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Mangia M, D'Andrea E, Cecchetto A, Beccari R, Mele D, Nistri S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. J Cardiovasc Dev Dis 2024; 11:241. [PMID: 39195149 DOI: 10.3390/jcdd11080241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.
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Affiliation(s)
- Mario Mangia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Emilio D'Andrea
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Stefano Nistri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
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Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
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Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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Jin C, Wu Y, Wang Z, Liu X, Wang Q. Isolated Partial Anomalous Pulmonary Veins: A 10-Year Experience at a Single Center. J Surg Res 2024; 298:63-70. [PMID: 38574463 DOI: 10.1016/j.jss.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/29/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Isolated partial anomalous pulmonary venous connection (PAPVC) is difficult to diagnose, and surgical indications remain controversial. We reviewed 10 y of isolated PAPVC cases. METHODS The data of patients with isolated PAPVC admitted to the Anzhen Congenital Heart Disease Department from 2010 to 2019 were reviewed retrospectively. RESULTS Thirty patients, aged between 4 mo and 32 y, were included in this study. Significant correlations were found between the right ventricle (RV), end-diastolic dimension Z-score (RVED-z) and age (r = 0.398, P = 0.03), and between estimated pulmonary pressure and age (r = 0.423, P = 0.02). However, no significant correlations were found between the RVED-z and the number of anomalous pulmonary veins (r = 0.347, P = 0.061), between estimated pulmonary pressure and the RVED-z (r = 0.218, P = 0.248), and between estimated pulmonary pressure and the number of anomalous veins (r = 0.225, P = 0.232). Transthoracic echocardiography (TTE) confirmed 90% of isolated PAPVC cases. Surgical repair was performed in 29 patients with RV enlargement, persistent low weight, pulmonary hypertension, or respiratory symptoms. Among the surgical patients, nine had elevated pulmonary pressure before surgery, which decreased postoperatively; no mortality or reintervention was observed. The mean duration of echocardiographic follow-up was 1.9 y. CONCLUSIONS TTE is recommended for routine assessments, and further clarification can be obtained with computed tomography when TTE proves inconclusive for diagnosis. Transesophageal echocardiography and computed tomography are further recommended for adult patients if TTE fails to provide clear results. PAPVC should be considered as an underlying cause when unexplained RV enlargement is observed. Surgery is recommended for patients with RV enlargement, pulmonary hypertension, or respiratory symptoms.
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Affiliation(s)
- Can Jin
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Yongtao Wu
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Zhiyi Wang
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Xiaoran Liu
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Qiang Wang
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China.
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Dvir T, Amsalem I, Carasso S, Gilad O, Asher E, Dvir D, Postell YY, Glikson M, Marmor D, Shuvy M. Pulmonary venous flow patterns associated with long-term mitral transcatheter edge-to-edge outcomes. Hellenic J Cardiol 2024:S1109-9666(24)00119-2. [PMID: 38821380 DOI: 10.1016/j.hjc.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/20/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE Transcatheter edge-to-edge repair (TEER) is a prominent therapeutic option for mitral regurgitation (MR) patients. However, it lacks objective parameters to assess procedural efficacy. This study aims to investigate pulmonary venous (PV) flow as a surrogate for valvular hemodynamics and its associations to clinical outcomes. METHODS Consecutive MR patients who underwent TEER in our center from January 2020 to October 2021 were retrospectively investigated. PV flow parameters were measured before and after TEER, including velocity (cm/s), velocity time integral (VTI) (cm), and systolic/diastolic ratios. Primary outcomes were 1, 6, and 12 months heart failure hospitalizations (HFH) and 1 year all-cause mortality. RESULTS The cohort consisted of 80 patients. The mean age was 74.76 ± 10.13 years, 26 with primary and 54 with secondary MR. Systolic wave parameters improved significantly after TEER: mean peak velocity increased from 9.94 ± 31.95 to 35.74 ± 15.03 cm/s, and VTI from 3.62 ± 5.99 to 8.33 ± 4.72 cm. Furthermore, systolic to diastolic VTI and peak-velocities ratios showed significant improvement of 0.39 ± 0.63 to 0.81 ± 0.47 and 0.23 ± 0.66 to 0.91 ± 0.43, respectively. Using multivariable analysis, higher post-procedural SVTI was associated with less HFH: 1-month (OR = 0.72, CI [0.52,0.98]), 6-months (OR = 0.8, CI [0.66,0.97]), 1-year (OR = 0.85, CI [0.73,0.99]), as well as reduced 1-year mortality (OR = 0.64 95% CI [0.45,0.91]). Furthermore, compared to patients with SVTI ≥ 3, patients with SVTI < 3 had a higher risk for HFH at: 1-month (OR = 16.59, CI [1.48,186.02]), 6-months (OR = 12.2, CI [1.69,88.07]), and 1-year (OR = 8.61, CI [1.27,58.27]), as well as elevated 1-year mortality (OR = 8.07, 95% CI [1.04,62.28]). CONCLUSION PV flow was significantly improved following TEER, and several hemodynamic parameters were associated with HFH and mortality. These results may offer a basis for establishing future procedural goals to ensure better clinical outcomes.
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Affiliation(s)
- Tomer Dvir
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Or Gilad
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Danny Dvir
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yael Yan Postell
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - David Marmor
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mony Shuvy
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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5
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Cai SR, Pollak A, Madsen G, McCartney S, Hashmi N, Haney JC, Nicoara A. Pulmonary Vein Systolic Flow Reversal Seen With Severe Tricuspid Regurgitation. CASE (PHILADELPHIA, PA.) 2023; 7:266-272. [PMID: 37546361 PMCID: PMC10403631 DOI: 10.1016/j.case.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
•Systolic PVF reversal is specific to severe MR. •We report systolic PVF reversal with severe TR and TS. •This may be caused by interatrial dependence due to elevated RAP.
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Affiliation(s)
- Sunny R. Cai
- Correspondence: Sunny R. Cai, MD, ECU Health, Department of Anethesiology, 1905 Belles Ferry Court, Winterville, North Carolina 28590.
