baseline and after acute ischemia. Results In vitro, pooled data demonstrated good correlation ( r = 0.99, P r = 0.94, P Conclusion The 2DSE demonstrated good overall correlation and agreement with sonomicrometry for the tested in vitro and in vivo values. Some caution with 2DSE measurements is needed for combinations of low strains and strain rates.
372 citations
TL;DR: The preliminary results suggest the hemodynamic consequences of exercise-induced increase in diastolic filling pressure can be demonstrated noninvasively with exercise Doppler echocardiography.
Abstract: Left ventricular filling pressures can be estimated reliably by combining mitral inflow early diastolic velocity (E) and annulus velocity (E′). An increased E/E′ ratio reflects elevated filling pressures and may be useful in assessing an abnormal increase in filling pressures for patients with diastolic dysfunction. The purpose of this study was to evaluate the feasibility of supine bicycle exercise Doppler echocardiography for assessing left ventricular diastolic pressure during exercise. Mitral inflow and septal mitral annulus velocities were measured at rest and during supine bicycle exercise (25-W 3-minute increments) in 45 patients (19 men; mean age, 59 years) referred for evaluation of exertional dyspnea. None had echocardiographic or electrocardiographic evidence of myocardial ischemia with exercise. Patients were classified according to E/E′ ratio at rest: 26 had E/E′ ≤ 10 at rest (group 1) and 19 had E/E′ > 10 (group 2). For group 1, 17 had no increase in E/E′ during exercise (group 1A) and 9 did (group 1B). For group 2, E/E′ did not increase during exercise. Despite different responses of E/E′, there was no significant difference in changes of mitral inflow indices (E, A, E/A, deceleration time) between groups. Although the percentage of dyspnea as a primary reason for stopping exercise was similar for the groups, exercise duration was significantly shorter for groups 1B (7.2 ± 2.5 minutes) and 2 (7.1 ± 3.3 minutes) than in group 1A (10.4 ± 3.7 minutes, P = .0129). Diastolic stress echocardiography using a supine bicycle is technically feasible for demonstrating changes in E/E′ (filling pressure) with exercise. Our preliminary results suggest the hemodynamic consequences of exercise-induced increase in diastolic filling pressure can be demonstrated noninvasively with exercise Doppler echocardiography.
262 citations
TL;DR: The combination of RV systolic and diastolic functional parameters represents a very powerful tool for risk stratification of patients with symptomatic heart failure.
Abstract: Little is known about the prognostic importance of right ventricular (RV) systolic and diastolic function. The purpose of this study was to determine the prognostic power of systolic and diastolic RV functional parameters derived from Doppler tissue imaging of tricuspid annular motion and to assess whether their combination might improve the risk stratification of patients with heart failure. In all, 140 patients with symptomatic heart failure and left ventricular ejection fraction of 40% or less underwent standard echocardiography, Doppler tissue imaging of tricuspid annular motion, and right heart catheterization. They were followed up for a mean period of 17 months for cardiac-related death and nonfatal cardiac events including the implantation of cardioverter-defibrillator and hospitalization for heart failure decompensation. A total of 48 cardiac events occurred; 19 patients died, 26 were hospitalized for heart failure decompensation, and 3 because of the need for implantation of a cardioverter-defibrillator. The peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less, peak early diastolic tricuspid annular velocity of 8.9 cm/s or less, tricuspid annular acceleration during isovolumic contraction of 2.52 m/s 2 or less, and Doppler RV index (Tei index) of 1.20 or more were found to significantly worsen survival or event-free survival. However, their combination significantly exceeded the predictive potential of individual parameters. The worst survival was predicted by the combination of peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less plus peak early diastolic tricuspid annular velocity of 8.9 cm/s or less plus tricuspid annular acceleration during isovolumic contraction of 2.52 m/s 2 or less (relative risk 6.17, P P
194 citations
TL;DR: This single-center study demonstrates that TEE examinations are associated with a very low risk of esophagogastric trauma when performed in a safe setting by experienced operators.
Abstract: Background Transesophageal echocardiography (TEE) is an essential diagnostic tool that has gained widespread use in clinical cardiology. It is considered reasonably noninvasive and safe; however, insertion and operation of the TEE probe may cause hypopharyngeal, esophageal, or gastric trauma. The current study reports a single-center experience of esophagogastric trauma in 10,000 consecutive TEE examinations. Methods TEE examinations were performed by 9 attending physicians who were trained in endoscopic procedures and had been performing TEE studies for at least 1 year. Results One case of hypopharyngeal perforation (0.01%), 2 cases of cervical esophageal perforation (0.02%), and no cases of gastric perforation (0%) occurred after TEE examination. No fatalities (0%) occurred. We describe the clinical characteristics of individuals who experienced esophageal perforation during this 10-year period. Conclusions This single-center study demonstrates that TEE examinations are associated with a very low risk of esophagogastric trauma when performed in a safe setting by experienced operators.
181 citations
TL;DR: It is concluded that noninvasive quantification of LA function using SR imaging enables evaluation of LA dysfunction due to aging and LA dilatation.
