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Papadopoulos CH, Kadoglou NPE, Theodosis-Georgilas A, Papadopoulos KG, Rallidis L, Loizos S, Karabinos I, Kassinos N, Sahpekidis V, Chrysoheris M, Ninios V, Frogoudaki A, Makavos G, Drakopoulou M, Yiangou K, Karagiannis S, Zois N, Patrianakos A, Ikonomidis I, Tsiapras D, Kouris N, Aggeli K, Pappas K, Prappa E, Stefanidis A. Practical guidance and clinical applications of transoesophageal echocardiography. A position paper of the working group of echocardiography of the Hellenic Society of Cardiology. Curr Probl Cardiol 2024; 49:102634. [PMID: 38734120 DOI: 10.1016/j.cpcardiol.2024.102634] [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: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Transoesophageal echocardiography (TOE) is a well-established imaging modality, providing more accurate and of higher quality information than transthoracic echocardiography (TTE) for a wide spectrum cardiac and extra-cardiac diseases. The present paper represents an effort by the Echocardiography Working Group (WG) of the Hellenic Cardiology Society to state the essential steps of the typical TOE exam performed in echo lab. This is an educational text, describing the minimal requirements and the preparation of a meticulous TOE examination. Most importantly, it gives practical instructions to obtain and optimize TOE views and analyses the implementation of a combined two-and multi-dimensional protocol for the imaging of the most common cardiac structures during a TOE. In the second part of the article a comprehensive review of the contemporary use of TOE in a wide spectrum of valvular and non-valvular cardiac diseases is provided, based on the current guidelines and the experience of the WG members.
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Affiliation(s)
- Constantinos H Papadopoulos
- 2nd Cardiology Department, Korgialenio - Benakio Red Cross Hospital, +10 Platonos street, Neo Psychiko, Athens 15451, Greece.
| | | | | | | | | | | | | | | | | | | | - Vlasis Ninios
- 2nd Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | | | - Maria Drakopoulou
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | | | | | - Nikolaos Zois
- Private Practice, Cardiology Department, University Hospital of Ioannina, Greece
| | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Konstantina Aggeli
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | | | - Efstathia Prappa
- Cardiology Department, General Hospital of Evaggelismos, Athens, Greece
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2
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De Luca VM, Cammalleri V, Antonelli G, Bombace S, Ruf TF, Gößler TAM, Lurz P, von Bardeleben RS, Grigioni F, Ussia GP. The Other Side of the Coin: Transesophageal Echocardiography Complications following Cardiac Surgery and Transcatheter Structural Heart Interventions. J Clin Med 2024; 13:4291. [PMID: 39124557 PMCID: PMC11312835 DOI: 10.3390/jcm13154291] [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: 05/19/2024] [Revised: 06/21/2024] [Accepted: 07/15/2024] [Indexed: 08/12/2024] Open
Abstract
Transesophageal echocardiography (TEE) is widely used in cardiac surgery and interventional cardiology and is often an indispensable tool, giving supportive anatomical understanding and smooth guidance in both settings. Despite it being considered safe, fatal complications can commonly occur after a TEE examination in cardiac surgery operating rooms and catheterization laboratories. Currently, there is a lack of awareness of the scale of the problem, as there are only small amounts of data available, mainly derived from the surgical literature. This review summarizes the main predisposing factors for TEE-associated complications (classified as patient and procedure-related) and the main preventive strategies. We aim to apply preventive strategies more broadly, especially to patients at high risk of developing TEE-related serious adverse events.
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Affiliation(s)
- Valeria Maria De Luca
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (V.M.D.L.)
| | - Valeria Cammalleri
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (V.M.D.L.)
| | - Giorgio Antonelli
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (V.M.D.L.)
| | - Sara Bombace
- Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
| | | | | | - Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
| | | | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (V.M.D.L.)
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (V.M.D.L.)
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Romański M, Giebułtowicz J, Gniazdowska E, Piotrowski R, Żuk A, Kułakowski P, Paszkowska J, Myslitska D, Sczodrok J, Garbacz G, Danielak D. An extension of biorelevant fed-state dissolution tests to clinical pharmacokinetics - A study on gastrointestinal factors influencing rivaroxaban exposure and efficacy in atrial fibrillation patients. Int J Pharm 2024; 649:123626. [PMID: 38000647 DOI: 10.1016/j.ijpharm.2023.123626] [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: 09/15/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
A direct oral anticoagulant rivaroxaban fails to prevent stroke and systemic embolism in one-to-several percent of patients with nonvalvular atrial fibrillation (NVAF), but the reasons are unknown. The study used semi-mechanistic in vitro-in vivo prediction (IVIVP) modeling to explore the reasons for ineffective thrombosis prevention in NVAF patients. Steady-state drug concentrations in plasma were measured at 0 h (Ctrough), 3 h (C3h), and 12 h post-dosing in thirty-four patients treated with 20 mg rivaroxaban daily. The clinical data were compared against "virtual twins" generated with a novel IVIVP model that combined drug dissolution modeling, mechanistic description of gastric drug transit, and population pharmacokinetics defining the variability of drug disposition. The nonresponders had significantly lower C3h and Ctrough than the responders (p < 0.001) and the covariates included in the population pharmacokinetic submodel did not fully explain this difference. Simulations involving varied gastrointestinal parameters in the "virtual twins" revealed that lower small intestinal effective permeability (Peff), rather than a slower stomach emptying rate, could explain low rivaroxaban exposure in the nonresponders. IVIVP modeling was effectively used for exploring pharmacotherapy failure. Low Peff, found as a major determinant of ineffective rivaroxaban treatment, encourages further research to find (pato)physiological factors influencing suboptimal absorption.