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6
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Shechter A, Butcher SC, Siegel RJ, Awesat J, Abitbol M, Vaturi M, Sagie A, Kornowski R, Shapira Y, Yedidya I. The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation. J Cardiovasc Dev Dis 2023; 10:jcdd10020049. [PMID: 36826545 PMCID: PMC9965059 DOI: 10.3390/jcdd10020049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: We retrospectively analyzed consecutive patients referred to a tertiary center for evaluation of dMR of greater than moderate degree, who had normal sinus rhythm, had a left ventricular ejection fraction of above 60%, and did not suffer from any other major valvular disorders. The primary outcome was the combined rate of all-cause mortality, mitral intervention, or new-onset atrial fibrillation (AF) at 5 years following index echocardiogram. Secondary outcomes included individual components of the primary outcome. Results: Overall, 135 patients (median age 68 (IQR, 58-74) years; 93 (68.9%) males; 89 (65.9%) with severe MR) met the inclusion criteria and were followed for 115.2 (IQR, 60.0-155.0) months. Patients with a reversed PV flow pattern (PVFP) (n = 34) more often presented with severe MR compared to those with a normal (n = 49) and non-reversed PVFP (n = 101) (RR = 2.03 and 1.59, respectively, all p < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, p = 0.008 and 0.018, respectively). Furthermore, a reversed PVFP was independently associated with a higher risk of the primary outcome compared to normal PVFP (HR 2.53, 95% CI 1.21-5.31, p = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12-4.10, p = 0.022). Conclusion: PV flow reversal is associated with a worse 5-year composite of mortality, mitral intervention, or AF in patients with significant dMR.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Correspondence: or ; Tel.: +1-(310)-423-2726; Fax: +1-(310)-423-0166
| | - Steele C. Butcher
- Department of Cardiology, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Robert J. Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Jenan Awesat
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Merry Abitbol
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Mordehay Vaturi
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Alex Sagie
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yaron Shapira
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Idit Yedidya
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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7
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Osada SS, Szeghy RE, Stute NL, Province VM, Augenreich MA, Putnam A, Stickford JL, Stickford ASL, Grosicki GJ, Ratchford SM. Monthly transthoracic echocardiography in young adults for 6 months following SARS-CoV-2 infection. Physiol Rep 2023; 11:e15560. [PMID: 36597212 PMCID: PMC9810842 DOI: 10.14814/phy2.15560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can elicit acute and long-term effects on the myocardium among survivors, yet effects among otherwise healthy young adults remains unclear. Young adults with mild symptoms of SARS-CoV-2 (8M/8F, age: 21 ± 1 years, BMI: 23.5 ± 3.1 kg·m-2 ) underwent monthly transthoracic echocardiography (TTE) and testing of circulating cardiac troponin-I for months 1-6 (M1-M6) following a positive polymerase chain reaction test to better understand the acute effects and post-acute sequelae of SARS-CoV-2 on cardiac structure and function. Left heart structure and ejection fraction were unaltered from M1-M6 (p > 0.05). While most parameters of septal and lateral wall velocities, mitral and tricuspid valve, and pulmonary vein (PV) were unaltered from M1-M6 (p > 0.05), lateral wall s' wave velocity increased (M1: 0.113 ± 0.019 m·s-1 , M6: 0.135 ± 0.022 m·s-1 , p = 0.013); PV S wave velocity increased (M1: 0.596 ± 0.099 m·s-1 , M6: 0.824 ± 0.118 m·s-1 , p < 0.001); the difference between PV A wave and mitral valve (MV) A wave durations decreased (M1: 39.139 ± 43.715 ms, M6: 18.037 ± 7.227 ms, p = 0.002); the ratio of PV A duration to MV A duration increased (M1: 0.844 ± 0.205, M6: 1.013 ± 0.132, p = 0.013); and cardiac troponin-I levels decreased (M1: 0.38 ± 0.20 ng·ml-1 , M3: 0.28 ± 0.34 ng·ml-1 , M6: 0.29 ± 0.16 ng·ml-1 ; p = 0.002) over time. While young adults with mild symptoms of SARS-CoV-2 lacked changes to cardiac structure, the subclinical improvements to cardiac function and reduced inflammatory marker of cardiac troponin-I over 6 months following SARS-CoV-2 infection provide physiologic guidance to post-acute sequelae and recovery from SARS-CoV-2 and its variants using conventional TTE.
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Affiliation(s)
- Sophie S. Osada
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Rachel E. Szeghy
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Nina L. Stute
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Valesha M. Province
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Marc A. Augenreich
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Andrew Putnam
- Department of Cardiovascular MedicineNorthwest Health – PorterValparaisoIndianaUSA
| | - Jonathon L. Stickford
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | | | - Gregory J. Grosicki
- Biodynamics and Human Performance CenterGeorgia Southern University (Armstrong)SavannahGeorgiaUSA
| | - Stephen M. Ratchford
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
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8
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Gianni C, Sanchez JE, Chen Q, Della Rocca DG, Mohanty S, Trivedi C, Al-Ahmad A, Bassiouny MA, Burkhardt JD, Gallinghouse GJ, Horton RP, Hranitzky PM, Romero JE, Di Biase L, Garcia MJ, Natale A. Transesophageal Echocardiography Following Left Atrial Appendage Electrical Isolation: Diagnostic Pitfalls and Clinical Implications. Circ Arrhythm Electrophysiol 2022; 15:e010975. [PMID: 35617267 DOI: 10.1161/circep.122.010975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. METHODS One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. RESULTS Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%-89%]). CONCLUSIONS Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, China (Q.C.)
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Mohamed A Bassiouny
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Biomedical Engineering, University of Texas, Austin (R.P.H.)
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Jorge E Romero
- Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Clinical and Experimental Medicine, University of Foggia, Italy (L.D.B.)
| | - Mario J Garcia
- Division of Cardiology (M.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,HCA Healthcare, Nashville, TN (A.N.).,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA (A.N.).,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.)
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9
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Inoue K, Kawakami H, Akazawa Y, Higashi H, Higaki T, Yamaguchi O. Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases. J Cardiovasc Dev Dis 2022; 9:jcdd9030068. [PMID: 35323616 PMCID: PMC8955277 DOI: 10.3390/jcdd9030068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease.
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Affiliation(s)
- Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
- Correspondence: ; Tel.: +81-89-960-5303
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon 791-029, Ehime, Japan;
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
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10
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Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework. Med Sci (Basel) 2022; 10:medsci10010012. [PMID: 35225945 PMCID: PMC8883898 DOI: 10.3390/medsci10010012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Ultrasonography is becoming the favored hemodynamic monitoring utensil of emergentologists, anesthesiologists and intensivists. While the roles of ultrasound grow and evolve, many clinical applications of ultrasound stem from qualitative, image-based protocols, especially for diagnosing and managing circulatory failure. Often, these algorithms imply or suggest treatment. For example, intravenous fluids are opted for or against based upon ultrasonographic signs of preload and estimation of the left ventricular ejection fraction. Though appealing, image-based algorithms skirt some foundational tenets of cardiac physiology; namely, (1) the relationship between cardiac filling and stroke volume varies considerably in the critically ill, (2) the correlation between cardiac filling and total vascular volume is poor and (3) the ejection fraction is not purely an appraisal of cardiac function but rather a measure of coupling between the ventricle and the arterial load. Therefore, management decisions could be enhanced by quantitative approaches, enabled by Doppler ultrasonography. Both fluid ‘responsiveness’ and ‘tolerance’ are evaluated by Doppler ultrasound, but the physiological relationship between these constructs is nebulous. Accordingly, it is argued that the link between them is founded upon the Frank–Starling–Sarnoff relationship and that this framework helps direct future ultrasound protocols, explains seemingly discordant findings and steers new routes of enquiry.
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11
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Alsalman AW, Farhan H, Qasim M. Echocardiographic assessment of left ventricle diastolic dysfunction using transmitral doppler acceleration rate of mitral inflow E-Wave. MUSTANSIRIYA MEDICAL JOURNAL 2022. [DOI: 10.4103/mj.mj_37_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Gokkus H, Cosgun Z, Cosgun M, Ekici MA, Kalaycioglu O. Sonographic Evaluation of Pulmonary Interstitial Edema in Patient With Preeclampsia. Ultrasound Q 2021; 37:267-271. [PMID: 34478426 DOI: 10.1097/ruq.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this study was to sonographically detect pulmonary edema, which is a major problem in pregnant women with preeclampsia, in the interstitial phase. We evaluated 41 preeclampsia patients and 21 control subjects prospectively. In the preeclampsia group, 26 patients had severe features, whereas the other 15 patients had none. To detect early fluid loading in lungs, sonographic B lines were counted from the intercostal space by using ultrasonography, and left ventricular loading findings were examined for corporation by using transthoracic echocardiography both before and after birth. In severe preeclampsia, the number of B lines before and after birth is statistically significant compared with the other groups. In addition, the total number of B lines calculated at 24 hours after delivery was significantly lower than that calculated before delivery (P < 0.018). In terms of prenatal E values, a statistically significant difference was found between all groups (P < 0.001). A strong positive and statistically significant relationship was found between B lines and prenatal E/e' (r = 0.768; P < 0.001). The overall accuracy rate of the prenatal E/e' and E value for estimation of the B line number classification is 0.791 (95% confidence interval, 0.674-0.908; P < 0.001) and 0.829 (95% confidence interval, 0.722-0.936; P < 0.001), respectively. Pulmonary edema is a serious complication in patients with severe preeclampsia and may be detected interstitially in some patients, even if it does not occur clinically.
