1
|
Adedinsewo D, Morales-Lara AC, Hardway H, Johnson P, Young KA, Garzon-Siatoya WT, Butler Tobah YS, Rose CH, Burnette D, Seccombe K, Fussell M, Phillips S, Lopez-Jimenez F, Attia ZI, Friedman PA, Carter RE, Noseworthy PA. Artificial intelligence-based screening for cardiomyopathy in an obstetric population: A pilot study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:132-140. [PMID: 38989045 PMCID: PMC11232425 DOI: 10.1016/j.cvdhj.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background Cardiomyopathy is a leading cause of pregnancy-related mortality and the number one cause of death in the late postpartum period. Delay in diagnosis is associated with severe adverse outcomes. Objective To evaluate the performance of an artificial intelligence-enhanced electrocardiogram (AI-ECG) and AI-enabled digital stethoscope to detect left ventricular systolic dysfunction in an obstetric population. Methods We conducted a single-arm prospective study of pregnant and postpartum women enrolled at 3 sites between October 28, 2021, and October 27, 2022. Study participants completed a standard 12-lead ECG, digital stethoscope ECG and phonocardiogram recordings, and a transthoracic echocardiogram within 24 hours. Diagnostic performance was evaluated using the area under the curve (AUC). Results One hundred women were included in the final analysis. The median age was 31 years (Q1: 27, Q3: 34). Thirty-eight percent identified as non-Hispanic White, 32% as non-Hispanic Black, and 21% as Hispanic. Five percent and 6% had left ventricular ejection fraction (LVEF) <45% and <50%, respectively. The AI-ECG model had near-perfect classification performance (AUC: 1.0, 100% sensitivity; 99%-100% specificity) for detection of cardiomyopathy at both LVEF categories. The AI-enabled digital stethoscope had an AUC of 0.98 (95% CI: 0.95, 1.00) and 0.97 (95% CI: 0.93, 1.00), for detection of LVEF <45% and <50%, respectively, with 100% sensitivity and 90% specificity. Conclusion We demonstrate an AI-ECG and AI-enabled digital stethoscope were effective for detecting cardiac dysfunction in an obstetric population. Larger studies, including an evaluation of the impact of screening on clinical outcomes, are essential next steps.
Collapse
Affiliation(s)
| | | | - Heather Hardway
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Patrick Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Carl H Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - David Burnette
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Mia Fussell
- Agape Community Health Center, Jacksonville, Florida
| | - Sabrina Phillips
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
2
|
Peteiro J. Peak treadmill exercise echocardiography for ischemia detection. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1125-1133. [PMID: 36218202 DOI: 10.1002/jcu.23270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 06/16/2023]
Abstract
Of the stress echocardiographic methods, exercise should be the first choice for patients able to exercise, according to guidelines. Among ExE modalities, treadmill ExE with acquisition of images at peak exercise has several advantages, including high sensitivity and prognostic value. Overall, sensitivity of ExE is around 80%-85%, although figures for peak imaging on the treadmill are 85%-90%. Despite it, guidelines do not mention this method.