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Affiliation(s)
- Michał Romański
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 3 Rokietnicka St., 60-806 Poznań, Poland
| | - Joanna Giebułtowicz
- Department of Drugs Chemistry, Pharmaceutical and Biomedical Analysis, Medical University of Warsaw, 1 Banacha St., 02-097 Warsaw, Poland.
| | - Elżbieta Gniazdowska
- Department of Drugs Chemistry, Pharmaceutical and Biomedical Analysis, Medical University of Warsaw, 1 Banacha St., 02-097 Warsaw, Poland; Łukasiewicz Research Network, Industrial Chemistry Institute, 8 Rydygiera, 01-793 Warsaw, Poland
| | - Roman Piotrowski
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, 51/59 Grenadierów St., 04-073 Warsaw, Poland
| | - Anna Żuk
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, 51/59 Grenadierów St., 04-073 Warsaw, Poland
| | - Piotr Kułakowski
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, 51/59 Grenadierów St., 04-073 Warsaw, Poland
| | | | - Daria Myslitska
- Physiolution Polska, 74 Piłsudskiego St., 50-020 Wrocław, Poland
| | - Jaroslaw Sczodrok
- Physiolution GmbH, 49a Walther-Rathenau-Straße, 17489 Greifswald, Germany
| | - Grzegorz Garbacz
- Physiolution Polska, 74 Piłsudskiego St., 50-020 Wrocław, Poland; Physiolution GmbH, 49a Walther-Rathenau-Straße, 17489 Greifswald, Germany
| | - Dorota Danielak
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 3 Rokietnicka St., 60-806 Poznań, Poland
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Chauhan A, Mudey A, Singh H. MRI and CT Appearances in Various Cardiac Tumours. Cureus 2024; 16:e51488. [PMID: 38304651 PMCID: PMC10831205 DOI: 10.7759/cureus.51488] [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: 08/23/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
While primary cardiac malignancies are infrequent, the heart often serves as a site for metastases. Myxomas are recognized as among the most prevalent primary benign tumours globally, while sarcomas represent the most common malignant primary tumours. The diverse range of potential clinical presentations depends on factors such as location, size, and the aggressiveness of the disease. The majority of diagnoses rely on medical imaging, making it crucial to familiarize oneself with their distinctive characteristics. When a cardiac mass is suspected, MRI of the heart has emerged as the preferred diagnostic method, surpassing previous techniques. CT is a valuable tool for assessing cardiac morphology and improving electrocardiography gating by providing enhanced details. This article conducts a comprehensive review of the MRI and CT characteristics of both primary and secondary cardiac malignancies, emphasizing crucial distinctions and common diagnostic pitfalls. Despite their rarity, cardiac masses continue to hold significance in the realm of cardio-oncology. Furthermore, this article explores conditions such as thrombus, Lambl's excrescences, and pericardial cysts, which can mimic tumours. Multimodal imaging has played a pivotal role in identifying the origin of cardiac masses in numerous cases, particularly when combined with the clinical context. This article offers an in-depth examination of the frequency, clinical indicators, imaging, diagnostic procedures, available treatments, and prognoses related to cardiac masses.
