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Row# ID# Date Journal Article
1  29252015-10-28
Authors: Pamela S. Douglas, MD, et al
Citation: J Am Soc Echocardiogr 2011;24:229-67
Abstract: This report addresses the appropriate use of TTE, TEE, and stress echocardiography. Improvements in cardiovascular imaging tech- nology and an expanding armamentarium of noninvasive diagnos- tic tools and therapeutic options for cardiovascular disease have led to an increase in cardiovascular imaging. As the field of echocardi- ography continues to advance along with other imaging modalities and treatment options, the healthcare community needs to under- stand how to best incorporate this technology into daily clinical care.
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2  29242015-10-13
Authors: Gulati VK, Katz WE, Follansbee WP, Gorcsan J rd.
Citation: Am J Cardiol. 1996 May 1;77(11):979-84.
Abstract: Mitral annular descent has been described as an index of left ventricular (LV) systolic function, which is independent of endocardial definition. Echocardiographic tissue Doppler imaging is a new technique that calculates and displays color-coded cardiac tissue velocities on-line. To evaluate mitral annular descent velocity as a rapid index of global LV function, we performed tissue Doppler imaging studies in 55 patients, aged 56 +/-15 years, within 3 hours of radionuclide ventriculographic ejection fraction. Tissue Doppler M-mode studies were obtained from each of 6 mitral annular sites, as follows: inferoseptal and lateral from apical 4-chamber views, anterior and inferior from apical 2-chamber views, and anteroseptal and posterior from apical long-axis views. Only 1 patient with severe mitral annular calcification was excluded. The group mean 6-site average peak mitral annular descent velocity was 5.5 +/- 1.9 cm/s (range 2.4 to 10.5), and the group mean ejection fraction was 49 +/- 18% (range 17 to 80%). The 6-site average peak annular descent velocity correlated linearly with LV ejection fraction (r = 0.86, SEE = 1.02 cm/s): LV ejection fraction = 8.2 (average peak mitral annular descent velocity) + 3%. The 6-site peak mitral annular descent velocity average >5.4 cm/s was 88% sensitive and 97% specific for ejection fraction >50%. The peak mitral annular descent velocity from the apical 4-chamber view (average from inferoseptal and lateral sites) correlated most closely with the LV ejection fraction (r = 0.85) as an individual view. Peak mitral annular descent velocity by tissue Doppler imaging has the potential to estimate rapidly the global LV function.
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3  29232015-06-08
Authors: Baek HK, Park TH, Park JS, Seo JM, Park SY, Kim BG, Kim SO, Cha KS, Kim MH, Kim YD.
Citation: Korean Circ J. 2010 Mar;40(3):114-8. doi: 10.4070/kcj.2010.40.3.114. Epub 2010 Mar 24.
Abstract: BACKGROUND AND OBJECTIVES: Although the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities.SUBJECTS AND METHODS: We prospectively studied 17 patients (mean age 62+/-9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments.RESULTS: Mean LV ejection fraction was 41.8+/-8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714+/-0.169 vs. 0.669+/-0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742+/-0.201, 4.206+/-1.336, 5.258+/-1.867, and 5.578+/-2.354 in akinetic segments; 0.677+/-0.101, 4.908+/-1.615, 5.369+/-2.121, and 5.542+/-2.492 in hypokinetic segments; and 0.669+/-0.135, 5.409+/-1.519, 6.108+/-2.356, and 6.719+/-2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001).CONCLUSION: These data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.
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4  29222015-04-18
Authors: Swaminathan M, Nicoara A, Phillips-Bute BG, Aeschlimann N, Milano CA, Mackensen GB, Podgoreanu MV, Velazquez EJ, Stafford-Smith M, Mathew JP; Cardiothoracic Anesthesia Research Endeavors (CARE) Group.
Citation: Ann Thorac Surg. 2011 Jun;91(6):1844-50. doi: 10.1016/j.athoracsur.2011.02.008. Epub 2011 Apr 14.
Abstract: BACKGROUND: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE).METHODS: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables-transmitral early flow velocity and early mitral annular tissue velocity-for ease of grading and association with MACE.RESULTS: Using algorithm A, only 563 patients (62%) could be graded, whereas 895 patients (99%) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p=0.013), but not algorithm A (p=0.79). Patients with the highest incidence of MACE could not be graded with algorithm A.CONCLUSIONS: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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5  29202015-04-15
Authors: Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A.
Citation: J Am Soc Echocardiogr. 2009 Feb;22(2):107-33. doi: 10.1016/j.echo.2008.11.023.
Abstract: No abstract available.
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6  29192015-03-07
Authors: Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB.
Citation: J Am Soc Echocardiogr. 2010 Jul;23(7):685-713
Abstract: No abstract available.
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7  29182015-03-07
Authors: Shillcutt SK, Markin NW, Montzingo CR, Brakke TR.
Citation: J Cardiothorac Vasc Anesth. 2012 Jun;26(3):362-70
Abstract: OBJECTIVE: To investigate if modified "rescue" echocardiography enhanced management during perioperative hemodynamic instability in patients undergoing noncardiac surgery.DESIGN: A retrospective analysis of the medical data.SETTING: Perioperative setting at a single academic medical center.PARTICIPANTS: Thirty-one adult patients undergoing noncardiac surgery who experienced perioperative hemodynamic instability and were evaluated by either transthoracic echocardiography (TTE, n = 9) or transesophageal echocardiography (TEE, n = 22).INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Rapid "rescue" echocardiography was performed on each patient looking for a specific cause for the patient's perioperative compromise. Echocardiography results, medical management, surgical management, and patient outcomes were all reviewed from the medical record and the department database. All patients were found to have an explainable diagnosis for the hemodynamic instability on the echocardiographic examination. The most common diagnoses were left-heart dysfunction (n = 16), right-heart dysfunction (n = 9), hypovolemia (n = 5), pulmonary embolus (n = 5), and myocardial ischemia (n = 4). Based on findings at echocardiography, 4 patients (13%) underwent and survived an emergent secondary procedure. All 31 patients recovered during their surgical procedure, and 25 (81%) progressed to hospital discharge.CONCLUSIONS: Both TTE and TEE can play a critical role in the diagnosis and management of perioperative hemodynamic instability.Copyright © 2012 Elsevier Inc. All rights reserved.
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8  29172015-03-07
Authors: Otto CM
Citation: 5th Edition. April 2013
Abstract: No abstract available.
9  29162015-03-07
Authors: Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and
Citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63.
Abstract: No abstract available.
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10  29152015-03-07
Authors: Shillcutt SK1, Bick JS.
Citation: Anesth Analg. 2013 Jun;116(6):1231-6
Abstract: No abstract available.
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11  29142015-03-07
Authors: Pamela S. Douglas et al
Citation: J Am Soc Echocardiogr 2011;24:229-67
Abstract: The American College of Cardiology Foundation (ACCF), in partnership with the American Society of Echocardiography (ASE) and along with key specialty and subspecialty societies, conducted a review of common clinical scenarios where echocardiography is frequently considered. This document combines and updates the original transthoracic and transesophageal echocardiography appropriateness criteria published in 2007 (1) and the original stress echocardiography appropriateness criteria published in 2008 (2). This revision reflects new clinical data, reflects changes in test utilization patterns,and clarifies echocardiography use where omissions or lack of clarity existed in the original criteria.The indications (clinical scenarios)were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC).The 202 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9,to designate appropriate use(median 7 to 9), uncertain use(median 4 to 6), and inappropriate use (median 1 to 3). Ninety-seven indications were rated as appropriate, 34 were rated as uncertain, and 71 were rated as inappropriate. In general,the use of echocardiography for initial diagnosis when there is a change in clinical status or when the results of the echocardiogram are anticipated to change patient management were rated appropriate. Routine testing when there was no change in clinical status or when results of testing were unlikely to modify management were more likely to be inappropriate than appropriate/uncertain.The AUC for echocardiography have the potential to impact physician decision making,healthcare delivery, and reimbursement policy. Furthermore,recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.
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12  29132015-01-15
Authors: Golba K, Mokrzycki K, Drozdz J, Cherniavsky A, Wrobel K, Roberts BJ, Haddad H, Maurer G, Yii M, Asch FM, Handschumacher MD, Holly TA, Przybylski R, Kron I, Schaff H, Aston S, Horton J, Lee KL, Velazquez EJ, Grayburn PA; STICH TEE Substudy Investigators.
Citation: Am J Cardiol. 2013 Dec 1;112(11):1812-8. doi: 10.1016/j.amjcard.2013.07.047. Epub 2013 Sep 13.
Abstract: The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR.Copyright © 2013 Elsevier Inc. All rights reserved.
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13  29122015-01-11
Authors: Geske JB, Scantlebury DC, Thomas JD, Nishimura RA.
Citation: J Am Coll Cardiol. 2013 Nov 12;62(20):e441. doi: 10.1016/j.jacc.2013.05.100. Epub 2013 Sep 18.
Abstract: No abstract available.
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14  29112015-01-11
Authors: Dandel M, Potapov E, Krabatsch T, Stepanenko A, Löw A, Vierecke J, Knosalla C, Hetzer R.
Citation: Circulation. 2013 Sep 10;128(11 Suppl 1):S14-23. doi: 10.1161/CIRCULATIONAHA.112.000335.
Abstract: BACKGROUND: Left ventricular assist devices (LVADs) provide better outcome than biventricular devices, but it is a challenge to predict the impact of LV mechanical unloading on postoperative right ventricular (RV) function preoperatively. We assessed the load dependency in RV performance before and after LVAD implantation aiming to improve preoperative decision making.METHODS AND RESULTS: Laboratory, echocardiography, and right heart catheterization data collected from 205 patients before LVAD implantation were tested for relationship with postoperative RV function. Comparing patients with different time-course of RV function after LVAD implantation, we found significant differences (P<0.01) in preoperative RV end-diastolic short-/long-axis and long-axis/length-area ratios, tricuspid annulus peak systolic velocity, RV peak longitudinal global systolic strain rate, systolic pressure gradient between RV and right atrium (ΔPRV-RA), tricuspid regurgitation velocity-time integral, and pulmonary arterial pressure between patients with and without postoperative RV failure. High predictive values for postoperative RV failure were found for end-diastolic short-/long-axis ratio ≥ 0.6, tricuspid annulus peak systolic velocity <8 cm/s, and peak systolic longitudinal strain rate <0.6/s in patients with maximum ΔPRV-RA <35 mm Hg. These parameters also seemed predictive for RV failure in patients with tricuspid regurgitation grade >2 and pulmonary arterial pressure <50 mm Hg. End-diastolic short-/long-axis ratio <0.6, tricuspid annulus peak systolic velocity ≥ 8 cm/s, and peak systolic longitudinal strain rate ≥ 0.6 in patients with maximum ΔPRV-RA ≥ 35 mm Hg showed high predictive values for postoperative freedom from RV failure. The RV load adaptation index seemed particularly predictive for RV function after LVAD implantation.CONCLUSIONS: RV geometry and velocity of contraction before LVAD implantation become more predictive for postoperative RV function and can improve decision making before VAD implantation if preoperative RV pressure load and tricuspid regurgitation are also considered.
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15  29102015-01-11
Authors: Beaudoin J, Levine RA, Guerrero JL, Yosefy C, Sullivan S, Abedat S, Handschumacher MD, Szymanski C, Gilon D, Palmeri NO, Vlahakes GJ, Hajjar RJ, Beeri R.
Citation: Circulation. 2013 Sep 10;128(11 Suppl 1):S248-52. doi: 10.1161/CIRCULATIONAHA.112.000124.
Abstract: BACKGROUND: Ischemic mitral regurgitation (MR) is a frequent complication of myocardial infarction associated with left ventricular (LV) dilatation and dysfunction, which doubles mortality. At the molecular level, moderate ischemic MR is characterized by a biphasic response, with initial compensatory rise in prohypertrophic and antiapoptotic signals, followed by their exhaustion. We have shown that early MR repair 30 days after myocardial infarction is associated with LV reverse remodeling. It is not known whether MR repair performed after the exhaustion of compensatory mechanisms is also beneficial. We hypothesized that late repair will not result in LV reverse remodeling.METHODS AND RESULTS: Twelve sheep underwent distal left anterior descending coronary artery ligation to create apical myocardial infarction and implantation of an LV-to-left atrium shunt to create standardized moderate volume overload. At 90 days, animals were randomized to shunt closure (late repair) versus sham (no repair). LV remodeling was assessed by 3-dimensional echocardiography, dP/dt, preload-recruitable stroke work, and myocardial biopsies. At 90 days, animals had moderate volume overload, LV dilatation, and reduced ejection fraction (all P<0.01 versus baseline, P=NS between groups). Shunt closure at 90 days corrected the volume overload (regurgitant fraction 6 ± 5% versus 27 ± 16% for late repair versus sham, P<0.01) but was not associated with changes in LV volumes (end-diastolic volume 106 ± 15 versus 110 ± 22 mL; end-systolic volume 35 ± 6 versus 36 ± 6 mL) or increases in preload-recruitable stroke work (41 ± 7 versus 39 ± 13 mL mm Hg) or dP/dt (803 ± 210 versus 732 ± 194 mm Hg/s) at 135 days (all P=NS). Activated Akt, central in the hypertrophic process, and signal transducer and activator of transcription 3 (STAT3), a critical node in the hypertrophic stimulus by cytokines, were equally depressed in both groups.CONCLUSIONS: Late correction of moderate volume overload after myocardial infarction did not improve LV volume or contractility. Upregulation of prohypertrophic intracellular pathways was not observed. This contrasts with previously reported study in which early repair (30 days) reversed LV remodeling. This suggests a window of opportunity to repair ischemic MR after which no beneficial effect on LV is observed, despite successful repair.
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16  29092015-01-10
Authors: Mornoş C, Petrescu L, Ionac A, Cozma D.
Citation: Int J Cardiovasc Imaging. 2014 Jan;30(1):47-55. doi: 10.1007/s10554-013-0294-7. Epub 2013 Sep 17.
Abstract: It has been shown a good accuracy to predict high left ventricular end-diastolic pressure for a value >1.6 of a new tissue Doppler index, E/(E' × S'), including the ratio between early diastolic transmitral and mitral annulus velocity (E/E'), and the systolic mitral annulus velocity (S'). Our aim was to evaluate the prognostic value of E/(E' × S') > 1.6 in patients with heart failure (HF). Echocardiography was performed in 345 consecutive hospitalized patients with HF, in sinus rhythm, at hospital discharge and after 1 month. Worsening of E/(E' × S') was defined as any increase of baseline value. The primary end point consisted of cardiac death or readmission due to HF worsening in long term follow-up. At discharge, 153 patients (44.3%) presented E/(E' × S') ≤ 1.6 (group I) while 192 patients (55.7%) presented E/(E' × S') > 1.6 (group II). During the follow-up period (35.1 ± 8.7 months) the first cardiac event was cardiac death in 11 patients (3.1%) and readmission for HF in 179 patients (51.9%). The composite end point was significantly higher in group II than in group I (163 events, 84.9 % vs. 27 events, 17.6%, p < 0.001). By multivariate Cox regression analysis, E/(E' × S') > 1.6 was the best independent predictor of cardiac events (hazard ratio = 4.46, 95% CI = 2.44-8.13, p = 0.001). Patients with E/(E' × S') > 1.6 at discharge and its worsening after 1 month have presented the worst prognosis (all p < 0.05). In patients with HF, E/(E' × S') > 1.6 at hospital discharge is a powerful predictor of clinical outcome particularly if it is associated with worsening.
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17  29082015-01-10
Authors: Agarwal A, Khandheria BK, Paterick TE, Treiber SC, Bush M, Tajik AJ.
Citation: J Am Soc Echocardiogr. 2013 Nov;26(11):1306-13. doi: 10.1016/j.echo.2013.08.003. Epub 2013 Sep 14.
Abstract: BACKGROUND: Left ventricular noncompaction (LVNC) is commonly associated with complex congenital anomalies. The association of LVNC with less complex but more frequent anomalies, such as bicuspid aortic valve (BAV), is not well described in the literature. The aims of this study were to (1) determine the incidence of association of LVNC with the most common congenital anomaly, BAV, in an echocardiographic database and (2) describe clinical and imaging characteristics of these patients.METHODS: An echocardiography database was retrospectively interrogated to identify 109 patients who fulfilled the echocardiographic criteria for BAV from July 1, 2011, to March 31, 2013. Echocardiograms were carefully evaluated to identify patients with concomitant LVNC.RESULTS: Twelve patients (11.0%) with BAV fulfilled the criteria for LVNC. The mean age at diagnosis was 33 ± 16.9 years; nine of 12 were men. Eight patients (66.7%) had symptoms during initial presentation. The most common BAV morphology was fusion of the right and left coronary cusps. Nine patients had mild or moderate aortic valve dysfunction (aortic regurgitation and/or stenosis), and eight had associated aortopathy. LVNC was located at the apex in all patients except one. Mean systolic global longitudinal strain was -16.9 ± 2.7%.CONCLUSIONS: In this series of patients, concomitant BAV and LVNC were observed in 11% of a BAV population. Further studies are needed to understand the genetic and pathophysiologic basis of this association.Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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18  29072015-01-10
Authors: Pibarot P, Dumesnil JG.
Citation: Circulation. 2013 Oct 15;128(16):1729-32. doi: 10.1161/CIRCULATIONAHA.113.005718. Epub 2013 Sep 18.
Abstract: No abstract available.
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19  29062015-01-10
Authors: Patsalis PC, Al-Rashid F, Neumann T, Plicht B, Hildebrandt HA, Wendt D, Thielmann M, Jakob HG, Heusch G, Erbel R, Kahlert P.
Citation: JACC Cardiovasc Interv. 2013 Sep;6(9):965-71. doi: 10.1016/j.jcin.2013.05.006.
Abstract: OBJECTIVES: This study sought to evaluate whether supra-aortic angiography during preparatory balloon aortic valvuloplasty (BAV) improves valve sizing.BACKGROUND: Current recommendations for valve size selection are based on annular measurements by transesophageal echocardiography and computed tomography, but paravalvular aortic regurgitation (PAR) is a frequent problem.METHODS: Data of 270 consecutive patients with either conventional sizing (group 1, n = 167) or balloon aortic valvuloplasty-based sizing (group 2, n = 103) were compared. PAR was graded angiographically and quantitatively using several hemodynamic indices.RESULTS: PAR was observed in 113 patients of group 1 and 41 patients of group 2 (67.7% vs. 39.8%, p < 0.001). More than mild PAR was found in 24 (14.4%) patients of group 1 and 8 (7.8%) patients of group 2. According to pre-interventional imaging, 40 (39%) patients had a borderline annulus size, raising uncertainty regarding valve size selection. Balloon sizing resulted in selection of the bigger prosthesis in 30 (29%) and the smaller prosthesis in the remaining patients, and only 1 of these 40 patients had more than mild PAR. As predicted by the hemodynamic indices of PAR, mortality at 30 days and 1 year was less in group 2 than in group 1 (5.8% vs. 9%, p = 0.2 and 10.6% vs. 20%, p = 0.01).CONCLUSIONS: Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation improves valve size selection, reduces the associated PAR, and increases survival in borderline cases.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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20  29052015-01-10
Authors: Garcia J, Capoulade R, Le Ven F, Gaillard E, Kadem L, Pibarot P, Larose É.
Citation: J Cardiovasc Magn Reson. 2013 Sep 20;15:84. doi: 10.1186/1532-429X-15-84.