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Affiliation(s)
- Halil Gokkus
- Department of Radiology, Izzet Baysal State Hospital
| | | | | | | | - Oya Kalaycioglu
- Biostatistics and Medical Informatics, Izzet Baysal Faculty of Medicine, Izzet Baysal University, Bolu, Turkey
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13
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Itakura K, Utsunomiya H, Takemoto H, Takahari K, Ueda Y, Izumi K, Ikenaga H, Hidaka T, Fukuda Y, Nakano Y. Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation. Eur Heart J Cardiovasc Imaging 2021; 22:964-973. [PMID: 34041531 DOI: 10.1093/ehjci/jeab098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS This study aimed to evaluate the prevalence and distribution of pulmonary venous systolic flow reversal (PVSFR) in patients with severe mitral regurgitation (MR), and to examine the relationship between PVSFR profile and cardiac parameters. METHODS AND RESULTS A total of 125 patients with severe MR who had transoesophageal echocardiography (TOE) performed were reviewed. Of these, 121 (96.8%) patients showed all four pulmonary venous (PV) flows by TOE. They were categorized into three groups by the MR aetiology: degenerative MR (DMR) (n = 72), ventricular functional MR (V-FMR) (n = 20), and atrial functional MR (A-FMR) (n = 16). Eighteen (16.7%) patients had PVSFR in all four PVs. Twenty-nine (26.9%) had PVSFR in three PVs, 23 (21.3%) in two PVs, and 23 (21.3%) in one PV. PVSFR appeared at right PVs more frequently compared with left PVs. A high number of PVSFR was significantly correlated with higher pulmonary capillary wedge pressure (PCWP) and 3D vena contracta area (3D-VCA). With regard to MR aetiology, the number of PVSFRs was correlated with high 3D-VCA in patients with DMR and A-FMR, while it was correlated with high PCWP in patients with V-FMR. Laminar-type PVSFR appeared more frequently in FMR compared with DMR, and it had a relationship with higher PCWP and lower right ventricular fractional area change (RVFAC). CONCLUSION All four PV were detected in 96.8%, and 16.8% patients had PVSFR in all four PVs. PCWP and 3D-VCA were correlated with the number of PVSFRs in severe MR patients. Laminar-type PVSFR was related to higher PCWP and lower RVFAC.
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Affiliation(s)
- Kiho Itakura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hajime Takemoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kosuke Takahari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yusuke Ueda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kanako Izumi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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14
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Feng L, Gao H, Qi N, Danton M, Hill NA, Luo X. Fluid-structure interaction in a fully coupled three-dimensional mitral-atrium-pulmonary model. Biomech Model Mechanobiol 2021; 20:1267-1295. [PMID: 33770307 PMCID: PMC8298265 DOI: 10.1007/s10237-021-01444-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/01/2021] [Indexed: 12/17/2022]
Abstract
This paper aims to investigate detailed mechanical interactions between the pulmonary haemodynamics and left heart function in pathophysiological situations (e.g. atrial fibrillation and acute mitral regurgitation). This is achieved by developing a complex computational framework for a coupled pulmonary circulation, left atrium and mitral valve model. The left atrium and mitral valve are modelled with physiologically realistic three-dimensional geometries, fibre-reinforced hyperelastic materials and fluid–structure interaction, and the pulmonary vessels are modelled as one-dimensional network ended with structured trees, with specified vessel geometries and wall material properties. This new coupled model reveals some interesting results which could be of diagnostic values. For example, the wave propagation through the pulmonary vasculature can lead to different arrival times for the second systolic flow wave (S2 wave) among the pulmonary veins, forming vortex rings inside the left atrium. In the case of acute mitral regurgitation, the left atrium experiences an increased energy dissipation and pressure elevation. The pulmonary veins can experience increased wave intensities, reversal flow during systole and increased early-diastolic flow wave (D wave), which in turn causes an additional flow wave across the mitral valve (L wave), as well as a reversal flow at the left atrial appendage orifice. In the case of atrial fibrillation, we show that the loss of active contraction is associated with a slower flow inside the left atrial appendage and disappearances of the late-diastole atrial reversal wave (AR wave) and the first systolic wave (S1 wave) in pulmonary veins. The haemodynamic changes along the pulmonary vessel trees on different scales from microscopic vessels to the main pulmonary artery can all be captured in this model. The work promises a potential in quantifying disease progression and medical treatments of various pulmonary diseases such as the pulmonary hypertension due to a left heart dysfunction.
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Affiliation(s)
- Liuyang Feng
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK.
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK
| | - Nan Qi
- Institute of Marine Science and Technology, Shandong University, Shangdong, 266237, People's Republic of China
| | - Mark Danton
- Department of Cardiac Surgery, Royal Hospital for Children, Glasgow, UK
| | - Nicholas A Hill
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK
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15
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Fadel BM, Pibarot P, Kazzi BE, Al-Admawi M, Galzerano D, Alhumaid M, Alamro B, Mahjoub H, Echahidi N, Mohty D. Spectral Doppler Interrogation of the Pulmonary Veins for the Diagnosis of Cardiac Disorders: A Comprehensive Review. J Am Soc Echocardiogr 2021; 34:223-236. [DOI: 10.1016/j.echo.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
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16
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Meers JB, Nanda NC, Watts TE, Prejean S, Hoopes CW, Lenneman A, Ahmed MI. Utility of transesophageal echocardiography to assess real time left atrial pressure changes and dynamic mitral regurgitation following placement of transseptal multistage venous cannula for systemic venous drainage and indirect left ventricular venting in venoarterial extracorporeal membrane oxygenation. Echocardiography 2021; 38:493-499. [PMID: 33619808 DOI: 10.1111/echo.14990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022] Open
Abstract
A patient with heart failure due to nonischemic cardiomyopathy presented as a transfer to our institution following peripheral (femoral) venoarterial (VA) extracorporeal membrane oxygenation (ECMO) placement. With peripheral VA ECMO cannulation, the patient continued to have unstable ventricular tachyarrhythmias. Echocardiography demonstrated left ventricular (LV) dilation and severe mitral regurgitation (MR) with clinical and chest X-ray evidence of pulmonary edema. To provide venous drainage and simultaneous decompression of the left atrium (LA) and thereby indirect LV venting, a single multistage venous cannula was placed across the inter-atrial septum (IAS) using the previously described left atrial venoarterial (LA-VA) ECMO cannulation technique. Two- and three-dimensional (3D) transesophageal echocardiography (TEE) demonstrated utility in guiding cannula placement into the appropriate position and providing real time assessment of ventricular decompression and MR severity. There was subsequent improvement in pulmonary edema. This case is thought to be the first demonstration of real time resolution of pulmonary venous flow reversal in a patient undergoing LA-VA ECMO cannulation. This demonstration offers important mechanistic insight into some of the potential benefits of such an approach.