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Affiliation(s)
- Aayush Chauhan
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Mudey
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshit Singh
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Blaszczyk E, Hellwig S, Saad H, Ganeshan R, Stengl H, Nolte CH, Fiebach JB, Endres M, Kuhnt J, Gröschel J, Schulz-Menger J, Scheitz JF. Myocardial injury in patients with acute ischemic stroke detected by cardiovascular magnetic resonance imaging. Eur J Radiol 2023; 165:110908. [PMID: 37315403 DOI: 10.1016/j.ejrad.2023.110908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/29/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Patients with acute ischemic stroke (AIS) are at high risk of adverse cardiovascular events. Until now, the burden of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) has not been established in this population. METHODS Patients with AIS underwent CMR at 3 Tesla within 120 h after the index stroke as part of a prospective, single-center study. Patients with persistent atrial fibrillation were excluded. Morphology and function of both cardiac chambers and atria were assessed applying SSFP cine. Myocardial tissue differentiation was based on native and contrast-enhanced imaging including late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol for focal fibrosis and parametric T2- and T1-mapping for diffuse findings. To detect myocardial deformation global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain was measured applying feature tracking. Cardiac troponin was measured using a high-sensitivity assay (99th percentile upper reference limit 14 ng/L). T2 mapping values were compared with 20 healthy volunteers. RESULTS CMR with contrast media was successfully performed in 92 of 115 patients (mean age 74 years, 40% female, known myocardial infarction 6%). Focal myocardial fibrosis (LGE) was detected in 31 of 92 patients (34%) of whom 23/31 (74%) showed an ischemic pattern. Patients with LGE were more likely to have diabetes, prior myocardial infarction, prior ischemic stroke, and to have elevated troponin levels compared to those without. Presence of LGE was accompanied by diffuse fibrosis (increased T1 native values) even in remote cardiac areas as well as reduced global radial, circumferential and longitudinal strain values. In 14/31 (45%) of all patients with LGE increased T2-mapping values were detectable. CONCLUSIONS More than one-third of patients with AIS have evidence of focal myocardial fibrosis on CMR. Nearly half of these changes may have acute or subacute onset. These findings are accompanied by diffuse myocardial changes and reduced myocardial deformation. Further studies, ideally with serial CMR measurements during follow-up, are required to establish the impact of these findings on long-term prognosis after AIS.
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Affiliation(s)
- E Blaszczyk
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - S Hellwig
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - H Saad
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany
| | - R Ganeshan
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - H Stengl
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - C H Nolte
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Germany
| | - J B Fiebach
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - M Endres
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; ExcellenceCluster NeuroCure, Germany; German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Germany; Berlin Institute of Health (BIH), Germany
| | - J Kuhnt
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany
| | - J Gröschel
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - J Schulz-Menger
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - J F Scheitz
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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Labus J, Winata J, Schmidt T, Nicolai J, Zwaag SV, Sveric K, Wilbring M, Scholz M, Fassl J. Normal range of intraoperative three-dimensionally derived right ventricular free-wall strain in coronary artery bypass surgery patients. Echocardiography 2023. [PMID: 37229579 DOI: 10.1111/echo.15624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Data on intraoperative three-dimensionally derived right ventricular free-wall strain (3D-RV FWS) is sparse. OBJECTIVES We sought to evaluate the normal range of intraoperative 3D-RV FWS in patients scheduled for coronary artery bypass graft (CABG) surgery and compared to conventional echocardiographic parameters. Prospective observational study. METHODS A total of 150 patients with preserved left and right ventricular (RV) function and sinus rhythm, without significant heart valve disease or pulmonary hypertension undergoing isolated on-pump CABG surgery, with an uneventful, complication-free intraoperative course. 3D-RV FWS analysis and conventional echocardiographic assessment of RV function were performed intraoperatively in anesthetized and ventilated patients using transesophageal echocardiography (TEE). TomTec 4D RV-Function 2.0 software for assessment of 3D-RV FWS and three-dimensional right ventricular ejection fraction (3D-RV EF). Philips QLAB 10.8 was used to evaluate tissue velocity of the tricuspid annulus (RV S´), tricuspid annular systolic excursion (TAPSE), and RV fractional area change (FAC). All echocardiographic measurements were performed under stable hemodynamic conditions and predefined fluid management without any vasoactive support or pacing. The prospective observational study was performed in a single university hospital setting. RESULTS Assessment of 3D-RV FWS was feasible in 95% of patients. No included patient experienced any serious perioperative complication. In our group of patients, median values with interquartile range (IQR) for 3D-RV FWS and 3D-RV EF were -25.2 (IQR -29.9 to -21.8) and 46.3% (IQR 41.0%-50.1%), respectively. RV FAC, RV S´, and TAPSE accounted for 39.7% (IQR 34.5%-44.4%), 14.8 cm/s (IQR 11.8-19.0 cm/s), and 22 mm (IQR 20-25 mm). The normal range (2.5% to 97.5% percentile) for 3D-RV FWS was -37.1 to -12.8. There was no relevant correlation of 3D-RV FWS to postoperative outcome in this group of CABG patients. CONCLUSION We present distribution values for intraoperative 3D-RV FWS and conventional parameters of RV function assessment in a healthy on-pump CABG patient population without serious perioperative complications. We observed no correlations of these parameters with any of the outcome parameters considered. Therefore, we consider these values to be intraoperative TEE-assessed normal values, which can be expected in on-pump CABG patients.
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Affiliation(s)
- Jakob Labus
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Johan Winata
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Torsten Schmidt
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Joachim Nicolai
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Stanislaw Vander Zwaag
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Kunislav Sveric
- Department of Cardiology and Internal Medicine, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Manuel Wilbring
- Department of Heart Surgery, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jens Fassl
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
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Paneque I, Galán-Páez N, Camacho-Fernández de Líger MR, Lao-Peña C, Aguilera-Saborido A, López-Haldón J. Safety and efficacy of a sedation protocol combined with propofol as the second step in transesophageal echocardiography. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:201-204. [PMID: 36244658 DOI: 10.1016/j.rec.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Inmaculada Paneque
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain; Facultad de Enfermería, Universidad de Sevilla, Seville, Spain
| | - Nuria Galán-Páez
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Carolina Lao-Peña
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - José López-Haldón
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain.