Abstract: Strain rate (SR) imaging enables quantitative measurement of left ventricular (LV) function independent of cardiac translation. However, whether SR imaging is applicable for detection of left atrial (LA) dysfunction remains unknown. The purpose of this study was to assess the feasibility of measuring LA function by SR imaging, focusing on the effects of aging and LA dilatation during atrial fibrillation (AF). Echocardiographic evaluation including SR imaging was performed in 50 controls (29 males and 21 females; mean age, 41 ± 14 years) and in 27 patients with AF (15 males and 12 females; mean age, 62 ± 12 years; 8 with persistent AF and 19 with paroxysmal AF) from 3 apical views and analyzed off-line. Peak SR was measured at each LA segment (septum, lateral, posterior, anterior, and inferior), and mean peak systolic SR (SR-LAs), early diastolic SR (SR-LAe), and late diastolic SR (SR-LAa) were calculated by averaging the results for each segment. LA dimension, peak mitral and pulmonary velocities at late diastole, LA fractional shortening, and atrial filling fraction were calculated as parameters of LA function. Normal values for mean SR-LAs, SR-LAe, and SR-LAa were 3.4 ± 1.0 s −1 , −3.9 ± 1.7 s −1 , and −3.1 ± 1.0 s −1 , respectively, and they were successfully measured in more than 95% of the LA segments. In controls, both mean SR-LAs and mean SR-LAe correlated with age, LA dimension, and early to late diastolic mitral flow velocity ratio. Conversely, mean SR-LAa did not show significant correlation with age or parameters of LA function. In AF patients, mean SR-LAs was correlated inversely with age. The mean SR-LAs was significantly lower in persistent AF patients than in age-matched controls (1.7 ± 0.8 vs 2.9 ± 0.9 s −1 ; P
169 citations
TL;DR: Left atrial (LA) volume (LAV) volume is a prognostically important biomarker for diastolic dysfunction, but its reproducibility on repeated testing is not well defined, and 2D measurements correlate closely with 3DE.
Abstract: Objectives Left atrial (LA) volume (LAV) is a prognostically important biomarker for diastolic dysfunction, but its reproducibility on repeated testing is not well defined. LA assessment with 3-dimensional (3D) echocardiography (3DE) has been validated against magnetic resonance imaging, and we sought to assess whether this was superior to existing measurements for sequential echocardiographic follow-up. Methods Patients (n = 100; 81 men; age 56 ± 14 years) presenting for LA evaluation were studied with M-mode (MM) echocardiography, 2-dimensional (2D) echocardiography, and 3DE. Test-retest variation was performed by a complete restudy by a separate sonographer within 1 hour without alteration of hemodynamics or therapy. In all, 20 patients were studied for interobserver and intraobserver variation. LAVs were calculated by using M-mode diameter and planimetered atrial area in the apical 4-chamber view to calculate an assumed sphere, as were prolate ellipsoid, Simpson's biplane, and biplane area-length methods. All were compared with 3DE. Results The average LAV was 72 ± 27 mL by 3DE. There was significant underestimation of LAV by M-mode (35 ± 20 mL, r = 0.66, P r = 0.77, P r = 0.73, P = .04), area-length (64 ± 30 mL, r = 0.74, P r = 0.78, P = .06). Test-retest variation for 3DE was most favorable ( r = 0.98, P r = 0.99, P r = 0.89, P r = 0.99, P r = 0.91, P Conclusions The 2D measurements correlate closely with 3DE. Follow-up assessment in daily practice appears feasible and reliable with both 2D and 3D approaches.
169 citations
165 citations
TL;DR: Independent of the basic rhythm, there is a close relationship between LAAV and qualitative parameters of elevated thromboembolic risk and could, therefore, be a quantitative surrogate parameter for risk stratification.
Abstract: Background Hemostasis in the left atrial (LA) appendage (LAA) is an important cause in the formation of thrombi. Determination of the LAA flow velocity (LAAV) could be a quantitative parameter for estimating thromboembolic risk. The objective of this study was to: (1) determine the relationship between LAAV and qualitative parameters with elevated thromboembolic risk (thrombus/spontaneous echocontrast [SEC]); and (2) define factors that influence LAAV. Methods In all, 500 patients with stroke were examined consecutively by transesophageal echocardiography. In addition to measurement of the LAAV, the atrial appendage was examined for the presence of thrombi or SEC. Results LAAV differed significantly among patients with sinus rhythm (71 ± 16 cm/s), paroxysmal atrial fibrillation (AF) and in sinus rhythm during transesophageal echocardiography (46 ± 13 cm/s), paroxysmal AF and AF during transesophageal echocardiography (32 ± 12 cm/s), and chronic AF (27 ± 9 cm/s, P P Conclusion Independent of the basic rhythm, there is a close relationship between LAAV and qualitative parameters of elevated thromboembolic risk. LAAV could, therefore, be a quantitative surrogate parameter for risk stratification. It is influenced by both cardiac and extracardiac factors.