Collapse
Affiliation(s)
- Jesus Peteiro
- Laboratory of Echocardiography, Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, CIBER-CV A Coruña, A Coruña, Spain
| |
Collapse
|
3
|
Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, Sawada SG. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:1-41.e8. [DOI: 10.1016/j.echo.2019.07.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
4
|
Clinical correlates and heritability of cardiac mechanics: The HyperGEN study. Int J Cardiol 2019; 274:208-213. [PMID: 30045819 DOI: 10.1016/j.ijcard.2018.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/15/2018] [Accepted: 07/10/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Indices of cardiac mechanics are sensitive markers of subclinical myocardial dysfunction. Improved understanding of the clinical correlates and heritability of cardiac mechanics could result in novel insight into the acquired and genetic risk factors for myocardial dysfunction. Therefore, we sought to determine the clinical correlates and heritability of indices of cardiac mechanics in whites and African Americans (AAs). METHODS We examined 2058 participants stratified by race (1104 whites, 954 AA) in the Hypertension Genetic Epidemiology Network (HyperGEN), a population- and family-based study, and performed digitization of analog echocardiograms with subsequent speckle-tracking analysis. We used linear mixed effects models to determine the clinical correlates of indices of cardiac mechanics (longitudinal, circumferential, radial strain; early diastolic strain rate; and early diastolic tissue velocities). Heritability estimates for cardiac mechanics were calculated using maximum-likelihood variance component analyses in Sequential Oligogenic Linkage Analysis Routine (SOLAR), with adjustment for clinical and echocardiographic covariates. RESULTS Several clinical characteristics and conventional echocardiographic parameters were found to be associated with speckle-tracking traits of cardiac mechanics. Male sex, blood pressure, and fasting glucose were associated with worse longitudinal strain (LS) (P < 0.05 for all) after multivariable adjustment. After adjustment for covariates, LS, e' velocity, and early diastolic strain rate were found to be heritable; LS and e' velocity had higher heritability estimates in AAs compared to whites. CONCLUSIONS Indices of cardiac mechanics are heritable traits even after adjustment for clinical and conventional echocardiographic correlates. These findings provide the basis for future studies of genetic determinants of these traits that may elucidate race-based differences in heart failure development.
Collapse
|
5
|
Berbarie RF, Dib E, Ahmad M. Stress echocardiography using real-time three-dimensional imaging. Echocardiography 2018; 35:1196-1203. [DOI: 10.1111/echo.14050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Rafic F. Berbarie
- Division of Cardiology; Department of Internal Medicine; University of Texas Medical Branch; Galveston TX USA
| | - Elie Dib
- Division of Cardiology; Department of Internal Medicine; University of Texas Medical Branch; Galveston TX USA
| | - Masood Ahmad
- Division of Cardiology; Department of Internal Medicine; University of Texas Medical Branch; Galveston TX USA
| |
Collapse
|
6
|
Selvaraj S, Djoussé L, Aguilar FG, Martinez EE, Polsinelli VB, Irvin MR, Arnett DK, Shah SJ. Association of Estimated Sodium Intake With Adverse Cardiac Structure and Function: From the HyperGEN Study. J Am Coll Cardiol 2017; 70:715-724. [PMID: 28774377 PMCID: PMC5571737 DOI: 10.1016/j.jacc.2017.06.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/05/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The optimal level of sodium intake remains controversial. OBJECTIVES This study sought to determine whether examination of left ventricular longitudinal strain (LS), circumferential strain, and e' velocity can provide insight into thresholds for the detrimental effects of estimated sodium intake (ESI) on subclinical cardiovascular disease. METHODS We performed speckle-tracking analysis on HyperGEN (Hypertension Genetic Epidemiology Network) study echocardiograms with available urinary sodium data (N = 2,996). We evaluated the associations among ESI and LS, circumferential strain, and e' velocity using multivariable-adjusted linear mixed-effects models (to account for relatedness among subjects) with linear splines (spline 1: ESI ≤3.7 g/day, spline 2: ESI >3.7 g/day based on visual inspection of fractional polynomial plots of the association between ESI and indices of strain and e' velocity). We performed mediation analysis to understand the indirect effects of systolic blood pressure and serum aldosterone on the relationship between ESI and strain and e' velocity. RESULTS Mean age of participants was 49 ± 14 years, 57% were female, 50% were African American, and 54% had hypertension. The median ESI was 3.73 (interquartile range: 3.24, 4.25) g/day. ESI >3.7 g/day was associated with larger left atrial and left ventricular dimensions (p < 0.05). After adjusting for speckle-tracking analyst, image quality, study site, age, sex, smoking status, alcohol use, daily blocks walked, diuretic use, estimated glomerular filtration rate, left ventricular mass, ejection fraction, and wall motion score index, ESI >3.7 g/day was associated with both strain parameters and e' velocity (p < 0.05 for all comparisons), but ESI ≤3.7 g/day was not (p > 0.05 for all comparisons). There were significant interactions by potassium excretion for circumferential strain. Mediation analysis suggested that systolic blood pressure explained 14% and 20% of the indirect effects between ESI and LS and e' velocity, respectively, whereas serum aldosterone explained 19% of the indirect effects between ESI and LS. CONCLUSIONS ESI >3.7 g/day is associated with adverse cardiac remodeling and worse systolic strain and diastolic e' velocity.