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Liu H, Lin M, Han W, Ge J, Maduray K, Zhong J. The risk factors of thrombus formation and the effect of catheter ablation on repetitive thrombus formation in patients with atrial fibrillation: a single center retrospective study in China. BMC Cardiovasc Disord 2023; 23:28. [PMID: 36650447 PMCID: PMC9843887 DOI: 10.1186/s12872-023-03050-z] [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: 04/28/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) predisposes patients to the formation of atrial thrombi. The CHA2DS2-VASc score does not include all risk factors for atrial thrombosis. The present study is designed to explore the influencing factors of thrombus formation in patients with AF and to investigate the effect of catheter ablation (CA) on recurrent thrombosis in patients with a history of intracardiac thrombus. METHODS (1) This study consisted of 1726 patients that underwent CA, among which 58 patients had a history of intracardiac thrombus prior to CA. The risk factors for thrombus formation were explored by comparing the baseline clinical characteristics of patients with and without atrial thrombus. (2) The left atrial appendage flow velocity (LAAFV) in patients with a history of intracardiac thrombus who were willing to undergo transesophageal echocardiography (TEE) at the latest follow-up were examined, and comparisons of the LAAFV was made before and after CA. RESULTS The median follow-up period is 13 months. Persistent AF was found to be the only independent risk factor affecting the formation of atrial thrombus among the investigated factors (OR 3.152; 95%CI 1.806-5.500; p < 0.001). Twenty-seven patients agreed to undergo TEE during follow-up, no clinical ischemic stroke events were recorded, no recurrent intracardiac thrombus formation was detected in patients, 15 patients maintained sinus rhythm (55.6%) during follow-up; successful CA significantly increased LAAFV (difference between latest evaluation prior to CA 17.46 ± 14.81 cm/s, p < 0.001). CONCLUSIONS Persistent AF is the only independent risk factor for thrombus formation. Successful CA may improve the LAAFV and thereby decrease the risk of intracardiac thrombus formation.
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Affiliation(s)
- Huiyu Liu
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China ,Department of Cardiology, Nanyang Central Hospital, Nanyang, China
| | - Mingjie Lin
- grid.27255.370000 0004 1761 1174Department of Cardiology, Qilu Hospital (Qingdao) of Shandong University, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035 Shandong China
| | - Wenqiang Han
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Junye Ge
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Kellina Maduray
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Jingquan Zhong
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China ,grid.27255.370000 0004 1761 1174Department of Cardiology, Qilu Hospital (Qingdao) of Shandong University, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035 Shandong China
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9
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Lasica RM, Perunicic JP, Popovic DR, Mrdovic IB, Arena RA, Radovanovic NL, Radosavljevic-Radovanovic MR, Djukanovic LD, Asanin MR. Early and Late Mortality Predictors in Patients with Acute Aortic Dissection Type B. Cardiol Res Pract 2022; 2022:7869356. [PMID: 36471803 PMCID: PMC9719417 DOI: 10.1155/2022/7869356] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 11/01/2022] [Accepted: 11/18/2022] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND/AIM Despite technological advances in diagnosis and treatment, in-hospital mortality with acute aortic dissection type B is still about 11%. The purpose of this study was to assess the risk factors for early and long-term adverse outcomes in patients with acute aortic dissection type B treated medically or with conventional open surgery. METHODS The present study included 104 consecutive patients with acute aortic dissection type B treated in our Center from January 1st, 1998 to January 1st, 2007. Patient demographic and clinical characteristics as well as in-hospital complications were reviewed. Univariate and multivariate testing was performed to identify the predictors of in-hospital (30-day) and late (within 9 years) mortality. RESULTS 92 (88.5%) patients were treated medically, while 12 (11.5%) patients with complicated acute aortic dissection type B were treated by open surgical repair. In-hospital complications occurred in 35.7% patients, the most often being acute renal failure (28%), hypotension/shock (24%), mesenteric ischemia (12%), and limb ischemia (8%). The in-hospital mortality rate was 15.7% and the 9-year mortality rate was 51.9%. Independent predictors of early mortality in patients with acute aortic dissection type B were uncontrolled hypertension (HR-20.69) and a dissecting aorta diameter >4.75 cm (HR-6.30). Independent predictors of late mortality were relapsing pain (HR-7.93), uncontrolled hypertension (HR-7.25), and a pathologic difference in arterial blood pressure (>20 mmHg) (HR-5.33). CONCLUSION Knowledge of key risk factors may help with a better choice of treatment and mortality reduction in acute aortic dissection type B patients.