Abstract: BACKGROUND: Valve effective orifice area EOA and transvalvular mean pressure gradient (MPG) are the most frequently used parameters to assess aortic stenosis (AS) severity. However, MPG measured by cardiovascular magnetic resonance (CMR) may differ from the one measured by transthoracic Doppler-echocardiography (TTE). The objectives of this study were: 1) to identify the factors responsible for the MPG measurement discrepancies by CMR versus TTE in AS patients; 2) to investigate the effect of flow vorticity on AS severity assessment by CMR; and 3) to evaluate two models reconciling MPG discrepancies between CMR/TTE measurements.METHODS: Eight healthy subjects and 60 patients with AS underwent TTE and CMR. Strouhal number (St), energy loss (EL), and vorticity were computed from CMR. Two correction models were evaluated: 1) based on the Gorlin equation (MPG(CMR-Gorlin)); 2) based on a multivariate regression model (MPG(CMR-Predicted)).RESULTS: MPGCMR underestimated MPGTTE (bias = -6.5 mmHg, limits of agreement from -18.3 to 5.2 mmHg). On multivariate regression analysis, St (p = 0.002), EL (p = 0.001), and mean systolic vorticity (p < 0.001) were independently associated with larger MPG discrepancies between CMR and TTE. MPG(CMR-Gorlin) and MPGTTE correlation and agreement were r = 0.7; bias = -2.8 mmHg, limits of agreement from -18.4 to 12.9 mmHg. MPG(CMR-Predicted) model showed better correlation and agreement with MPGTTE (r = 0.82; bias = 0.5 mmHg, limits of agreement from -9.1 to 10.2 mmHg) than measured MPGCMR and MPG(CMR-Gorlin).CONCLUSION: Flow vorticity is one of the main factors responsible for MPG discrepancies between CMR and TTE.
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21  29042015-01-10
Authors: Zaid RR, Barker CM, Little SH, Nagueh SF.
Citation: J Am Coll Cardiol. 2013 Nov 19;62(21):1922-30. doi: 10.1016/j.jacc.2013.08.1619. Epub 2013 Sep 18.
Abstract: Patients with valvular heart disease often have left ventricular diastolic dysfunction. This review summarizes the underlying mechanisms for diastolic dysfunction in patients with mitral and aortic valve disease. In addition to load, intrinsic myocardial abnormalities occur related to changes in sarcomeric proteins, abnormal calcium handling, and fibrosis. Echocardiography is the initial modality for the diagnosis of left ventricular diastolic function. Although there are challenges to conventional Doppler parameters of diastolic function, it is often possible to arrive at a clinically useful assessment of left ventricular filling pressures using a comprehensive approach. When needed, cardiac magnetic resonance and cardiac catheterization can be obtained. Medical therapy can be of value for the treatment of diastolic dysfunction, but there is a paucity of data evaluating its clinical utility. More importantly, diastolic dysfunction usually improves with timely surgical intervention, although surgery does not always lead to normalization of function. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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22  29032015-01-10
Authors: Franchi F, Faltoni A, Cameli M, Muzzi L, Lisi M, Cubattoli L, Cecchini S, Mondillo S, Biagioli B, Taccone FS, Scolletta S.
Citation: Biomed Res Int. 2013;2013:918548. doi: 10.1155/2013/918548. Epub 2013 Aug 28.
Abstract: PURPOSE: The effects of mechanical ventilation (MV) on speckle tracking echocardiography- (STE-)derived variables are not elucidated. The aim of the study was to evaluate the effects of positive end-expiratory pressure (PEEP) ventilation on 4-chamber longitudinal strain (LS) analysis by STE.METHODS: We studied 20 patients admitted to a mixed intensive care unit who required intubation for MV and PEEP titration due to hypoxia. STE was performed at three times: (T1) PEEP = 5 cmH2O; (T2) PEEP = 10 cmH2O; and (T3) PEEP = 15 cmH2O. STE analysis was performed offline using a dedicated software (XStrain MyLab 70 Xvision, Esaote).RESULTS: Left peak atrial-longitudinal strain (LS) was significantly reduced from T1 to T2 and from T2 to T3 (P < 0.05). Right peak atrial-LS and right ventricular-LS showed a significant reduction only at T3 (P < 0.05). Left ventricular-LS did not change significantly during titration of PEEP. Cardiac chambers' volumes showed a significant reduction at higher levels of PEEP (P < 0.05).CONCLUSIONS: We demonstrated for the first time that incremental PEEP affects myocardial strain values obtained with STE in intubated critically ill patients. Whenever performing STE in mechanically ventilated patients, care must be taken when PEEP is higher than 10 cmH2O to avoid misinterpreting data and making erroneous decisions.
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23  29022015-01-10
Authors: Wada T, Hirata K, Shiono Y, Orii M, Shimamura K, Ishibashi K, Tanimoto T, Yamano T, Ino Y, Kitabata H, Yamaguchi T, Kubo T, Imanishi T, Akasaka T.
Citation: Eur Heart J Cardiovasc Imaging. 2014 Apr;15(4):399-408. doi: 10.1093/ehjci/jet168. Epub 2013 Sep 25.
Abstract: AIMS: Coronary flow velocity reserve (CFVR) measurement in three major coronary arteries by transthoracic echocardiography is a promising and non-invasive method for detecting myocardial ischaemia. Its value when compared with fractional flow reserve (FFR) is unknown. Our aim was to determine the diagnostic accuracy of CFVR in three major coronary arteries for detecting ischaemia compared with FFR.METHODS: This is a prospective study in 172 vessels of 140 patients with at least one ≥50% stenosis in a major epicardial artery as determined by visual assessment on computed tomography coronary angiography. We performed CFVR measurement by transthoracic echocardiography within 48 h before coronary angiography and FFR measurement. The cut-off value of CFVR was estimated by the receiver operating characteristic (ROC) curve based on that of FFR ≤0.75.RESULTS: The CFVR was 1.86 ± 0.36 in coronary arteries with FFR ≤0.75 (n = 79) and 2.54 ± 0.48 in those with FFR >0.75 (n = 93, P < 0.0001). CFVR with cut-off of 2.2, determined by the ROC curve, was 85% sensitive and 79% specific in predicting the stenotic condition of the coronary artery with FFR ≤0.75 in three major vessels. In each vessel, the sensitivity and specificity were 85 and 78% (left anterior descending coronary artery), 94 and 83% (right coronary artery), and 88 and 88% (left circumflex coronary artery). CFVR was indirect proportional to FFR (r = 0.56, P < 0.0001) and to per cent diameter stenosis (r = 0.26, P = 0.0008).CONCLUSIONS: The non-invasive CFVR measurement could be a reliable stenosis-specific method for determining the haemodynamic significance of three major coronary arteries.
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24  29002015-01-09
Authors: Mohty D, Damy T, Cosnay P, Echahidi N, Casset-Senon D, Virot P, Jaccard A.
Citation: Arch Cardiovasc Dis. 2013 Oct;106(10):528-40. doi: 10.1016/j.acvd.2013.06.051. Epub 2013 Sep 23.
Abstract: Amyloidosis is a severe systemic disease. Cardiac involvement may occur in the three main types of amyloidosis (acquired monoclonal light-chain, hereditary transthyretin and senile amyloidosis) and has a major impact on prognosis. Imaging the heart to characterize and detect early cardiac involvement is one of the major aims in the assessment of this disease. Electrocardiography and transthoracic echocardiography are important diagnostic and prognostic tools in patients with cardiac involvement. Cardiac magnetic resonance imaging better characterizes myocardial involvement, functional abnormalities and amyloid deposition due to its high spatial resolution. Nuclear imaging has a role in the diagnosis of transthyretin amyloid cardiomyopathy. Cardiac biomarkers are now used for risk stratification and staging of patients with light-chain systemic amyloidosis. Different types of cardiac complications may occur, including diastolic followed by systolic heart failure, atrial and/or ventricular arrhythmias, conduction disturbances, embolic events and sometimes sudden death. Senile amyloid and hereditary transthyretin amyloid cardiomyopathy have better prognoses than light-chain amyloidosis. Cardiac treatment of heart failure is usually ineffective and is often poorly tolerated because of its hypotensive and bradycardiac effects. The three main types of amyloid disease, despite their similar cardiac appearance, have specific new aetiological treatments that may change the prognosis of this disease. Cardiologists should be aware of this disease to allow early treatment. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
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25  28992015-01-09
Authors: LaPietra A, Santana O, Mihos CG, DeBeer S, Rosen GP, Lamas GA, Lamelas J.
Citation: J Thorac Cardiovasc Surg. 2014 Jul;148(1):156-60. doi: 10.1016/j.jtcvs.2013.08.016. Epub 2013 Sep 26.
Abstract: OBJECTIVES: Minimally invasive valve surgery has been associated with increased cerebrovascular complications. Our objective was to evaluate the incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery.METHODS: We retrospectively reviewed all the minimally invasive valve surgery performed at our institution from January 2009 to June 2012. The operative times, lengths of stay, postoperative complications, and mortality were analyzed.RESULTS: A total of 1501 consecutive patients were identified. The mean age was 73 ± 13 years, and 808 patients (54%) were male. Of the 1501 patients, 206 (13.7%) had a history of a cerebrovascular accident, and 225 (15%) had undergone previous heart surgery. The procedures performed were 617 isolated aortic valve replacements (41.1%), 658 isolated mitral valve operations (43.8%), 6 tricuspid valve repairs (0.4%), 216 double valve surgery (14.4%), and 4 triple valve surgery (0.3%). Femoral cannulation was used in 1359 patients (90.5%) and central cannulation in 142 (9.5%). In 1392 patients (92.7%), the aorta was clamped, and in 109 (7.3%), the surgery was performed with the heart fibrillating. The median aortic crossclamp and cardiopulmonary bypass times were 86 minutes (interquartile range [IQR], 70-107) minutes and 116 minutes (IQR, 96-143), respectively. The median intensive care unit length of stay was 47 hours (IQR, 29-74), and the median postoperative hospital length of stay was 7 days (IQR, 5-10). A total of 23 cerebrovascular accidents (1.53%) and 38 deaths (2.53%) had occurred at 30 days postoperatively.CONCLUSIONS: Minimally invasive valve surgery was associated with an acceptable stroke rate, regardless of the cannulation technique.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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26  28982015-01-09
Authors: Mesana TG, Lam BK, Chan V, Chen K, Ruel M, Chan K.
Citation: J Thorac Cardiovasc Surg. 2013 Dec;146(6):1418-23; discussion 1423-5. doi: 10.1016/j.jtcvs.2013.08.011. Epub 2013 Sep 26.
Abstract: BACKGROUND: Mitral annuloplasty with either a partial band or complete ring is an integral part of mitral valve repair for degenerative disease. The affect of annuloplasty type on outcomes has not been well described. The objective of our study was to compare echocardiographic and functional characteristics of patients who underwent mitral repair with either a complete ring or a partial band.METHODS: We evaluated 107 patients who underwent mitral repair of myxomatous degeneration at our institution by stress echocardiography, 6-minute walk testing, and short form-36 questionnaire. These assessments were performed 4.3 ± 2.2 years following mitral repair by a single surgeon. A band was used in 65 patients (61%) and a ring in 42 patients (39%). Parametric and nonparametric tests were used in the analyses.RESULTS: The labeled band and ring size used for repair were 30.7 ± 2.8 mm and 30.4 ± 2.1 mm, respectively (P = .6). The resting mean mitral gradient and valve area were 3.7 ± 1.9 mm Hg and 2.3 ± 0.6 cm(2) for patients who received a band and 5.8 ± 2.6 mm Hg and 1.8 ± 0.5 cm(2) for patients who received a ring (both P < .001). Distance traversed on 6-minute walk testing was 471 ± 77 m in the band group and 443 ± 107 m in the ring group (P = .1). At peak exercise, the mean mitral gradient (15.3 ± 8.2 mm Hg vs 10.6 ± 4.8 mm Hg; P < .001) and right ventricular systolic pressure (52.6 ± 14.2 mm Hg vs 45.8 ± 9.5 mm Hg; P = .004) were higher for patients who received a ring versus a band. Ring patients reported lower levels of energy (P = .02) and general health (P = .007) on short form-36 assessment.CONCLUSIONS: Annuloplasty using a complete ring may be associated with a higher mitral valve gradient at rest and at peak exercise in certain patients. These patients may also have worse quality of life. In view of these findings, we recommend careful consideration of annuloplasty type and size at the time of mitral repair of organic disease.Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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27  28972015-01-09
Authors: Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA, Michelena HI, Cueff C, Larose E, Capoulade R, Vahanian A, Enriquez-Sarano M.
Citation: J Am Coll Cardiol. 2013 Dec 17;62(24):2329-38. doi: 10.1016/j.jacc.2013.08.1621. Epub 2013 Sep 24.
Abstract: OBJECTIVES: With concomitant Doppler echocardiography and multidetector computed tomography (MDCT) measuring aortic valve calcification (AVC) load, this study aimed at defining: 1) independent physiologic/structural determinants of aortic valve area (AVA)/mean gradient (MG) relationship; 2) AVC thresholds best associated with severe aortic stenosis (AS); and 3) whether, in AS with discordant MG, severe calcified aortic valve disease is generally detected.BACKGROUND: Aortic stenosis with discordant markers of severity, AVA in severe range but low MG, is a conundrum, unresolved by outcome studies.METHODS: Patients (n&nbsp;= 646) with normal left ventricular ejection fraction AS underwent Doppler echocardiography and AVC measurement by MDCT. On the basis of AVA-indexed-to-body surface area (AVAi) and MG, patients were categorized as concordant severity grading (CG) with moderate AS (AVAi &gt;0.6 cm²/m², MG&nbsp;&lt;40 mm Hg), severe AS (AVAi&nbsp;≤0.6 cm²/m², MG&nbsp;≥ 40 mm Hg), discordant-severity-grading (DG) with low-MG (AVAi&nbsp;≤0.6 cm(2)/m(2), MG&nbsp;&lt;40 mm Hg), or high-MG (AVAi &gt;0.6 cm(2)/m(2), MG&nbsp;≥40 mm Hg).RESULTS: The MG (discordant in 29%) was strongly determined by AVA and flow but also independently and strongly influenced by AVC-load (p&nbsp;&lt; 0.0001) and systemic arterial compliance (p&nbsp;&lt; 0.0001). The AVC-load (median [interquartile range]) was similar within patients with DG (low-MG: 1,619 [965 to 2,528] arbitrary units [AU]; high-MG: 1,736 [1,209 to 2,894] AU; p&nbsp;= 0.49), higher than CG-moderate-AS (861 [427 to 1,519] AU; p&nbsp;&lt; 0.0001) but lower than CG-severe-AS (2,931 [1,924 to 4,292] AU; p&nbsp;&lt; 0.0001). The AVC-load thresholds separating severe/moderate AS were defined in CG-AS with normal flow (stroke-volume-index &gt;35 ml/m(2)). The AVC-load, absolute or indexed, identified severe AS accurately (area under the curve&nbsp;≥0.89, sensitivity&nbsp;≥86%, specificity&nbsp;≥79%) in men and women. Upon application of these criteria to DG-low MG, at least one-half of the patients were identified as severe calcified aortic valve disease, irrespective of flow.CONCLUSIONS: Among patients with AS, MG is often discordant from AVA and is determined by multiple factors, valvular (AVC) and non-valvular (arterial compliance) independently of flow. The AVC-load by MDCT, strongly associated with AS severity, allows diagnosis of severe calcified aortic valve disease. At least one-half of the patients with discordant low gradient present with heavy AVC-load reflective of severe calcified aortic valve disease, emphasizing the clinical yield of AVC quantification by MDCT to diagnose and manage these complex patients.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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28  28952015-01-09
Authors: Bassareo PP, Fanos V, Puddu M, Cadeddu C, Cadeddu F, Saba L, Cugusi L, Mercuro G.
Citation: J Matern Fetal Neonatal Med. 2014 Jul;27(11):1123-8. doi: 10.3109/14767058.2013.850667. Epub 2013 Oct 22.
Abstract: BACKGROUND: The cardiovascular vulnerability of young adults who were born preterm was first acknowledged over a decade ago.AIMS: (1) To examine the echocardiographic characteristics of a group of young adults born preterm with an extremely low birthweight (&lt;1000 g; ex-ELBW) in comparison with healthy controls born at term (C); (2) to identify a correlation between the potential echocardiographic abnormalities detected in ex-ELBW and their anthropometric parameters, age, presence of respiratory distress, patency of ductus arteriosus, length of stay in Neonatal Intensive Care Unit.METHODS: Thirty-seven ex-ELBW (11 males, 26 females; mean age: 22.2 ± 1.8 years) were compared with 37 C (11 males, 26 females). Both groups underwent standard mono- and bi-dimensional transthoracic echocardiogram with color Doppler.RESULTS: No statistically significant differences were detected between the two groups regarding mono-dimensional echocardiography or Doppler measurements (p = ns). Conversely, a statistically significant difference was observed between the prevalence of interatrial septal aneurysm (ASA) in ex-ELBW compared to C (p = 0.0016). A significant association was likewise observed between ASA and the presence of both respiratory distress at birth (p &lt; 0.05) and patency of the ductus arteriosus (p &lt; 0.05).CONCLUSIONS: A significant prevalence of ASA was detected in ex-ELBW subjects compared to C, underlining a probable correlation with respiratory distress and patent ductus arteriosus. In view of the association between ASA and stroke in young adults devoid of other cerebrovascular risk factors, this unexpected observation suggests that all ex-preterm subjects should undergo transthoracic or transesophageal echocardiographic examination with the aim of detecting this potentially emboligenic cardiac abnormality.
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29  28942015-01-07
Authors: Addetia K, Mor-Avi V, Weinert L, Salgo IS, Lang RM.
Citation: J Am Soc Echocardiogr. 2014 Jan;27(1):8-16. doi: 10.1016/j.echo.2013.08.025. Epub 2013 Oct 2.
Abstract: BACKGROUND: Differentiating between mitral valve (MV) prolapse (MVP) and MV billowing (MVB) on two-dimensional echocardiography is challenging. The aim of this study was to test the hypothesis that color-coded models of maximal leaflet displacement from the annular plane into the atrium derived from three-dimensional transesophageal echocardiography would allow discrimination between these lesions.METHODS: Three-dimensional transesophageal echocardiographic imaging of the MV was performed in 50 patients with (n&nbsp;=&nbsp;38) and without (n&nbsp;=&nbsp;12) degenerative MV disease. Definitive diagnosis of MVP versus MVB was made using inspection of dynamic three-dimensional renderings and multiple two-dimensional cut planes extracted from three-dimensional data sets. This was used as a reference standard to test an alternative approach, wherein the color-coded parametric models were inspected for integrity of the coaptation line and location of the maximally displaced portion of the leaflet. Diagnostic interpretations of these models by two independent readers were compared with the reference standard.RESULTS: In all cases of MVP, the color-coded models depicted loss of integrity of the coaptation line and maximal leaflet displacement extending to the coaptation line. MVB was depicted by preserved leaflet apposition with maximal displacement away from the coaptation line. Interpretation of the 50 color-coded models by novice readers took 5 to 10 min and resulted in good agreement with the reference technique (κ&nbsp;=&nbsp;0.81 and κ&nbsp;=&nbsp;0.73 for the two readers).CONCLUSIONS: Three-dimensional color-coded models provide a static display of MV leaflet displacement, allowing differentiation between MVP and MVB, without the need to inspect multiple planes and while taking into account the saddle shape of the mitral annulus.Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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30  28932015-01-06
Authors: Fine NM, Topilsky Y, Oh JK, Hasin T, Kushwaha SS, Daly RC, Joyce LD, Stulak JM, Pereira NL, Boilson BA, Clavell AL, Edwards BS, Park SJ.
Citation: JACC Cardiovasc Imaging. 2013 Nov;6(11):1129-40. doi: 10.1016/j.jcmg.2013.06.006. Epub 2013 Oct 2.