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Affiliation(s)
- Jacob Bradley Meers
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Navin C Nanda
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Thomas Evan Watts
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Shane Prejean
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Charles W Hoopes
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Andrew Lenneman
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Mustafa I Ahmed
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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17
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Schiller NB, Wong JM. From Doppler to Dante: Common and Avoidable Malfeasance in Echocardiography. J Am Soc Echocardiogr 2020; 34:199-200. [PMID: 33223355 DOI: 10.1016/j.echo.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Jonathan M Wong
- California Pacific Medical Center, San Francisco, California
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18
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Wakefield BJ, Alfirevic A. Pulmonary Venous Flow After Lung Transplantation: Turbulence and High Velocities. J Cardiothorac Vasc Anesth 2020; 34:1985-1989. [DOI: 10.1053/j.jvca.2020.01.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/11/2022]
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19
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Chetrit M, Cremer PC, Klein AL. Imaging of Diastolic Dysfunction in Community-Based Epidemiological Studies and Randomized Controlled Trials of HFpEF. JACC Cardiovasc Imaging 2020; 13:310-326. [DOI: 10.1016/j.jcmg.2019.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
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20
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Abstract
Heart failure (HF) with either reduced or preserved ejection fraction is an increasingly prevalent condition. Cardiac imaging plays a central role in trying to identify the underlying cause of the underlying systolic and diastolic dysfunction, as the imaging findings have implications for patient's management and individualised treatment. The imaging modalities used more frequently in patients with heart failure in clinical routine are echocardiography and cardiac magnetic resonance. Both techniques keep some strengths and weakness due to their spatial and temporal resolution. Notably, several features in the diagnostic algorithm of heart failure with preserved systolic function (HFpEF) may be improved by an integrated approach. This review focuses on the role of each modality in characterising cardiac anatomy, systolic and diastolic function as well as myocardial tissue characterisation in the most common phenotypes of dilated and hypertrophied hearts.
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21
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Kossaify A, Nasr M. Diastolic Dysfunction and the New Recommendations for Echocardiographic Assessment of Left Ventricular Diastolic Function: Summary of Guidelines and Novelties in Diagnosis and Grading. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319836781] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Antoine Kossaify
- Cardiology Division, Echocardiography and Arrhythmia Units, University Hospital Notre Dame des Secours, USEK, Byblos, Jbeil, Lebanon
| | - Mireille Nasr
- Intensive Care Unit, University Hospital Notre Dame des secours, USEK, Byblos, Jbeil, Lebanon
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22
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Vandecasteele T, Cornillie P, van Steenkiste G, Vandevelde K, Gielen I, Vanderperren K, van Loon G. Echocardiographic identification of atrial-related structures and vessels in horses validated by computed tomography of casted hearts. Equine Vet J 2018; 51:90-96. [DOI: 10.1111/evj.12969] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | - P. Cornillie
- Department of Morphology; Ghent University; Merelbeke Belgium
| | - G. van Steenkiste
- Department of Large Animal Internal Medicine; Ghent University; Merelbeke Belgium
| | - K. Vandevelde
- Department of Morphology; Ghent University; Merelbeke Belgium
| | - I. Gielen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics; Ghent University; Merelbeke Belgium
| | - K. Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics; Ghent University; Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Ghent University; Merelbeke Belgium
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23
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Naoum C, Kritharides L, Falk GL, Martin D, Yiannikas J. Left atrial compression and right ventricular outflow tract diameter on echocardiography are independently associated with exercise capacity in patients with large hiatal hernia. Echocardiography 2018; 35:592-602. [PMID: 29790224 DOI: 10.1111/echo.13835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Large hiatal hernia (HH) is often associated with left atrial (LA) compression, anteroposterior cardiac compression (manifesting as reduced right ventricular outflow tract (RVOT) diameter), and left ventricular (LV) compression (manifesting as systolic paradoxical outward motion (LV-PM) of the posterobasal LV segment). Exercise impairment, also common in this population, improves following HH surgery. We aimed to identify echocardiographic parameters independently associated with exercise impairment due to HH-mediated cardiogenic compression. METHODS Patients with a large HH (>30% intra-thoracic stomach, n = 163) referred for cardiac evaluation were included. Echocardiographic parameters were retrospectively analyzed in relation to HH-related LA compression severity and the presence of LV-PM. Echocardiographic parameters independently associated with exercise capacity were identified by multivariable analysis. RESULTS Mean baseline metabolic equivalents were reduced (70 ± 28% predicted). Moderate-severe LA compression and LV-PM were present in 91 of 163 (56%) and 65 of 162 (40%) patients, respectively. Patients with moderate-severe LA compression and LV-PM had decreased LA and LV dimensions. Moderate-severe LA compression was also associated with reduced RVOT diameter while LV-PM predicted a greater reduction in LV volumes. LA compression and RVOT diameter were independently associated with baseline exercise capacity and increased following HH surgery performed in a subgroup (n = 72, LA diameter: 14 ± 5 vs 20 ± 4 mm/m2 ; RVOT diameter: 17 ± 3 vs 19 ± 3 mm/m2 , P < .001 for both). Conversely, LV-PM was not independently associated with exercise capacity. CONCLUSION Hiatal hernia-related cardiac compression reduces LA and RVOT dimensions. These parameters are independently associated with baseline exercise capacity and improve following HH surgery. LV-PM is associated with decreased LV volumes but not exercise capacity in this population.
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Affiliation(s)
- Christopher Naoum
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Gregory L Falk
- Department of Upper GI Surgery, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - David Martin
- Department of Upper GI Surgery, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
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24
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Donal E, Galli E. Clinical relevance of spectral tissue Doppler-derived E/e' in the diagnosis of heart failure with preserved ejection fraction: reply. Eur J Heart Fail 2018; 20:941-942. [DOI: 10.1002/ejhf.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Erwan Donal
- Cardiology and CIC-IT1414, CHU de Rennes LTSI; Université Rennes-1, INSERM 1099; Rennes France
| | - Elena Galli
- Cardiology and CIC-IT1414, CHU de Rennes LTSI; Université Rennes-1, INSERM 1099; Rennes France
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25
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Abstract
Although Doppler analysis of pulmonary veins (PVs) is crucial in the assessment of cardiac hemodynamics, there is controversy regarding individual anatomical PV imaging with transthoracic echocardiography (TTE). This report is a discussion of how to image PVs accurately using TTE. To resolve any contradiction, multiple TTE images were obtained during the selective catheterization of the PV in patients undergoing atrial fibrillation ablation procedure. Fluoroscopic images were used as a reference for the identification of each PV and simultaneous echocardiographic imaging of the catheter positioned in the distal PV was used for accurate anatomical localization of the ostium and distal part of the PV.
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome. J Int Med Res 2017; 45:1680-1692. [PMID: 29239257 PMCID: PMC5805198 DOI: 10.1177/0300060517698265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chest pain is an important presenting symptom. However, few cases of chest pain
are diagnosed as acute coronary syndrome (ACS) in the acute setting. This
results in frequent inappropriate discharge and major delay in treatment for
patients with underlying ACS. The conventional methods of assessing ACS, which
include electrocardiography and serological markers of infarct, can take time to
manifest. Recent studies have investigated more sensitive and specific imaging
modalities that can be used. Diastolic dysfunction occurs early following
coronary artery occlusion and its detection is useful in confirming the
diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic
resonance provides a single imaging modality for comprehensive evaluation of
chest pain in the acute setting. In particular, cardiac magnetic resonance has
many imaging techniques that assess diastolic dysfunction post-coronary artery
occlusion. Techniques such as measurement of left atrial size, mitral inflow,
and mitral annular and pulmonary vein flow velocities with phase-contrast
imaging enable general assessment of ventricular diastolic function. More novel
imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and
myocardial tagging, allow early determination of regional diastolic dysfunction
and oedema. These findings may correspond to specific infarcted arteries that
may be used to tailor eventual percutaneous coronary artery intervention.
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Affiliation(s)
- Shah M. Azarisman
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
- Department of Internal Medicine,
International Islamic University Malaysia, Pahang, Malaysia
- Shah M Azarisman, Professor of Medicine,
International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar
InderaMahkota, 25200 Kuantan, Pahang, Malaysia.
| | - Karen S Teo
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
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Files MD, Morray B. Total Anomalous Pulmonary Venous Connection: Preoperative Anatomy, Physiology, Imaging, and Interventional Management of Postoperative Pulmonary Venous Obstruction. Semin Cardiothorac Vasc Anesth 2016; 21:123-131. [PMID: 27831520 DOI: 10.1177/1089253216672442] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Total anomalous pulmonary venous connection refers to a spectrum of cardiac anomalies where the pulmonary veins fail to return to the left atrium and the pulmonary venous blood returns through a systemic vein or directly to the right atrium. There is a wide anatomical variety of venous connections and degrees of pulmonary venous obstruction that affect the presentation, surgical repair, and outcomes. In this review, we explore the preoperative physiology, echocardiographic diagnosis, and approach to postoperative complications.
