ECHOCARDIOGRAPHY, Issue 5 2010
Arnd Schaefer M.D.
Background: Symptomatic severe aortic stenosis is associated with increased mortality and morbidity. Early identification of these patients by echocardiography is crucial. We conducted this study to evaluate a handheld ultrasound device (HCU) in patients with suspected severe aortic stenosis (AS) in comparison to a standard echocardiography device (SE). Methods: A HCU (Vivid I; GE Healthcare) and a SE device (Philips iE 33) were used to evaluate 50 consecutive patients with suspected severe AS. Two consecutive echocardiographic studies were performed by two experienced and blinded examiners using HCU and SE device. AS was graded by mean transaortic pressure, aortic valve area (AVA), and indexed AVA (AVA adjusted for body surface area). Results: Mean difference for mean transaortic gradient, AVA and indexed AVA for the SE and HCU device were 1.28 mmHg (,0.70 to 3.26 mmHg), ,0.02 cm2 (,0.06 to 0.01 cm2), and ,0.01 cm2/m2 (,0.03 to 0.01 cm2/m2), respectively. Discrepancies between both devices were not associated with misinterpretation of the degree of AS. Conclusion: Our study demonstrates that HCU can be used to evaluate patients with suspected AS. (ECHOCARDIOGRAPHY 2010;27:481-486) [source]

Clinical Value of the Tissue Doppler S Wave to Characterize Left Ventricular Hypertrophy as Defined by Echocardiography

ECHOCARDIOGRAPHY, Issue 4 2010
Demian Chejtman M.D.
Left ventricular hypertrophy (LVH) may be a physiological finding and may also be associated with different disease entities and hence, with different outcomes. Regional myocardial function can be assessed with color Doppler tissue imaging, specifically by the waveform of the isovolumic contraction (IC) period and the regional systolic wave ("s"). Methods and Results: We studied five groups (G): healthy, sedentary young volunteers (G1, n:10); healthy sedentary adult volunteers (G2, n:8); and subjects with LVH (left ventricular mass index >125 g/m2) including: high performance athletes (G3, n:21), subjects with hypertension (G4, n:21), subjects with hypertrophic cardiomyopathy (HCM) (G5, n:18). We measured peak "s" wave velocity (cm/sec) at the basal and mid septum, the IC/s ratio, and basal to mid-septal velocity difference (BMVD) of the "s" wave. Regional "s" wave values (cm/sec) were G1 = 5.6 ± 1; G2 = 5.4 ± 0.8; G3 = 5.7 ± 0.6; G4 = 5.3 ± 1.1; G5 = 4.2 ± 1.1 (P < 0.0001). The IC/s ratio was G1 = 0.28 ± 0.18; G2 = 0.39 ± 0.21; G3 = 0.23 ± 0.10; G4 = 0.42 ± 0.15; G5 = 0.64 ± 0.15 (P < 0.0001). The BMVD (cm/sec) was G1 = 2 ± 0.51; G2 = 1.71 ± 0.29; G3 = 1.78 ± 0.44; G4 = 1.26 ± 0.96; G5 = 0.45 ± 0.4 (P < 0.0001). IC/s < 0.38 discriminated physiological from pathological forms of hypertrophy (sensitivity 90%; specificity 88%). Peak "s" wave velocity discriminated HCM from other causes of hypertrophy, with a cutoff value of 4.46 cm/sec (sensitivity 72%; specificity 90%). BMVD <0.98 cm/sec detected HCM with 89% sensitivity and 86% specificity. Conclusions: Peak "s" wave velocity and two indices: IC/s and BMDV are novel parameters that may allow to discriminate physiological from pathological forms of hypertrophy as well as different subtypes of hypertrophy. (ECHOCARDIOGRAPHY 2010;27:370-377) [source]

Estimation of Coronary Flow Velocity Reserve Using Transthoracic Doppler Echocardiography and Cold Pressor Test Might Be Useful for Detecting of Patients with Variant Angina