153 citations
TL;DR: In this paper, the feasibility of teaching medical students to use hand-carried ultrasound (HCU) devices to make bedside cardiac diagnoses and compared the accuracy of their HCU and physical examinations.
Abstract: Background Hand-carried ultrasound (HCU) devices used by cardiologists as extensions of the physical examination have been shown to improve the accuracy of bedside diagnoses. We tested the feasibility of teaching medical students to use HCU devices to make bedside cardiac diagnoses and compared the accuracy of their HCU and physical examinations. Methods In all, 10 fourth-year medical students enrolled in a 4-week medical school course on the cardiac examination. Students examined 12 standardized patients at 3 different time intervals: (1) on day 1 of the course; (2) on day 10 after review of cardiac physical examination using traditional teaching methods; and (3) after instruction on the use of HCU devices. Students were scored at each time interval for primary findings (most salient) and all findings, accounting for both errors of commission and omission. Scores could range from +12 to −12 for primary findings and from +22 to −22 for all findings. A perfect score was +12 for primary findings and +22 for all findings. Results The average score for all students at baseline was −3.2 ± 3.1 and −5.7 ± 4.8 for primary and all findings, respectively. A significant improvement in the scores was noted with use of the HCU device (2.6 ± 3.1 and 5.2 ± 6.6 for primary and all findings, respectively) compared with the baseline and two subsequent physical examinations. Conclusion Instruction of fourth-year medical students on the use of HCU device is feasible and results in significantly more accurate bedside diagnoses.
135 citations
TL;DR: Patients with hypertrophic cardiomyopathy and LA enlargement had more serious cardiovascular events and demonstrated greater LV hypertrophy, more diastolic dysfunction, and higher filling pressures.
Abstract: Background Patients with hypertrophic cardiomyopathy and left atrial (LA) enlargement have increased morbidity and mortality We analyzed the clinical and echocardiographic factors related to LA enlargement, particularly the degree of left ventricular (LV) hypertrophy and diastolic function Methods A total of 104 patients with hypertrophic cardiomyopathy (age 53 ± 15 years, 64% men) were divided into two groups based on the indexed LA volume (LAVI) (mL/m 2 ) measured by echocardiography: group A (or smaller LAVI group, n=43) was defined as LAVI ≤ 34 mL/m 2 ; and group B (or larger LAVI group, n=61) as LAVI > 34 mL/m 2 Detailed clinical and echocardiographic data were obtained LV wall thickness was measured at 15 sites at 3 levels (base, mid, and apex) Diastolic function was assessed from mitral and pulmonary venous inflow velocities and Doppler tissue imaging Results Both groups were similar in terms of sex, functional class (16 ± 08 vs 15 ± 08, group B vs A, P = 64), and incidence of atrial fibrillation (13% vs 5%, P = 19) However, patients of group B had a significantly higher incidence of serious cardiovascular events (164% vs 23%, group B vs A, P = 024) Both groups had a similar degree of resting LV outflow tract obstruction (19 ± 30 vs 12 ± 13 mm Hg, group B vs A, P = 06) However, those in group B had a higher incidence of at least moderate mitral regurgitation (25% vs 5%, group B vs A, P = 007), more LV hypertrophy at 6 LV nonapical wall segments ( P P P P = 003), a higher early diastolic velocity/early diastolic mitral annular velocity (102 ± 49 vs 75 ± 29, group B vs A, P = 003), and a higher calculated LA pressure (148 ± 65 vs 111 ± 34 mm Hg, group B vs A, P = 0011) Conclusions Patients with hypertrophic cardiomyopathy and LA enlargement had more serious cardiovascular events and demonstrated greater LV hypertrophy, more diastolic dysfunction, and higher filling pressures
TL;DR: Atrial electromechanical delay is related with left atrial size but not with severity of MS, and is correlated with P-wave dispersion.
Abstract: Objective The aim of our study was to: (1) measure atrial electromechanical delay in patients with mitral stenosis (MS) and in a control group; (2) find the echocardiographic parameters that affect atrial electromechanical delay; and (3) examine the correlation between atrial electromechanical delay and P-wave dispersion (PWD). Methods A total of 25 patients with pure MS (age 43 ± 10 years; 18 women, 7 men) and 16 control subjects (age 41 ± 8 years; 9 women, 7 men) were studied. Interatrial and intra-atrial electromechanical delay was measured with Doppler tissue echocardiography. From the 12-lead electrocardiograms, PWD was calculated. Results Interatrial electromechanical delay was 71.2 ± 33 in the MS group and 40.5 ± 21.0 in the control group ( P = .01). In the MS group, PWD was 50 ± 7 and in the control group it was 29 ± 5 ( P = .03). A positive correlation was detected between interatrial electromechanical delay and PWD ( r = 0.6, P = .03). Conclusion This study shows that interatrial electromechanical delay gets longer in MS and is correlated with PWD. Atrial electromechanical delay is related with left atrial size but not with severity of MS.
TL;DR: The findings indicate that automated analysis of SR and strain, with some manual adjustment, is feasible and quicker than manual analysis.