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Affiliation(s)
- Ratko M. Lasica
- Emergency Hospital, University Clinical Center Serbia, Pasterova 2, Belgrade 11000, Serbia
| | - Jovan P. Perunicic
- Emergency Hospital, University Clinical Center Serbia, Pasterova 2, Belgrade 11000, Serbia
| | - Dejana R. Popovic
- Division of Cardiology, University Clinical Center Serbia, Visegradska 26, Belgrade 11000, Serbia
| | - Igor B. Mrdovic
- Emergency Hospital, University Clinical Center Serbia, Pasterova 2, Belgrade 11000, Serbia
| | - Ross A. Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1200W Harrison St, Chicago, IL 60607, USA
| | - Nebojsa L. Radovanovic
- Emergency Hospital, University Clinical Center Serbia, Pasterova 2, Belgrade 11000, Serbia
| | | | - Lazar D. Djukanovic
- Emergency Hospital, University Clinical Center Serbia, Pasterova 2, Belgrade 11000, Serbia
| | - Milika R. Asanin
- Emergency Hospital, University Clinical Center Serbia, Pasterova 2, Belgrade 11000, Serbia
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10
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Freitas TM, David C, Almeida AG, Pinto FJ, Costa J, Caldeira D. Cardiovascular and Respiratory Safety of Sedation Strategies Used in Transesophageal Echocardiography: A Systematic Review Incorporating Network Meta-Analysis. J Cardiothorac Vasc Anesth 2022; 36:4129-4140. [PMID: 36028379 DOI: 10.1053/j.jvca.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/11/2022]
Abstract
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) is carried out in various clinical settings, with an increasing importance, and sedation usually is required to perform it. Several sedative agents are available, and the authors aimed to compare the cardiovascular and respiratory safety of the strategies used for sedation in TEE through a systematic review with network meta-analysis (NMA). The MEDLINE, CENTRAL, EMBASE, and PsycInfo databases were searched in December 2020 for randomized clinical trials (RCTs) comparing sedation strategies for patients undergoing TEE. The authors assessed variations in systolic blood pressure (SBP), heart rate (HR), and peripheral oxygen saturation (SpO2), along with the incidences of hypotension, bradycardia, and desaturation. A random-effect meta-analysis was performed. Nine RCTs (N = 881 patients) with 20 active arms (5 dexmedetomidine; 4 propofol; 4 midazolam; 3 midazolam + opioid; 2 ketamine + propofol; 1 midazolam + ondansetron; 1 midazolam + metoclopramide) and 1 placebo arm were included. Dexmedetomidine was associated with decreases in SBP (mean difference [MD] = -18.78 mmHg; 95% CI [-26.27 to -11.28]) and HR (MD = -11.15 beats/min; 95% CI [-16.15 to -6.15]). Dexmedetomidine significantly reduced the HR compared with ketamine + propofol (-16.90 beats/min; 95% CI: -33.21 to -0.58]) and midazolam + opioid (-24.15 beats/min; 95% CI: -42.67 to -5.63). Midazolam was found to reduce SBP (-12.09 mmHg; 95% CI: -20.43 to -3.74) and was shown to reduce SpO2 compared with the placebo (-1.00%; 95% CI -1.74 to -0.26). Based on the NMA, the drugs with a higher likelihood of decreasing both SBP and HR were dexmedetomidine and midazolam. All of the drugs led to a small decrease (only statistically significant for midazolam) in SpO2, with the systematic use of supplemental O2 in some trials. The risks of hypotension, bradycardia, or desaturation were not significantly different among the evaluated drugs.
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Affiliation(s)
| | - Claúdio David
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Lisbon, Portugal
| | - Ana G Almeida
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa-CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa-CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa-CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Portugal..
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11
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Dunkman WJ, Manning MW, Williams DA. Patterns of Use in Transesophageal Echocardiography for Liver Transplantation: A Systematic Review. Semin Cardiothorac Vasc Anesth 2022; 26:274-281. [PMID: 36202226 DOI: 10.1177/10892532221133247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transesophageal echocardiography is frequently but not always used to guide anesthetic management during liver transplantation. We performed a systematic review of the literature to identify and summarize any studies reporting on the frequency and characteristics of TEE use for liver transplantation. Studies were identified by searching several relevant terms on PubMed and citation searching of relevant reviews. We identified 5 studies reporting the results of surveys performed between 2003 and 2018. Use of TEE for liver transplantation increased from 11.3% of centers in 2003 to greater than 90% of centers by 2014 and 2018. Only 38%-56% of centers use it routinely with the rest using it only in special circumstances. About a third of centers usually perform a comprehensive exam, with the majority performing a more limited exam based on the needs of the case. Use of TEE for liver transplantation is common but not universal. This review summarizes the current knowledge about the frequency and circumstances of use, but there is an opportunity for further systematic study and discussion.