Collapse
Affiliation(s)
- Senthil Selvaraj
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Luc Djoussé
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Frank G Aguilar
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eva E Martinez
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vincenzo B Polsinelli
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, Birmingham, Alabama
| | - Donna K Arnett
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, Birmingham, Alabama
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
7
|
Selvaraj S, Martinez EE, Aguilar FG, Kim KYA, Peng J, Sha J, Irvin MR, Lewis CE, Hunt SC, Arnett DK, Shah SJ. Association of Central Adiposity With Adverse Cardiac Mechanics: Findings From the Hypertension Genetic Epidemiology Network Study. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004396. [PMID: 27307550 DOI: 10.1161/circimaging.115.004396] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/09/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Central obesity, defined by increased waist circumference or waist:hip ratio (WHR), is associated with increased cardiovascular events, including heart failure. However, the pathophysiological link between central obesity and adverse cardiovascular outcomes remains poorly understood. We hypothesized that central obesity and larger WHR are independently associated with worse cardiac mechanics (reduced left ventricular strain and systolic [s'] and early diastolic [e'] tissue velocities). METHODS AND RESULTS We performed speckle-tracking analysis of echocardiograms from participants in the Hypertension Genetic Epidemiology Network (HyperGEN) study, a population- and family-based epidemiological study (n=2181). Multiple indices of systolic and diastolic cardiac mechanics were measured. We evaluated the association between central obesity and cardiac mechanics using multivariable-adjusted linear mixed-effects models to account for relatedness among participants. The mean age of the cohort was 51±14 years, 58% were women, and 47% were black. Mean body mass index was 30.8±7.1 kg/m(2), waist circumference was 102±17 cm, WHR was 0.91±0.08, and 80% had central obesity based on waist circumference and WHR criteria. After adjusting for multiple potential confounders (including age, sex, race, physical activity, body mass index, heart rate, smoking status, systolic blood pressure, fasting glucose, total cholesterol, antihypertensive medication use, glomerular filtration rate, left ventricular mass index, wall motion abnormalities, and ejection fraction), central obesity and WHR remained associated with worse global longitudinal strain, early diastolic strain rate, s' velocity, and e' velocity (P<0.05 for all comparisons). There were no significant statistical interactions between WHR and obesity status. CONCLUSIONS In this cross-sectional study of participants with multiple comorbidities, central obesity was found to be associated with adverse cardiac mechanics.
Collapse
Affiliation(s)
- Senthil Selvaraj
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Eva E Martinez
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Frank G Aguilar
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Kwang-Youn A Kim
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Jie Peng
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Jin Sha
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Marguerite R Irvin
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Cora E Lewis
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Steven C Hunt
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Donna K Arnett
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Sanjiv J Shah
- From the Division of Cardiology, Department of Medicine (S.S., E.E.M., F.G.A., S.J.S.) and the Department of Preventive Medicine (K.-Y.A.K., J.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Epidemiology, School of Public Health, University of Alabama Birmingham (J.S., M.R.I., C.E.L., D.K.A.); the Department of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, (S.C.H.); and the Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
| |
Collapse
|
8
|
Katz DH, Deo RC, Aguilar FG, Selvaraj S, Martinez EE, Beussink-Nelson L, Kim KYA, Peng J, Irvin MR, Tiwari H, Rao DC, Arnett DK, Shah SJ. Phenomapping for the Identification of Hypertensive Patients with the Myocardial Substrate for Heart Failure with Preserved Ejection Fraction. J Cardiovasc Transl Res 2017; 10:275-284. [PMID: 28258421 DOI: 10.1007/s12265-017-9739-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/09/2017] [Indexed: 02/07/2023]
Abstract
We sought to evaluate whether unbiased machine learning of dense phenotypic data ("phenomapping") could identify distinct hypertension subgroups that are associated with the myocardial substrate (i.e., abnormal cardiac mechanics) for heart failure with preserved ejection fraction (HFpEF). In the HyperGEN study, a population- and family-based study of hypertension, we studied 1273 hypertensive patients utilizing clinical, laboratory, and conventional echocardiographic phenotyping of the study participants. We used machine learning analysis of 47 continuous phenotypic variables to identify mutually exclusive groups constituting a novel classification of hypertension. The phenomapping analysis classified study participants into 2 distinct groups that differed markedly in clinical characteristics, cardiac structure/function, and indices of cardiac mechanics (e.g., phenogroup #2 had a decreased absolute longitudinal strain [12.8 ± 4.1 vs. 14.6 ± 3.5%] even after adjustment for traditional comorbidities [p < 0.001]). The 2 hypertension phenogroups may represent distinct subtypes that may benefit from targeted therapies for the prevention of HFpEF.