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Oki T, Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Yamada H, Nakatani S. Challenges for 'diastology': contributions from Japanese researchers. J Echocardiogr 2016; 14:93-103. [PMID: 27539160 DOI: 10.1007/s12574-016-0307-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
Abstract
Diastology is a study to treat diastole of the heart. Transmitral flow and pulmonary venous flow velocities recorded by pulsed Doppler echocardiography provide more important information about left ventricular (LV) diastolic dysfunction [left atrial (LA)-LV coupling] than cardiac catheterization in clinical practice; however, these waveforms are influenced by loading conditions, particularly preload. The early diastolic mitral annular and LV wall motion indices measured by tissue Doppler echocardiography can evaluate LV relaxation abnormality and filling pressure by being relatively preload independent. In addition, the role of concomitant systolic longitudinal dysfunction is well characterized in asymptomatic patients and in patients with heart failure and preserved ejection fraction. Two-dimensional speckle tracking echocardiography is an angle-independent method, and has the potential to evaluate the contraction and relaxation abnormalities in the longitudinal, circumferential, and radial directions of the LV myocardium as well as LV torsion/untwisting and, moreover, deformation of the LA myocardium and large arterial wall. As a result, this new technique can facilitate the early detection of impaired LA-LV-arterial coupling in patients before occurrence of overt heart failure symptoms.
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Affiliation(s)
- Takashi Oki
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan.
| | - Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yoshifumi Oishi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Arata Iuchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Choi JO, Shin MS, Kim MJ, Jung HO, Park JR, Sohn IS, Kim H, Park SM, Yoo NJ, Choi JH, Kim HK, Cho GY, Lee MR, Park JS, Shim CY, Kim DH, Shin DH, Shin GJ, Shin SH, Kim KH, Park JH, Lee SY, Kim WS, Park SW. Normal Echocardiographic Measurements in a Korean Population Study: Part II. Doppler and Tissue Doppler Imaging. J Cardiovasc Ultrasound 2016; 24:144-52. [PMID: 27358707 PMCID: PMC4925392 DOI: 10.4250/jcu.2016.24.2.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. METHODS Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. RESULTS Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. CONCLUSION Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex.
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Affiliation(s)
- Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hae Ok Jung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyungseop Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Jin Yoo
- Department of Internal Medicine, Wonkwang University Hospital, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Rae Lee
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hee Shin
- Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gil Ja Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Woo-Shik Kim
- Department of Internal Medicine, Cardiovascular Center, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Badkoubeh RS, Tavoosi A, Jabbari M, Parsa AFZ, Geraeli B, Saadat M, Larti F, Meysamie AP, Salehi M. Acceleration rate of mitral inflow E wave: a novel transmitral doppler index for assessing diastolic function. Cardiovasc Ultrasound 2016; 14:24. [PMID: 27287228 PMCID: PMC4902964 DOI: 10.1186/s12947-016-0067-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/04/2016] [Indexed: 12/03/2022] Open
Abstract
Background We performed comprehensive transmitral and pulmonary venous Doppler echocardiographic studies to devise a novel index of diastolic function. This is the first study to assess the utility of the acceleration rate (AR) of the E wave of mitral inflow as a primary diagnostic modality for assessing diastolic function. Methods Study group consisted of 84 patients (53 + 11 years) with left ventricle (LV) diastolic dysfunction and 34 healthy people (35 ± 9 years) as control group, who were referred for clinically indicated two-dimensional transthoracic echocardiogram (TTE) during 2012 and 2013 to Imam Hospital. Normal controls were defined as patients without clinical evidence of cardiac disease and had normal TTE. LV diastolic function was determined according to standardized protocol of American Society of Echocardiography (ASE). As our new parameter, AR of E wave of mitral inflow was also measured in all patients. It was represented by the slope of the line between onset of E wave and peak of it. Correlation between AR of E wave and LV diastolic function grade was measured using the Spearman correlation coefficient. Receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of AR of E wave in diagnosing LV diastolic dysfunction in randomly selected two-thirds of population then its derived cutoff was evaluated in rest of the population. The institutional review board of the hospital approved the study protocol. All participants gave written informed consent. This investigation was in accordance with the Declaration of Helsinki. Results The mean value of AR was 1010 ± 420 cm/s2 in patients whereas the mean value for the normal controls was 701 ± 210 cm/s2. There was a strong and graded relation between AR of E wave of mitral inflow and LV diastolic function grade (Spearman P ≤0.0001, rs =0.69). ROC curve analysis revealed that AR of E wave of mitral inflow =750 cm/s2 predicted moderate or severe LV diastolic dysfunction with 89 % sensitivity and 89 % specificity (area under curve [AUC] = 0.903, P <0.0001). Application of this cutoff on test group showed 96 % sensitivity and 77 % specificity with AUC = 0.932 and P <0.0001. Conclusion AR of E wave of mitral inflow could be used for assessment of diastolic function, especially moderate or severe diastolic dysfunction. However, before its clinical application, external validation should be considered.
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Affiliation(s)
| | - Anahita Tavoosi
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Jabbari
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Farhang Zand Parsa
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Geraeli
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadat
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Pasha Meysamie
- Department of community medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Salehi
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Newman JH, Brittain EL, Robbins IM, Hemnes AR. Effect of acute arteriolar vasodilation on capacitance and resistance in pulmonary arterial hypertension. Chest 2015; 147:1080-1085. [PMID: 25340330 PMCID: PMC4388116 DOI: 10.1378/chest.14-1461] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/29/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Pulmonary vascular capacitance (PVC) is reduced in pulmonary arterial hypertension (PAH). In normal lung, PVC is largely a function of vascular compliance. In PAH, increased pulmonary vascular resistance (PVR) arises from the arterioles. PVR and PVC share pressure and volume variables. The dependency between the two qualities of the vascular bed is unclear in a state of intense vasoconstriction. METHODS We compared PVC and PVR before and during nitric oxide (NO) inhalation during right-sided heart catheterization in eight NO-responsive patients with PAH. NO only directly affects tone in parenchymal vessels. RESULTS During NO inhalation, pulmonary arterial systolic pressure decreased, 80 ± 20 SD to 48 ± 20 mm Hg, and stroke volume increased, 62 ± 19 mL to 86 ± 24 mL (P < .01). PVR dropped from 10 ± 4.4 Wood units to 4.7 ± 2.2 Wood units (P < .012), and PVC increased from 1.4 ± 1.1 mL/mm Hg to 3.2 ± 1.8 mL/mm Hg (P < .018). The magnitude of PVR drop was 57% ± 6% and the decrease in 1/PVC was 54% ± 14% (P = not significant). CONCLUSIONS In vasoresponsive PAH, PVC is a function of the pressure response of the vasoconstricted arterioles to stroke volume. Immediately upon vasodilation, the capacitance increases markedly. The compliance vessels are, thus, the same as the resistance vessels. The immediate reduction in pulmonary arterial pressure during NO inhalation suggests that large vessel remodeling is not a major contributor to systolic pressure in these patients.