Abstract: Background: This study evaluated 3 new automated methods, based on a combination of speckle tracking and tissue Doppler, for the analysis of strain rate (SR) and strain. Feasibility and values for peak systolic strain rate (SRs) and end-systolic strain (Ses) were assessed. Methods: Thirty patients with myocardial infarction and 30 normal subjects were examined. Customized software with automatic definition of segments was used for automated measurements. SRs and SRes were measured over each segment simultaneously and identified automatically. The study compared tissue Doppler–based SR and strain measurements without (method 1) and with segment tracking (method 2) to speckle tracking–based measurements (method 3). For tracking, speckle tracking and tissue Doppler were used in combination. Standard manual analysis was used as a reference. Results: The automated analysis (16 segments, 3 apical views) required 2 minutes; manual analysis took 11 minutes. Accuracy was compared in 56 segments (28 mid-infarcted and 28 normal) from 28 patients and was 93.9% for method 1, 93.8% for method 2, 95.8% for method 3, and 96.2% for the manual method. In the normal group, mean SRs (0.27 s 1 ) was less with method 3 than with the other methods (P < .001). Conclusions: Our findings indicate that automated analysis of SR and strain, with some manual adjustment, is feasible and quicker than manual analysis. Diagnostic accuracy was similar with all methods. SRs was lower in the speckle tracking–based method than in the Doppler-based methods. (J Am Soc Echocardiogr 2005;18:411-8.) Strain rate (SR) and strain are new methods for quantifying regional deformation rate and deformation by either tissue Doppler 1 or speckle tracking. 2 Manual analysis is time-consuming, and the postprocessing required for acceptable results requires experience. Further, strain rate imaging (SRI) has a high variability and thus is currently of limited clinical use. The new scanner technology simultaneously acquires not only high-quality 2-dimensional images with adequate frame rates for gray-scale imaging, but also high-frame-rate tissue Doppler data, enabling applications that use both modali
TL;DR: Although some NC criteria are occasionally found in other heart disease, the combination of all criteria is very specific: all criteria of NC are rarely met in other disease than IVNC.
Abstract: Background Echocardiographic characteristics typical of isolated left ventricular noncompaction (IVNC) have been well defined. The aim of this study was to validate diagnostic criteria of IVNC in valvular or hypertensive heart disease (HHD) or dilated cardiomyopathy. Methods We conducted a retrospective analysis of records and blind review of videotapes of all 19 patients with IVNC seen within 7 years in comparison with randomly selected patients from the same study period with dilated cardiomyopathy (31 patients), HHD (22 patients), and chronic severe valvular heart disease: mitral regurgitation (22 patients); aortic regurgitation (20); and aortic stenosis with bicuspid (22) or tricuspid (22) valves. Results Clinical characteristics and electrocardiographic findings did not differ between IVNC and other diseases. In IVNC, all patients had noncompacted (NC) segments with a 2-layered structure and wall thickening, and in most patients perfused recesses (95%) or hypokinetic segments (89%) were present. Both hypertrabeculation or presence of a meshwork were specific for IVNC, but the sensitivity for IVNC was only 11% for hypertrabeculation, respectively, 68% for meshwork. In dilated cardiomyopathy, perfused recesses (48%) and a 2-layered structure (26%) were seen but without wall thickening of these segments; all NC criteria including wall thickening were fulfilled in one patient (3%) only. In valvular heart disease or HHD, perfused recesses and a 2-layered myocardium were rare: two patients (5%) with aortic stenosis and one patient with HHD (5%) had NC. Although in IVNC wall thickening was confined to the 2-layered myocardial segments, it was diffuse in other diseases. Conclusions Although some NC criteria are occasionally found in other heart disease, the combination of all criteria is very specific. All criteria of NC are rarely met in other disease than IVNC (≤ 5%).
TL;DR: Semiautomated LV endocardial surface detection from FM3DE images is feasible and results in fast and accurate assessment of LV function, which resulted in higher levels of agreement with MRI than conventional 2-dimensional echocardiography, with lower interobserver variability.
Abstract: Our goals were to: (1) develop a technique for 3-dimensional (3D) direct, model-independent quantitative assessment of left ventricular (LV) volume and ejection fraction based on semiautomated detection of LV endocardial surface from transthoracic near real-time full matrix-array 3D echocardiographic (FM3DE) imaging; (2) evaluate the accuracy of LV volumes obtained with this technique, using cardiac magnetic resonance imaging (MRI) measurements as the reference for comparison; and (3) determine the effects of contrast enhancement on the accuracy of FM3DE measurements. A total of 46 patients underwent 2-dimensional echocardiography, FM3DE, and cardiac MRI. End-diastolic volume, end-systolic volume, and ejection fraction were derived from endocardial borders manually traced from 2-dimensional echocardiographic images and from semiautomatically detected LV cavity from FM3DE data. In 14 patients, FM3DE was also acquired with contrast. All measurements were compared with MRI values using linear regression and Bland-Altman analyses. FM3DE was feasible in 44 of 46 patients with LV volumes
TL;DR: It is concluded that the novel AUTO CIMT measurement program improved reproducibility and was accurate and compared with MAN tracing, the AUTO method agreed better with the REF lab and decreased reading time.