Collapse
Affiliation(s)
- Daniel H Katz
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Rahul C Deo
- Division of Cardiology, Department of Medicine, Institute for Human Genetics, California Institute for Quantitative Biosciences, and Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Frank G Aguilar
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 600, Chicago, IL, 60611, USA
| | - Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 600, Chicago, IL, 60611, USA
| | - Eva E Martinez
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 600, Chicago, IL, 60611, USA
| | - Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 600, Chicago, IL, 60611, USA
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jie Peng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marguerite R Irvin
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hemant Tiwari
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D C Rao
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Donna K Arnett
- School of Public Health, University of Kentucky, Lexington, KY, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 600, Chicago, IL, 60611, USA.
| |
Collapse
|
9
|
Vamvakidou A, Gurunathan S, Senior R. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages. Expert Rev Cardiovasc Ther 2016; 14:477-94. [DOI: 10.1586/14779072.2016.1135054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Aguilar FG, Selvaraj S, Martinez EE, Katz DH, Beussink L, Kim KYA, Ping J, Rasmussen-Torvik L, Goyal A, Sha J, Irvin MR, Arnett DK, Shah SJ. Archeological Echocardiography: Digitization and Speckle Tracking Analysis of Archival Echocardiograms in the HyperGEN Study. Echocardiography 2015; 33:386-97. [PMID: 26525308 DOI: 10.1111/echo.13095] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Several large epidemiologic studies and clinical trials have included echocardiography, but images were stored in analog format and these studies predated tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). We hypothesized that digitization of analog echocardiograms, with subsequent quantification of cardiac mechanics using STE, is feasible, reproducible, accurate, and produces clinically valid results. METHODS In the NHLBI HyperGEN study (N = 2234), archived analog echocardiograms were digitized and subsequently analyzed using STE to obtain tissue velocities/strain. Echocardiograms were assigned quality scores and inter-/intra-observer agreement was calculated. Accuracy was evaluated in: (1) a separate second study (N = 50) comparing prospective digital strain versus post hoc analog-to-digital strain, and (2) in a third study (N = 95) comparing prospectively obtained TDI e' velocities with post hoc STE e' velocities. Finally, we replicated previously known associations between tissue velocities/strain, conventional echocardiographic measurements, and clinical data. RESULTS Of the 2234 HyperGEN echocardiograms, 2150 (96.2%) underwent successful digitization and STE analysis. Inter/intra-observer agreement was high for all STE parameters, especially longitudinal strain (LS). In accuracy studies, LS performed best when comparing post hoc STE to prospective digital STE for strain analysis. STE-derived e' velocities correlated with, but systematically underestimated, TDI e' velocity. Several known associations between clinical variables and cardiac mechanics were replicated in HyperGEN. We also found a novel independent inverse association between fasting glucose and LS (adjusted β = -2.4 [95% CI -3.6, -1.2]% per 1-SD increase in fasting glucose; P < 0.001). CONCLUSIONS Archeological echocardiography, the digitization and speckle tracking analysis of archival echocardiograms, is feasible and generates indices of cardiac mechanics similar to contemporary studies.