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Affiliation(s)
- John H Newman
- Pulmonary Circulation Center, Divisions of Pulmonary and Critical Care Medicine and Cardiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
| | - Evan L Brittain
- Pulmonary Circulation Center, Divisions of Pulmonary and Critical Care Medicine and Cardiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Ivan M Robbins
- Pulmonary Circulation Center, Divisions of Pulmonary and Critical Care Medicine and Cardiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Anna R Hemnes
- Pulmonary Circulation Center, Divisions of Pulmonary and Critical Care Medicine and Cardiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Fadel BM, Mohty D, Aldawood W, Dahdouh Z, Di Salvo G. Spectral Doppler Interrogation of the Pulmonary Veins in Atrial Septal Defect. Echocardiography 2015; 32:1027-9. [DOI: 10.1111/echo.12892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bahaa M. Fadel
- King Faisal Specialist Hospital & Research Center; Riyadh Saudi Arabia
| | | | - Wafa Aldawood
- King Faisal Specialist Hospital & Research Center; Riyadh Saudi Arabia
| | - Ziad Dahdouh
- King Faisal Specialist Hospital & Research Center; Riyadh Saudi Arabia
| | - Giovanni Di Salvo
- King Faisal Specialist Hospital & Research Center; Riyadh Saudi Arabia
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Sattarzadeh R, Tavoosi A, Tajik P. Echocardiographic estimation of left ventricular filling pressures in patients with mitral valve stenosis. Cardiovasc J Afr 2014; 25:34-9. [PMID: 24626519 PMCID: PMC3959187 DOI: 10.5830/cvja-2013-088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022] Open
Abstract
Background Estimation of left ventricular end-diastolic pressure (LVEDP) among patients with mitral valve disease may help to explain their symptoms. However, conventional Doppler measurements have limitations in predicting LVEDP in this group of patients. The aim of this study was to construct a Doppler-derived LVEDP prediction model based on the combined analysis of transmitral and pulmonary venous flow velocity curves. Methods Thirty-three patients with moderate to severe mitral stenosis (MS) who had indications for left heart catheterisation enrolled. Two-dimensional, M-mode, colour Doppler and tissue Doppler imaging indices, such as annular early diastolic velocity (Ea), isovolumic relaxation time (IVRT), pulmonary vein systolic and diastolic flow velocities, velocity propagation, left atrium area (LAA), interval between the onset of mitral E and annular Ea (TE–Ea), and Tei index were obtained. LVEDP was measured in all patients during left cardiac catheterisation. Linear correlation and multiple linear regressions were used for analysis. Results The mean of LVEDP was 9.9 ± 5.3 mmHg. In univariate analysis, the only significant relationship was noted with LAA (p = 0.05, R2 = 0.11). However, in multivariate regression, LAA, Tei index and Ea remained in the model to predict LVEDP (p = 0.02, R2 = 0.26). For prediction of LVEDP ≥ 15 mmHg, the best model consisted of LAA, IVRT and Ea, and had a sensitivity of 85% and specificity of 85%. Conclusion Our results provided evidence that, in patients with moderate to severe MS, LVEDP can be estimated by combining Doppler echocardiographic variables of mitral flow. However, more studies are required to confirm these results.
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Affiliation(s)
- Roya Sattarzadeh
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Tavoosi
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Tajik
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Heywood TJ, Seethala S, Khan T, Johnson A, Smith M, Rubenson D, Reynolds E. Left Atrial Diastolic Dysfunction And Pulmonary Venous Hypertension In Atrial Fibrillation: Clinical, Hemodynamic And Echocardiographic Characteristics. J Atr Fibrillation 2014; 7:1117. [PMID: 27957116 DOI: 10.4022/jafib.1117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/02/2014] [Accepted: 09/06/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Left ventricular diastolic dysfunction has been well described; diastolic abnormalities of the LA are less frequently recognized and poorly understood. OBJECTIVE The purpose of this study was to investigate the clinical, hemodynamic and echocardiographic features of left atrial (LA) diastolic dysfunction. METHODS Patients with atrial fibrillation (AF), severe LA enlargement, and pulmonary venous hypertension (PVH, Group 1) were compared to patients with pulmonary arterial hypertension (PAH), normal LA size and sinus rhythm (Group 2). All underwent right heart catheterization and transthoracic echo to evaluate hemodynamics and LA function. Mitral regurgitation was evaluated by transesophageal echocardiography. LA diastolic function was measured by comparing filling fraction, pulmonary venous flow and compliance. RESULTS Right atrial, pulmonary artery systolic and mean pressures were similar. Mean wedge pressure were increased in Group 1, 20.8±2.6 versus 9.7±2.8 mm of Hg (p<0.0001). The most striking hemodynamic difference was large V wave in Group 1 without significant mitral regurgitation. LA filling fraction was abnormal in Group 1, 11.4%±8.5 compared to Group 2, 111.5%±44 (p<0.0001). LA compliance was 0.39±0.27 ml/m2/mmHg in Group 1 versus 6.8±4.54 ml/m2/mmHg in Group 2 (p=0.001). There was a strong negative correlation between the V wave and LA filling fraction (r= 0.756, p<0.001). The ratio of the height of the transmitral E wave divided by the S/D ratio (the LA diastolic dysfunction index) correlated very strongly with the V wave (r=0.907, p<0.001). CONCLUSION LA diastolic dysfunction is present in some patients with long standing AF and PVH. LA diastolic dysfunction, in addition to left ventricular diastolic dysfunction, may contribute to the syndrome of heart failure with preserved left ventricular systolic function.
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Affiliation(s)
- Thomas J Heywood
- Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA
| | | | - Tariq Khan
- Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA
| | - Allen Johnson
- Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA
| | - Michael Smith
- Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA
| | - David Rubenson
- Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA
| | - Eric Reynolds
- Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA
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Wibmer T, Rüdiger S, Scharnbeck D, Radermacher M, Markovic S, Stoiber KM, Rottbauer W, Schumann C. Pulmonary pulse transit time: a novel echocardiographic indicator of hemodynamic and vascular alterations in pulmonary hypertension and pulmonary fibrosis. Echocardiography 2014; 32:904-11. [PMID: 25264113 DOI: 10.1111/echo.12772] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Pulse transit time (PTT) is generally assumed to be a surrogate marker for blood pressure changes and arterial stiffness. The aim was to evaluate whether pulmonary PTT (pPTT) may be noninvasively measured by Doppler echocardiography and whether it might be valuable for detecting pulmonary hemodynamic and vascular alterations. METHODS We defined pPTT as the interval between R-wave in the ECG and the corresponding peak late systolic pulmonary vein flow velocity measured by pw-Doppler in the pulmonary vein. Twelve consecutive patients with pulmonary hypertension (PH) and 12 subjects without any cardiovascular or respiratory disease were included in the study. All patients underwent a standard echocardiography including pPTT measurement. RESULTS In the PH group, 5 patients had idiopathic pulmonary arterial hypertension (WHO 1), 1 patient PH associated with connective tissue disease (CTD, WHO 1) without pulmonary fibrosis (PF), and 6 patients PH associated with PF either due to CTD (WHO 1) or other etiology (WHO 3). Mean pPTT was significantly shorter in the PH group (138.0 ± 16.78 msec; P < 0.0001) than in the control group (383.5 ± 23.84 msec). Within the PH group, the subgroup of patients with PF showed significantly shorter mean pPTT (93.50 ± 15.47 msec; P = 0.004) than the subgroup of patients with PH without PF (182.6 ± 14.35 msec). CONCLUSIONS The results of this study suggest that pPTT might be an interesting surrogate marker of pulmonary hemodynamic and vascular alterations in PH and PF. Further studies are warranted to evaluate the possible influence of other variables on pPTT.