ECHOCARDIOGRAPHY, Issue 4 2010
Hui-Jeong Hwang M.D.
Purpose: The cold pressor test (CPT) has been used to detect variant angina, but its sensitivity in predicting vasospasm is low. The aim of this study was to determine whether estimates of the coronary flow velocity reserve (CFVR) in the distal left anterior descending coronary artery (dLAD) using transthoracic echocardiography (TTE) and CPT are useful tool to predict variant angina. Methods: 65 patients (mean age = 52 ± 10 years; male:female = 41:24) who had normal coronary artery on angiography and underwent acetylcholine provocation test were enrolled and divided into the spasm group (n = 31) and the no spasm group (n = 34). During CPT, the peak (PDV) and mean diastolic flow velocity (MDV) of the dLAD were estimated using TTE with a high-frequency transducer, and electrocardiography, blood pressures, heart rate, and symptoms were monitored every 30 seconds. CPT%PDV and CPT%MDV were defined as the percentage changes in PDV and MDV during CPT, respectively. Results: CPT%PDV was 4.99 ± 23.62% in the spasm group and 52.75 ± 24.78% in the no spasm group (P < 0.001). CPT%MDV was 6.83 ± 23.81% in the spasm group and 50.22 ± 27.83% in the no spasm group (P < 0.001). CPT%PDV<31.1% had a sensitivity of 93.5% and a specificity of 82.4% in predicting variant angina (95% confidence interval [CI]: 0.939,0.979, P < 0.001). CPT%MDV<30.55% had a sensitivity of 90% and a specificity of 76.5% in predicting variant angina (95% CI: 0.884,0.950, P < 0.001). Conclusion: The measurement of changes in the coronary flow velocity of the dLAD using TTE and CPT might be useful for the estimation of endothelial dysfunction in patients with variant angina. (ECHOCARDIOGRAPHY 2010;27:435-441) [source]

Does Left Atrial Size Predict Mortality in Asymptomatic Patients with Severe Aortic Stenosis?

ECHOCARDIOGRAPHY, Issue 2 2010
Grace Casaclang-Verzosa M.D.
Background: We assessed the hypothesis that diastolic function represented by left atrial size determines the rate of development of symptoms and the risk of all-cause mortality in asymptomatic patients with severe aortic stenosis (AS). Methods: From a database of 622 asymptomatic patients with isolated severe AS (velocity by Doppler , 4 m/sec) followed for 5.4 ± 4 years, we reviewed the echocardiograms and evaluated Doppler echocardiographic indices of diastolic function. Prediction of symptom development and mortality by left atrial diameter with and without adjusting for clinical and echocardiographic parameters was performed using Cox proportional-hazards regression analysis. Results: The age was 71 ± 11 years and 317 (62%) patients were males. The aortic valve mean gradient was 46 ± 11 mmHg, and the Doppler-derived aortic valve area was 0.9 ± 0.2 cm2. During follow-up, symptoms developed in 233 (45%), valve surgery was performed in 290 (57%) and 138 (27%) died. Left atrial enlargement was significantly correlated with symptom development (P < 0.05) but the association diminished after adjusting for aortic valve area and peak velocity (P = 0.2). However, atrial diameter predicted death independent of age and gender (P = 0.007), comorbid conditions (P = 0.03), and AS severity and Doppler parameters of diastolic function (P = 0.002). Conclusion: Diastolic function, represented as left atrial diameter, is related to mortality in asymptomatic patients with severe AS. (ECHOCARDIOGRAPHY 2010;27:105-109) [source]

Ventricular Mechanical Asynchrony in Patients with Different Degrees of Systolic Dysfunction: Results from AVE Registry by the Italian Society of Cardiovascular Echography (SIEC)

ECHOCARDIOGRAPHY, Issue 2 2010
Scipione Carerj M.D.
Objective: The aim of the study was to compare the prevalence of interventricular and intraventricular asynchrony in patients with different degrees of left ventricular (LV) dysfunction. Methods: We enrolled 182 patients (male 79%, mean age 64 ± 11 years) with LV ejection fraction (EF) < 50% and identified two groups: Group A (n = 79) with mild-to-moderate LV dysfunction (EF between 36% and 49%) and Group B (n = 103) with severe dysfunction (EF , 35%). An echocardiogram was performed in all patients and a delay longer than 40 msec in the time difference between the aortic and pulmonary preejection intervals was considered as an index of interventricular asynchrony. The electromechanical delays were assessed by pulsed tissue Doppler technique. A time difference between the earliest and the latest segment greater than 40 msec was considered the cutoff for intraventricular asynchrony. The sum of asynchrony was calculated by adding to the LV intraventricular delay the delay between the lateral basal right ventricular segment and the most delayed LV basal segment. Results: The prevalence of interventricular asynchrony was lower among Group A patients (19.8% vs. 37.9%; P = 0.007) while the prevalence of intraventricular asynchrony did not differ between groups (32.9% vs. 44% in Group A and Group B respectively; P = 0.18). The sum of asynchrony (cutoff >102 msec) did not differ between groups either (29.9% vs. 35.9%; P = 0.39). Conclusions: The prevalence of intraventricular asynchrony is independent of the LV systolic dysfunction severity. This could indicate the potential role of cardiac resynchronization therapy in patients with mild-moderate systolic dysfunction. (ECHOCARDIOGRAPHY 2010;27:110-116) [source]