Collapse
Affiliation(s)
- Frank G Aguilar
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eva E Martinez
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel H Katz
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren Beussink
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jie Ping
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amita Goyal
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jin Sha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donna K Arnett
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
11
|
Real-time three-dimensional echocardiography: never before clinical efficacy looked so picturesque. Int J Cardiol 2015; 198:15-21. [DOI: 10.1016/j.ijcard.2015.06.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/04/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022]
|
12
|
Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KYA, Peng J, Lee DC, Patel A, Sha J, Irvin MR, Arnett DK, Shah SJ. Diastolic wall strain: a simple marker of abnormal cardiac mechanics. Cardiovasc Ultrasound 2014; 12:40. [PMID: 25277882 PMCID: PMC4197332 DOI: 10.1186/1476-7120-12-40] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diastolic wall strain (DWS), defined using posterior wall thickness (PWT) measurements from standard echocardiographic images (DWS = [PWT(systole)-PWT(diastole)]/PWT(systole)), has been proposed as a marker of left ventricular (LV) diastolic stiffness. However, the equation for DWS is closely related to systolic radial strain, and whether DWS is associated with abnormal cardiac mechanics (reduced systolic strains and diastolic tissue velocities) is unknown. We sought to determine the relationship between DWS and systolic and diastolic cardiac mechanics. METHODS We calculated DWS and performed speckle-tracking analysis in a large population- and family-based study (Hypertension Genetic Epidemiology Network [HyperGEN]; N=1907 after excluding patients with ejection fraction [EF] <50% or posterior wall motion abnormalities). We measured global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS, respectively) and early diastolic (e') tissue velocities, and we determined the independent association of DWS with cardiac mechanics using linear mixed effects models to account for relatedness among study participants. We also prospectively performed receiver-operating characteristic (ROC) analysis of DWS for the detection of abnormal cardiac mechanics in a separate, prospective validation study (N=35). RESULTS In HyperGEN (age 51 ± 14 years, 59% female, 45% African-American, 57% hypertensive), mean DWS was 0.38 ± 0.05. DWS decreased with increasing comorbidity burden (β-coefficient -0.013 [95% CI -0.015, -0.011]; P<0.0001). DWS was independently associated with GLS, GCS, GRS, and e' velocity (adjusted P<0.05) but not LV chamber compliance (EDV20, P=0.97). On prospective speckle-tracking analysis, DWS correlated well with GLS, GCS, and GRS (R=0.61, 0.57, and 0.73, respectively; P<0.001 for all comparisons). C-statistics for DWS as a diagnostic test for abnormal GLS, GCS, and GRS were: 0.78, 0.79, and 0.84, respectively. CONCLUSIONS DWS, a simple parameter than can be calculated from routine 2D echocardiography, is closely associated with systolic strain parameters and early diastolic (e') tissue velocities but not LV chamber compliance.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N, St, Clair St,, Suite 600, Chicago, IL 60611, USA.
| |
Collapse
|
13
|
Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KYA, Peng J, Rasmussen-Torvik L, Sha J, Irvin MR, Gu CC, Lewis CE, Hunt SC, Arnett DK, Shah SJ. Association of comorbidity burden with abnormal cardiac mechanics: findings from the HyperGEN study. J Am Heart Assoc 2014; 3:e000631. [PMID: 24780206 PMCID: PMC4309045 DOI: 10.1161/jaha.113.000631] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Comorbidities are common in heart failure (HF), and the number of comorbidities has been associated with poor outcomes in HF patients. However, little is known about the effect of multiple comorbidities on cardiac mechanics, which could impact the pathogenesis of HF. We sought to determine the relationship between comorbidity burden and adverse cardiac mechanics. Methods and Results We performed speckle‐tracking analysis on echocardiograms from the HyperGEN study (n=2150). Global longitudinal, circumferential, and radial strain, and early diastolic (e') tissue velocities were measured. We evaluated the association between comorbidity number and cardiac mechanics using linear mixed effects models to account for relatedness among subjects. The mean age was 51±14 years, 58% were female, and 47% were African American. Dyslipidemia and hypertension were the most common comorbidities (61% and 58%, respectively). After adjusting for left ventricular (LV) mass index, ejection fraction, and several potential confounders, the number of comorbidities remained associated with all indices of cardiac mechanics except global circumferential strain (eg, β=−0.32 [95% CI −0.44, −0.20] per 1‐unit increase in number of comorbidities for global longitudinal strain; β=−0.16 [95% CI −0.20, −0.11] for e' velocity; P≤0.0001 for both comparisons). Results were similar after excluding participants with abnormal LV geometry (P<0.05 for all comparisons). Conclusions Higher comorbidity burden is associated with worse cardiac mechanics, even in the presence of normal LV geometry. The deleterious effect of multiple comorbidities on cardiac mechanics may explain both the high comorbidity burden and adverse outcomes in patients who ultimately develop HF.