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12
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Eficacia y seguridad de un protocolo de sedación combinado con propofol como segundo escalón para el ecocardiograma transesofágico. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Bølviken HS, Gerard O, Veronesi F, Samset E. Automatic alignment of standard views for transesophageal echocardiographic images. J Med Imaging (Bellingham) 2022; 9:057001. [PMID: 36330040 PMCID: PMC9618462 DOI: 10.1117/1.jmi.9.5.057001] [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: 02/18/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
Purpose 3D transesophageal echocardiography (TEE) has become an important modality for pre- and peri-operative imaging of valvular heart disease. TEE can give excellent visualization of valve morphology in 3D rendering. As a convention, 3D TEE images are reformatted in three standard views. We describe a method for automatic calculation of parameters needed to define the standard views from 3D TEE images using no manual input. Approach An algorithm was designed to find the center of the mitral valve and the left ventricular outflow tract (OT). These parameters defined the three-chamber view. The problem was modeled as a state estimation problem in which a 3D model was deformed based on shape priors and edge detection using a Kalman filter. This algorithm is capable of running in real time after initialization. Results The algorithm was validated by comparing the automatic alignments of 106 TEE images against manually placed landmarks. The median error for determining the mitral valve center was 7.1 mm, and the median error for determining the left ventricular OT orientation was 13.5 deg. Conclusion The algorithm is an accurate tool for automating the process of finding standard views for TEE images of the mitral valve.
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Affiliation(s)
| | | | | | - Eigil Samset
- University of Oslo, Oslo, Norway
- GE Vingmed Ultrasound, Oslo, Norway
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14
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Dunkman WJ, Williams DA, Manning MW. Bleeding Complications from Transesophageal Echocardiography for Liver Transplantation: A Systematic Review. Semin Cardiothorac Vasc Anesth 2022; 26:304-309. [DOI: 10.1177/10892532221122666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Transesophageal echocardiography (TEE) for liver transplant has historically been avoided due to concern it may cause bleeding from esophageal varices. However, several recent studies, as well as increasing clinical experience, have indicated that it may be safe in many circumstances. We performed a systematic review of the literature to identify and summarize studies reporting complications in patients having TEE during liver transplant. Studies were identified by searching relevant key terms on PubMed as well as citation searching in relevant reviews. We identified 6 studies between 1996 and 2015 which evaluated complications of TEE during liver transplant. They reported an overall bleeding complication rate between .3% and 2.8% and a major bleeding complication rate between .0% and .8%. Most of the major bleeds had identifiable high-risk features such as recent variceal bleeding or banding. Review of the literature suggests that TEE may be safely used in patients undergoing liver transplantation, even with known varices, with a complication rate similar to that of all patients undergoing TEE. However, the risks of TEE may outweigh the potential benefits among patients undergoing liver transplant with particular high-risk features.
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15
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Făgărășan A, Săsăran MO. The Predictive Role of Plasma Biomarkers in the Evolution of Aortopathies Associated with Congenital Heart Malformations. Int J Mol Sci 2022; 23:ijms23094993. [PMID: 35563383 PMCID: PMC9102091 DOI: 10.3390/ijms23094993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
Dilatation of the aorta is a constantly evolving condition that can lead to the ultimate life-threatening event, acute aortic dissection. Recent research has tried to identify quantifiable biomarkers, with both diagnostic and prognostic roles in different aortopathies. Most studies have focused on the bicuspid aortic valve, the most frequent congenital heart disease (CHD), and majorly evolved around matrix metalloproteinases (MMPs). Other candidate biomarkers, such as asymmetric dimethylarginine, soluble receptor for advanced glycation end-products or transforming growth factor beta have also gained a lot of attention recently. Most of the aortic anomalies and dilatation-related studies have reported expression variation of tissular biomarkers. The ultimate goal remains, though, the identification of biomarkers among the serum plasma, with the upregulation of circulating MMP-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), asymmetric dimethylarginine (ADMA), soluble receptor for advanced glycation end-products (sRAGE) and transforming growth factor beta (TGF-β) being reported in association to several aortopathies and related complications in recent research. These molecules are apparently quantifiable from the early ages and have been linked to several CHDs and hereditary aortopathies. Pediatric data on the matter is still limited, and further studies are warranted to elucidate the role of plasmatic biomarkers in the long term follow-up of potentially evolving congenital aortopathies.