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Affiliation(s)
- Thomas Wibmer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Stefan Rüdiger
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Dominik Scharnbeck
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Michael Radermacher
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Kathrin M Stoiber
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Christian Schumann
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
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Mou Y, Cheng Y, Feng Q, Ni C. Etiology of pulmonary venous aneurysm diagnosed by a combination of echocardiography and contrast-enhanced computed tomography: a case report. J Cardiothorac Surg 2014; 9:132. [PMID: 25239668 PMCID: PMC4172824 DOI: 10.1186/s13019-014-0132-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/17/2014] [Indexed: 11/10/2022] Open
Abstract
Pulmonary venous aneurysm is rare and its etiology is still debated. Some studies have shown that acquired aneurysms are caused by an increase in left atrial pressure and mitral regurgitation. However, few reports have provided direct evidence of this pathology. We present a case of pulmonary venous aneurysm diagnosed using a combination of echocardiography and contrast-enhanced computed tomography with strong evidence for an etiology of severe mitral valve regurgitation. A 24-year-old Chinese man was diagnosed with mitral valve perforation with severe mitral regurgitation caused by infectious endocarditis. A right inferior pulmonary venous aneurysm was diagnosed by contrast-enhanced computed tomography. Color Doppler echocardiography revealed a mitral regurgitation jet filling the giant aneurysm. Three-dimensional echocardiography provided a clear stereoscopic view of the aneurysm. These imaging modalities provided direct evidence for the etiology of the pulmonary venous aneurysm.
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Affiliation(s)
| | | | | | - Chenyao Ni
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, China.
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Kumar S, Waldenborg M, Bhumireddy P, Ramkissoon K, Loiske K, Innasimuthu AL, Grodman RS, Heitner JF, Emilsson K, Lazar JM. Diastolic function improves after resolution of takotsubo cardiomyopathy. Clin Physiol Funct Imaging 2014; 36:17-24. [PMID: 25208087 DOI: 10.1111/cpf.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) systolic dysfunction. However, the diastolic function (DF) manifestations of TTC have not been widely investigated. We performed a bicentric study with retrospective analysis of DF in patients with TTC, during onset and at follow-up. METHODS Twenty-eight patients with TTC (64 ± 10 years, F 24) were included. All underwent echocardiograms acutely and at the recovery phase (average three months later). Diastolic and systolic function parameters were recorded, including E-wave velocity (E), A-wave velocity, E/A ratio, relaxation (e') and contractility (S') based on tissue Doppler velocities of the mitral annuli, ejection fraction (EF), left atrial (LA) size and DF stages. RESULTS Recovery, including the mean difference with 95% confidence interval, was associated with tending improvement (i.e. uncorrected significance) in E [13 cm s(-1) (-24, -2·3), P = 0·02] and in E/A ratio [0·2 (-0·41, -0·02), P = 0·04], as well as significant improvement (after multiple comparison correction) in mean e' [2·0 cm s(-1) (-3·3, -1·2), P<0·001] and in A-wave duration [29 ms (-46·7, -12·7), P = 0·002]. LA area tended to decrease during recovery [-2 cm² (0·33, 2·4), P = 0·01]. Improvement in DF stages was significant between the phases (21% versus 58% defined as normal DF, P = 0·016). Improvement in LVEF correlated with improvement in mean e' (r = 0·52, P = 0·02). CONCLUSIONS TTC is associated with an acute impairment of conventional DF variables, which improves during recovery. DF recovery seems to occur in parallel with systolic recovery in patients with TTC.
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Affiliation(s)
- Sanjay Kumar
- SUNY Downstate Medical Center, Brooklyn, NY, USA.,Marshfield clinic-weston center, Weston, WI, USA
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Freiermuth D, Skarvan K, Filipovic M, Seeberger M, Bolliger D. Volatile anaesthetics and positive pressure ventilation reduce left atrial performance: a transthoracic echocardiographic study in young healthy adults. Br J Anaesth 2014; 112:1032-41. [DOI: 10.1093/bja/aet583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lung Ultrasound Predicts Interstitial Syndrome and Hemodynamic Profile in Parturients with Severe Preeclampsia. Anesthesiology 2014; 120:906-14. [DOI: 10.1097/aln.0000000000000102] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abstract
Background:
The role of lung ultrasound has never been evaluated in parturients with severe preeclampsia. The authors’ first aim was to assess the ability of lung ultrasound to detect pulmonary edema in severe preeclampsia. The second aim was to highlight the relation between B-lines and increased left ventricular end-diastolic pressures.
Methods:
This prospective cohort study was conducted in a level-3 maternity during a 12-month period. Twenty parturients with severe preeclampsia were consecutively enrolled. Both lung and cardiac ultrasound examinations were performed before (n = 20) and after delivery (n = 20). Each parturient with severe preeclampsia was compared with a control healthy parturient. Pulmonary edema was determined using two scores: the B-pattern and the Echo Comet Score. Left ventricular end-diastolic pressures were assessed by transthoracic echocardiography.
Results:
Lung ultrasound detected interstitial edema in five parturients (25%) with severe preeclampsia. A B-pattern was associated to increased mitral valve early diastolic peak E (116 vs. 90 cm/s; P = 0.05) and to increased E/E’ ratio (9.9 vs. 6.6; P < 0.001). An Echo Comet Score of greater than 25 predicted an increase in filling pressures (E/E’ ratio >9.5) with a sensitivity and specificity of 1.00 (95% CI, 0.69 to 1.00) and 0.82 (95% CI, 0.66 to 0.92), respectively.
Conclusions:
In parturients with severe preeclampsia, lung ultrasound detects both pulmonary edema and increased left ventricular end-diastolic pressures. The finding of a B-pattern should restrict the use of fluid. However, these preliminary results are associations from a single sample. They need to be replicated in a larger, definitive study.
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Sripathi S, Mahajan A. Comparative study evaluating the role of color Doppler sonography and computed tomography in predicting chest wall invasion by lung tumors. JOURNAL OF ULTRASOUND IN MEDICINE 2014; 32:1539-46. [PMID: 23980213 DOI: 10.7863/ultra.32.9.1539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To analyze qualitative and quantitative parameters of lung tumors by color Doppler sonography, determine the role of color Doppler sonography in predicting chest wall invasion by lung tumors using spectral waveform analysis, and compare color Doppler sonography and computed tomography (CT) for predicting chest wall invasion by lung tumors. METHODS Between March and September 2007, 55 patients with pleuropulmonary lesions on chest radiography were assessed by grayscale and color Doppler sonography for chest wall invasion. Four patients were excluded from the study because of poor acoustic windows. Quantitative and qualitative sonographic examinations of the lesions were performed using grayscale and color Doppler imaging. The correlation between the color Doppler and CT findings was determined, and the final outcomes were correlated with the histopathologic findings. RESULTS Of a total of 51 lesions, 32 were malignant. Vascularity was present on color Doppler sonography in 28 lesions, and chest wall invasion was documented in 22 cases. Computed tomography was performed in 24 of 28 evaluable malignant lesions, and the findings were correlated with the color Doppler findings for chest wall invasion. Of the 24 patients who underwent CT, 19 showed chest wall invasion. The correlation between the color Doppler and CT findings revealed that color Doppler sonography had sensitivity of 95.6% and specificity of 100% for assessing chest wall invasion, whereas CT had sensitivity of 85.7% and specificity of 66.7%. CONCLUSIONS Combined qualitative and quantitative color Doppler sonography can predict chest wall invasion by lung tumors with better sensitivity and specificity than CT. Although surgery is the reference standard, color Doppler sonography is a readily available, affordable, and noninvasive in vivo diagnostic imaging modality that is complementary to CT and magnetic resonance imaging for lung cancer staging.