Collapse
Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Right Ventricular Involvement in Coronary Artery Disease: Role of Echocardiography for Diagnosis and Prognosis. J Am Soc Echocardiogr 2014; 27:223-9. [DOI: 10.1016/j.echo.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 11/17/2022]
|
15
|
Katz DH, Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KYA, Peng J, Sha J, Irvin MR, Eckfeldt JH, Turner ST, Freedman BI, Arnett DK, Shah SJ. Association of low-grade albuminuria with adverse cardiac mechanics: findings from the hypertension genetic epidemiology network (HyperGEN) study. Circulation 2014; 129:42-50. [PMID: 24077169 PMCID: PMC3888488 DOI: 10.1161/circulationaha.113.003429] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/23/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Albuminuria is a marker of endothelial dysfunction and has been associated with adverse cardiovascular outcomes. The reasons for this association are unclear but may be attributable to the relationship between endothelial dysfunction and intrinsic myocardial dysfunction. METHODS AND RESULTS In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, a population- and family-based study of hypertension, we examined the relationship between urine albumin-to-creatinine ratio (UACR) and cardiac mechanics (n=1894, all of whom had normal left ventricular ejection fraction and wall motion). We performed speckle-tracking echocardiographic analysis to quantify global longitudinal, circumferential, and radial strain, and early diastolic (e') tissue velocities. We used E/e' ratio as a marker of increased left ventricular filling pressures. We used multivariable-adjusted linear mixed effect models to determine independent associations between UACR and cardiac mechanics. The mean age was 50±14 years, 59% were female, and 46% were black. Comorbidities were increasingly prevalent among higher UACR quartiles. Albuminuria was associated with global longitudinal strain, global circumferential strain, global radial strain, e' velocity, and E/e' ratio on unadjusted analyses. After adjustment for covariates, UACR was independently associated with lower absolute global longitudinal strain (multivariable-adjusted mean global longitudinal strain [95% confidence interval] for UACR Quartile 1 = 15.3 [15.0-15.5]% versus UACR Q4 = 14.6 [14.3-14.9]%, P for trend <0.001) and increased E/e' ratio (Q1 = 25.3 [23.5-27.1] versus Q4 = 29.0 [27.0-31.0], P=0.003). The association between UACR and global longitudinal strain was present even in participants with UACR < 30 mg/g (P<0.001 after multivariable adjustment). CONCLUSIONS Albuminuria, even at low levels, is associated with adverse cardiac mechanics and higher E/e' ratio.
Collapse
Affiliation(s)
- Daniel H. Katz
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank G. Aguilar
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eva E. Martinez
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Beussink
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jie Peng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin Sha
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Marguerite R. Irvin
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Stephen T. Turner
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Barry I. Freedman
- Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donna K. Arnett
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
16
|
|
17
|
Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13:1-46. [PMID: 22275509 DOI: 10.1093/ehjci/jer316] [Citation(s) in RCA: 352] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 2012; 25:3-46. [PMID: 22183020 DOI: 10.1016/j.echo.2011.11.010] [Citation(s) in RCA: 473] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
19
|
Izumo M, Suzuki K, Moonen M, Kou S, Shimozato T, Hayashi A, Akashi YJ, Osada N, Omiya K, Miyake F, Ohtaki E, Lancellotti P. Changes in mitral regurgitation and left ventricular geometry during exercise affect exercise capacity in patients with systolic heart failure. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:54-60. [DOI: 10.1093/ejechocard/jeq105] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
20
|
Peteiro J, Bouzas-Mosquera A. Exercise echocardiography. World J Cardiol 2010; 2:223-32. [PMID: 21160588 PMCID: PMC2998822 DOI: 10.4330/wjc.v2.i8.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 08/01/2010] [Accepted: 08/08/2010] [Indexed: 02/06/2023] Open
Abstract
Exercise echocardiography has been used for 30 years. It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). Of the stress echocardiography techniques, it represents the first choice for patients who are able to exercise. Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques, its use is likely to be expanded further. Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD. Although the role of new technology is promising, the assessment of cardiac function relies on good quality black and white harmonic images.