Abstract: OBJECTIVES: This study sought to characterize the echocardiographic findings of patients presenting with intravascular hemolysis (IVH) due to suspected continuous-flow left ventricular assist device (LVAD) pump thrombosis.BACKGROUND: LVAD patients who develop pump thrombosis often present with IVH. Echocardiography may be able to detect device dysfunction in this setting.METHODS: Continuous-flow LVAD patients presenting with IVH due to suspected pump thrombosis were identified. Patients underwent echocardiography with cannula Doppler flow velocity interrogation. Findings were compared with baseline and follow-up studies, and with 49 stable LVAD control patients.RESULTS: Of 145 patients, 14 (10%) had IVH due to suspected pump thrombosis. The mean age was 55 ± 15 years, 93% were men, and 50% received LVAD as destination therapy. Mean duration between implantation and IVH was 231 ± 218 days. Eleven (79%) patients presented with hemoglobinuria, 9 (64%) with jaundice, and 5 (36%) with acute heart failure. Reduced cannula diastolic flow velocity and increased systolic/diastolic (S/D) flow velocity ratio were the only echocardiographic parameters significantly different from controls (outflow cannula 0.3 ± 0.2 m/s vs. 0.8 ± 0.3 m/s, p = 0.03, and 5.9 ± 2.8 vs. 1.7 ± 0.7, p &lt; 0.01, respectively), and were worse for IVH patients with acute heart failure compared with those without (outflow cannula 0.2 ± 0.1 m/s vs. 0.5 ± 0.2 m/s, p = 0.04, and 7.2 ± 3.3 vs. 5.3 ± 2.0, p = 0.02, respectively). Outflow cannula diastolic flow velocity and S/D flow velocity ratio changed significantly from baseline (p = 0.01 and p &lt; 0.01, respectively) in IVH patients, whereas systolic flow velocity did not change (p = 0.59). Odds ratios for outflow cannula diastolic flow velocity and S/D flow velocity ratio for predicting IVH were 0.60 (95% confidence interval [CI]: 0.51 to 0.73), p = 0.02, and 2.45 (95% CI: 2.37 to 2.52) p &lt; 0.01, respectively. Corresponding inflow cannula values were similarly significant. Pump thrombosis was confirmed in 7 (50%) patients after LVAD retrieval.CONCLUSIONS: Reduced cannula diastolic flow velocity and increased S/D flow velocity ratio identified continuous-flow LVAD dysfunction in patients with IVH due to suspected pump thrombosis better than other echocardiographic parameters.Copyright © 2013. Published by Elsevier Inc.
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31  28922015-01-06
Authors: O'Sullivan CJ, Stortecky S, Heg D, Pilgrim T, Hosek N, Buellesfeld L, Khattab AA, Nietlispach F, Moschovitis A, Zanchin T, Meier B, Windecker S, Wenaweser P.
Citation: Eur Heart J. 2013 Nov;34(44):3437-50. doi: 10.1093/eurheartj/eht408. Epub 2013 Oct 3.
Abstract: AIMS: Our aim was to evaluate the invasive haemodynamic indices of high-risk symptomatic patients presenting with 'paradoxical' low-flow, low-gradient, severe aortic stenosis (AS) (PLF-LG) and low-flow, low-gradient severe AS (LEF-LG) and to compare clinical outcomes following transcatheter aortic valve implantation (TAVI) among these challenging AS subgroups.METHODS AND RESULTS: Of 534 symptomatic patients undergoing TAVI, 385 had a full pre-procedural right and left heart catheterization. A total of 208 patients had high-gradient severe AS [HGAS; mean gradient (MG) ≥40 mmHg], 85 had PLF-LG [MG ≤ 40 mmHg, indexed aortic valve area [iAVA] ≤0.6 cm(2) m(-2), stroke volume index ≤35 mL/m(2), ejection fraction (EF) ≥50%], and 61 had LEF-LG (MG ≤ 40 mmHg, iAVA ≤0.6 cm(2) m(-2), EF ≤40%). Compared with HGAS, PLF-LG and LEF-LG had higher systemic vascular resistances (HGAS: 1912 ± 654 vs.PLF-LG: 2006 ± 586 vs.LEF-LG: 2216 ± 765 dyne s m(-5), P = 0.007) but lower valvulo-arterial impedances (HGAS: 7.8 ± 2.7 vs.PLF-LG: 6.9 ± 1.9 vs.LEF-LG: 7.7 ± 2.5 mmHg mL(-1) m(-2), P = 0.027). At 30 days, no differences in cardiac death (6.5 vs. 4.9 vs. 6.6%, P = 0.90) or death (8.4 vs. 6.1 vs. 6.6%, P = 0.88) were observed among HGAS, PLF-LG, and LEF-LG groups, respectively. At 1 year, New York Heart Association functional improvement occurred in most surviving patients (HGAS: 69.2% vs.PLF-LG: 71.7% vs.LEF-LG: 89.3%, P = 0.09) and no significant differences in overall mortality were observed (17.6 vs. 20.5 vs. 24.5%, P = 0.67). Compared with HGAS, LEF-LG had a higher 1 year cardiac mortality (adjusted hazard ratio 2.45, 95% confidence interval 1.04-5.75, P = 0.04).CONCLUSION: TAVI in PLF-LG or LEF-LG patients is associated with overall mortality rates comparable with HGAS patients and all groups profit symptomatically to a similar extent.
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32  28912015-01-06
Authors: Wani ML, Ahangar AG, Singh S.
Citation: Ann Card Anaesth. 2013 Oct-Dec;16(4):304-5. doi: 10.4103/0971-9784.119192.
Abstract: No abstract available.
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33  28902015-01-06
Authors: Khan JA, Hussain M, Rizvi NH, Fehmi N, Hussain A, Sial JA.
Citation: J Coll Physicians Surg Pak. 2013 Oct;23(10):745-7. doi: 10.2013/JCPSP.745747.
Abstract: A 26 years old male presented with vertigo and history of fall. The electrocardiogram revealed 2:1 second-degree heart block and later progression to complete heart block. Transthoracic echocardiography revealed aneurysm at the site of ascending aorta and computed tomographic scan showed an aneurysm of right sinsus of Valsalva extending into right atrioventricular and interventricular groove and causing complete heart block by compression on the conduction system. He also suffered from lymph node tuberculosis. This case report is unique because of rare presentation as complete heart block.
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34  28892015-01-06
Authors: Costa SP, Beaver TA, Rollor JL, Vanichakarn P, Magnus PC, Palac RT.
Citation: J Am Soc Echocardiogr. 2014 Jan;27(1):50-4. doi: 10.1016/j.echo.2013.08.021. Epub 2013 Oct 9.
Abstract: BACKGROUND: Global longitudinal strain (GLS) derived from two-dimensional speckle-tracking is an emerging technology, but lack of industry standards limits its application. Prior studies support using this tool to identify subclinical disease through serial changes, but the variability introduced by a change in vendor or reader is not well defined.METHODS: Fifty study subjects were prospectively identified to include four subgroups to ensure a broad range of GLS: normal (n&nbsp;= 20), left ventricular hypertrophy (n&nbsp;= 10), ST-segment elevation myocardial infarction (n&nbsp;= 10), and systolic heart failure (n&nbsp;= 10). Raw data were obtained using equipment from two vendors during the same session, and GLS was analyzed using an offline workstation. Intraobserver and interobserver variation was measured using correlation coefficients, intraclass correlation coefficients, and Bland-Altman plots.RESULTS: GLS measurements were highly reproducible by the same reader or a different reader using vendor 1 and vendor 2 or comparing vendors (correlation coefficients and intraclass correlation coefficients ≥ 0.95). However, the Bland-Altman plots suggested that the variation in repeat GLS measurements may range from ± 2% to ± 5% on the basis of a change in vendor, reader, or both.CONCLUSIONS: The expected variation in GLS measurements associated with a change in vendor, reader, or&nbsp;both should be considered when making conclusions about significant changes in serial measurements.Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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35  28882015-01-05
Authors: Okeke T, Ezenyeaku C, Ikeako L.
Citation: Ann Med Health Sci Res. 2013 Jul;3(3):313-9. doi: 10.4103/2141-9248.117925.
Abstract: Peripartum cardiomyopathy (PPCM) is a rare form of unexplained cardiac failure of unknown origin, unique to the pregnant woman with highly variable outcome associated with high morbidity and mortality. PPCM is fraught with controversies in its definition, epidemiology, pathophysiology, diagnosis and management. PPCM is frequently under diagnosed, inadequately treated and without a laid down follow-up regimen, thus, the aim of this review. Publications on PPCM were accessed using Medline, Google scholar and Pubmed databases. Relevant materials on PPCM, selected references from internet services, journals, textbooks, and lecture notes on PPCM were also accessed and critically reviewed. PPCM is multifactorial in origin. It is a diagnosis of exclusion and should be based on classic echocardiographic criteria. The outcome of PPCM is also highly variable with high morbidity and mortality rates. Future pregnancies are not recommended in women with persistent ventricular dysfunction because the heart cannot tolerate increased cardiovascular workload associated with the pregnancy. Although, multiparity is associated with PPCM, there is an increased risk of fetal prematurity and fetal loss. PPCM is a rare form of dilated cardiomyopathy of unknown origin, unique to pregnant women. The pathophysiology is poorly understood. Echocardiography is central to diagnosis of PPCM and effective treatment monitoring in patients of PPCM. The outcome is highly variable and related to reversal of ventricular dysfunction.
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36  28872015-01-05
Authors: Guidoux C, Mazighi M, Lavallée P, Labreuche J, Meseguer E, Cabrejo L, Messika-Zeitoun D, Escoubet B, Touboul PJ, Steg PG, Amarenco P.
Citation: Atherosclerosis. 2013 Nov;231(1):124-8. doi: 10.1016/j.atherosclerosis.2013.08.025. Epub 2013 Sep 11.
Abstract: OBJECTIVE: Aortic arch atheroma (AAA) is associated with vascular risk factors and with stroke risk. Its prevalence and prognosis remain to be defined in patients with transient ischemic attack (TIA).METHODS: Using data from the SOS-TIA registry, we assessed the prevalence of AAA detected by transesophageal echocardiography (TEE). AAA was graded as moderate (&lt;4 mm) or severe (≥4 mm). All patients had a standardized work-up investigation and were followed for 1 year.RESULTS: Between January 2003 and December 2008, 1850 patients with definite/possible TIA or minor stroke were enrolled and 1231 (67%) underwent TEE. Moderate AAA was found in 26% of patients (n = 324) and severe AAA in 14% (n = 171), giving an overall AAA prevalence of 40%. Among the 873 patients without identified cause of TIA, the prevalence of moderate and severe AAA were 24% and 12% respectively. Intracranial or extracranial stenosis ≥50% were detected in 21% of patients and were independently associated with AAA (adjusted odds ratio, 1.65, 95% confidence interval (CI), 1.23-2.22). At one-year, incidence of recurrent vascular events was 2.2% in patients without AAA, 4.1% in moderate AAA and 6.6% in severe AAA (log-rank, p for trend = 0.003). Using patients without AAA as reference, and after adjustment on vascular risk factors, the hazard ratio (95% CI) for moderate was 1.36 (0.62-2.99) and 2.08 (0.89-4.86) for severe (p for trend = 0.095).CONCLUSIONS: These findings support a systematic identification of AAA in TIA patients to optimize risk stratification in this specific population.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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37  28862015-01-05
Authors: Hakim FA, Aryal MR, Pandit A, Pandit AA, Alegria JR, Kendall CB, Click RL.
Citation: Echocardiography. 2014 Feb;31(2):234-40. doi: 10.1111/echo.12388. Epub 2013 Oct 15.
Abstract: The pulmonary valve is the least affected site for valvular papillary fibroelastoma. With increasing use of routine echocardiography and other modalities of imaging, pulmonary valve papillary fibroelastomas (PVPFE) are being recognized more frequently. PVPFE is more often an incidental diagnosis and symptomatic patients usually present with shortness of breath. Embolic phenomena and right ventricular outflow tract obstruction are the most serious complications of PVPFE. Since PVPFE is rare, the purpose of this systematic review is to address demographic characteristics, the clinical presentation, management, and outcome of this benign tumor of the pulmonary valve. © 2013, Wiley Periodicals, Inc.
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38  28852015-01-05
Authors: López-Candales A, Lopez FR, Trivedi S, Elwing J.
Citation: Echocardiography. 2014 Apr;31(4):516-23. doi: 10.1111/echo.12419. Epub 2013 Oct 18.
Abstract: BACKGROUND: The severity of pulmonary vascular resistance (PVR) is known to be a critical determinant of right ventricular (RV) systolic function; this relationship remains poorly characterized. We therefore, designed a study to examine the relationship that exists between echocardiographically measured PVR and maximal tricuspid annular plane systolic excursion (TAPSE) to gain some insight regarding RV ejection efficiency (RVEe) in patients with chronic pulmonary hypertension (cPH).METHODS: Standard echocardiographic measures of RV size and systolic performance were recorded from 95 patients (age 54 ± 15 years and pulmonary artery systolic pressures [PASP] that range from 20 to 125 mmHg). For this study, RVEe was defined as TAPSE/Echocardiographic PVR.RESULTS: A strong negative correlation (R(2) = -0.51, P &lt; 0.001) was seen between TAPSE and PASP; however, a power curve trend line fit the relationship between RVEe and PASP (R(2) = 0.77; P &lt; 0.01). In a multiple regression analysis, abnormal pulmonary pressures were better identified when RVEe (P &lt; 0.0001) was used.CONCLUSIONS: Based on these results, it appears that measurement of RVEe might be extremely useful for the assessment of RV mechanics and plasticity. The power curve relationship clearly demonstrates that minimal changes in PASP (up to 50 mmHg) result in dramatic reductions in RVEe. A steady decline in RVEe, though at a lower rate, continues to occur with increasing PASP. Additional studies are required using RVEe into a functional RV imaging algorithm and determine if RVEe correlates with development of symptoms, response to therapy and overall clinical outcomes.© 2013, Wiley Periodicals, Inc.
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39  28842015-01-04
Authors: Biaggi P, Felix C, Gruner C, Herzog BA, Hohlfeld S, Gaemperli O, Stähli BE, Paul M, Held L, Tanner FC, Grünenfelder J, Corti R, Bettex D.
Citation: Circ Cardiovasc Imaging. 2013 Nov;6(6):1032-40. doi: 10.1161/CIRCIMAGING.113.000620. Epub 2013 Oct 17.
Abstract: BACKGROUND: Quantification of the mitral valve area (MVA) is important to guide percutaneous mitral valve repair using the MitraClip system. However, little is known about how to best assess MVA in this specific situation.METHODS AND RESULTS: Immediately before and after MitraClip implantation, comprehensive 3-dimensional (3D) transesophageal echocardiography data were acquired for MVA assessment by the pressure half-time method and by two 3D quantification methods (mitral valve quantification software and 3D quantification software). In addition, transmitral gradients by continuous-wave Doppler (dPmeanCW) were measured to indirectly assess MVA. Data are given as median (interquartile range). Thirty-three patients (39% women) with a median age of 77.1 years (12.4 years) were studied. Before intervention, the median MVAs by the pressure half-time method, mitral valve quantification software, and 3D quantification software were 4.4 cm(2) (2.0 cm(2)), 4.7 cm(2) (2.4 cm(2)), and 6.2 cm(2) (2.4 cm(2)), respectively (P&lt;0.001). After intervention, MVA was reduced to 1.9 cm(2) (0.7 cm(2)), 2.1 cm(2) (1.1 cm(2)), and 2.8 cm(2) (1.1 cm(2)), respectively (P=0.001). The median values for dPmeanCW before and after intervention were 1.0 mm Hg (1.0 mm Hg) and 3.0 mm Hg (3.0 mm Hg; P&lt;0.001), respectively. At discharge, the median dPmeanCW was 4.0 mm Hg (3.0 mm Hg). In multivariate regression analyses including body surface area, the 3 different MVA methods, and dPmeanCW, a post-dPmeanCW ≥5 mm Hg was the best independent predictor of an elevated transmitral gradient at discharge.CONCLUSIONS: Transmitral gradients by continuous-wave Doppler are quick, feasible in all patients, and superior to direct peri-interventional assessment of MVA. A postinterventional transmitral gradient by continuous-wave Doppler of ≥5 mm Hg best predicted elevated transmitral gradients at discharge.
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40  28832015-01-04
Authors: De Torres-Alba F, López-Fernández T, Ramírez-Valdiris U, Valbuena-López S, Iniesta-Manjavacas AM, Montoro-López N, Moreno-Yangüela M, Mesa-García JM, López-Sendón J.
Citation: JACC Cardiovasc Imaging. 2013 Oct;6(10):1115-8. doi: 10.1016/j.jcmg.2013.08.003.
Abstract: No abstract available.
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41  28822015-01-04
Authors: Fenster BE, Curran-Everett D, Freeman AM, Weinberger HD, Kern Buckner J, Carroll JD.
Citation: Echocardiography. 2014 Apr;31(4):420-7. doi: 10.1111/echo.12403. Epub 2013 Oct 18.
Abstract: Although the "3 beat rule" is widely utiized to discriminate patent foramen ovale (PFO)-mediated right-to-left shunt (RTLS) from intrapulmonary RTLS using saline contrast transthoracic echocardiography (SCE), SCE diagnostic performance has yet to be validated using an invasive intracardiac standard. Percutaneous PFO occluder placement was recently shown to ameliorate hypoxia in patients with suspected PFO-mediated RTLS. We evaluated the ability of SCE to predict PFO presence and size using intracardiac echocardiography (ICE) as a gold standard in a hypoxic cohort. Sixty-three hypoxic patients with suspected PFO-mediated RTLS who underwent SCE at rest, with Valsalva maneuver, and with cough prior to ICE were evaluated retrospectively. PFO RTLS was defined by ICE findings including PFO anatomy, RTLS by saline contrast and color Doppler, and probe patency. SCE shunt severity and timing of left heart saline target appearance were compared to the presence of ICE-defined PFO RTLS. Forty-seven patients (75%) met criteria for PFO-mediated RTLS. A 4 beat cutoff for resting SCE provided optimal diagnostic performance for detection of PFO-mediated RTLS with a 71% sensitivity, 94% specificity, and 97% positive predictive value (PPV). Valsalva and cough maneuvers improved sensitivity compared to rest SCE (89% and 80%, respectively). Valsalva SCE shunt severity more accurately predicted PFO size than resting SCE. In contrast to the widely accepted "3 beat rule," resting SCE for the detection of PFO RTLS in a hypoxic population performs optimally using a 4-cycle cutoff with both excellent specificity and PPV. © 2013, Wiley Periodicals, Inc.
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42  28812015-01-04
Authors: Lee Y, Mori N, Nakamura D, Yoshimura T, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Tanouchi J, Yamada Y, Nishino M.
Citation: Echocardiography. 2014 Apr;31(4):492-8. doi: 10.1111/echo.12406. Epub 2013 Oct 18.
Abstract: Left ventricular (LV) twist can be evaluated using two-dimensional speckle tracking echocardiography (2DSTE) by analyzing difference between apical and basal rotation. However, it is unable to evaluate global rotational dyssynchrony because it cannot assess mid-wall rotation. Recently developed three-dimensional STE (3DSTE) can investigate LV global rotational dyssynchrony. In this study, we investigated the role of torsion on the long-term effects of cardiac resynchronization therapy (CRT) using 3DSTE. We evaluated 43 patients by 3DSTE: 12 CRT responders, 14 CRT nonresponders, and 17 healthy normal controls. Regional torsion and rotation were assessed using 3DSTE across 16 segments during CRT-off (native conduction) and CRT-on. The following parameters were calculated: global peak twist, Δ global peak twist (difference between CRT-on and CRT-off), and torsion delay index. The torsion delay index was considered to be the rotational energy lost by rotational dyssynchrony. Global peak twist did not show significant differences between the responders and nonresponders during CRT-off (4.0 ± 3.4° vs. 2.8 ± 2.3°, P = 0.295), but it significantly improved in responders compared to nonresponders after CRT-on (5.4 ± 3.5° vs. 2.6 ± 2.6°, P = 0.029). The torsion delay index during CRT-off was significantly higher in responders compared to nonresponders and normal controls (18.5 ± 11.3 vs. 8.6 ± 3.8 and 7.8 ± 5.5, P = 0.010 and P = 0.004, respectively). The torsion delay index during CRT-off significantly correlated with the Δ global peak twist (r = 0.503, P = 0.009). Improvement in LV global peak twist, which is one of the mechanisms for the long-term effects of CRT correlated with the torsion delay index during native conduction that can only be calculated by 3DSTE.© 2013, Wiley Periodicals, Inc.