Segmental Contribution to Left Ventricular Systolic Function at Rest and Stress: A Quantitative Real Time Three-Dimensional Echocardiographic Study

ECHOCARDIOGRAPHY, Issue 2 2010
F.A.S.E., Smadar Kort M.D.
Objective: To assess the relative contribution of each myocardial segment to global systolic function during stress using real time three-dimensional echocardiography (RT3DE). Background: During stress, global augmentation in contractility results in an increased stroke volume. The relative contribution of each myocardial segment to these volumetric changes is unknown. Methods: Full volume was acquired using RT3DE at rest and following peak exercise in 22 patients who had no ischemia and no systolic dyssynchrony on two-dimensional (2D) stress echocardiography. The following were calculated at rest and peak stress: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), relative SV, and relative EF. Results: With stress, an increase in global EDV from 90.8 to 101.1 ml (P < 0.001), SV from 59 to 78.4 ml (P = 0.01), and EF from 65.6 to 78.4% (P = 0.001) was observed. ESV decreased from 31.8 to 22.7 ml (P < 0.001). Segmental analysis revealed significantly higher SV, relative SV, and relative EF for the basal anterior, basal anterolateral, and basal inferolateral segments compared with the apical septum and apical inferior segments at both rest and stress (P < 0.001). The SV, relative SV, and relative EF increased significantly from apex to mid to base at both rest and stress (P < 0.001). Conclusions: The relative volumetric contribution of each myocardial segment to global left ventricular systolic function at rest and stress is not uniform. The basal segments contribute more than the mid and apical segments. Specifically, the basal anterior, basal anterolateral, and basal inferolateral segments contribute the most to augmentation of left ventricular systolic function with exercise. (ECHOCARDIOGRAPHY 2010;27:167-173) [source]

Association of Bicuspid Aortic Valve Morphology and Aortic Root Dimensions: A Substudy of the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin (ASTRONOMER) Study

ECHOCARDIOGRAPHY, Issue 2 2010
Davinder S. Jassal M.D., F.R.C.P.C.
Background: Bicuspid aortic valve (BAV) is the leading cause of aortic stenosis in patients younger than the age of 50. A classification scheme of BAVs is based upon leaflet orientation: Type I (fusion of right and left coronary cusps) and Type II (fusion of right and noncoronary cusps). The correlation between BAV leaflet orientation and aortic root pathology however remains ill defined. Objective: The objective was to describe a potential relationship between BAV leaflet morphology and aortic root measurements in the ASTRONOMER study, a multicenter study to assess the effect of rosuvastatin on the progression of AS. Methods: BAV morphology was classified as Type I or Type II orientation based on the parasternal short-axis view. Echo measurements including left ventricular and aortic root dimensions were obtained. Results: The study population included 89 patients (56 ± 11 years; 44 males). There were 63 patients with Type I and 26 patients with Type II BAV. Baseline demographics, hemodynamics, and left heart dimensions were similar between both groups. Patients with Type I BAV had larger aortic annulus and ascending root dimensions compared to those patients with Type II BAV (P < 0.05). Conclusion: In patients with mild to moderate aortic stenosis due to a BAV, the presence of Type I valve orientation was associated with significantly greater aortic root parameters compared to Type II valve orientation. (ECHOCARDIOGRAPHY 2010;27:174-179) [source]

Hand-Held Echocardiogram Does Not Aid in Triaging Chest Pain Patients from the Emergency Department

ECHOCARDIOGRAPHY, Issue 6 2009
Mayank Kansal M.D.
Background: Accurate triage of emergency department (ED) patients presenting with chest pain is a primary goal of the ED physician. In addition to standard clinical history and examination, a hand-held echocardiogram (HHE) may aid the emergency physician in making correct decisions. We tested the hypothesis that an HHE performed and interpreted by a cardiology fellow could help risk-stratify patients presenting to the ED with chest pain. Methods: ED physicians evaluated 36 patients presenting with cardiovascular symptoms. Patients were then dispositioned to either an intensive care bed, a monitored bed, an unmonitored bed, or home. Following disposition, an HHE was performed and interpreted by a cardiology fellow to evaluate for cardiac function and pathology. The outcomes evaluated (1) a change in the level of care and (2) additional testing ordered as a result of the HHE. Results: The HHE showed wall motion abnormalities in 31% (11 out of 36) of the studies, but the level of care did not change after HHE for any patients who presented with chest pain to the ED. No additional laboratory or imaging tests were ordered for any patients based on the results of the HHE. Eighty-six percent (31 out of 36) of the studies were of adequate quality for interpretation, and 32 out of 36 (89%) interpretations correlated with an attending overread. Conclusion: Despite the high prevalence of abnormal wall motion in this population, hand-held echocardiography performed in this ED setting did not aid in the risk stratification process of chest pain patients. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source]