Abstract: We have developed a novel, semiautomated carotid intima-media thickness (CIMT) border detection program (AUTO) and evaluated its measurement reproducibility and accuracy. Images from 6 carotid segments were acquired in 50 subjects, for a total of 300 segments. Mean and maximum CIMT values were measured blindly at a reference (REF) lab and in duplicate by experienced (EXP) and novice (NOV) readers using manual (MAN) and AUTO methods. Coefficients of variation for AUTO measurements of mean (3.2%) and maximum (4.1%) CIMT were low, and the AUTO method improved the NOV reader's reproducibility. Compared with the REF lab, mean (0.012 +/- 0.006 mm) and maximum (0.144 +/- 0.006 mm) CIMT biases were small and equivalent to those of the REF lab ( P < .001). The AUTO method shortened reading times by 35% to 46% ( P < .001). We conclude that our novel AUTO CIMT measurement program improved reproducibility and was accurate. Compared with MAN tracing, the AUTO method agreed better with the REF lab and decreased reading time.
TL;DR: LA DTI is an easy, fast, and reliable method to estimate the total atrial electrical activation time, and may be useful in the identification of those prone to develop atrial fibrillation.
Abstract: Background Currently, the total atrial activation time, as indicated by the P-wave duration using signal-averaged (SA) electrocardiogram (ECG) (SA-ECG), is the most powerful predictor of atrial fibrillation. However, because of practical limitations, this technique is not used in clinical routine. In this study we evaluated several alternative techniques to measure the total atrial activation time, including a new parameter that uses atrial Doppler tissue imaging (DTI). Methods For 30 patients who were in sinus rhythm and underwent a transthoracic echocardiogram, we determined the P-wave duration on surface ECG and SA-ECG, and the interval from the onset of the P wave (lead II) until the onset of the echocardiographic flow Doppler A wave over the mitral valve. In addition, using pulsed wave DTI in the 4-chamber view, we measured the interval of time from initiation of the ECG P wave (lead II) until the peak of the local lateral left atrial (LA) DTI signal. Correlation between the SA-ECG, surface ECG, and echocardiographic parameters were evaluated by Spearman correlation tests. Results All parameters that were used to estimate total atrial activation time showed a significant correlation with the SA-ECG P-wave duration. Although the interval of time from initiation of the ECG P wave until the peak of the local lateral LA DTI signal was significantly longer than the SA-ECG P-wave duration (151.12 ± 19.4 vs 128.4 ± 15.8 milliseconds, respectively, P R = 0.91, P P Conclusion LA DTI is an easy, fast, and reliable method to estimate the total atrial electrical activation time, and may be useful in the identification of those prone to develop atrial fibrillation.
TL;DR: In patients undergoing MV repair for myxomatous MV degeneration and evaluated using a standardized transesophageal echocardiographic protocol, annular disjunction was seen at the base of the posterior leaflet in 98% of patients with advanced, and in 9% of Patients with mild/moderate MV degenerations.
Abstract: Mitral annular disjunction is a structural abnormality of the mitral annulus fibrosus described by pathologists in association with mitral leaflet prolapse and defined as a separation between the atrial wall-mitral valve (MV) junction and the left ventricular attachment allowing for hypermobility of the MV apparatus. The transesophageal echocardiographic characteristics of this abnormality have not been previously described. In patients undergoing MV repair for myxomatous MV degeneration and evaluated using a standardized transesophageal echocardiographic protocol, annular disjunction (mean value 10 +/- 3 mm) was seen at the base of the posterior leaflet in 98% of patients with advanced, and in 9% of patients with mild/moderate MV degeneration. There was a significant correlation between the magnitude of disjunction and the number of segments with prolapse/flail (r = 0.397, P = .001). We found annular disjunction to be a common component of MV apparatus in advanced MV degeneration. Its recognition on transesophageal echocardiography is important to facilitate optimal MV repair. The modification of the repair technique allows surgical correction of the annular disjunction, which seems to optimize long-term results in these challenging cases.
TL;DR: This study supports the use of a higher MPI cut-point for best diagnostic accuracy when using the new PW-TD method, which had similarly high diagnostic accuracy for CHF.