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43  28802015-01-04
Authors: Yamamoto M, Mouillet G, Meguro K, Gilard M, Laskar M, Eltchaninoff H, Fajadet J, Iung B, Donzeau-Gouge P, Leprince P, Leuguerrier A, Prat A, Lievre M, Chevreul K, Dubois-Rande JL, Teiger E; FRANCE- Registry Investigators.
Citation: Ann Thorac Surg. 2014 Jan;97(1):29-36. doi: 10.1016/j.athoracsur.2013.07.100. Epub 2013 Oct 17.
Abstract: BACKGROUND: Although transcatheter aortic valve implantation has been developing as an alternative treatment in elderly patients with high surgical risk, age-specific differences in clinical outcome have not been fully validated.METHODS: Data were analyzed for 2,254 patients at least 80 years old who were enrolled between January 2010 and October 2011 in the French national transcatheter aortic valve implantation registry, FRANCE-2. Procedural and clinical outcomes defined according to the Valve Academic Research Consortium criteria were compared among subjects in three age groups: 80 to 84 years (n = 867), 85 to 89 years (n = 1,064), and at least 90 years (n = 349; range, 90 to 101 years).RESULTS: The self-expandable prosthesis was implanted in 710 patients, and the balloon-expandable prosthesis was implanted in 1,544 patients. No differences were observed in rates of procedural success, Valve Academic Research Consortium-defined complications, and length of hospitalization among groups. Cumulative 30-day mortalities did not change among the three groups (80 to 84 years, 10.3% versus 85 to 89 years, 9.5% versus ≥ 90 years, 11.2%; p = 0.53). Cumulative 1-year mortalities also showed no statistical differences, although the mortality rate was higher in patients 85 to 89 years old and at least 90 years old compared with those 80 to 84 years old (19.8% versus 26.1% versus 27.7%; p = 0.16). After adjustment for differential baseline characteristics and potential confounders, patient age (85 to 89 years and ≥ 90 years compared with 80 to 84 years) was not associated with increasing risk of 30-day mortality (hazard ratio, 0.92, 1.26; 95% confidence interval, 0.66 to 1.27, 0.83 to 1.94; p = 0.38, 0.28, respectively) and 1-year mortality (hazard ratio, 1.16, 1.36; 95% confidence interval, 0.90 to 1.49, 0.97 to 1.89; p = 0.25, 0.073, respectively).CONCLUSIONS: This study revealed acceptable clinical results of transcatheter aortic valve implantation even in very elderly populations.Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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44  28792015-01-04
Authors: Drechsler C, Schmiedeke B, Niemann M, Schmiedeke D, Krämer J, Turkin I, Blouin K, Emmert A, Pilz S, Obermayer-Pietsch B, Weidemann F, Breunig F, Wanner C.
Citation: J Inherit Metab Dis. 2014 Mar;37(2):289-95. doi: 10.1007/s10545-013-9653-8. Epub 2013 Oct 19.
Abstract: Patients with Fabry disease frequently develop left ventricular (LV) hypertrophy and renal fibrosis. Due to heat intolerance and an inability to sweat, patients tend to avoid exposure to sunlight. We hypothesized that subsequent vitamin D deficiency may contribute to Fabry cardiomyopathy. This study investigated the vitamin D status and its association with LV mass and adverse clinical symptoms in patients with Fabry disease. 25-hydroxyvitamin D (25[OH]D) was measured in 111 patients who were genetically proven to have Fabry disease. LV mass and cardiomyopathy were assessed by magnetic resonance imaging and echocardiography. In cross-sectional analyses, associations with adverse clinical outcomes were determined by linear and binary logistic regression analyses, respectively, and were adjusted for age, sex, BMI and season. Patients had a mean age of 40 ± 13 years (42% males), and a mean 25(OH)D of 23.5 ± 11.4 ng/ml. Those with overt vitamin D deficiency (25[OH]D ≤ 15 ng/ml) had an adjusted six fold higher risk of cardiomyopathy, compared to those with sufficient 25(OH)D levels &gt;30 ng/ml (p = 0.04). The mean LV mass was distinctively different with 170 ± 75 g in deficient, 154 ± 60 g in moderately deficient and 128 ± 58 g in vitamin D sufficient patients (p = 0.01). With increasing severity of vitamin D deficiency, the median levels of proteinuria increased, as well as the prevalences of depression, edema, cornea verticillata and the need for medical pain therapy. In conclusion, vitamin D deficiency was strongly associated with cardiomyopathy and adverse clinical symptoms in patients with Fabry disease. Whether vitamin D supplementation improves complications of Fabry disease, requires a randomized controlled trial.
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45  28782015-01-04
Authors: Sonmez O, Kayrak M, Altunbas G, Abdulhalikov T, Alihanoglu Y, Bacaksiz A, Ozdemir K, Gok H.
Citation: Clinics (Sao Paulo). 2013 Sep;68(9):1225-30. doi: 10.6061/clinics/2013(09)09.
Abstract: OBJECTIVE: Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction.METHODS: The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained.RESULTS: The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant.CONCLUSION: Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate.
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46  28772014-12-28
Authors: Elitok A, Oz F, Cizgici AY, Kilic L, Ciftci R, Sen F, Bugra Z, Mercanoglu F, Oncul A, Oflaz H.
Citation: Cardiol J. 2014 Mar 27. doi: 10.5603/CJ.a2013.0150. [Epub ahead of print]
Abstract: BACKGROUND: The use of Antracycline (ANT) in breast cancer has been associated with adverse cardiac events. Two-dimensional strain imaging (SI) can provide a more sensitive measure of altered left ventricle ( LV) systolic function. We aimed to evaluate the preventive effect of carvedilol administration assessed by SI in a patient with breast cancer treated with ANT.METHODS: Patients receiving ANT were randomly assigned to the carvedilol- or placebo-receiving group. Each received an echocardiographic examination with conventional two-dimensional echocardiography (2D), pulsed tissue Doppler, and 2D SI prior to and 6 months post ANT treatment.RESULTS: During the 6-month follow-up period there were no patient deaths or interrupted chemotherapy (CT) treatments due to doxorubicin-induced cardiotoxicity. Both left ventricular ejection fraction (LVEF) and fractional shortening (FS) were within normal limits for all patients before and after ANT therapy. EF, FS and LV dimensions were measured using M mode echocardiography and found to be similar in both groups before and after ANT therapy. The mean EF, FS, and LV echocardiograph baseline and control dimensions were similar in both groups after 6 months. Though baseline SI parameters were similar between the groups, there was a significant decrease in LV basal septal and basal lateral peak systolic strain in the control group compared to the carvedilol group.CONCLUSIONS: These results indicate that carvedilol has a protective effect against the cardiotoxicity induced by ANT.
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47  28762014-12-28
Authors: Bartel T, Müller S, Biviano A, Hahn RT.
Citation: Eur Heart J. 2014 Jan;35(2):69-76. doi: 10.1093/eurheartj/eht411. Epub 2013 Oct 21.
Abstract: Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac echocardiography (ICE) complements and has in part replaced transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative.
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48  28752014-12-28
Authors: Ring L, Dutka DP, Wells FC, Fynn SP, Shapiro LM, Rana BS.
Citation: Eur Heart J Cardiovasc Imaging. 2014 May;15(5):500-8. doi: 10.1093/ehjci/jet191. Epub 2013 Oct 20.
Abstract: AIMS: Functional mitral regurgitation (FMR) is a consequence of mitral annular enlargement, leaflet tethering and reduced co-aptation. The importance of the left atrium (LA) as a cause of mitral regurgitation (MR) is less clear. We applied a co-aptation index using three-dimensional (3D) transoesophageal echocardiography to FMR and MR secondary to LA dilatation (atrial mitral regurgitation, AMR).METHODS AND RESULTS: Seventy-two patients underwent comprehensive 3D echo studies: FMR (n = 19); AMR (n = 33); and 20 controls. We recorded: LV size and function; LA dimensions; mitral annular area (MVA); and leaflet area in early and late systole. MVA fractional change was defined: (MVA late systole - MVA early systole)/MVA late systole × 100%; the co-aptation index was defined: (leaflet area early systole - leaflet area late systole)/leaflet area early systole × 100%. Despite normal LV size and function in AMR, MVA was increased similarly to FMR (AMR 12.86 cm(2) vs. FMR 12.33 cm(2), P = ns; both P &lt; 0.01 vs. controls 8.83 cm(2)), and MVA fractional change similarly reduced (AMR 5.1% vs. FMR 6.3%; P = ns; both P &lt; 0.001 vs. controls 14.6%). The co-aptation index was reduced in both MR groups (FMR 6.6% vs. AMR 7.0%, P = ns; both P &lt; 0.001 vs. controls 19.6%). After multivariate analysis, the co-aptation index (χ(2) = 41.2) and MVA fractional change (χ(2) = 22.1) remained the strongest predictors of MR (both P &lt; 0.001 for the model). A co-aptation index of ≤13% was 96% sensitive and 90% specific for the presence of MR.CONCLUSION: LA dilatation leads to MVA enlargement, reduced leaflet co-aptation and MR even without LV dilatation. A co-aptation index describes this in vivo. This work provides insights into the mechanism of AMR.
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49  28742014-12-28
Authors: Pellicori P, Kallvikbacka-Bennett A, Khaleva O, Carubelli V, Costanzo P, Castiello T, Wong K, Zhang J, Cleland JG, Clark AL.
Citation: Int J Cardiovasc Imaging. 2014 Jan;30(1):69-79. doi: 10.1007/s10554-013-0310-y. Epub 2013 Oct 23.
Abstract: Many patients have clinical, structural or bio-marker evidence of heart failure (HF) but a normal left ventricular ejection fraction (LVEF; HeFNEF). Measurement of global longitudinal strain (GLS) may add diagnostic and prognostic information. Patients with symptoms suggesting heart failure and LVEF ≥50% were studied: 76 had no substantial cardiac dysfunction (left atrial diameter (LAD) &lt;40 mm and amino-terminal pro-brain natriuretic peptide (NTproBNP) &lt;400 ng/l); 99 had "possible HeFNEF" (LAD ≥40 mm or NTproBNP ≥400 ng/l); and 138 had "definite HeFNEF" (LAD ≥40 mm and NTproBNP ≥400 ng/L). Mean LVEF was 58% in each subgroup. Patients with definite HeFNEF were older, more likely to have atrial fibrillation, had more symptoms and signs of fluid retention, were more likely to have right ventricular dysfunction and had higher pulmonary pressures than other groups. Mean GLS (SD) was less negative in patients with definite HeFNEF (-13.6 (3.0)% vs. possible HeFNEF: -15.2 (3.1)% vs. no substantial cardiac dysfunction: -15.9 (2.4)%; p &lt; 0.001). GLS was -19.1 (2.1)% in 20 controls. During a median follow up of 647 days, cardiovascular death or an unplanned hospitalisation for heart failure occurred in 62 patients. In univariable analysis, GLS but not LVEF predicted events. However, in a multi-variable analysis, only urea, NTproBNP, left atrial volume, inferior vena cava diameter and atrial fibrillation independently predicted adverse outcome. GLS is abnormal in patients who have other evidence of HeFNEF, is associated with a worse prognosis in this population but is not a powerful independent predictor of outcome.
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50  28732014-12-28
Authors: Nishizaki Y, Daimon M, Miyazaki S, Suzuki H, Kawata T, Miyauchi K, Chiang SJ, Makinae H, Shinozaki T, Daida H.
Citation: J Heart Valve Dis. 2013 May;22(3):287-94.
Abstract: BACKGROUND AND AIM OF THE STUDY: The recognition of clinical symptoms is critical to a therapeutic strategy for aortic valve stenosis (AS). It was hypothesized that AS symptoms might have multiple causes; hence, a study was conducted to investigate the factors that separately influence the classic symptoms of dyspnea, angina and syncope in AS.METHODS: The medical records of 170 consecutive patients with AS (&gt; or = moderate grade) were reviewed. A multivariate logistic regression analysis was used to evaluate the hemodynamic and clinical factors that separately influence the development of three clinical symptoms: dyspnea (defined as NYHA class &gt; or = 2), angina, and syncope.RESULTS: The most common symptom was dyspnea (47.1%), followed by angina (12.4%) and syncope (4.7%). The factors associated with dyspnea were a higher e' ratio (p = 0.04) and peak aortic valve velocity (p = 0.01). Only the severity of AS was associated with syncope. The presence of hypertension was associated with angina (p = 0.04). Moreover, coronary angiography was performed in 59 patients before aortic valve replacement and revealed coronary stenosis (&gt; 50% diameter stenosis) in 11/16 patients (69%) that had angina. The presence of coronary stenosis was significantly associated with angina (p = 0.02). The development of dyspnea, angina or syncope was influenced by different factors in AS.CONCLUSION: Dyspnea and syncope were mainly associated with AS severity, and diastolic dysfunction also influenced dyspnea. In contrast, angina was mainly related to the presence of coronary stenosis rather than to AS severity. These factors should be considered when, selecting a therapeutic strategy for AS patients in the modern era.
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51  28722014-12-28
Authors: Bleiziffer S, Hettich I, Hutter A, Wagner A, Deutsch MA, Piazza N, Lange R.
Citation: J Heart Valve Dis. 2013 May;22(3):309-16.
Abstract: BACKGROUND AND AIM OF THE STUDY: The study aim was to investigate the incidence of patient-prosthesis mismatch (PPM) with new catheter valves, and its influence on the patients' clinical state. At present, few echocardiographic data are available on the incidence and impact of PPM with the CoreValve and Sapien prostheses for transcatheter aortic valve implantation (TAVI).METHODS: The reliability of effective orifice area (EOA) measurements was assured by awaiting an interval of six months after TAVI. Of 256 survivors after TAVI, 149 complete echocardiographic data sets were available for the assessment of the indexed EOA (iEOA). In total, 106 CoreValve prostheses and 43 Sapien prostheses were implanted in this high-risk cohort (mean age 81 +/- 6 years, mean logistic EuroSCORE 20 +/- 13%).RESULTS: The overall incidence of PPM (iEOA &lt; 0.85 cm2/m2) was 61%. Patients with a larger body surface area were more likely to develop PPM (p = 0.001), while the prosthesis type, native annulus diameter, preoperative EOA, gender and prosthesis size had no influence. The mean aortic gradient was significantly higher in patients with PPM. A reduction in the left ventricular end-diastolic diameter was seen in all patients, without significant differences between groups. There were no differences in postoperative NYHA class or self-assessed health state between patients with or without PPM.CONCLUSION: PPM was common after TAVI in the presented cohort, presumably because the native calcium masses narrow the outflow area available for blood flow. As expected for low gradients, there was no impairment of left ventricular dimension regression or clinical state of the patients, even if severe PPM was present. Based on the presented data, it is assumed that PPM might be less relevant in TAVI patients.
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52  28712014-12-28
Authors: Morimoto N, Aoki M, Murakami H, Nakagiri K, Yoshida M, Mukohara N.
Citation: J Heart Valve Dis. 2013 May;22(3):326-32.
Abstract: BACKGROUND AND AIM OF THE STUDY: The efficacy of chordal-preserved mitral valve replacement (MVR) on left ventricular function was investigated in patients with mitral stenosis.METHODS: Eighty patients (25 males, 55 females; mean age 64.5 +/- 8.7 years) with pure mitral stenosis who underwent MVR between January 1999 and May 2008 were studied retrospectively. Of these patients, 20 had total chordal-preserved MVR (group I), 36 had posterior leaflet-preserved MVR (group II), and 24 had MVR without chordal preservation (group III). Echocardiographic assessments were performed preoperatively and at four years postoperatively.RESULTS: Both, preoperatively and intraoperatively, there were no significant differences between the three groups. Mid-term echocardiography showed significant improvements in the left ventricular ejection fraction (LVEF) of the chordal preservation groups (group I, 55 +/- 12% to 60 +/- 7%, p = 0.017; group II, 56 +/-10% to 61 +/- 8%, p = 0.025), whereas the LVEF was significantly decreased after non-chordal-preserved MVR (group III, 56 +/- 7% to 49 +/- 11%, p = 0.036). Furthermore, the non-chordal preservation group demonstrated a significant increase in left ventricular volumes (end-diastolic volume, from 92 +/- 15 ml/m2 to 107 +/- 23 ml/m2, p = 0.005, end-systolic volume, from 43 +/- 7 ml/m2 to 58 +/- 20 ml/m2, p &lt; 0.001) and a spherical change in left ventricular geometry (sphericity index, from 1.6 +/- 0.2 to 1.3 +/- 0.2, p &lt; 0.001).CONCLUSION: Chordal preservation during MVR resulted in an improved ejection performance and the maintenance of left ventricular volume in mitral stenosis. However, these hemodynamic advantages were similar after total chordal preservation and posterior leaflet preservation.
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53  28702014-12-28
Authors: Tabata M, Kasegawa H, Suzuki T, Watanabe H, Fukui T, Takanashi S, Ono M.
Citation: J Heart Valve Dis. 2013 May;22(3):354-60.
Abstract: BACKGROUND AND AIM OF THE STUDY: The long-term outcomes of early surgery in patients with asymptomatic severe chronic mitral regurgitation (MR) and the impact of preoperative left ventricular dysfunction, atrial fibrillation (AF) and/or pulmonary hypertension (PH) on outcomes in this patient group, were evaluated.METHODS: Between 1992 and 2007, a total of 212 patients (mean age 50 +/- 15 years) with asymptomatic severe chronic degenerative MR underwent early mitral valve surgery within 12 months after echocardiographic diagnosis at the authors' institution. Mitral valve repair was attempted in all cases. The mean follow up period was 82 +/- 36 months. The patients were allocated to two groups; 111 with preoperative left ventricular dysfunction, AF and/or PH (group A), and 101 patients without those findings (group B). The outcomes were compared using univariate and multivariate analyses.RESULTS: Mitral valve repair was performed successfully in 211 patients (99.5%). The operative mortality was 0.5% (1/212). The 10-year actuarial survivals were 97.3% in all patients, 95.1% in group A, and 100% in group B. The 10-year cardiac adverse event-free rates (cardiac death, mitral valve reoperation or readmission with congestive heart failure) were 94.7% in all patients, 92.7% in group A, and 96.2% in group B. The seven-year freedom rates from recurrent MR were 93.1% in all patients, 90.0% in group A, and 97.0% in group B. In comparative analyses, group A had poorer late outcomes than group B, although the differences were not statistically significant. The multivariate analysis failed to show that preoperative left ventricular dysfunction, AF and/or PH were significantly associated with late cardiac adverse event (HR: 2.1, 95% CI: 0.4 to 10.8; p = 0.392).CONCLUSION: Early surgery for asymptomatic chronic MR demonstrated excellent early and late outcomes. The study results failed to confirm that preoperative left ventricular dysfunction, AF and/or PH were significantly associated with adverse outcomes of early mitral valve surgery in this patient group.
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54  28692014-12-28
Authors: Banovic M, Bosiljka VT, Voin B, Milan P, Ivana N, Dejana P, Danijela T, Serjan N.
Citation: Echocardiography. 2014 Apr;31(4):428-33. doi: 10.1111/echo.12404. Epub 2013 Oct 24.