Comparison of LVEF Obtained with Single-Plane RAO Ventriculography and Echocardiography in Patients with and without Obstructive Coronary Artery Disease

ECHOCARDIOGRAPHY, Issue 6 2009
Vijayasree Kudithipudi M.D.
The left ventricular ejection fraction (LVEF) determined by invasive ventriculography (routine cardiac cath; LV-gram) was compared with that determined by echocardiography in 100 patients scheduled for angiography (86% had LV-gram and 2DE during same hospital admission). Seventy percent of patients had at least single-vessel obstructive coronary artery disease, defined as more than 50% stenosis. By all estimates, the LVEF was higher in patients without coronary artery disease (CAD) compared to patients with CAD. There was an excellent correlation between the LVEF by cath and echo, but this correlation was noticeably less strong in patients with CAD, especially with involvement of the left circumflex artery. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source]

Integrating Research into Clinical Practice: Development of an Echocardiography Research Unit

ECHOCARDIOGRAPHY, Issue 6 2009
R.D.C.S., Tammy M. Green B.A.
Introducing a research program into an echocardiography clinical practice can pose many challenges. Some initial factors to consider are the possible effects on the current clinical schedule and the equipment and personnel resources required to support the research projects. More importantly, how can an organization successfully complete reliable and accurate research projects? Here, we describe our experience with establishing an echocardiography research center within our clinical echocardiography practice. In addition, we identify key staff roles, highlight our current research practice methods, and suggest essential components that may prove advantageous when incorporating echocardiography research into a clinical practice. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source]

Embolization of Atrial Septal Occluder Device into the Pulmonary Artery: A Rare Complication and Usefulness of Live/Real Time Three-Dimensional Transthoracic Echocardiography

ECHOCARDIOGRAPHY, Issue 6 2009
Harvinder S. Dod M.D.
Percutaneous closure of atrial septal defects (ASD) in adults has emerged as an alternative to surgery. We report a rare complication of an atrial septal occluder device embolization into the pulmonary artery which was detected by fluoroscopy and echocardiography. The potential usefulness of live/real time three-dimensional transthoracic echocardiography in the management of patients undergoing percutaneous ASD occlusion is described. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source]

Tricuspid Valve Involvement in Carcinoid Disease

ECHOCARDIOGRAPHY, Issue 4 2007
Bernard Abi-Saleh M.D.
(ECHOCARDIOGRAPHY, Volume **, **********) [source]

Echocardiographic Diagnosis of a Case with Giant Right Atrial Aneurysm

ECHOCARDIOGRAPHY, Issue 2 2006
Nesligül Yildirim M.D.
Right atrial aneurysm (RAA) is a very rare anomaly. Rarer still is its association with atrial septal defect (ASD). We reported a case of a 42-year-old woman with giant RRA and secundum type ASD detected by means of transthoracic echocardiography. (ECHOCARDIOGRAPHY, Volume 23, February 2006) [source]

ORIGINAL INVESTIGATIONS: Comparison of Left Atrial Dimensions by Transesophageal and Transthoracic Echocardiography

ECHOCARDIOGRAPHY, Issue 10 2005
Harshinder Singh M.D.
Transesophageal echocardiography (TEE) is an established cardiovascular diagnostic technique. Left atrial (LA) size, as measured by transthoracic echocardiography (TTE), is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke, death, and the success of cardioversion. Assessment of LA size has not been as well validated on TEE as on TTE. We determined LA size measurements in four standard views in 122 patients undergoing TEE and TTE at the same setting. In this study, we found that measurement of LA dimensions by TEE suffers from significant limitations in all views except the basal long-axis view (mid-esophageal level) with transducer plane at 120,150 degrees. This view had the best correlation with transthoracic LA measurements: r = 0.79 for TEE long axis (CI 0.71,0.85), P <.0001. (ECHOCARDIOGRAPHY, Volume 22, November 2005) [source]