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Affiliation(s)
- Amalia Făgărășan
- Department of Pediatrics III, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Târgu Mureș, Romania;
| | - Maria Oana Săsăran
- Department of Pediatrics III, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Târgu Mureș, Romania
- Correspondence: ; Tel.: +40-720-332-503
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16
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Gun M, Barry M, Bohbot Y, Tribouilloy C, Touati G. Modeling of mitral chordae's length in echocardiography as a function of their manual measurement in the operating room. J Cardiothorac Surg 2022; 17:64. [PMID: 35379261 PMCID: PMC8981775 DOI: 10.1186/s13019-022-01816-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective In mitral insufficiency, trans-esophageal echocardiography (TEE) analysis of the mitral valve is an indispensable and irreplaceable examination to establish precisely the type of surgical repair to be performed and the exact length of neo-chordae to be used for an anatomical repair. The aim of our study is to find a predictive model of the Echographic Measurement (EM) variable according to the Manual Measurement (MM) variable of the mitral valve chordae, when the echocardiography measurement is not feasible. Patients and methods This is a retrospective study on 191 patients undergoing mitral valve repair. The sex ratio (M/F) is 2.13 (130 men and 61 women). The collection of data of mitral chordae measurements performed echographically in preoperatively conditions, and then manually in intraoperatively conditions from January 2008 to December 2016 was made from the medical records of patients at the cardiology and cardiac surgery department of the University Hospital Center of Amiens in Picardy. Results For this study 191 patients of mean age of 68 ± 13 years were included. The averages of the MM and EM of the mitral chordae were respectively 23 ± 2.5 mm and 24 ± 2.4 mm. The Pearson correlation coefficient was 0.897 (p-value < 10−4) showing a strong positive correlation between MM and EM. The results of the linear regression allow us to found the following mathematical model: EM = 0.87 × MM + 4. Conclusions When patients have a contraindication to transesophageal echocardiography or when TEE is not feasible, manual measurement is performed during the surgery. By using the values obtained (MM) in the model, it is possible to predict the corresponding echographic measurements. This allows us to achieve the mitral tendinous chordae substitution with a very high precision. Trial registration: Retrospectively registered.
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Affiliation(s)
- Mesut Gun
- Department of Cardiology, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens Cedex 1, France.
| | - Misbaou Barry
- Department of Cardiac Surgery, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens Cedex 1, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens Cedex 1, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens Cedex 1, France
| | - Gilles Touati
- Department of Cardiac Surgery, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens Cedex 1, France
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17
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Alexander J, Castelow C, Cieker C, Wilbanks D, Asbeutah AA, Khouzam RN, Melton CD. Is NPO (Nil Per Os) order helping or hindering elective cardiac procedures? Curr Probl Cardiol 2022:101179. [PMID: 35341803 DOI: 10.1016/j.cpcardiol.2022.101179] [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: 02/27/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
The practice of fasting before elective cardiac procedures including cardiac catheterization and transesophageal echocardiography is commonly implemented but evidence for these requirements is lacking. Fasting periods often exceed the intended length of time, increasing the risk of irritability, dehydration, acute kidney injury, hypoglycemia, and length of hospitalization. The practice of perioperative fasting relies on the premise that aspiration during general anesthesia can be mitigated by minimizing the volume of gastric contents, and stomach acidity. But the evidence has shown that fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. Elective cardiac procedures are performed using procedural sedation, where the risk of serious aspiration is small. In most patients, we argue, that strict fasting requirements should be reduced, and a more nuanced fasting protocol based on individual patient characteristics and risk factors should be utilized given the overall low risk of aspiration with elective procedures utilizing procedural sedation. In this review, we examine the historical origins and current evidence relating to the practice of fasting as it relates to cardiac catheterization and transesophageal echocardiography.
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Affiliation(s)
- John Alexander
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN.
| | | | | | - David Wilbanks
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Abdul Aziz Asbeutah
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN
| | - Charles D Melton
- Baylor Scott and White Health, All Saints Medical Center, Fort Worth, TX
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18
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Risk of Death and Ischemic Stroke in Patients with Atrial Arrhythmia and Thrombus or Sludge in Left Atrial Appendage at One-Year Follow-Up. J Clin Med 2022; 11:jcm11041128. [PMID: 35207399 PMCID: PMC8879808 DOI: 10.3390/jcm11041128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/10/2022] Open
Abstract
Thrombus in the left atrial appendage is a contraindication for cardioversion. Sludge is considered similarly as threatening as thrombus; however, the risk of death and ischemic stroke in patients with atrial arrhythmia and thrombus or sludge is not well-known. This study focused on assessing the risk of death and ischemic stroke at one-year follow-up in patients with atrial arrhythmia and thrombus or sludge, as well as the effectiveness of anticoagulation in thrombus resolution. 77 out of 267 (29%) of patients who were scheduled for cardioversion were diagnosed with thrombus or sludge. The annual mortality in patients with thrombus or sludge was 23%. In the group without thrombus, the annual mortality was 1.6%. Overall, 17% of patients with thrombus or sludge experienced ischemic stroke. In patients without thrombus, the risk of stroke was 1%. Sludge increased risk of stroke compared to those without thrombus or sludge by 11% vs. 1%, respectively. No differences in mortality or stroke prevalence were observed between sludge and thrombus. Thrombus or sludge in the LAA have a poor prognosis. A diagnosis of sludge has a similar impact on risk of ischemic strokes as does a diagnosis of thrombus.