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Chaturvedi RR, Ryan G, Seed M, van Arsdell G, Jaeggi ET. Fetal stenting of the atrial septum: Technique and initial results in cardiac lesions with left atrial hypertension. Int J Cardiol 2013; 168:2029-36. [DOI: 10.1016/j.ijcard.2013.01.173] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/13/2013] [Indexed: 11/26/2022]
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Cartwright BL, Jackson A, Cooper J. Intraoperative Pulmonary Vein Examination by Transesophageal Echocardiography: An Anatomic Update and Review of Utility. J Cardiothorac Vasc Anesth 2013; 27:111-20. [DOI: 10.1053/j.jvca.2012.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Indexed: 11/11/2022]
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Shaikh AY, Meyer TE, Robotis DA, Aurigemma GP, Tighe DA. Systolic pulmonary and hepatic vein flow reversal due to pacemaker-induced retrograde ventriculoatrial conduction. Echocardiography 2013; 30:E61-3. [PMID: 23305160 DOI: 10.1111/echo.12095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Systolic pulmonary and hepatic vein flow reversals can typically be seen with severe atrioventricular (AV) valve regurgitation and during atrial fibrillation (AF). We report the case of a 67-year-old woman who presented with recent-onset exertional dyspnea. Her pacemaker was near end-of-life and reverted to a VVI mode from the preset DDDR mode. Electrocardiography demonstrated retrograde 1:1 ventriculoatrial (VA) conduction and spectral Doppler analysis revealed prominent systolic pulmonary and hepatic vein flow reversals. Symptoms, electrocardiogram (ECG) findings, and the spectral Doppler abnormalities resolved completely following a generator replacement and resumption of DDDR pacing.
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Affiliation(s)
- Amir Y Shaikh
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
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To ACY, Klein AL. Role of Echocardiography in Pulmonary Vein Ablation for Atrial Fibrillation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chuen MJNK, Lip GYH, MacFadyen RJ. Repeated assessment of physical biomeasures or blood biomarkers for the definition of volume status and cardiac loading in LVSD. Biomark Med 2012; 1:355-74. [PMID: 20477380 DOI: 10.2217/17520363.1.3.355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The application of biomarker technology can be usefully implemented in areas where current techniques are inadequate and where a clinical issue, which affects outcome, can be defined. The definition of the loading status of the heart where there is pre-existent impairment of contractile function is a key target. Heart failure is a complex clinical presentation with many varied etiologies, but at the essence of its successful management is the reliable definition of cardiac volume loading. Traditional and many current technological measures are applied to define this relationship, yet their accuracy and performance in individual patients is either basically inadequate or poorly understood and applied. There is a wide range of both physical measurements and blood biomarkers that can be considered to better define this key issue in patients with ventricular systolic impairment. Their performance is considered in detail in this review.
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New pulmonary vein Doppler echocardiographic index predicts significant interatrial shunting in secundum atrial septal defect. Int J Cardiol 2012; 160:59-65. [DOI: 10.1016/j.ijcard.2011.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/14/2011] [Accepted: 03/16/2011] [Indexed: 11/22/2022]
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Silbiger JJ. Anatomy, mechanics, and pathophysiology of the mitral annulus. Am Heart J 2012; 164:163-76. [PMID: 22877801 DOI: 10.1016/j.ahj.2012.05.014] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/19/2012] [Indexed: 11/15/2022]
Abstract
The mitral annulus plays an important role in leaflet coaptation, in unloading mitral valve closing forces, and in promoting left atrial and left ventricular filling and emptying. Perturbations of annular mechanics figure prominently in a number of disorders including functional and ischemic mitral regurgitation, mitral valve prolapse, atrial fibrillation, mitral annular calcification, and annular submitral aneurysm. This review discusses the role of annular dysfunction in the pathogenesis of these disorders.
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Affiliation(s)
- Jeffrey J Silbiger
- Echocardiography Laboratory, Department of Cardiology, Mount Sinai Services at Elmhurst Hospital Center, 79-01 Broadway, Room D3-24C, Elmhurst, NY 11373, USA.
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Clinical application of cine-MRI in the visual assessment of mitral regurgitation compared to echocardiography and cardiac catheterization. PLoS One 2012; 7:e40491. [PMID: 22815751 PMCID: PMC3398949 DOI: 10.1371/journal.pone.0040491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 06/08/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Detecting and quantifying the severity of mitral regurgitation is essential for risk stratification and clinical decision-making regarding timing of surgery. Our objective was to assess specific visual parameters by cine-magnetic resonance imaging (MRI) in the determination of the severity of mitral regurgitation and to compare it to previously validated imaging modalities: echocardiography and cardiac ventriculography. METHODS The study population consisted of 68 patients who underwent a cardiac MRI followed by an echocardiogram within a median time of 2.0 days and 49 of these patients who had a cardiac catheterization, median time of 2.0 days. The inter-rater agreement statistic (Kappa) was used to evaluate the agreement. RESULTS There was moderate agreement between cine MRI and Doppler echocardiography in assessing mitral regurgitation severity, with a kappa value of 0.47, confidence interval (CI) 0.29-0.65. There was also fair agreement between cine MRI and cardiac catheterization with a kappa value of 0.36, CI of 0.17-0.55. CONCLUSION Cine MRI offers a reasonable alternative to both Doppler echocardiography and, to a lesser extent, cardiac catheterization for visually assessing the severity of mitral regurgitation with specific visual parameters during routine clinical cardiac MRI.
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Gayat E, Mor-Avi V, Weinert L, Shah SJ, Yodwut C, Lang RM. Noninvasive estimation of left ventricular compliance using three-dimensional echocardiography. J Am Soc Echocardiogr 2012; 25:661-6. [PMID: 22465872 DOI: 10.1016/j.echo.2012.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Left ventricular (LV) compliance is an important determinant of LV function and can be affected by a variety of cardiovascular conditions. In particular, diastolic dysfunction is associated with altered LV compliance. However, the evaluation of LV compliance is complex. Although the end-diastolic pressure-volume relationship (EDPVR) allows a direct, accurate evaluation of LV compliance, it requires invasive measurements. The aim of this study was to test the feasibility of noninvasive estimation of the EDPVR as a tool to evaluate LV compliance using three-dimensional echocardiography. METHODS Sixty-eight subjects were studied, including 23 normal controls, 22 patients with increased LV compliance due to dilated cardiomyopathy, and 23 patients with reduced LV compliance secondary to isolated diastolic dysfunction as defined using current American Society of Echocardiography guidelines. The EDPVR was calculated for each subject using a nonlinear model with echocardiographic estimates of end-diastolic pressure and volume. For both the isolated diastolic dysfunction and dilated cardiomyopathy groups, predicted end-diastolic volumes at predetermined pressure values (5, 10, 20, and 30 mm Hg) were compared with values in normal controls. RESULTS Compared with controls, noninvasive estimates of the EDPVR resulted in predicted end-diastolic volumes that were lower in the isolated diastolic dysfunction group and higher in the dilated cardiomyopathy group (P < .0001 for all four pressure levels). In addition, a stepwise trend of decreased compliance was noted for the different grades of diastolic dysfunction. CONCLUSIONS This is the first study to demonstrate the feasibility of noninvasive estimation of the LV EDPVR and its ability to differentiate normal from abnormal LV compliance using three-dimensional echocardiography.
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Affiliation(s)
- Etienne Gayat
- University of Chicago Medical Center, Chicago, Illinois 60637, USA
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Maharaj R. Diastolic dysfunction and heart failure with a preserved ejection fraction: Relevance in critical illness and anaesthesia. J Saudi Heart Assoc 2012; 24:99-121. [PMID: 23960679 DOI: 10.1016/j.jsha.2012.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/22/2012] [Accepted: 01/23/2012] [Indexed: 01/19/2023] Open
Abstract
Epidemiological and clinical studies suggest that HF with a preserved ejection fraction will become the more common form of HF which clinicians will encounter. The spectrum of diastolic disease extends from the asymptomatic phase to fulminant cardiac failure. These patients are commonly encountered in operating rooms and critical care units. A clearer understanding of the underlying pathophysiology and clinical implications of HF with a preserved ejection fraction is fundamental to directing further research and to evaluate interventions. This review highlights the impact of diastolic dysfunction and HF with a preserved ejection fraction during the perioperative period and during critical illness.
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Affiliation(s)
- R Maharaj
- Department of Intensive Care Medicine, Kings College Hospital, London SE5 9RS, UK
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