Abstract: Objectives The aims of this study were to investigate the clinical agreement between myocardial performance index (MPI) measured conventionally and by pulsed-wave tissue Doppler (PW-TD) of the mitral annulus, and to test whether PW-TD MPI can accurately differentiate between healthy subjects and patients affected by congestive heart failure (CHF) with mild to moderate reduction of systolic function. Background Calculation of MPI using PW-TD may have advantages over conventional left ventricle inflow/outflow tract pulsed-wave Doppler (PWD) method; for example, all of the data needed for PW-TD MPI calculation can be derived from one single cardiac cycle, whereas with PWD at least two different cycles are needed. Thus, heart rate variability does not interfere with PW-TD MPI. Methods and Results In group A, we included 70 healthy adults with normal left ventricular ejection fraction and normal diastole, whereas for group B we studied 50 patients with CHF and left ventricular ejection fraction between 35% and 45%. MPI measured with PWD was statistically different ( P Conclusion We found clinical agreement between MPI measured in the same subject with the conventional PWD method and with PW-TD. Both methods had similarly high diagnostic accuracy for CHF, but this study supports the use of a higher MPI cut-point for best diagnostic accuracy when using the new PW-TD method. Summary We performed a study in healthy adults and in patients with congestive heart failure to investigate the clinical agreement between MPI measured conventionally and by PW-TD of the mitral annulus. We found mild agreement between MPI measured by the conventional method and by PW-TD. Both methods had high diagnostic accuracy for CHF. PW-TD method requires a higher MPI cut-point for best diagnostic accuracy.
TL;DR: Atrial electromechanical coupling using M-mode Doppler tissue is evaluated to test its clinical impact for detecting atrial abnormalities in paroxysmal atrial fibrillation (AF) and the sensitivity, the specificity, and the positive predictive values for parxysmal AF are found.
Abstract: The aim of this study was to: (1) evaluate atrial electromechanical coupling using M-mode Doppler tissue; and (2) test its clinical impact for detecting atrial abnormalities in paroxysmal atrial fibrillation (AF). Using Doppler tissue, the time intervals from the onset of P wave until the backward motions of the right and left atrioventricular rings in the apical 4-chamber view corresponding to the atrial contractions were measured. In paroxysmal AF group, these intervals were significantly longer than in the control group. Using the criteria that an abnormal time interval from the onset of P wave until the backward motion of the left atrioventricular ring is longer than 112 milliseconds, the sensitivity, the specificity, and the positive predictive values for paroxysmal AF are 73%, 93%, and 93%, respectively. This parameter is affected in patients with paroxysmal AF and should be useful for detecting atrial impairment related to paroxysmal AF.
TL;DR: Results show that, with appropriate instruction, pediatric critical care physicians are effective using limited portable echocardiography.
Abstract: Prompt diagnosis of children with suggested cardiac disease in the acute care setting is critical for initiation of life-saving therapy. We hypothesized that pediatric critical care physicians could perform limited portable echocardiography in children. Portable hand-carried cardiac ultrasound units with 2.5-MHz phased-array transducers were used (Optigo, Philips Medical Systems, Andover, Mass). Noncardiologists were trained through a 1-hour introductory course and 2 hours of practical training. Portable echocardiography performed by noncardiologists was compared with a standard echocardiogram for diagnostic accuracy. In all, 23 patients (age 3 months-20 years) were screened during 18 months. The presence or absence of a pericardial effusion was correctly diagnosed in 21 of 23 patients (91%). Left ventricular size was correctly determined in 22 of 23 patients (96%). Left ventricular systolic function was correctly diagnosed in 22 of 23 patients (96%). These results show that, with appropriate instruction, pediatric critical care physicians are effective using limited portable echocardiography.
TL;DR: RT 3DE measurements of LV end-systolicVolume, end-diastolic volume, mass, SV, and EF in children using rapid full volume acquisition strategy are feasible, accurate, and reproducible and are comparable with MRI measurements.
Abstract: Objective We sought to assess the feasibility, accuracy, and reproducibility of a rapid full volume acquisition strategy using real-time (RT) 3-dimensional (3D) echocardiography (3DE) for measurement of left ventricular (LV) volumes, mass, stroke volume (SV), and ejection fraction (EF) in children. Methods A total of 19 healthy children (mean 10.6 ± 2.8 years, 11 male and 9 female) were prospectively enrolled in this study. RT 3DE was performed using an ultrasound system to acquire full volume 3D dataset from the apical window with electrocardiographic triggering in 8 s/dataset. The images were processed offline using software. The LV endocardial and epicardial borders were traced manually to derive LV end-systolic volume, end-diastolic volume, mass, SV, and EF. Magnetic resonance imaging (MRI) studies were performed on a 1.5-T scanner using a breath hold 2-dimensional cine-FIESTA (fast imaging employing steady-state acquisition) sequence. Results All RT 3DE and MRI data were acquired successfully for analysis. Measurements of LV end-systolic volume, end-diastolic volume, mass, SV, and EF by RT 3DE correlated well by Pearson regression ( r = 0.86–0.97, P Conclusions This prospective study demonstrated that RT 3DE measurements of LV end-systolic volume, end-diastolic volume, mass, SV, and EF in children using rapid full volume acquisition strategy are feasible, accurate, and reproducible and are comparable with MRI measurements.
TL;DR: Evaluated for the first time both left atrial and right atrial function of children after transcatheter ASD closure with that of sex- and age-matched patients with surgically treated ASD, and sex-and-age-matched control subjects using strain (epsilon) and epsilon rate imaging (SR).