Abstract: AIM: Patients with moderate and severe aortic stenosis (AS) and without obstructive epicardial coronary disease have been shown to have an impairment of coronary flow reserve (CFR). We investigated the prognostic significance of CFR in predicting death during mid-to-long-term follow-up in asymptomatic patients with moderate/severe AS, preserved ejection fraction (EF), and with nonobstructed coronary arteries.METHOD AND RESULT: A total of 127 patients with moderate or severe AS (effective orifice area of 1.5 cm(2) or less), mean age 66 ± 11 were enrolled in this prospective study. The median follow-up was 32 ± 7 months. All patients had standard Doppler echo study, coronary angiography, and adenosine-stress transthoracic Doppler echo for CFR measurement. Univariate analysis showed that diabetes mellitus, CFR, aortic valve area (AVA), maximal velocity (Vmax ), mean pressure gradient (Pmean ), energy loss index (ELI), aortic valve resistance (AVR), NT-proBNP, E/E', valvulo-arterial impedance (Zva ), and stroke work loss (SWL) were associated (P &lt; 0.05) with death. Multivariable logistic regression analysis revealed that only Zva and CFR were independent predictors of death, with the CFR being the single strongest predictor (Table 2). Using receiver operating characteristics (ROC) analysis, the CFR value of 1.85 had the highest accuracy in predicting the death during mid-to-long-term follow-up (area under the curve; AUC 0.890, P = 0.009, sensitivity 96.3%, specificity 75%; 95% CI 0.287-0.946; Fig. 1). The Zva value of 5.52 Hg/mL per m had a sensitivity 70.0% and specificity 72.0% (AUC 0.766, 95% CI 0.587-0.946; P = 0.005).CONCLUSION: This study demonstrates that CFR has a prognostic value in patients with asymptomatic moderate or severe AS with preserved EF and nonobstructed coronary arteries.© 2013, Wiley Periodicals, Inc.
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55  28682014-12-27
Authors: Barbanti M, Webb JG, Hahn RT, Feldman T, Boone RH, Smith CR, Kodali S, Zajarias A, Thompson CR, Green P, Babaliaros V, Makkar RR, Szeto WY, Douglas PS, McAndrew T, Hueter I, Miller DC, Leon MB; Placement of Aortic Transcatheter Valve Trial Investigators.
Citation: Circulation. 2013 Dec 24;128(25):2776-84. doi: 10.1161/CIRCULATIONAHA.113.003885. Epub 2013 Oct 23.
Abstract: BACKGROUND: The effect of preoperative mitral regurgitation (MR) on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is controversial. This study sought to examine the impact of moderate and severe MR on outcomes after TAVR and surgical aortic valve replacement (SAVR).METHODS AND RESULTS: Data were drawn from the randomized Placement of Aortic Transcatheter Valve (PARTNER) Trial cohort A patients with severe, symptomatic aortic stenosis undergoing either TAVR (n=331) or SAVR (n=299). Both TAVR and SAVR patients were dichotomized according to the degree of preoperative MR (moderate/severe versus none/mild). At baseline, moderate or severe MR was reported in 65 TAVR patients (19.6%) and 63 SAVR patients (21.2%). At 30 days, among survivors who had isolated SAVR/TAVR, moderate/severe MR had improved in 25 SAVR patients (69.4%) and 30 TAVR patients (57.7%), was unchanged in 10 SAVR patients (27.8%) and 19 TAVR patients (36.5%), and worsened in 1 SAVR patient (2.8%) and 4 TAVR patients (5.8%; all P=NS). Mortality at 2 years was higher in SAVR patients with moderate or severe MR than in those with mild or less MR (49.8% versus 28.1%; adjusted hazard ratio, 1.73; 95% confidence interval, 1.01-2.96; P=0.04). In contrast, MR severity at baseline did not affect mortality in TAVR patients (37.0% versus 32.7%, moderate/severe versus none/mild; hazard ratio, 1.14; 95% confidence interval, 0.72-1.78; P=0.58; P for interaction=0.05).CONCLUSIONS: Both TAVR and SAVR were associated with a significant early improvement in MR in survivors. However, moderate or severe MR at baseline was associated with increased 2-year mortality after SAVR but not after TAVR. TAVR may be a reasonable option in selected patients with combined aortic and mitral valve disease.CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
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56  28672014-12-27
Authors: Mokhles MM, Charitos EI, Stierle U, Rajeswaran J, Blackstone EH, Bogers AJ, Takkenberg JJ, Sievers HH.
Citation: Heart. 2013 Dec;99(24):1857-66. doi: 10.1136/heartjnl-2013-304425. Epub 2013 Oct 23.
Abstract: OBJECTIVE: To assess allograft function over time after the Ross procedure.DESIGN: Prospective multicentre registry.SETTING: 10 cardiac surgery departments in Germany and the Netherlands.PATIENTS: Among 1775 consecutive adult patients (mean age 43.7±12.0) who underwent the Ross procedure, 1645 (93%) received an allograft (pulmonary=1612, aortic=12, unknown=21), 120 (6%) a bioprosthesis, and 5 (0.3%) a bovine jugular vein for right ventricular outflow tract reconstruction.INTERVENTION: Ross procedure.MAIN OUTCOME MEASURES: Using non-linear longitudinal models, serial echocardiographic records (N=6950) were studied to assess pulmonary conduit function over time in patients who had undergone the Ross procedure, with a maximum echocardiographic follow-up of 22.4 years (5.5±4.3 years).RESULTS: A slight increase in pulmonary conduit regurgitation grade was observed during follow-up. Freedom from regurgitation grade ≥2+ was 95% after 14 years. Female patient gender, allograft use (compared to bioprosthesis), male donor gender, antibiotic treatment of the allograft, and specific surgical adjustments were associated with a significantly higher regurgitation grade. Mean conduit gradient increased from 4.7 mm Hg at 1 month to 10 mm Hg by 14 years, while peak gradient increased from 8.4 to 18.5 mm Hg. Smaller conduit diameter, male patient gender, younger patient age, younger donor age, and use of a bioprosthesis were associated with a significantly higher mean and peak gradient. During follow-up, 76 reinterventions were required on the pulmonary conduit in 67 patients. Freedom from pulmonary conduit reintervention or dysfunction was 90.6% (95% CI 87.7% to 93.6%) and 79.5% (95% CI 75.2% to 84.0%) at 15 years, respectively.CONCLUSIONS: Echocardiographic follow-up of pulmonary conduits shows good conduit durability. Clinically important conduit regurgitation and stenosis are rare in adult patients after the Ross operation.
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57  28662014-12-27
Authors: Celik M, Yuksel UC, Yalcinkaya E, Gokoglan Y, Barcin C.
Citation: Herz. 2013 Oct 25. [Epub ahead of print]
Abstract: No abstract available.
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58  28652014-12-27
Authors: Stanton T, Jenkins C, Haluska BA, Marwick TH.
Citation: J Am Soc Echocardiogr. 2014 Jan;27(1):65-73. doi: 10.1016/j.echo.2013.09.012. Epub 2013 Oct 23.
Abstract: BACKGROUND: Left ventricular (LV) ejection fraction (EF) measured by two-dimensional echocardiographic (2DE) imaging is an important correlate of survival. Real-time three-dimensional echocardiographic (3DE) imaging has addressed some of the limitations of 2DE imaging. The aim of this study was to determine whether 3DE imaging is more predictive of outcomes than 2DE imaging.METHODS: A total of 529 patients undergoing LV assessment with 2DE and 3DE imaging in 2003 and 2004 at a&nbsp;tertiary referral cardiac center were studied. Patients had a high frequency of cardiovascular risk factors. Images were gathered over four cardiac cycles using a matrix-array transducer, with measurements performed offline. Follow-up (all-cause mortality or cardiac hospitalization) was obtained over 6.6 ± 3.4 years in 455 of 486 patients with images suitable for measurement (94%).RESULTS: There were 194 events (43%), including 75 deaths (16.4%). Larger LV volumes and lower EF were associated with worse outcomes independent of age, heart failure, or end-stage renal disease. In stepwise Cox regression analyses, the associations of cardiac hospitalization and survival with clinical variables (age,&nbsp;chronic kidney disease, and heart failure) were augmented by 3DE EF and end-systolic volume more than by 2DE parameters. The incremental model χ(2) value with 3DE EF was 14.67 (P &lt; .001), compared with 9.72 (P&nbsp;= .002) for 2DE EF. Similarly, in Cox regression analyses of mortality, the effects of clinical variables (age, advanced renal disease, and heart failure) were augmented more by 3DE EF (incremental χ(2)&nbsp;= 14.04, P &lt; .0001) than 2DE EF (incremental χ(2)&nbsp;= 5.13, P&nbsp;= .024).CONCLUSIONS: In this outcome study, 3DE EF and volumes showed stronger associations with outcomes than&nbsp;those derived from 2DE imaging.Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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59  28642014-12-27
Authors: Sinning JM, Hammerstingl C, Chin D, Ghanem A, Schueler R, Sedaghat A, Bence J, Spyt T, Werner N, Kovac J, Grube E, Nickenig G, Vasa-Nicotera M.
Citation: EuroIntervention. 2014 Jan 22;9(9):1042-9. doi: 10.4244/EIJV9I9A177.
Abstract: AIMS: Transcatheter aortic valve replacement (TAVR) is established as a treatment strategy for patients with end-stage aortic stenosis, many of whom are suffering from severe pulmonary hypertension (PH). In cardiac surgery patients, PH is associated with less symptomatic improvement and increased late mortality. This study elucidates the impact of PH on outcome after TAVR.METHODS AND RESULTS: Pre and 90 days post-TAVR, pulmonary artery systolic pressure (PASP) was determined non-invasively by echocardiography in 353 patients undergoing TAVR. PH was classified as absent (&lt;30 mmHg), mild-to-moderate (30-60 mmHg), and severe (&gt;60 mmHg). Three hundred and fifty-three patients at high surgical risk, indicated by a logistic EuroSCORE of 26.6±16.5%, underwent TAVR. The severity of PH before TAVR was related to outcome with two-year mortality rates of 13.9%, 27.3%, and 48.4% for PASP &lt;30 mmHg, 30-60 mmHg, and &gt;60 mmHg, respectively (p=0.001). In patients with baseline PASP &gt;60 mmHg, PASP decreased from 65.6±7.6 mmHg to 49.5±14.0 mmHg (p&lt;0.001) at 90 days after TAVR. Patients with persistent severe PH had a worse prognosis than patients with a decrease of PASP below 60 mmHg (two-year mortality rate: 50.0% vs. 18.6%; p=0.001).CONCLUSIONS: Severe pulmonary hypertension predicts adverse outcome after TAVR. Reduction of PASP after the procedure is associated with favourable prognosis.
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60  28632014-12-27
Authors: Meredith IT, Worthley SG, Whitbourn RJ, Antonis P, Montarello JK, Newcomb AE, Lockwood S, Haratani N, Allocco DJ, Dawkins KD.
Citation: EuroIntervention. 2014 Mar 20;9(11):1264-70. doi: 10.4244/EIJV9I11A216.
Abstract: AIMS: To assess outcomes with a new fully repositionable and retrievable valve for transcatheter aortic valve replacement (TAVR).METHODS AND RESULTS: The Lotus Aortic Valve System is designed to facilitate precise positioning and minimise paravalvular regurgitation. REPRISE I enrolled symptomatic, high-surgical-risk patients with severe aortic stenosis. The primary endpoint (clinical procedural success) included successful implantation without major adverse cardiovascular or cerebrovascular events (MACCE). In all patients (N=11) the first Lotus Valve was successfully deployed. Partial resheathing to facilitate accurate placement was attempted and successfully performed in four patients; none required full retrieval. The primary endpoint was achieved in 9/11 with no in-hospital MACCE in 10/11. There was one major stroke; in another patient, discharge mean aortic gradient was 22 mmHg (above the primary endpoint threshold of 20 mmHg), but improved to 15 mmHg at 30 days. The cohort's mean aortic gradient decreased from 53.9±20.9 mmHg at baseline to 15.4±4.6 mmHg (p&lt;0.001) at one year; valve area increased from 0.7±0.2 cm2 to 1.5±0.2 cm2 (p&lt;0.001). Discharge paravalvular aortic regurgitation, adjudicated by an independent core laboratory, was mild (n=2), trivial (n=1), or absent (n=8). Four patients required a permanent pacemaker post-procedure. There were no deaths, myocardial infarctions or new strokes through one year.CONCLUSIONS: Initial results support proof-of-concept with the Lotus Valve for TAVR.
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61  28622014-12-27
Authors: Buccheri S, Monte I, Mangiafico S, Bottari V, Leggio S, Tamburino C.
Citation: Biomed Res Int. 2013;2013:297895. doi: 10.1155/2013/297895. Epub 2013 Sep 22.
Abstract: BACKGROUND: Left ventricular (LV) longitudinal deformation can be assessed with new echocardiographic techniques like triplane echocardiography (3PE) and four-dimensional echocardiography (4DE). We aimed to assess the feasibility, reproducibility, and agreement between these different speckle-tracking techniques for the assessment of longitudinal deformation.METHODS: 101 consecutive subjects underwent echocardiographic examination. 2D cine loops from the apical views, a triplane view, and an LV 4D full volume were acquired in all subjects. LV longitudinal strain was obtained for each imaging modality.RESULTS: 2DE analysis of LV strain was feasible in 90/101 subjects, 3PE strain in 89/101, and 4DE strain in 90/101. The mean value of 2DE and 3PE longitudinal strains was significantly higher with respect to 4DE. The relationship between 2DE and 3PE derived strains (r = 0.782) was significantly higher (z = 3.72, P &lt; 0.001) than that between 2DE and 4DE (r = 0.429) and that between 3PE and 4DE (r = 0.510; z = 3.09, P = 0.001). The mean bias between 2DE and 4DE strains was -6.61 ± 7.31% while -6.42 ± 6.81% between 3PE and 4DE strains; the bias between 2DE and 3PE strain was of 0.21 ± 4.16%. Intraobserver and interobserver variabilities were acceptable among the techniques.CONCLUSIONS: Echocardiographic techniques for the assessment of longitudinal deformation are not interchangeable, and further studies are needed to assess specific reference values.
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62  28612014-12-27
Authors: Barasch E, Petillo F, Pollack S, Rhee PD, Stovold W, Reichek N.
Citation: Circ J. 2014;78(1):232-9. Epub 2013 Oct 30.
Abstract: BACKGROUND: Many symptomatic patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) are denied surgery and have a grim prognosis with medical management.METHODS AND RESULTS: Between 2003 and 2012, among 550 patients with severe isolated AS and preserved LVEF on transthoracic echocardiography, 241 did not undergo aortic valve replacement (mean age, 83.2±7.6 years; 54% female; aortic valve area index, 0.40±0.13cm(2)/m(2); mean LVEF, 64.8±7.6%) and 67% presented with cardiac symptoms. At a mean follow-up of 25.5±25.1 months, 134 patients (56%) had died. Survival at 1, 5 and 9.5 years was 71%, 28% at 12%, respectively. Median survival was 36.3 months (95% confidence interval [CI]: 27.2-42.4 months). In unadjusted analyses, age, heart failure, hypertension, renal insufficiency, left atrial size, pulmonary artery systolic pressure (PASP), relative wall thickness and LV mass/LV end diastolic volume ratio were associated with mortality. On multivariate analysis adjusted for all significant univariate predictors, age ≥78 years, history of hypertension, left atrial diameter ≥40mm and PASP ≥42mmHg gave a joint area under the curve of 0.80 (95% CI: 0.73-0.86) for mortality.CONCLUSIONS: In medically treated patients with severe isolated AS and preserved LVEF, older age, history of hypertension, and echo-Doppler variables reflecting LV diastolic dysfunction are independent predictors of death.
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63  28602014-12-27
Authors: Dahl JS, Christensen NL, Videbæk L, Poulsen MK, Carter-Storch R, Hey TM, Pellikka PA, Steffensen FH, Møller JE.
Citation: Circ Cardiovasc Imaging. 2014 Jan;7(1):142-8. doi: 10.1161/CIRCIMAGING.113.000636. Epub 2013 Oct 30.
Abstract: BACKGROUND: In aortic valve stenosis (AS), the occurrence of heart failure symptoms does not always correlate with severity of valve stenosis and left ventricular (LV) function. Therefore, we tested the hypothesis that symptomatic patients with AS have impaired diastolic, longitudinal systolic function, and left atrial dilatation compared with asymptomatic patients.METHODS AND RESULTS: In a retrospective descriptive study, we compared clinical characteristics and echocardiographic parameters in 99 symptomatic and 139 asymptomatic patients with severe AS and LV ejection fraction ≥50%. Independent predictors of symptomatic state were identified using logistic regression analysis. Symptomatic patients were younger (72±10 versus 76±12 years of age; P=0.002), presented less often with atrial fibrillation (13% versus 24%; P=0.05) and chronic obstructive pulmonary disease (2% versus 19%; P&lt;0.001), and had a lower prevalence of hypertension (73% versus 40%; P&lt;0.001). Despite similar AS severity, symptomatic patients had higher LV mass index (120±39 versus 95±25 g/m2; P&lt;0.0001), increased relative wall thickness (0.61±0.15 versus 0.50±0.11; P&lt;0.0001), shorter mitral deceleration time (199±58 versus 268±62 ms; P&lt;0.0001), and increased left atrial volume index (49±18 versus 42±15 mL/m2; P=0.02). When adjusting for age, history of hypertension, atrial fibrillation, and chronic obstructive pulmonary disease in a multivariable logistic regression analysis, LV mass index, relative wall thickness, left atrial volume index, and deceleration time were still associated with the presence of symptoms.CONCLUSIONS: The present study demonstrates that symptomatic status in severe AS is associated with impaired diastolic function, LV hypertrophy, concentric remodeling, and left atrial dilatation when corrected for indices of AS severity.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00294775.
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64  28592014-12-27
Authors: Islam AK, Sayami LA, Zaman S.
Citation: J Saudi Heart Assoc. 2013 Jul;25(3):225-9. doi: 10.1016/j.jsha.2012.12.002. Epub 2013 Jan 8.
Abstract: The Chiari network is mobile, net-like structures occasionally seen in right atrium near the opening of inferior vena cava and coronary sinus. This is usually of no clinical significance and is often diagnosed incidentally. However, sometimes it may cause diagnostic confusion with right atrial pathologies, and may favour thromboembolism by causing flow obstruction. It may be associated with infective endocarditis, arrhythmias, and migraine. Sometimes, it acts as a physical barrier during invasive procedures. The Chiari network has also been described to protect from pulmonary embolism by acting as an inferior vena cava filter due to its sieve-like effect at the cavo-atrial junction. Here, the Chiari network has been described in a case of Ebstein anomaly of tricuspid valve which produced diagnostic confusion during echocardiography. A brief overview has also been presented.
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65  28582014-12-27
Authors: Shin SH, Park SD, Woo SI, Kim DH, Park KS, Kwan J.
Citation: Korean Circ J. 2013 Sep;43(9):615-21. doi: 10.4070/kcj.2013.43.9.615. Epub 2013 Sep 30.