Regional Response of Myocardial Acceleration During Isovolumic Contraction During Dobutamine Stress Echocardiography: A Color Tissue Doppler Study and Comparison with Angiocardiographic Findings

ECHOCARDIOGRAPHY, Issue 10 2005
Linda B. Pauliks M.D.
Background: Color tissue Doppler imaging permits noninvasive quantitation of regional wall motion. In experimental studies, a new marker, the slope of the isovolumic contraction wave, isovolumic acceleration (IVA) was more insensitive to ventricular loading conditions than myocardial velocities. This study compared the regional response IVA to dobutamine stress echocardiography to angiographic findings. Methods: The Myocardial Doppler in Stress Echocardiography (MYDISE) study prospectively recruited 149 consecutive patients with chest pain for dobutamine stress tissue Doppler echocardiography prior to coronary angiography. This color tissue Doppler database was analyzed for IVA in 1192 basal and mid segments at rest and again at peak stress. Angiographic findings were compared to IVA and peak systolic velocities (PSV) in corresponding cardiac segments. The diagnostic accuracy of IVA to predict coronary artery stenosis was determined using cut-off values for three representative segments and with the MYDISE diagnostic model including eight segments. Results: Regional IVA increased in a dose-dependent manner during dobutamine infusion. The response was blunted in the supply territory of stenosed coronary artery branches. IVA performed slightly better than PSV as single marker for coronary artery stenosis. A diagnostic model incorporating IVA and PSV was 85,95% accurate (area under receiver operating characterstic curves). Conclusions: Regional changes of isovolumic acceleration during dobutamine stress echocardiography reflect regional wall motion and can be used to predict coronary artery stenosis with similar accuracy as a model based on systolic myocardial velocities. As a single marker, IVA performed better than myocardial velocities. (ECHOCARDIOGRAPHY, Volume 22, November 2005) [source]

Rupture of a Right Sinus of Valsalva Aneurysm into the Right Ventricle During Vaginal Delivery: A Case Report

ECHOCARDIOGRAPHY, Issue 10 2005
F.E.S.C., Josip Vincelj M.D., Ph.D.
A case is reported of a right sinus of Valsalva aneurysm rupture into the right ventricle during vaginal delivery in a 34-year-old healthy woman in her third pregnancy. Pregnancy was carried to term and a healthy baby was delivered vaginally. On day 7 following vaginal delivery she was admitted to hospital for dyspnea and cough, with clinical signs of severe heart failure. The diagnosis of the right sinus of Valsalva aneurysm rupture into the right ventricle was established by transthoracic and transesophageal echocardiography. Clinical recognition and early echocardiographic diagnosis followed by immediate surgical repair proved lifesaving in our patient. (ECHOCARDIOGRAPHY, Volume 22, November 2005) [source]

Noninvasive Assessment of Influence of Resistant Respiration on Blood Flow Velocities Across the Cardiac Valves in Humans,A Quantification Study by Echocardiography

ECHOCARDIOGRAPHY, Issue 5 2004
Lijun Yuan M.D.
The aim of our study is to quantitatively investigate influence of the intrathoracic pressure change on the four cardiac valves' velocities and further verify a new proposal of the mechanism of respiratory influence on hemodynamics. Methods: Thirty healthy volunteers with no cardiopulmonary diseases were included. The intrathoracic pressure changes were measured with self-designed device. The velocity across the four cardiac valves during spontaneous respiration and with the intrathoracic pressure change at ,4, ,8, and ,12 mmHg, respectively, were recorded simultaneously with the electrocardiogram and respiratory curve. The respiratory variation indices (RVIs) were calculated. The average RVIs of mitral, aortic, tricuspid, and pulmonary valves were 12.54%, 13.19%; 6.23%, 8.27%; 20.27%, 24.36%; and 6.45%, 7.69% with intrathoracic pressure change at ,8 mmHg and ,12 mmHg, respectively. All the above parameters have a significant difference from those during spontaneous respiration (P < 0.01 or P < 0.001). We concluded that it might be the respiratory intrathoracic pressure change that causes the change of the velocity across the valves. (ECHOCARDIOGRAPHY, Volume 21, July 2004) [source]

Automated Volumetric Flow Quantification Using Angle-Corrected Color Doppler Image