Abstract: The effect of operation and the effect of the imposition of an occluding device on atrial function for patients with an atrial septal defect (ASD) has never been studied. Thus, the aim of this study was to evaluate for the first time both left atrial (LA) and right atrial (RA) function of children after transcatheter ASD closure with that of sex- and age-matched patients with surgically treated ASD, and sex- and age-matched control subjects using strain (ϵ) and ϵ rate imaging (SR). In all, 45 participants formed our studied sample: 15 patients after successful ASD device closure (ASD-D [atrial septal defect device closure] group, mean age: 9 ± 3 years) and 15 age- and sex-matched patients after successful ASD surgical closure (ASD-S [atrial septal defect surgical closure] group, mean age: 9 ± 3 years). All patients underwent ASD correction at least 6 months before the study. As a control group we selected 15 age- and sex-matched control subjects. In the ASD-S group the peak systolic ϵ and SR values were significantly reduced in both RA and LA when compared with control and ASD-D groups ( P
TL;DR: In this paper, the potential relationship of demographic and echocardiographic parameters on regional strain (S) and strain rate (SR) in healthy children over a large age range was evaluated.
Abstract: Based on myocardial Doppler echocardiography, regional strain (S) and strain rate (SR) can be evaluated as regional parameters of ventricular function. The use of these techniques in clinical pediatric cardiology remains a challenge. This study establishes reference values for S and SR in both systole and diastole in healthy children over a large age range and evaluates the potential relationships of demographic and echocardiographic parameters on S and SR, and, in particular, assesses the clinical effect of heart rate on S and SR in healthy children. It is shown that heart rate changes in children during growth have an important impact on both systolic and diastolic myocardial S and late diastolic SR. Therefore, to evaluate regional myocardial function in children, heart rate at rest should be considered an important factor.
TL;DR: It is concluded that increases in chronic LV preload do not significantly affect the majority of DTI velocities in children with ventricular septal defects and significantly increased chronic LV afterload inChildren with aortic valve stenosis is associated with decreased DTI velocity in the absence of other identifiable abnormalities of LV function.
Abstract: Background Doppler tissue imaging (DTI) velocities have been reported to be relatively independent of changes in ventricular loading conditions in adult studies. The clinical impact of altered left ventricular (LV) preload and afterload on DTI velocities in children with congenital heart disease has not been adequately evaluated. The purpose of this study was to evaluate the impact of chronic LV preload and afterload on DTI velocities in children with isolated ventricular septal defect and aortic valve stenosis compared with age-matched normal and abnormal (dilated cardiomyopathy) control groups. Methods From an apical 4-chamber view, DTI velocities were obtained at the cardiac base at the lateral mitral annulus, lateral tricuspid annulus, and interventricular septum in early diastole, late diastole, and ventricular systole. Results The majority of DTI velocities did not change significantly in patients with increased LV preload. Patients with increased LV afterload had significantly decreased systolic and early diastolic DTI velocities at both the lateral mitral annulus and ventricular septum compared with control subjects. Children with dilated cardiomyopathy had significantly decreased DTI velocities at all myocardial annular locations. Conclusions We conclude that increases in chronic LV preload do not significantly affect the majority of DTI velocities in children with ventricular septal defects. In addition, significantly increased chronic LV afterload in children with aortic valve stenosis is associated with decreased DTI velocities in the absence of other identifiable abnormalities of LV function. Decreased DTI velocity may be secondary to increased afterload or may alternatively be an early marker of subclinical LV longitudinal dysfunction.
TL;DR: Both LV systolic and diastolic functions are impaired in COPD, especially in patients with pulmonary hypertension, and this impairment is independently associated with pulmonary arterial syStolic pressure, RVMPI, and forced expiratory volume in 1 second.
Abstract: Background The effects of chronic obstructive pulmonary disease (COPD) on right ventricular (RV) systolic and diastolic functions and left ventricular (LV) diastolic function have been shown. Whereas LV myocardial performance index (LVMPI), which incorporates ejection and isovolumic relaxation and contraction times and is an index of global ventricular function, has not yet been evaluated in COPD. Methods Our study population consisted of 24 age-matched control subjects (group 1), 24 patients with COPD without pulmonary hypertension (group 2), and 20 patients with COPD with pulmonary hypertension (group 3). Pulmonary function tests, analyses of arterial blood gases, and transthoracic echocardiographic examination were performed. RV myocardial performance index (RVMPI) and LVMPI were obtained by pulsed wave Doppler tissue. Results RVMPI was higher in both group 2 (0.61 ± 0.15) and group 3 (0.94 ± 0.27) than group 1 (0.41 ± 0.08) ( P = .038 and P P = .018). LVMPI was higher for group 3 (0.77 ± 0.25) than in both group 1 (0.49 ± 0.08) and group 2 (0.59 ± 0.10) ( P = .001 and P = .037, respectively). However, difference between groups 1 and 2 was not significant ( P > .05). For patients with COPD, LVMPI was positively correlated with age, heart rate, pulmonary arterial systolic pressure, RVMPI, and partial pressure of carbon dioxide, and negatively correlated with tricuspid annular plane systolic excursion, forced expiratory volume in 1 second, and partial pressure of oxygen. In multiple linear regression analysis ( R 2 = 0.676), LVMPI was independently associated with forced expiratory volume in 1 second (Beta = 0.549, P = .017), pulmonary arterial systolic pressure (Beta = 0.488, P = .014), and RVMPI (Beta = 0.278, P = .042). Conclusions Both LV systolic and diastolic functions are impaired in COPD, especially in patients with pulmonary hypertension. This impairment is independently associated with pulmonary arterial systolic pressure, RVMPI, and forced expiratory volume in 1 second.