Abstract: BACKGROUND AND OBJECTIVES: We evaluated the utility of two-dimensional (2D) and three-dimensional (3D) left ventricular (LV) global myocardial deformity parameters for assessing LV diastolic function by comparing invasive measures of LV performance.SUBJECTS AND METHODS: Echocardiography and LV pressure were assessed in 39 patients. Myocardial LV longitudinal, circumferential, and radial deformations, as well as area strain, were evaluated utilizing 2D and 3D speckle tracking software. The 2D early diastolic strain rate (2D-SRe) was measured from the 3 apical and 3 short axis views. The 3D diastolic index (3D-DI) was calculated by the % change of global strain during the first one-third of the diastolic period. LV end diastolic pressure (LVEDP) and the rate of LV pressure change (dP/dt) were collected using a pressure-conducted catheter and tau was calculated.RESULTS: dP/dtmin were related to early mitral annular velocity (e'), 2D-SRelong, 2D-SReradial, as well as 3D-DIlong, and 3D-DIas. Additionally, LVEDP was associated with the ratio of mitral early diastolic velocity (E) to 2D-SRelong, 2D-SRecirc, 2D-SReradial, 3D-DIlong, 3D-DIcirc, and 3D-DIas. E/2D-SRelong, E/2D-SReradial, E/3D-DIlong, and E/3D-DIas were comparable with E/e' in predicting patients with elevated LVEDP. Among those patients with E/e' of 8 to 15, E/3D-DIlong provided incremental value in identifying those with LVEDP ≥15 mm Hg.CONCLUSION: 2D-SRelong, 2D-SReradial, 3D-DIlong, and 3D-DIas were related to LV relaxation, and the ratios of E to those parameters were associated with LVEDP. In addition, among patients with indeterminate E/e', E/3D-DIlong offered incremental value in predicting elevated LVEDP, suggesting it may provide supplementary information in the evaluation of LV diastolic function.
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66  28572014-12-27
Authors: Guenzinger R, Schneider EP, Guenther T, Wolf P, Mazzitelli D, Lange R, Voss B.
Citation: J Thorac Cardiovasc Surg. 2014 Jul;148(1):176-82. doi: 10.1016/j.jtcvs.2013.08.071. Epub 2013 Oct 28.
Abstract: OBJECTIVES: Undersized ring annuloplasty is the treatment of choice for functional mitral regurgitation. However, recurrence of mitral regurgitation within the first years is frequent. The aim of this study was to analyze the functional and clinical outcome after mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm (Edwards Lifesciences LLC, Irvine, Calif) annuloplasty ring in patients with ischemic mitral regurgitation.METHODS: Between November 2006 and November 2012, 70 patients (mean age, 68 ± 10 years; mean left ventricular ejection fraction, 40% ± 15%) with functional mitral regurgitation due to ischemic cardiomyopathy underwent mitral valve repair with the Edwards GeoForm annuloplasty ring. Concomitant procedures, such&nbsp;as&nbsp;coronary artery bypass grafting (75.7%), tricuspid valve repair (25.7%), aortic valve replacement (8.6%), and the Maze procedure (4.3%), were performed in 92.9% of patients. Follow-up is 97% complete (mean, 3.0 ± 1.7 years). Transthoracic echocardiography was obtained 2.4 ± 1.7 years postoperatively.RESULTS: Thirty-day mortality was 5.9%. Overall survival at 5 years was 71.3% ± 6.9%. At 4 years, overall freedom from recurrence of mitral regurgitation grade 3+ or greater was 92.5% ± 3.6%, and freedom from recurrence of mitral regurgitation grade 2+ or greater was 71.0% ± 8.7%. Three patients required a mitral valve-related reoperation for ring dehiscence. New York Heart Association functional class improved from 3.6 ± 0.6 to 1.6 ± 0.6 during follow-up (P&nbsp;&lt;&nbsp;.05). Mean mitral valve pressure gradient was 3.3 ± 1.8 mm Hg across all ring sizes at the time of follow-up.CONCLUSIONS: Mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm annuloplasty ring in case of ischemic mitral regurgitation shows a low rate of recurrent regurgitation at 4 years. Clinically relevant mitral stenosis was not detected. The importance of secure anchoring of the device in the mitral annulus has to be emphasized to prevent ring dehiscence.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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67  28562014-12-27
Authors: Møller-Sørensen H, Graeser K, Hansen KL, Zemtsovski M, Sander EM, Nilsson JC.
Citation: Acta Anaesthesiol Scand. 2014 Jan;58(1):80-8. doi: 10.1111/aas.12227. Epub 2013 Nov 5.
Abstract: BACKGROUND: Echocardiography is increasingly becoming an integrated tool for circulatory evaluation in the intensive care unit and the operating room. Therefore, it is imperative to know the reproducibility of measurements obtained by echocardiography. In this study, a comparison of cardiac output (CO) measurements obtained with transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) thermodilution (TD) was carried out to test the precision, accuracy and trending ability of CO measurements obtained with TEE.METHODS: Twenty-five patients completed the study. Each patient was placed in the following successive positions: supine, head-down tilt, head-up tilt, supine, supine with phenylephrine administration, pace heart rate 80 beats per minute (bpm), pace heart rate 110 bpm. TEE CO and PAC CO were measured simultaneously. The agreement was analysed by Bland-Altman plots, and to assess trending ability, a polar plot was constructed.RESULTS: Both methods showed an acceptable precision 8% (PAC TD) and 16% (TEE). In comparison with PAC TD, the TEE was associated with a bias of -0.22 l/minute [95% confidence interval: -0.54; 0.10], wide limits of agreement (-1.73 l/minute; 1.29 l/minute), a percentage error of 38.6% and a trending ability with a radial degree of 53.6°, corresponding to a poor trending ability.CONCLUSION: In comparison, CO measurements obtained with TEE and PAC TD had wide limits of agreement, a larger percentage error than would be expected from the precision of the two methods, and a poor trending ability. Thus, TEE is not interchangeable with PAC TD for measuring CO.© 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley &amp; Sons Ltd.
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68  28552014-12-25
Authors: Kraigher-Krainer E, Shah AM, Gupta DK, Santos A, Claggett B, Pieske B, Zile MR, Voors AA, Lefkowitz MP, Packer M, McMurray JJ, Solomon SD; PARAMOUNT Investigators.
Citation: J Am Coll Cardiol. 2014 Feb 11;63(5):447-56. doi: 10.1016/j.jacc.2013.09.052. Epub 2013 Oct 30.
Abstract: OBJECTIVES: This study sought to determine the frequency and magnitude of impaired systolic deformation in heart failure with preserved ejection fraction (HFpEF).BACKGROUND: Although diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF, the prevalence of concomitant systolic dysfunction has not been clearly defined.METHODS: We assessed myocardial systolic and diastolic function in 219 HFpEF patients from a contemporary HFpEF clinical trial. Myocardial deformation was assessed using a vendor-independent 2-dimensional speckle-tracking software. The frequency and severity of impaired deformation was assessed in HFpEF, and compared to 50 normal controls free of cardiovascular disease and to 44 age- and sex-matched hypertensive patients with diastolic dysfunction (hypertensive heart disease) but no HF. Among HFpEF patients, clinical, echocardiographic, and biomarker correlates of left ventricular strain were determined.RESULTS: The HFpEF patients had preserved left ventricular ejection fraction and evidence of diastolic dysfunction. Compared to both normal controls and hypertensive heart disease patients, the HFpEF patients demonstrated significantly lower longitudinal strain (LS) (-20.0 ± 2.1 and&nbsp;-17.07 ± 2.04 vs.&nbsp;-14.6 ± 3.3, respectively, p&nbsp;&lt; 0.0001 for both) and circumferential strain (CS) (-27.1 ± 3.1 and&nbsp;-30.1 ± 3.5&nbsp;vs.&nbsp;-22.9&nbsp;± 5.9, respectively; p&nbsp;&lt; 0.0001 for both). In HFpEF, both LS and CS were related to LVEF (LS, R&nbsp;=&nbsp;-0.46; p&nbsp;&lt;&nbsp;0.0001; CS, R&nbsp;=&nbsp;-0.51; p&nbsp;&lt; 0.0001) but not to standard echocardiographic measures of diastolic function (E' or E/E'). Lower LS was modestly associated with higher NT-proBNP, even after adjustment for 10 baseline covariates including LVEF, measures of diastolic function, and LV filling pressure (multivariable adjusted p&nbsp;= 0.001).CONCLUSIONS: Strain imaging detects impaired systolic function despite preserved global LVEF in HFpEF that may contribute to the pathophysiology of the HFpEF syndrome. (LCZ696 Compared to Valsartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction; NCT00887588).Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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69  28522014-12-14
Authors: Hoffmann R, Kaestner W, Altiok E.
Citation: J Invasive Cardiol. 2013 Nov;25(11):E210-1.
Abstract: Although closure of paravalvular leaks with Amplatzer occluders has been described in patients with increased perioperative risk, beneficial outcomes have not been consistently reported. Recent reports have described real-time three-dimensional transesophageal echocardiography (3D TEE) for facilitated guidance of the closure procedure. However, they did not focus on the critical issue of defect sizing. We report a case in which 3D TEE with off-line analysis of images to generate en face views of the mitral valve dehiscence allowed a simplified interrogation and definition of defect dimensions. 3D TEE was used for selection of the device size. The improved sizing was an important means to prevent device embolization as well as secure complete defect closure. Surprises with regard to the device size or the ability to anchor the device in a stable position were reduced.
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70  28512014-12-14
Authors: Ramzy D, Trento A, Cheng W, De Robertis MA, Mirocha J, Ruzza A, Kass RM.
Citation: J Thorac Cardiovasc Surg. 2014 Jan;147(1):228-35. doi: 10.1016/j.jtcvs.2013.09.035. Epub 2013 Nov 4.
Abstract: OBJECTIVE: The study objective was to review our first 300 consecutive robotic-assisted mitral repairs performed from June 2005 to October 2012 and to compare the surgical outcomes of our previously reported initial 120 cases with the subsequent 180 procedures.METHODS: Our initial 120 robotic-assisted mitral repairs were previously reported, and we now compare our early experience with the recent 180 consecutive procedures for a total of 300 robotic-assisted mitral repairs. There was no patient selection. Every patient in need of isolated mitral valve repair underwent this procedure. All patients received an annuloplasty band and 1 or more of the following: leaflet resection, secondary chordal transposition, or polytetrafluoroethylene neochordal replacement and edge-to-edge repair.RESULTS: All 300 patients had preoperative echocardiographic findings of severe mitral regurgitation. There were no differences (P&nbsp;=&nbsp;not significant) between the initial and the recent cohorts for preoperative characteristics, including age (58.4 ± 10.5 years vs 59.9 years), female gender (35.8% vs 36.1%), ejection fraction (61.9% vs 60.6%), congestive heart failure (35.0% vs 36.7%), creatinine (0.94 mg/dL vs 0.98 mg/dL), and New York Heart Association class. The incidence of anterior and posterior leaflet prolapse was similar in both groups, whereas Barlow syndrome was higher in group 2 (5.8% vs 27.8%). There was 1 (0.33%) hospital mortality and no deaths in the last 180 cases. Overall, 8 patients (2.7%) required subsequent mitral valve replacement via a median sternotomy, 6 (5.0%) in the first group and 2 (1.1%) in the second group (P&nbsp;=&nbsp;.06). One patient in each group had mitral valve re-repair through a right mini-thoracotomy, and 1 patient in the first group required a mitral valve replacement via a mini-thoracotomy during the original procedure. Two of the 180 patients had documented cerebrovascular accident, but both fully recovered clinically. There was no cerebrovascular accident in the last 120 patients. Crossclamp times decreased from 116 minutes to 91 minutes in the second group despite starting a training program with a junior associate performing part of the procedure at the console in the last 100 cases. Post-pump echocardiograms showed no/trace mitral regurgitation in 86.1% of the last 180 patients and mild mitral regurgitation in 11.1%. Follow-up echocardiography for the last 180 patients from 1 month to more than 1 year showed no/trace mitral regurgitation in 64.6% of patients and mild mitral regurgitation in 23.1% of patients. Seven patients (10.8%) had moderate mitral regurgitation, and 1 patient (1.5%) had severe mitral regurgitation.CONCLUSIONS: The majority of complications and reoperations occurred early in our experience, especially using the first-generation da Vinci robot (Intuitive Surgical Inc, Sunnyvale, Calif). The newer da Vinci Si HD system with the addition of an adjustable left atrial roof retractor together with increased experience has made robotic-assisted mitral repair of all types of degenerative mitral valve pathology reproducible. The training of young surgeons in a stepwise fashion in high-volume centers will help to avoid the complications encountered during the introduction of this technology.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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71  28502014-12-14
Authors: Fino C, Iacovoni A, Ferrero P, Senni M, Merlo M, Cugola D, Ferrazzi P, Caputo M, Miceli A, Magne J.
Citation: J Thorac Cardiovasc Surg. 2014 Aug;148(2):447-53.e2. doi: 10.1016/j.jtcvs.2013.05.053. Epub 2013 Nov 4.
Abstract: OBJECTIVE: Mitral valve annuloplasty and mitral valve replacement are common strategies for the management of functional ischemic mitral regurgitation with ischemic cardiomyopathy. However, mitral valve annuloplasty may create some degree of functional mitral stenosis. The purpose of this study was to compare the mitral valve hemodynamics in patients with functional ischemic mitral regurgitation undergoing mitral valve annuloplasty or mitral valve replacement, using exercise echocardiography.METHODS: We performed resting and exercise echocardiography in 70 patients matched for indexed effective orifice area, systolic pulmonary arterial pressure, and left ventricular ejection fraction after mitral valve annuloplasty or mitral valve replacement with coronary artery bypass grafting.RESULTS: There was no significant difference between the 2 groups regarding baseline demographic and clinical data. Exercise systolic pulmonary arterial pressure was higher in the mitral valve annuloplasty group compared with the mitral valve replacement group (from 36.3 ± 8.1 mm Hg to 55 ± 12 mm Hg, vs mitral valve replacement: 33 ± 6 mm Hg to 42 ± 6.2 mm Hg, P&nbsp;=&nbsp;.0001). Exercise-induced improvement in effective orifice area and indexed effective orifice area was better in the mitral valve replacement group (mitral valve replacement: +0.23 ± 0.04 vs mitral valve annuloplasty: -0.1 ± 0.09 cm², P&nbsp;=&nbsp;.001, for effective orifice area; mitral valve replacement: +0.14 ± 0.03 vs mitral valve annuloplasty: -0.04 ± 0.07 cm²/m², P&nbsp;=&nbsp;.03, for indexed effective orifice area). Exercise indexed effective orifice area was correlated with exercise systolic pulmonary arterial pressure (r&nbsp;=&nbsp;-0.45; P&nbsp;=&nbsp;.01). In a multivariable analysis mitral valve annuloplasty, postoperative indexed effective orifice area and resting mitral peak gradients were independent predictors of elevated systolic pulmonary arterial pressure during exercise.CONCLUSIONS: In patients with functional ischemic mitral regurgitation, mitral valve annuloplasty may cause functional mitral stenosis, especially during exercise. Mitral valve annuloplasty was associated with poor exercise mitral hemodynamic performance, lack of mitral valve opening reserve, and markedly elevated postoperative exercise systolic pulmonary arterial pressure compared with mitral valve replacement.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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72  28492014-12-14
Authors: Jiang L, Shakil O, Montealegre-Gallegos M, Jainandunsing JS, Matyal R, Wang A, Bardia A, Mahmood F.
Citation: J Cardiothorac Vasc Anesth. 2013 Nov 4. pii: S1053-0770(13)00316-9. doi: 10.1053/j.jvca.2013.05.041. [Epub ahead of print]
Abstract: No abstract available.
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73  28482014-12-14
Authors: Tan CO, Harley I.
Citation: J Cardiothorac Vasc Anesth. 2014 Aug;28(4):1112-33. doi: 10.1053/j.jvca.2013.05.031. Epub 2013 Nov 5.
Abstract: No abstract available.
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74  28472014-12-14
Authors: Mehrotra R, Alagesan R, Srivastava S.
Citation: Indian Heart J. 2013 Sep-Oct;65(5):620-8. doi: 10.1016/j.ihj.2013.08.027. Epub 2013 Sep 23.
Abstract: Assessment of left ventricular systolic function is the commonest and one of the most important indications for performance of echocardiography. It is important for prognostication, determination of treatment plan, for decisions related to expensive device therapies and for assessing response to treatment. The current methods based on two-dimensional echocardiography are not reliable, have high degree of inter-observer and intra-observer variability and are based on presumptions about the geometry of left ventricle (LV). Real-time three-dimensional echocardiography (RT3DE) on the other hand is fast, easy, accurate, relatively operator independent and is not based on any assumptions related to the shape of LV. Owing to these advantages, it is the Echocardiographic modality of choice for assessment of systolic function of the LV. We describe here a step by step approach to evaluation of LV volumes, ejection fraction, regional systolic function and Dyssynchrony analysis based on RT3DE. It has been well validated in clinical studies and is rapidly being incorporated in routine clinical practice. Copyright © 2013. Published by Elsevier B.V.
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75  28462014-11-18
Authors: Velagaleti RS, Gona P, Pencina MJ, Aragam J, Wang TJ, Levy D, D'Agostino RB, Lee DS, Kannel WB, Benjamin EJ, Vasan RS.
Citation: Am J Cardiol. 2014 Jan 1;113(1):117-22. doi: 10.1016/j.amjcard.2013.09.028. Epub 2013 Oct 4.
Abstract: Higher left ventricular (LV) mass, wall thickness, and internal dimension are associated with increased heart failure (HF) risk. Whether different LV hypertrophy patterns vary with respect to rates and types of HF incidence is unclear. In this study, 4,768 Framingham Heart Study participants (mean age 50 years, 56% women) were classified into 4 mutually exclusive LV hypertrophy pattern groups (normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy) using American Society of Echocardiography-recommended thresholds of echocardiographic LV mass indexed to body surface area and relative wall thickness, and these groups were related to HF incidence. Whether risk for HF types (HF with reduced ejection fraction [&lt;45%] vs preserved ejection fraction [≥45%]) varied by hypertrophy pattern was then evaluated. On follow-up (mean 21 years), 458 participants (9.6%, 250 women) developed new-onset HF. The age- and gender-adjusted 20-year HF incidence increased from 6.96% in the normal left ventricle group to 8.67%, 13.38%, and 15.27% in the concentric remodeling, concentric hypertrophy, and eccentric hypertrophy groups, respectively. After adjustment for co-morbidities and incident myocardial infarction, LV hypertrophy patterns were associated with higher HF incidence relative to the normal left ventricle group (p = 0.0002); eccentric hypertrophy carried the greatest risk (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.41 to 2.54), followed by concentric hypertrophy (HR 1.40, 95% CI 1.04 to 1.87). Participants with eccentric hypertrophy had a higher propensity for HF with reduced ejection fraction (HR 2.23, 95% CI 1.48 to 3.37), whereas those with concentric hypertrophy were more prone to HF with preserved ejection fraction (HR 1.66, 95% CI 1.09 to 2.51). In conclusion, in this large community-based sample, HF risk varied by LV hypertrophy pattern, with eccentric and concentric hypertrophy predisposing to HF with reduced and preserved ejection fraction, respectively.Copyright © 2014 Elsevier Inc. All rights reserved.
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76  28452014-11-18
Authors: Biner S, Birati EY, Topilsky Y, Steinvil A, Ben Assa E, Sadeh B, Arbel Y, Halkin A, Abramowitz Y, Leshem-Rubinow E, Banai S, Keren G, Finkelstein A.
Citation: Am J Cardiol. 2014 Jan 15;113(2):348-54. doi: 10.1016/j.amjcard.2013.08.048. Epub 2013 Oct 3.