ECHOCARDIOGRAPHY, Issue 5 2004
Beomjin Kim Ph.D.
We have developed a fully automated method for measuring volumetric blood flow with angle-corrected blood velocity from a color Doppler image. By computing the blood flow vector through a conduit, the angle of incidence between the direction of ultrasound beam and the direction of blood flow can be measured to correct the underestimated blood velocity. This correction immediately contributes to the improvement of measurement accuracy. The developed method also enhances the conduit identification procedure that is one of the most important factors affecting the accuracy of volumetric measurement. To evaluate the validity of the developed algorithm, experimental studies had been applied to 21 healthy subjects and 10 patients. Volumetric flows were measured from a color Doppler image of the left ventricular outflow track, which were compared with blood volumes that were measured by traditional pulsed-wave (PW)-Doppler technique. The mean stroke volume difference between two methods was ,0.45 ± 11.7 (mean ± SD). The proposed algorithm is a viable method for determining blood flow volume in an automated fashion. (ECHOCARDIOGRAPHY, Volume 21, July 2004) [source]

Technique and Imaging for Transthoracic Echocardiography of the Laboratory Pig

ECHOCARDIOGRAPHY, Issue 5 2004
Edmund Kenneth Kerut M.D.
(ECHOCARDIOGRAPHY, Volume 21, July 2004) [source]

Vasodilator Stress Induces Infrequent Wall Thickening Abnormalities Compared to Perfusion Defects in Mild-to-Moderate Coronary Artery Disease: Implications for the Choice of Imaging Modality with Vasodilator Stress

ECHOCARDIOGRAPHY, Issue 4 2004
M.R.C.P., Ph.D., Prem Soman M.D.
Background: Experimental evidence suggests that although vasodilator stress agents consistently induce regional flow disparity between stenosed and normal coronary vascular beds, the occurrence of functional myocardial ischemia is infrequent, especially in mild-to-moderate coronary artery stenosis. Thus, it is hypothesized that dipyridamole infusion, even at high doses, will result in a disproportionately higher frequency of perfusion defects compared to regional wall thickening abnormalities. Methods: We performed simultaneous high-dose (0.84 mg/kg) dipyridamole stress echocardiography (Echo) and Tc-99m sestamibi SPECT (MIBI, methoxyisobutyl isonitrile) in 46 patients with coronary artery diameter stenosis >50% and ,90% in one or two epicardial coronary arteries, and no previous myocardial infarction. Results: Of a total of 828 segments, MIBI showed 97 reversible defects while Echo showed only 23 reversible wall thickening abnormalities. Of the 97 segments with reversible MIBI defects, only 13 (13%) showed simultaneous reversible wall thickening abnormalities during dipyridamole infusion. There were 24 patients with MIBI defects, of whom 10 (41%) showed a corresponding wall thickening abnormality. The sensitivity of MIBI and Echo for the detection of coronary artery disease was 52% and 21%, respectively (P = 0.001). Conclusion: This suggests that vasodilator stress is not optimally suited for use with techniques that use regional wall thickening abnormality as a marker of ischemia for the diagnosis of coronary artery disease. (ECHOCARDIOGRAPHY, Volume 21, May 2004) [source]

Amplitude and Velocity of Mitral Annulus Motion in Rabbits

ECHOCARDIOGRAPHY, Issue 4 2004
Li-ming Gan M.D., Ph.D.
Objective: During recent years, the amplitude and the maximal systolic velocity of the mitral annulus motion (MAM) have been established as indices of the left ventricular systolic function and the maximal diastolic velocity of the annulus motion has been suggested as an index of diastolic function. The main aims of the present study were to investigate the feasibility of these techniques in rabbits and to investigate age-related changes concerning these variables. Methods: Twenty-one New Zealand white rabbits were investigated by echocardiographic M-mode and pulsed tissue Doppler. One subgroup (I) included 11 still-growing, 3.0 ± 0.2 month-old, animals and another group (II) included 10 young grown up rabbits, 12.1 ± 1.5 months old. Results: The amplitude (4.8 ± 0.6 and 3.5 ± 0.3 mm, respectively) and maximal systolic (98 ± 14 and 66 ± 7 mm/s, respectively) and diastolic (111 ± 21 and 80 ± 12 mm/s, respectively) velocities of the MAM were significantly (P < 0.001) higher in group I than in group II, despite a bigger heart in the animals in the latter group. A coefficient of variation of <5% was found for both inter- and intraobserver variability for both amplitude and velocities. Conclusions: The amplitude and velocities of MAM are easily recorded in rabbits with excellent reproducibility and the changes with age seem to be very similar to those in humans. These noninvasive M-mode and tissue Doppler methods are therefore suitable for the investigation of left ventricular function in experimental studies in rabbits. (ECHOCARDIOGRAPHY, Volume 21, May 2004) [source]