Collapse
Affiliation(s)
- Jesus Peteiro
- Jesus Peteiro, Alberto Bouzas-Mosquera, Laboratory of Echocardiography, Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, 15011-A Coruña, Spain
| | | |
Collapse
|
21
|
Stergiopoulos K, Bahrainy S, Buzzanca L, Blizzard B, Gamboa J, Kort S. Initial experience using contrast enhanced real-time three-dimensional exercise stress echocardiography in a low-risk population. Heart Int 2010; 5:e8. [PMID: 21977293 PMCID: PMC3184705 DOI: 10.4081/hi.2010.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/19/2010] [Accepted: 05/21/2010] [Indexed: 11/23/2022] Open
Abstract
Although emerging data support the utility of real-time three-dimensional echocardiography (RT3DE) during dobutamine stress testing, the feasibility of performing contrast enhanced RT3DE during exercise treadmill stress has not been explored. Two-dimensional (2D) and three-dimensional (3D) acquisition were performed in 39 patients at rest and peak exercise. Contrast was used in 29 patients (74%). Reconstruction was performed manually by generating short axis cut planes at the base, mid-ventricle and apex, and automatically by generating 9 short axis slices. Three-dimensional acquisition was feasible during rest and stress regardless of the use of contrast. Time to acquire stress images was reduced using 3D (35.2±17.9 s) as compared to 2D acquisition (51.6±14.7 s; P<0.05). Using a 17-segment model, of all 663 segments, 588 resting (88.6%) and 563 stress segments (84.9%) were adequately visualized using manually reconstructed 3D data, compared with 618 resting (93.2%) and 606 stress segments (91.4%) using 2D data (P rest=0.06; P stress=0.07). We concluded that contrast enhanced RT3DE is feasible during treadmill stress echocardiography.
Collapse
Affiliation(s)
- Kathleen Stergiopoulos
- Department of Internal Medicine, Division of Cardiovascular Medicine Section of Cardiovascular Imaging, Stony Brook University Medical Center Stony Brook, NY, USA
| | | | | | | | | | | |
Collapse
|
22
|
Badano LP, Muraru D, Rigo F, Del Mestre L, Ermacora D, Gianfagna P, Proclemer A. High Volume-Rate Three-Dimensional Stress Echocardiography to Assess Inducible Myocardial Ischemia: A Feasibility Study. J Am Soc Echocardiogr 2010; 23:628-35. [DOI: 10.1016/j.echo.2010.03.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Indexed: 10/19/2022]
|
23
|
Aguilar-Torres R, Gómez de Diego JJ, Forteza-Albert JF, Vivancos-Delgado R. Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada. Rev Esp Cardiol 2010; 63 Suppl 1:116-31. [DOI: 10.1016/s0300-8932(10)70145-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
24
|
|
25
|
[Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance, and multidetector computed tomography]. Rev Esp Cardiol 2009; 62 Suppl 1:129-50. [PMID: 19174056 DOI: 10.1016/s0300-8932(09)70047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article contains a review of the most important publications on cardiac imaging that have appeared during 2008. During the year, we assisted with the clinical implementation of three-dimensional real-time transesophageal echocardiography, with the use of echocardiography for selecting patients for and monitoring those who underwent percutaneous aortic valve replacement (the majority of centers performing the technique were still in the learning phase), and with the emergence in the clinic of techniques for studying myocardial deformation. Also reviewed are the most significant developments in the application of echocardiography to coronary heart disease and cardiac resynchronization therapy and in 2 other techniques whose use is constantly increasing: cardiac magnetic resonance and multidetector cardiac computed tomography. The review ends with a description of the current state of the art in contrast echocardiography, with particular emphasis on safety in the context of recommendations made by the US Food and Drug Administration at the end of 2007.
Collapse
|