Abstract: We aimed to evaluate the clinical and hemodynamic impact of transcatheter aortic valve implantation in patients with typical low-gradient severe aortic stenosis (LGSAS) and at high operative risk for surgical valve replacement. Prospectively collected clinical and echo Doppler data were retrospectively analyzed in 112 and 86 patients, respectively. Follow-up period was 31 months (21 to 38). Thirty-eight patients died; combined long-term cardiovascular events were identified in 68 patients. The 30-day mortality rate was 2.4% in patients with typical severe aortic stenosis (AS) and 3.3% in patients with LGSAS (p = 1.0). Two-year survival rate was 77 ± 5% for the former (n = 82) and 68 ± 8% for the latter (n = 30; hazard ratio 1.4, 95% confidence interval 0.7 to 2.7 for LGSAS; p = 0.3). Two-year cardiovascular event-free survival rates were 56.5 ± 5.0% and 48.4 ± 9.0%, respectively, (hazard ratio 1.4, 95% confidence interval 0.78 to 2.3 for LGSAS; p = 0.25). Patients with typical severe AS (n = 64) and those with LGSAS (n = 23) demonstrated similar increases in left ventricular ejection fraction and stroke volume (7 ± 10% vs 6 ± 6% and p = 0.67; 12 ± 22% vs 12 ± 16%, p = 0.88, respectively) and reduction in systolic pulmonary artery pressure (5 ± 14 vs 5 ± 9 mm Hg, respectively, p = 0.83). In conclusion, transcatheter aortic valve implantation appears to result in similar hemodynamic and long-term clinical outcomes for high-risk surgical patients with LGSAS as those with typical severe AS.Copyright © 2014 Elsevier Inc. All rights reserved.
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77  28442014-11-18
Authors: Wessler BS, Thaler DE, Ruthazer R, Weimar C, Di Tullio MR, Elkind MS, Homma S, Lutz JS, Mas JL, Mattle HP, Meier B, Nedeltchev K, Papetti F, Di Angelantonio E, Reisman M, Serena J, Kent DM.
Citation: Circ Cardiovasc Imaging. 2014 Jan;7(1):125-31. doi: 10.1161/CIRCIMAGING.113.000807. Epub 2013 Nov 8.
Abstract: BACKGROUND: Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), although the pathogenicity of a discovered PFO in the setting of CS is typically unclear. Transesophageal echocardiography features such as PFO size, associated hypermobile septum, and presence of a right-to-left shunt at rest have all been proposed as markers of risk. The association of these transesophageal echocardiography features with other markers of pathogenicity has not been examined.METHODS AND RESULTS: We used a recently derived score based on clinical and neuroimaging features to stratify patients with PFO and CS by the probability that their stroke is PFO-attributable. We examined whether high-risk transesophageal echocardiography features are seen more frequently in patients more likely to have had a PFO-attributable stroke (n=637) compared with those less likely to have a PFO-attributable stroke (n=657). Large physiologic shunt size was not more frequently seen among those with probable PFO-attributable strokes (odds ratio [OR], 0.92; P=0.53). The presence of neither a hypermobile septum nor a right-to-left shunt at rest was detected more often in those with a probable PFO-attributable stroke (OR, 0.80; P=0.45; OR, 1.15; P=0.11, respectively).CONCLUSIONS: We found no evidence that the proposed transesophageal echocardiography risk markers of large PFO size, hypermobile septum, and presence of right-to-left shunt at rest are associated with clinical features suggesting that a CS is PFO-attributable. Additional tools to describe PFOs may be useful in helping to determine whether an observed PFO is incidental or pathogenically related to CS.
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78  28432014-11-18
Authors: Berdejo J, Shibayama K, Harada K, Tanaka J, Mihara H, Gurudevan SV, Siegel RJ, Shiota T.
Citation: Circ Cardiovasc Imaging. 2014 Jan;7(1):149-54. doi: 10.1161/CIRCIMAGING.113.000938. Epub 2013 Nov 8.
Abstract: BACKGROUND: Two-dimensional (2D) echocardiography studies have shown that the maximum length of vegetation (MLV)≥10 mm is a predictor of embolic events (EEs) in patients with infective endocarditis. However, 2D measurements probably underestimate the vegetation dimensions. In this study, we evaluated the feasibility of real-time 3-dimensional transesophageal echocardiography (RT3DTEE) in determining MLV and its accuracy in identifying the risk for EEs compared with 2D transesophageal echocardiography (2DTEE).METHODS AND RESULTS: We analyzed 60 patients with vegetations. RT3DTEE measurement of MLV was obtained with Advanced QLAB Quantification Software by cropping the 3D volume with the appropriate 2D plane to obtain the largest value. The standard 2DTEE images were also evaluated to determine the MLV. Major EEs were registered from medical records, and a logistic regression analysis was performed to determine the association between MLV and EEs. The RT3DTEE MLV was larger than the 2DTEE value with a mean difference of 3.2 mm (95% confidence interval, 2.1-4.2 mm). The best cut-off value for prediction of EEs was MLV≥20 mm with RT3DTEE and MLV≥16 mm with 2DTEE. The positive predictive value increased from 59.1% to 65.2% when RT3DTEE was used. The accuracy of classification of patients with EEs increased from 65% to 70% with this new technique.CONCLUSIONS: RT3DTEE is a feasible technique for the analysis of vegetation morphology and size that may overcome the shortcoming of 2DTEE, leading to a better prediction of the embolism risk in patients with infective endocarditis.
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79  28422014-11-18
Authors: Doltra A, Bijnens B, Tolosana JM, Gabrielli L, Castel MÁ, Berruezo A, Brugada J, Mont L, Sitges M.
Citation: J Card Fail. 2013 Dec;19(12):795-801. doi: 10.1016/j.cardfail.2013.11.001. Epub 2013 Nov 8.
Abstract: BACKGROUND: The definition of response to cardiac resynchronization therapy (CRT) remains controversial, with variable rates of response depending on the criteria used. Our aim was to analyze the impact of CRT on diastolic function in different degrees of response, particularly in patients with positive clinical but no echocardiographic response.METHODS AND RESULTS: In 250 CRT patients clinical evaluation and echocardiography were performed before and after CRT. Absolute response to CRT was defined as a reduction in left ventricular (LV) end-systolic volume of ≥15% at 1-year follow-up. Additionally, patients were classified into 4 subgroups according to their amount of response: extensive reverse remodeling (RR), slight RR, clinical response without RR, and neither clinical response nor RR. An improvement in estimates of LV filling pressure and a decrease in left atrial dimensions were observed only in responders to CRT. Patients with clinical but no echocardiographic response had significant improvement in E-wave and deceleration time and nonsignificant improvement in other parameters.CONCLUSIONS: LV diastolic function improves with CRT. Clinical responders without echocardiographic response show improvement in parameters of diastolic function. That suggests that clinical-only response to CRT is secondary to a real effect of the therapy, rather than a placebo effect.Copyright © 2013 Elsevier Inc. All rights reserved.
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80  28412014-11-18
Authors: Budoff MJ, Shittu A, Hacioglu Y, Gang E, Li D, Bhatia H, Alvergue J, Karlsberg RP.
Citation: Am J Cardiol. 2014 Jan 1;113(1):173-7. doi: 10.1016/j.amjcard.2013.09.037. Epub 2013 Oct 5.
Abstract: Patients with atrial fibrillation, who are referred for radiofrequency pulmonary vein antral isolation, frequently undergo transesophageal echocardiography (TEE) to detect and/or exclude left atrial or left atrial appendage (LAA) thrombus and cardiac computed tomographic angiography (CCTA) to define and/or evaluate left atrial and pulmonary venous anatomy. Previous studies have reported CCTA to have high sensitivity and negative predictive value (NPV) for detecting thrombus in the LAA. Previous studies determining an optimal LAA/ascending aorta (AA) Hounsfield unit (HU) density ratio for detection of LAA thrombus have been small, with limited numbers of thrombi. We thus sought to determine both the optimal cutoff for LAA HU density and LAA/AA HU density ratio in detecting LAA thrombus compared with TEE in a multicenter population. We included 84 patients who had undergone CCTA and TEE. LAA was evaluated by 64-row CCTA qualitatively (visual filling defect) and quantitatively (measurement of LAA HU density and LAA/AA HU density ratio), using a 1-cm area of interest in the same axial plane. Results were compared with TEE visualization of thrombus or spontaneous echo contrast. Qualitative identification of thrombus in LAA by CCTA compared with TEE detection of thrombus had a sensitivity of 100%, a specificity of 77.9%, a positive predictive value (PPV) of 51.6%, an NPV of 100%, and a total accuracy of 82.1%. The optimal LAA HU density cutoff for thrombus detection was 119 with a sensitivity of 88%, a specificity of 86%, PPV 56%, and an area under the curve of 0.923 (p = 0.0004). The optimal LAA/aorta HU ratio was 0.242 with a sensitivity of 87%, a specificity of 88%, a PPV of 64%, and an area under the curve of 0.921 (p = 0.0011). There is no significant difference (p = 0.72) between both areas under the curve, and both measurements improved the specificity and PPV compared with qualitative measures. Multidetector computed tomography is an imaging technique that can exclude LAA thrombus with very high NPV. Quantitative measurement of LAA HU density (cutoff 119) or LAA/aorta HU density ratio (cutoff 0.242) improves accuracy of positively detecting LAA thrombus. This technique is especially useful when delayed scanning is not performed and LAA is found incidentally after the patient scanning is complete.Copyright © 2014 Elsevier Inc. All rights reserved.
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81  28402014-11-18
Authors: Sansone F, Dato GM, Zingarelli E, Ferrero E, Prot S, Ceresa F, Patanè F, Casabona R.
Citation: J Cardiol. 2014 May;63(5):365-72. doi: 10.1016/j.jjcc.2013.09.011. Epub 2013 Nov 8.
Abstract: BACKGROUND: Stentless prostheses have an interesting hemodynamic performance when compared to stented prostheses and are recommended in cases of small aortic annulus.MATERIALS AND METHODS: From January 1996 to January 2004, 138 patients suffering from aortic disease, underwent aortic valve replacement. • Group A: 93 patients underwent stentless aortic valve implantation [stentless Biocor (Biocor Industria e Pesguisa Ltda, Belo Horizonte, Brazil) and stentless Sorin (Sorin Group, Saluggia, Italy)]. • Group B: 45 patients underwent stented aortic valve implantation (stented Biocor). Patients were assessed by clinical evaluation and echocardiography after a mean follow up of 124.5 ± 58.2 months.RESULTS: There was a significant difference in terms of time of extracorporeal circulation and aortic cross clamp. The actuarial survival at 4, 8, 12, and 15 years is 77%, 50%, 21%, and 18%, respectively. Freedom from reoperation at 4, 8, 12, and 14 years was 92%, 83%, 73%, and 63%, respectively. Freedom from all events, death, and reoperation at 4, 8, 12, and 14 years was 70%, 39%, 13%, and 8%, respectively. There is no statistical difference among the two groups in terms of actuarial survival, freedom from reoperation, and freedom from re-hospitalization for prosthesis-related causes.DISCUSSION: There was a significantly higher incidence of pacemaker implantation in Group A and the causes are not known. The rate of freedom from reoperation is high in both groups for the patients who remained alive. There was no statistical difference about prosthesis dysfunction between the two groups. The higher incidence of death in Group A cannot be explained by causes related to the prosthesis because there is no difference in terms of causes of death. Rates of reoperation did not differ between the two groups.CONCLUSIONS: The results obtained with stentless prostheses are encouraging even in long-term follow-up.Copyright © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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82  28392014-11-17
Authors: Wang Q, Madhavan M, Viqar-Syed M, Asirvatham SJ.
Citation: Heart Rhythm. 2014 Feb;11(2):321-4. doi: 10.1016/j.hrthm.2013.11.004. Epub 2013 Nov 8.
Abstract: No abstract available.
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83  28382014-11-17
Authors: Gurzun MM, Husain F, Zaidi A, Ionescu A.
Citation: Echocardiography. 2014 Feb;31(2):E55-7. doi: 10.1111/echo.12436. Epub 2013 Nov 13.
Abstract: There is a long-standing debate between proponents of routine intra-operative echo and those who want it restricted to selected groups of patients (such as those undergoing valve repair or correction of congenital abnormalities). We present a case where routine transesophageal echocardiography (TEE) identified completely unexpected pathology, with implications for the postoperative follow-up and for patient outcomes. A 64-year-old male, with a history of surgical repair of coarctation of the aorta in childhood, was admitted for elective valve replacement for severe aortic stenosis (AS). Previous transthoracic echocardiography had not identified any other pathology apart from AS, but routine intra-operative TEE picked up severe turbulence in the left ventricular outflow tract (LVOT). On further analysis this was due to 2 mechanisms: a localized subaortic membrane and a "cystic" mass attached to the anterior mitral leaflet, protruding into the LVOT in systole. Multiplane imaging of the mass disclosed an accessory mitral valve (MV), a rare congenital abnormality. The patient had excision of the stenosed aortic valve and of the subaortic membrane, while the accessory MV was spared, as the surgeon judged its removal might distort the mitral apparatus. Postoperative recovery was unremarkable and the patient went home with symptomatic improvement. This case illustrates the fact that even "standard" cardiac procedures can benefit from intra-operative TEE which, in our view, should be available for all patients who undergo heart surgery. © 2013, Wiley Periodicals, Inc.
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84  28372014-11-17
Authors: Pendyala LK, Minha S, Barbash IM, Torguson R, Magalhaes MA, Okubagzi P, Loh JP, Chen F, Satler LF, Pichard AD, Waksman R.
Citation: Am J Cardiol. 2014 Jan 15;113(2):342-7. doi: 10.1016/j.amjcard.2013.09.031. Epub 2013 Oct 4.
Abstract: In patients with aortic stenosis who cannot have surgery, transcatheter aortic valve replacement using the Edwards SAPIEN valve has been shown to improve survival rate and is approved for commercial use in the United States. This study aims to assess the clinical profile, procedural characteristics, and in-hospital complications in patients treated with a commercial SAPIEN valve outside the clinical trial context. We retrospectively analyzed 69 consecutive patients who underwent transcatheter aortic valve replacement with a commercial SAPIEN valve compared with 55 Placement of AoRTic traNscathetER valves (PARTNER) trial patients from cohort B enrolled in the same institution by the same Heart Team. Compared with the commercial group, patients in the PARTNER cohort B had higher mean Society of Thoracic Surgeons score (10 ± 5 vs 9 ± 4, p&nbsp;= 0.04) and a lower rate of peripheral arterial disease (19% vs 44%, p&nbsp;= 0.004). Most patients in the commercial group had the procedure under conscious sedation (83% vs 66%, p&nbsp;= 0.03). Planned surgical cut down for vascular access was rare in the commercial group (1.4% vs 46%, p &lt;0.001). The overall rates of major vascular complications, life-threatening or major bleeding, and blood transfusions were lower in commercial group (7.2% vs 27%, p&nbsp;= 0.003; 2.9% vs 16%, p&nbsp;= 0.01; and 28% vs 60%, p &lt;0.001, respectively). In-hospital all-cause mortality (5.8% vs 9.1%, p&nbsp;= 0.51) and stroke rates (7.2% vs 14.5%, p&nbsp;= 0.19) were not statistically different between groups. The median length of hospitalization (p &lt;0.001) and postprocedural length of stay (p&nbsp;= 0.01) was shorter in the commercial group. In conclusion, transfemoral commercial use of the Edwards SAPIEN valve for inoperable patients shows similar in-hospital mortality and stroke rates compared with PARTNER cohort B. The refinements in the procedure such as more conscious sedation, experience of the operators, and careful vascular planning in the commercial group led to lesser vascular and bleeding complications and shorter length of stay. Copyright © 2014 Elsevier Inc. All rights reserved.
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85  28362014-11-17
Authors: Namdar M, Biaggi P, Stähli B, Bütler B, Casado-Arroyo R, Ricciardi D, Rodríguez-Mañero M, Steffel J, Hürlimann D, Schmied C, de Asmundis C, Chierchia GB, Sarkozy A, Lüscher TF, Jenni R, Duru F, Paulus WJ, Brugada P.
Citation: PLoS One. 2013 Nov 5;8(11):e79152. doi: 10.1371/journal.pone.0079152. eCollection 2013.
Abstract: BACKGROUND: Although the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD.METHODS AND RESULTS: ECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422 ± 24 ms and 434 ± 32 ms vs. 409 ± 25ms, p&lt;0.0005) and shorter Tend-P and Tend-Q intervals, reflecting the electrical and mechanical diastole (240 ± 78 ms and 276 ± 108 ms vs. 373 ± 110 ms, p&lt;0.0001; 409 ± 85 ms and 447 ± 115 ms vs. 526 ± 119 ms, p&lt;0.0001). The PQ-interval was significantly longer in the patient group (169 ± 28ms and 171 ± 38ms vs. 153 ± 22ms, p&lt;0.005). After adjusting for possible confounders, a novel index (Tend-P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%).CONCLUSIONS: A novel electrocardiographic index Tend-P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI.
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86  28352014-11-17
Authors: Gatti G, Dell'Angela L, Pinamonti B, Moncada A, Minati A, Benussi B, Sinagra G, Pappalardo A.
Citation: J Heart Valve Dis. 2013 Jul;22(4):500-8.
Abstract: BACKGROUND AND AIM OF THE STUDY: For patients who require aortic root replacement but are unwilling or unable to receive anticoagulants, a composite conduit was assembled intraoperatively that contained a stented biological valve sutured inside a vascular tube graft, rather than at its extremity. This simple modification of the Bentall concept may provide several advantages. The results obtained with this conduit over an 11-year period were analyzed.METHODS: Between May 2001 and April 2012, 101 consecutive patients (mean age 68.3 +/- 9.2 years) underwent aortic root replacement with the bioprosthetic valved conduit. Aortic pathologies included degenerative disease in 61 patients (60.4%), atherosclerosis in 20 (19.8%), annuloaortic ectasia in 12 (11.9%), porcelain aorta in four (4.0%), and acute dissection in four (4.0%). The whole ascending aorta was replaced in 79 patients (78.2%); a hemiarch reconstruction and a total arch replacement were added in 18 (17.8%) and four (4.0%) patients, respectively. Hypothermic circulatory arrest was performed in 60 cases (59.4%). Forty patients (39.6%) underwent additional cardiac procedures. All perioperative data were collected prospectively.RESULTS: There were five (5.0%) hospital deaths. During a mean follow up of 3.8 +/- 2.4 years there were two non-valve-related cardiac deaths and five noncardiac deaths. The seven-year actuarial survival was 79.2% (95% CI 67.0-91.4%). Bioprosthetic structural dysfunction occurred in only one patient; reoperation was easily performed by replacing the valve within the vascular graft. In the remaining 88 patients (87.1%), echocardiographic assessment showed a low transaortic mean pressure gradient (7.2 +/- 4.7 mmHg) and left ventricular wall mass reduction (p = 0.0002).CONCLUSION: This valved conduit is a safe and durable option for replacing the aortic root, thus facilitating the technique of implantation and simplifying reoperation in the case of valve failure.
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87  28342014-11-17
Authors: Miyahara S, Omura A, Sakamoto T, Nomura Y, Inoue T, Minami H, Okada K, Okita Y.
Citation: J Heart Valve Dis. 2013 Jul;22(4):509-16.
Abstract: BACKGROUND AND AIM OF THE STUDY: The study aim was to examine the echocardiographic features associated with recurrent aortic regurgitation (AR) after valve-preserving aortic root reconstruction surgery.METHODS: Echocardiographic data from 86 patients who underwent aortic root replacement with or without cusp repair were retrospectively reviewed. An analysis was conducted of the height difference between the level of the ventriculoaortic junction (VAJ) and the central free margin of the cusp, defined as the effective height (EH), and the length from the aortic annulus to the edge of the body of Arantius, defined as the geometric height (GH), in addition to root dimensions (diameter of VAJ, sinus of Valsalva, and sinotubular junction).RESULTS: All patients presented with &lt; or = mild AR at discharge. After a median follow up duration of 46.4 months, the development of moderate AR or greater was observed in 14 patients. The overall actuarial freedom from moderate AR or greater, and freedom from reoperation at three and five years were 86.2 +/- 4.4% and 81.8 +/- 5.2%, and 94.0 +/- 3.0% and 91.8 +/- 3.6%, respectively. The postoperative EH (7.47 +/- 3.3 mm in &gt; mild AR group, versus 8.81 +/- 2.1 mm in &lt; or = mild AR group, p = 0.049), the incidence of postoperative eccentric jet (57.1% in &gt; mild AR group versus 12.5% in &lt; or = mild AR group, p = 0.0005) and cusp billowing (78.6% in &gt; mild AR group versus 20.8% in &lt; or = mild AR group, p &lt; 0.0001) were significantly correlated with &gt; mild AR in the follow up. There was also correlation between postoperative EH and the severity of recurrent AR at follow up (p = -0.33, p = 0.0019).CONCLUSION: Objective information on cusp configuration, such as EH, should play an important role in stabilizing the outcome of valve-sparing surgery.