Transesophageal and Transpharyngeal Ultrasound Demonstration of Reversed Diastolic Flow in Aortic Arch Branches and Neck Vessels in Severe Aortic Regurgitation

ECHOCARDIOGRAPHY, Issue 4 2004
Deepak Khanna M.D.
In the current study, we describe an adult patient with torrential aortic regurgitation due to an aortic dissection flap interfering with aortic cusp motion, in whom a transesophageal echocardiogram with the probe positioned in the upper esophagus and transpharyngeal ultrasound examination demonstrated prominent reversed flow throughout diastole in the left subclavian, left vertebral, left common carotid, and left internal carotid arteries. Another unique finding was the demonstration of aortic valve leaflets held in the fully opened position in diastole by the dissection flap as it prolapsed into the left ventricular outflow tract, dramatically documenting the mechanism of torrential aortic regurgitation in this patient. (ECHOCARDIOGRAPHY, Volume 21, May 2004) [source]

Metoprolol CR/XL Improves Systolic and Diastolic Left Ventricular Function in Patients with Chronic Heart Failure

ECHOCARDIOGRAPHY, Issue 3 2004
Torstein Hole M.D.
Aims: To investigate whether metoprolol controlled release/extended release (CR/XL) once daily would improve diastolic and systolic left ventricular function in patients with chronic heart failure and decreased ejection fraction. Methods: In an echocardiographic substudy to the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF), 66 patients were examined three times during a 12-month period blinded to treatment group, assessing left ventricular dimensions and ejection fraction, and Doppler mitral inflow parameters, all measured in a core laboratory. Results: In the metoprolol CR/XL group left ventricular ejection fraction increased from 0.26 to 0.31 (P = 0.009) after a mean observation period of 10.6 months, and deceleration time of the early mitral filling wave (E) increased from 189 to 246 ms (P = 0.0012), time velocity integral of E-wave increased from 8.7 to 11.2 cm (P = 0.018), and the duration of the late mitral filling wave (A) increased from 122 to 145 ms (P = 0.014). No significant changes were seen in the placebo group regarding any of these variables. Conclusion: Metoprolol CR/XL once daily in addition to standard therapy improved both diastolic and systolic function in patients with chronic heart failure and decreased ejection fraction. (ECHOCARDIOGRAPHY, Volume 21, April 2004) [source]

Noninvasive Coronary Flow Velocity Reserve Measurement in the Posterior Descending Coronary Artery for Detecting Coronary Stenosis in the Right Coronary Artery Using Contrast-Enhanced Transthoracic Doppler Echocardiography

ECHOCARDIOGRAPHY, Issue 3 2004
Hiroyuki Watanabe M.D.
Background: Coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) has been found to be useful for assessing left anterior descending coronary artery (LAD) stenosis. However, this method has been restricted only for the LAD. The purpose of this study was to detect severe right coronary artery (RCA) stenosis by CFVR measurement using contrast-enhanced TTDE. Methods: In 60 consecutive patients with angina pectoris (mean (SD) age: 60 (11), 18 women), coronary flow velocities in the RCA were recorded in the postero-descending coronary artery by contrast-enhanced TTDE at rest and during hyperemia induced by intravenous infusion of adenosine triphosphate (140 mcg/ml/kg). CFVR was calculated as the ratio of hyperemic to basal peak and mean diastolic flow velocity. CFVR measurements by TTDE were compared with the results of coronary angiography performed within 1 week. Results: Coronary flow velocity was successfully recorded in 49 (82%) of the 60 patients with contrast agent. CFVR (mean (SD)) was 1.4 (0.4) in patients with, and 2.6 (0.6) in patients without significant stenosis in the RCA (%diameter stenosis > 75%, P < 0.001). Using the cutoff value 2.0 for CFVR in the RCA, its sensitivity and specificity in detecting significant stenosis in the RCA were 88% and 91%, respectively. Conclusion: CFVR measurement in the postero-descending coronary artery by contrast enhanced TTDE is a new, noninvasive method to detect significant stenosis in the RCA. (ECHOCARDIOGRAPHY, Volume 21, April 2004) [source]