TL;DR: The technical considerations, various routinely used methods to assess cardiac function, and some emerging techniques in the assessment of cardiac function in experimental mouse models of cardiac disease are described.
Abstract: There have now been literally hundreds of genetically manipulated mouse models developed during the past decade of cardiac research. Echocardiography is considered an extremely important tool to noninvasively assess and serially follow the phenotype of genetically and surgically altered mice. This review describes in detail the technical considerations, various routinely used methods to assess cardiac function, and some emerging techniques in the assessment of cardiac function in experimental mouse models of cardiac disease.
TL;DR: Early prenatal detection of abnormal delay in fetal AV time conduction is possible with the Doppler superior vena cava/ascending aorta approach.
Abstract: Background Complete fetal heart block (HB) and endocardial fibroelastosis (EFE) are known to be associated with maternal anti-Ro and anti-La antibodies. Complete fetal HB is irreversible. Objectives We sought to (1) assess the value of the superior vena cava/ascending aorta Doppler approach in the early detection of abnormal delay in the fetal atrioventricular (AV) time of conduction, before appearance of complete fetal HB; and (2) report the effect of prenatal steroid therapy on EFE, HB, or both. Results The clinical history, echocardiographic, and Doppler investigations of 3 fetuses and children born to mothers positive for anti-Ro and anti-La antibodies are reported. Two fetuses presented with EFE either isolated (29 weeks) or associated with AV block (25 weeks). In this last case, the superior vena cava/ascending aorta approach allowed the identification of a Luciani-Wenckebach phenomenon. In a third fetus, 2:1 AV block was noted at 23 weeks of gestation. Dexamethasone (4 mg/day) was administered to all 3 patients. Complete regression of the EFE and conduction abnormalities was documented in all cases. Conclusion Early prenatal detection of abnormal delay in fetal AV time conduction is possible with the Doppler superior vena cava/ascending aorta approach. Steroid therapy can cure fetal EFE and AV conduction delays associated with maternal anti-Ro and anti-La antibodies.
TL;DR: In healthy male volunteers, preload reduction induced by a 500-mL blood donation does not affect the color propagation velocity, rate, and Doppler tissue velocities.
Abstract: Objectives We sought to assess the effects of blood donation on different echocardiographic parameters in healthy volunteers. Methods A total of 101 healthy male volunteers were evaluated by echocardiography before and immediately after a 500-mL blood donation. In addition to traditional Doppler indices of left ventricular filling, Doppler tissue, color flow propagation, strain (ϵ), and ϵ rate were measured. Results There was a statistically significant decrease in mitral peak E and A values after blood donation (E wave 0.85 ± 0.12 vs 0.79 ± 0.14 cm/s, P = .01; A wave 0.65 ± 0.10 vs 0.60 ± 0.12 cm/s, P = .05). Mitral color flow propagation velocity was not affected (560 ± 123 vs 571 ± 132 mm/s, P = not significant). There were no significant differences in the Doppler tissue parameters of peak systolic, and early and late diastolic velocities after blood donation (Sm 13.5 ± 4.6 vs 13.3 ± 4.9 cm/s, P = not significant; Em 15.5 ± 4.9 vs 15.9 ± 5.1 cm/s, P = not significant; and Am 14.1 ± 3.9 vs 14.1 ± 3.5 cm/s, P = not significant, respectively). The peak systolic ϵ decreased significantly (−28 ± 8% vs −21 ± 4%, P = .03) whereas the peak systolic ϵ rate was not affected (1.5 ± 0.35 vs 1.4 ± 0.40 s −1 , P = not significant). Conclusion In healthy male volunteers, preload reduction induced by a 500-mL blood donation does not affect the color propagation velocity, ϵ rate, and Doppler tissue velocities.
TL;DR: This book presents a meta-analyses of the immune system’s response to certain types of infectious disease, including septicaemia, which is known as “superbugs” and is based on research published in “Superbug 411,” which describes the immune responses of dogs to infectious disease.
Abstract: Writing Committee: James D. Thomas, MD (Chair), David B. Adams, RDCS,Stephen DeVries, MD, Donna Ehler, RDCS, Neil Greenberg, PhD, Mario Garcia, MD,Leonard Ginzton, MD, John Gorcsan, III, MD, Alan S. Katz, MD, Andrew Keller, MD,Bijoy Khandheria, MD, Kit B. Powers, MD, Cindy Roszel, RDCS, David S. Rubenson, MD,and Jeffrey Soble, MD