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88  28332014-11-17
Authors: Kurt M, Tanboga IH, Karakas MF, Buyukkayal E, Nacar AB, Akcay AB, Aksakal E, Sen N.
Citation: J Heart Valve Dis. 2013 Jul;22(4):532-7.
Abstract: BACKGROUND AND AIM OF THE STUDY: The relationship between mitral valve (MV) resistance and left atrial (LA) mechanical function is unknown. Hence, the study aim was to investigate the relationship between LA mechanics and MV resistance, compared to conventional indices such as mitral valve area (MVA) and transmitral gradient, in patients with rheumatic mitral stenosis (MS).METHODS: The study population consisted of 73 patients with MS and 30 age- and gender-matched controls. MV resistance was calculated and LA strain parameters were assessed from the apical four-chamber view by speckle tracking echocardiography (LA reservoir strain, LA pump strain, LA strain rate (SR)) in all subjects.RESULTS: The MS group has a markedly higher MV resistance (94 +/- 46 versus 67 +/- 22 dynes x s x cm(-5), p = 0.003) and lower LA reservoir strain (24.5 +/- 7.4% versus 36.6 +/- 3.8%, p &lt; 0.001), LA pump strain (12.0 +/- 5.0% versus 17.1 +/- 3.4%, p &lt; 0.001) and SR (1.23 +/- 0.33 versus 1.4 +/- 0.29, p = 0.017) values compared to controls. Moreover, both LA reservoir strain and LA pump strain correlated with MV resistance more closely than did MVA and transmitral gradients. Multiple linear regression analysis revealed only MV resistance to be an independent predictor of LA reservoir strain, while MV resistance, indexed left atrial volume and mean gradient were independent predictors of LA pump strain.CONCLUSION: It can be concluded that, in patients with MS, mitral valve resistance was more closely related to LA mechanics measurements than were conventional indices of MS.
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89  28322014-11-17
Authors: Chong A, Maclaren G, Chen R, Connelly KA.
Citation: J Cardiothorac Vasc Anesth. 2014 Feb;28(1):128-40. doi: 10.1053/j.jvca.2013.04.020. Epub 2013 Nov 11.
Abstract: No abstract available.
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90  28312014-11-16
Authors: Wu VC, Kaku K, Takeuchi M, Otani K, Yoshitani H, Tamura M, Abe H, Lin FC, Otsuji Y.
Citation: J Am Soc Echocardiogr. 2014 Jan;27(1):32-41. doi: 10.1016/j.echo.2013.10.007. Epub 2013 Nov 13.
Abstract: BACKGROUND: The authors hypothesized that aortic root geometry is different between bicuspid and tricuspid aortic stenosis (AS) that can be assessed using real-time three-dimensional (3D) transesophageal echocardiography. The aims of this study were (1) to validate the accuracy of 3D transesophageal echocardiographic measurements of the aortic root against multidetector computed tomography as a reference, (2) to determine the difference of aortic root geometry between patients with tricuspid and bicuspid AS, and (3) to assess its impact on pressure recovery.METHODS: In protocol 1, 3D transesophageal echocardiography and contrast-enhanced multidetector computed tomography were performed in 40 patients. Multiplanar reconstruction was used to measure the aortic annulus, the sinus of Valsalva, and the sinotubular junction area, as well as the distance and volume from the aortic annulus to the sinotubular junction. In protocol 2, the same 3D transesophageal echocardiographic measurements were performed in patients with tricuspid AS (n&nbsp;= 57) and bicuspid AS (n&nbsp;= 26) and in patients without AS (n&nbsp;= 32). The energy loss coefficient was also measured in patients with AS.RESULTS: In protocol 1, excellent correlations of aortic root geometric parameters were noted between the two modalities. In protocol 2, compared with patients without AS, those with tricuspid AS had smaller both sinotubular junction areas and longitudinal distances, resulting in a 23% reduction of aortic root volume. In contrast, patients with bicuspid AS had larger transverse areas and longitudinal distances, resulting in a 30% increase in aortic root volume. The energy loss coefficient revealed more frequent reclassification from severe AS to moderate AS in patients with tricuspid AS (17%) compared with those with bicuspid AS (10%).CONCLUSIONS: Three-dimensional transesophageal echocardiography successfully revealed different aortic root morphologies between tricuspid and bicuspid AS, which have different impacts on pressure recovery.Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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91  28302014-11-16
Authors: Kaku K, Takeuchi M, Tsang W, Takigiku K, Yasukochi S, Patel AR, Mor-Avi V, Lang RM, Otsuji Y.
Citation: J Am Soc Echocardiogr. 2014 Jan;27(1):55-64. doi: 10.1016/j.echo.2013.10.002. Epub 2013 Nov 13.
Abstract: BACKGROUND: Three-dimensional (3D) speckle-tracking echocardiography (STE) is an emerging technology used to quantify left ventricular (LV) function. However, the accuracy and normal values of LV strain and twist&nbsp;using 3D STE have not been established in a large group of normal subjects. The aims of this study were to (1) to evaluate the accuracy of 3D STE analysis of LV strain against a cardiac magnetic resonance (CMR) reference and (2) to establish age-related normal values of LV strain and torsion using real-time 3D echocardiographic (RT3DE) images.METHODS: In protocol 1, RT3DE data sets and CMR images were acquired on the same day in 19 patients referred for clinically indicated CMR. Global LV longitudinal, circumferential, and radial strain was compared between the two modalities. In protocol 2, global and regional strain and twist and torsion were measured in 313 healthy subjects using 3D STE.RESULTS: In protocol 1, good correlations for each LV strain component were noted between RT3DE imaging&nbsp;and CMR (r&nbsp;= 0.61-0.86, P &lt; .001). In protocol 2, normal global longitudinal, circumferential, radial,&nbsp;and 3D strain were -20.3 ± 3.2%, -28.9 ± 4.6%, 88.0 ± 21.8%, and -37.6 ± 4.8%, respectively. A significant age dependency was observed for global longitudinal and 3D strain. Aging also affected LV torsion: the lowest values were found in children and adolescents, and values subsequently increased with&nbsp;age, while further aging was associated with a gradual reduction in basal rotation accompanied by an increase in apical rotation.CONCLUSIONS: This study provides initial validation of 3D strain analysis from RT3DE images and reference values of normal 3D LV strain and torsion. The age-related differences in LV strain and torsion may reflect myocardial maturation and aging.Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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92  28292014-11-16
Authors: Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P, Smith PK, Hung JW, Blackstone EH, Puskas JD, Argenziano M, Gammie JS, Mack M, Ascheim DD, Bagiella E, Moquete EG, Ferguson TB, Horvath KA, Geller NL, Miller MA, Woo YJ, D'Alessandro D
Citation: N Engl J Med. 2014 Jan 2;370(1):23-32. doi: 10.1056/NEJMoa1312808. Epub 2013 Nov 18.
Abstract: BACKGROUND: Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited.METHODS: We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank.RESULTS: At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P=0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P=0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P&lt;0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months.CONCLUSIONS: We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of Health; ClinicalTrials.gov number, NCT00807040.).
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93  28282014-11-10
Authors: Detaint D, Michelena HI, Nkomo VT, Vahanian A, Jondeau G, Sarano ME.
Citation: Heart. 2014 Jan;100(2):126-34. doi: 10.1136/heartjnl-2013-304920. Epub 2013 Nov 19.
Abstract: BACKGROUND: Bicuspid aortic valve (BAV) is related to aortic dilatation, but patterns/rates are conflicting with no comparison among aneurysms of different aetiology. We sought to define ascending aorta dilatation patterns/progression rates in BAV versus other aortopathies (Marfan syndrome (MFS), degenerative aortopathy (DA)).DESIGN AND SETTING: Retrospective, observational study. Aortic dilatation progression was evaluated in two tertiary care centres (US and European) by repeated echocardiography ≥2 years apart in adults with BAV (n=353), matched to MFS (n=50) and DA (n=51) for gender, blood pressure, and minimum follow-up time.RESULTS: At baseline, ascending aortic dilatation was present in 87% of BAV cases: tubular ascending aorta in 60% (irrespective of BAV morphology), and Valsalva sinuses dilatation in 27% (independently linked to typical BAV morphology and male gender (p=0.0001)). After 3.6±1.2 years, the aortic dilatation rate in BAV was higher than expected for the population for all aortic levels (p=0.005) and was maximal at the tubular ascending aorta for BAV (0.42±0.6 mm/year) and DA (0.20±0.3 mm/year), and was maximal at the Valsalva sinuses for MFS (0.49±0.5 mm/year). Maximal aortic dilatation rate was similar between BAV and MFS (p&gt;0.40) and lower in DA (p=0.02) but was heterogeneous in BAV, with 43% of BAV not progressing (vs 20% of MFS, p=0.01). Aortic dilatation rate was not proportionally related to baseline aortic size or BAV type (all models p&gt;0.40).CONCLUSIONS: In patients with BAV, tubular ascending aorta dilatation is the most common pattern and exhibits the fastest growing rate, irrespective of valve morphology and function. Dilatation of the Valsalva sinuses is less common and associated with typical BAV morphology and male gender. Aortic dilatation progresses equally fast in BAV (tubular segment) and MFS (Valsalva sinuses), but a significantly higher proportion of BAV patients does not progress at all, irrespective of BAV type. Baseline aortic diameter does not proportionally predict progression rate; systematic follow-up is therefore warranted in patients with BAV.
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94  28272014-11-10
Authors: Roberts JD, Dhawan R, Chaney MA, Lang RM.
Citation: Anesth Analg. 2013 Dec;117(6):1286-90. doi: 10.1213/01.ane.0000436606.33019.1b.
Abstract: No abstract available.
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95  28262014-11-09
Authors: McIlwain EF; American Society of Echocardiography.
Citation: J Am Soc Echocardiogr. 2013 Dec;26(12):A17. doi: 10.1016/j.echo.2013.10.004.
Abstract: No abstract available.
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96  28252014-11-09
Authors: Hongning Y, Stewart RA, Whalley GA.
Citation: Heart Lung Circ. 2014 Apr;23(4):378-80. doi: 10.1016/j.hlc.2013.10.090. Epub 2013 Nov 1.
Abstract: BACKGROUND: Although mitral regurgitation (MR) results in left ventricular (LV) volume overload, right ventricular (RV) function may also be impaired. We investigated the influence of short-term beta-blockade on RV function in patients with moderate-severe MR.METHODS: Twenty-six patients were randomised in a cross-over design to receive two weeks of beta-blockade or placebo. Echocardiography was performed at baseline and at the end of the treatment periods. Measurements included: RV ejection fraction (RVEF) tricuspid annular motion and Tei index.RESULTS: No differences in mean RVEF (64.0 ± 6.0 v 67.0 ± 8.0%, p=0.3), tricuspid annular motion (13.5 ± 3.0 v 14.7 ± 2.9 cm/s, p=0.5), or median Tei index (0.61 (0.54, 0.88) v 0.59 (0.54, 0.74), p=0.8) were observed between placebo and metoprolol, despite significantly longer cardiac time intervals. Tei index under both conditions was significantly reduced.CONCLUSIONS: Short-term treatment with a beta-blocker did not influence RV function in these patients. Interestingly, the RV Tei index was high suggesting significant RV dysfunction despite normal RVEF.Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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97  28242014-11-09
Authors: Della Corte A, Bancone C, Buonocore M, Dialetto G, Covino FE, Manduca S, Scognamiglio G, D'Oria V, De Feo M.
Citation: JACC Cardiovasc Imaging. 2013 Dec;6(12):1301-10. doi: 10.1016/j.jcmg.2013.07.009. Epub 2013 Oct 23.
Abstract: OBJECTIVES: This study sought to identify risk factors for rapid growth of the ascending aorta in patients with bicuspid aortic valve (BAV) disease, taking into account its phenotypic variability.BACKGROUND: Phenotypic heterogeneity of BAV-related aortopathy has recently been widely recognized. However, few studies have addressed the determinants of aortic growth so far, not distinguishing among morphological phenotypes.METHODS: Serial retrospective data on 133 adult outpatients with BAV undergoing echocardiographic follow-up were analyzed to search for factors associated with aortic diameter growth over time and with rapid aortic growth (fifth quintile of growth rate distribution), focusing on the impact of different valve morphotypes (i.e., cusp fusion pattern: right-left coronary [RL] and right-noncoronary [RN]) and previously defined aortic phenotypes (nondilated aorta, ascending dilation, root dilation).RESULTS: The RL pattern was present in 69% of patients with BAV and RN in 31%. At baseline, an ascending dilation phenotype was observed in 57% of patients and a root phenotype in 13.5%. No patient with RN-BAV had a root dilation phenotype at either baseline or last examination. Follow-up time averaged 4.0 ± 2.7 years (535 patient-years). The mean growth rate was 0.3 mm/year at the sinuses and 0.6 mm/year at the ascending level. Aortic regurgitation predicted an increase in ascending diameter over time (odds ratio [OR]: 2.3; p&nbsp;= 0.03). Root phenotype at presentation, not absolute baseline diameter, was an independent predictor of fast progression (&gt;0.9 mm/year) for the ascending tract (OR: 14; p&nbsp;= 0.001). Fast growth was rarely seen in patients with the RL morphotype and ascending phenotype (6% at the root and 10% at the ascending level).CONCLUSIONS: In patients with BAV, the root phenotype (aortic dilation predominantly at the sinuses, with normal or less dilated ascending tract) may be a marker of more severe aortopathy, warranting closer surveillance and earlier treatment. The more common ascending phenotype proved to be a more stable disease entity, generally with slower progression.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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98  28232014-11-09
Authors: Sohmer B, Hudson C, Hudson J, Posner GD, Naik V.
Citation: Can J Anaesth. 2014 Mar;61(3):235-41. doi: 10.1007/s12630-013-0081-x. Epub 2013 Nov 22.
Abstract: BACKGROUND: Performance of transesophageal echocardiography (TEE) requires the psychomotor ability to obtain interpretable echocardiographic images. The purpose of this study was to determine the effectiveness of a simulation-based curriculum in which a TEE simulator is used to teach the psychomotor skills to novice echocardiographers and to compare instructor-guided with self-directed online delivery of the curriculum.METHODS: After institutional review board approval, subjects inexperienced in TEE completed an online review of TEE material prior to a baseline pre-test of TEE psychomotor skills using the simulator. Subjects were randomized to two groups. The first group received an instructor-guided lesson of TEE psychomotor skills with the simulator. The second group received a self-directed slide presentation of TEE psychomotor skills with the simulator. Both lessons delivered identical information. Following their respective training sessions, all subjects performed a post-test of their TEE psychomotor skills using the simulator. Two assessors rated the TEE performances using a validated scoring system for acquisition of images.RESULTS: Pre-test TEE simulator scores were similar between the two instruction groups (9.0 vs 5.0; P = 0.28). The scores in both groups improved significantly following training, regardless of the method of instruction (P &lt; 0.0001). The improvement in scores (post-test scores minus pre-test scores) did not differ significantly between instruction groups (12.5 vs 14.5; P = 0.55). There was strong inter-rater reliability between assessors (α = 0.98; 95% confidence interval [CI]: 0.97 to 0.99).CONCLUSIONS: High-fidelity TEE simulators are an effective training adjunct for the acquisition of basic TEE psychomotor skills. There was no difference in improvement between the different modalities of instruction. Further research will examine the need for a faculty resource for a curriculum in which a simulator is used as an adjunct.
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99  28222014-11-09
Authors: Stortecky S, Heg D, Gloekler S, Wenaweser P, Windecker S, Buellesfeld L.
Citation: EuroIntervention. 2014 Jul;10(3):339-46. doi: 10.4244/EIJV10I3A59.
Abstract: AIMS: To evaluate the accuracy and reproducibility of aortic annulus sizing using a multislice computed tomography (MSCT) based aortic root reconstruction tool compared with conventional imaging among patients evaluated for transcatheter aortic valve replacement (TAVR).METHODS AND RESULTS: Patients referred for TAVR underwent standard preprocedural assessment of aortic annulus parameters using MSCT, angiography and transoesophageal echocardiography (TEE). Three-dimensional (3D) reconstruction of MSCT images of the aortic root was performed using 3mensio (3mensio Medical Imaging BV, Bilthoven, The Netherlands), allowing for semi-automated delineation of the annular plane and assessment of annulus perimeter, area, maximum, minimum and virtual diameters derived from area and perimeter (aVD and pVD). A total of 177 patients were enrolled. We observed a good inter-observer variability of 3D reconstruction assessments with concordance coefficients for agreement of 0.91 (95% CI: 0.87-0.93) and 0.91 (0.88-0.94) for annulus perimeter and area assessments, respectively. 3D derived pVD and aVD correlated very closely with a concordance coefficient of 0.97 (0.96-0.98) with a mean difference of 0.5±0.3 mm (pVD-aVD). 3D derived pVD showed the best, but moderate concordance with diameters obtained from coronal MSCT (0.67, 0.56-0.75; 0.3±1.8 mm), and the lowest concordance with diameters obtained from TEE (0.42, 0.31-0.52; 1.9±1.9 mm).CONCLUSIONS: MSCT-based 3D reconstruction of the aortic annulus using the 3mensio software enables accurate and reproducible assessment of aortic annulus dimensions.
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100  28212014-11-09
Authors: Kupczyńska K, Kasprzak JD, Michalski B, Lipiec P.
Citation: Arch Med Sci. 2013 Oct 31;9(5):808-14. doi: 10.5114/aoms.2013.38674. Epub 2013 Nov 5.
Abstract: INTRODUCTION: Echocardiographic diagnosis of spontaneous intracardiac contrast is the reflection of interactions between erythrocytes and plasma proteins. Underlying conditions are associated with low blood flow velocities in the heart. We sought to determine whether spontaneous echo contrast (SEC) detected in the era of widespread use of harmonic imaging still reflects poor prognosis and risk of thromboembolism.MATERIAL AND METHODS: We retrospectively analyzed the database of a tertiary cardiology centre echocardiographic laboratory and identified 60 patients with SEC, but without solid intracardiac structures, and subsequently selected 60 sex- and age-matched controls without SEC. Data regarding baseline characteristics, treatment and clinical course during follow-up (median: 33.5 months; 95% CI: 24.79-40) were gained based on hospital and out-patient clinic documentation and telephone interviews. The clinical end-points included: all-cause death, cardiovascular death, stroke or transient ischemic attack (TIA), pulmonary embolism, peripheral embolism and composite thromboembolic end-point.RESULTS: We observed that in the whole study group (p = 0.0016) and in the subgroup evaluated by TTE (p = 0.005) SEC predicted higher mortality. In the group assessed by TEE, SEC correlated with higher probability of stroke or TIA (p = 0.04). By multivariate analysis, in all patients SEC was a predictor of cardiovascular death (OR = 7.63; p = 0.008) and its localization in the left atrium independently predisposed to thromboembolism (OR = 10.15; p = 0.012). Furthermore, left ventricular SEC detected by TTE also emerged as an independent determinant of higher mortality (OR = 5.26; p = 0.015).CONCLUSIONS: Despite a lower threshold of detection using harmonic imaging SEC is still a risk factor of poor prognosis, especially when observed on transthoracic examination.
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