Three-Dimensional Echocardiography of Post-Myocardial Infarction Cardiac Rupture

ECHOCARDIOGRAPHY, Issue 3 2004
Timothy Puri B.S.
Ventricular septal defects and pseudoaneurysms are two serious complications of acute myocardial infarction and are associated with a high mortality if not surgically treated. Two-dimensional echocardiography provides excellent diagnostic information in such cases, but three-dimensional echocardiography may provide superior anatomic data of these potentially fatal complications. We describe two cases in which three-dimensional echocardiography provided incremental morphological information. (ECHOCARDIOGRAPHY, Volume 21, April 2004) [source]

Mediastinal Lymphoma Presenting as Asystolic Arrest

ECHOCARDIOGRAPHY, Issue 3 2004
Amgad N. Makaryus M.D.
(ECHOCARDIOGRAPHY, Volume 21, April 2004) [source]

Left Ventricular Long-Axis Function Is Reduced in Patients with Rheumatic Mitral Stenosis

ECHOCARDIOGRAPHY, Issue 2 2004
Necla Özer M.D.
Left ventricular long-axis function evaluated by M-mode or tissue Doppler echocardiography has been shown to be useful indexes of left ventricular systolic function; however it has not been evaluated in patients with mitral stenosis. We examined the left ventricular long-axis function of the patients with pure mitral stenosis and normal global systolic function as assessed by fractional shortening of the left ventricle (LV). Fifty-two patients with pure mitral stenosis and twenty-two healthy controls were evaluated by echocardiography. Although there was no statistically significant difference in global systolic function, M-mode derived systolic motion of the septal side and (12 ± 3 vs 14.4 ± 1.5 mm, P = 0.016) the lateral side of mitral annulus (13.2 ± 3 vs 16.8 ± 2 mm, P = 0.001) were both significantly lower in the patients with mitral stenosis than control subjects. Similarly tissue Doppler systolic velocity of the septal annulus (7.6 ± 1.1 vs 10.4 ± 3.2 cm/s, P = 0.03) and lateral mitral annulus (7.6 ± 1.1 vs 10.4 ± 3.2 cm/s, P = 0.003) were also significantly lower in patients with mitral stenosis than in controls. There was a statistically significant correlation between septal annular motion and annular velocity (r = 0.643, P = 0.002). Septal annular motion and annular velocity were also correlated with left atrial ejection fraction (r = 0.338, P = 0.005 and r = 0.676, P = 0.001, respectively). Thus, patients with mitral stenosis had significantly impaired long-axis function evaluated by M-mode or tissue Doppler echocardiography despite normal global systolic function. (ECHOCARDIOGRAPHY, Volume 21, February 2004) [source]

Unusually Large Left Atrial Myxoma Presenting with Severe Mitral Valve Obstruction Symptoms

ECHOCARDIOGRAPHY, Issue 2 2004
Mustafa Yilmaz M.D.
A 13-year-old girl with the complaint of severe mitral valve obstruction symptoms was diagnosed as having an unusually large left atrial tumor by echocardiography. The giant mass was surgically removed and the postoperative course was uneventful. Histologic examination confirmed the mass was a benign atrial myxoma. (ECHOCARDIOGRAPHY, Volume 21, February 2004) [source]

The Use of Contrast Echocardiography in the Diagnosis of an Unusual Cause of Congestive Heart Failure: Achalasia

ECHOCARDIOGRAPHY, Issue 2 2004
George Stoupakis M.D.
Extrinsic compression of the left atrium is a potentially life-threatening but unusual cause of congestive heart failure. Achalasia is a motility disorder characterized by impaired relaxation of the lower esophageal sphincter and dilation of the distal two-thirds of the esophagus. We report only the third known case in the world literature of massive left atrial compression by a dilated esophagus in a patient with achalasia. The use of contrast echocardiography with perflutren protein-type A microspheres allowed for differentiation between a compressive vascular structure and the esophagus. This resulted in prompt treatment leading to hemodynamic stability after nasogastric decompression and Botulinum toxin injection at the gastroesophageal junction. (ECHOCARDIOGRAPHY, Volume 21, February 2004) [source]

Extension of Bronchogenic Carcinoma Through Pulmonary Vein into the Left Atrium Detected by Echocardiography

ECHOCARDIOGRAPHY, Issue 2 2004
Milind Y Desai M.D.
This is the case of a 46-year-old female recently diagnosed with a squamous cell bronchogenic carcinoma that spread through the pulmonary veins into the left atrium. This mass was initially seen on surface echocardiography as emanating from the pulmonary vein and subsequently confirmed to be arising from the right superior pulmonary vein by transesophageal echocardiography. (ECHOCARDIOGRAPHY, Volume 21, February 2004) [source]