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19
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Hagendorff A, Helfen A, Flachskampf FA, Ewen S, Kruck S, La Rosée K, Knierim J, Voigt JU, Kreidel F, Fehske W, Brandt R, Zahn R, Knebel F. Manual zur Indikation und Durchführung spezieller echokardiographischer Anwendungen. DER KARDIOLOGE 2021. [PMCID: PMC8521495 DOI: 10.1007/s12181-021-00509-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Das zweite Manual zur Indikation und Durchführung der Echokardiographie bezieht sich auf spezifische Anwendungen der Echokardiographie und besondere Fragestellungen bei speziellen Patientengruppen. Dabei stehen v. a. praktische Aspekte im Vordergrund. Methodisch etabliert sind die transösophageale Echokardiographie, die Stressechokardiographie und die Kontrastechokardiographie. Bei nahezu allen echokardiographischen Untersuchungen spielen aktuell 3‑D-Echokardiographie und Deformationsbildgebung eine Rolle. Das gesamte Spektrum der echokardiographischen Möglichkeiten wird derzeit in Notfall- und Intensivmedizin, bei der Überwachung und Führung von Katheterinterventionen, bei strukturellen Herzerkrankungen, bei herzchirurgischen Operationen, bei der Nachsorge von kardialen Unterstützungssystemen, bei kongenitalen Vitien im Erwachsenenalter und bei der Versorgung von hochinfektiösen Patienten in Pandemiezeiten angewandt. Die diagnostischen Fortschritte der konventionellen und modernen echokardiographischen Anwendungen stehen im Fokus dieses Manuals. Die 3‑D-Echokardiographie zur Charakterisierung der kardialen Morphologie und die Deformationsbildgebung zur Objektivierung der kardialen Funktion sind bei vielen Indikationen im klinischen Alltag etabliert. Die Stressechokardiographie zur Ischämie‑, Vitalitäts- und Vitiendiagnostik, die Bestimmung der koronaren Flussreserve und die Kontrastechokardiographie bei der linksventrikulären Wandbewegungsanalyse und kardialen Tumordetektion finden zunehmend klinische Anwendung. Wie für die konventionelle Echokardiographie im ersten Manual der Echokardiographie 2009 beschrieben, erfordert der Einsatz moderner echokardiographischer Verfahren die standardisierte Dokumentation und Akquisition bestimmter Bildsequenzen bei optimierter Geräteeinstellung, da korrekte und reproduzierbare Auswertungen nur bei guter Bildqualität möglich sind.
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Affiliation(s)
- Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Deutschland
| | - Andreas Helfen
- Medizinische Klinik I, Katholisches Klinikum Lünen Werne GmbH St. Marien-Hospital Lünen, Lünen, Deutschland
| | - Frank A. Flachskampf
- Department of Medical Sciences, Universität Uppsala, und Klinisk fysiologi och kardiologi, Uppsala University Hospital, Uppsala, Schweden
| | - Sebastian Ewen
- Klinik für Innere Medizin III – Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Sebastian Kruck
- Cardio Centrum Ludwigsburg Bietigheim, Ludwigsburg, Deutschland
| | - Karl La Rosée
- Gemeinschaftspraxis Dr. La Rosée & Prof. Dr. Müller, Bonn, Deutschland
| | - Jan Knierim
- Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Gasthuisberg und Department of Cardiovascular Sciences, Cath. University Leuven, Leuven, Belgien
| | - Felix Kreidel
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Wolfgang Fehske
- Klinik III für Innere Medizin, Universitätsklinikum Köln – Herzzentrum, Universität zu Köln, Köln, Deutschland
| | - Roland Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B – Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Fabian Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland
- Sana Klinikum Lichtenberg, Berlin, Deutschland
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Pilichowska-Paszkiet E, Baran J, Kułakowski P, Zaborska B. Echocardiographic assessment of left atrial function for prediction of efficacy of catheter ablation for atrial fibrillation. Medicine (Baltimore) 2021; 100:e27278. [PMID: 34559133 PMCID: PMC8462594 DOI: 10.1097/md.0000000000027278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Proper selection for catheter ablation (CA) for atrial fibrillation (AF) is still an issue. Echocardiographic assessment of left atrium (LA) is complex and challenging. Speckle tracking echocardiography (STE) with recent standardized LA deformation analysis allows for the quantitative assessment of various LA function parameters. We aimed to assess the value of detailed evaluations of LA function using STE in patients with non-valvular AF without structural heart disease to predict the outcomes after CA for AF. Secondary aim was to analyze the prediction of CA efficacy in patients with normal LA dimension in baseline echocardiography.We studied with transthoracic and transesophageal echocardiography 82 patients (58% males, mean age 57.3 ± 9.5 years) with non-valvular paroxysmal AF without structural heart disease scheduled for CA. Peak longitudinal LA strain (LAS) and strain rate (LASR) during the reservoir (r), conduit (cd) and contraction (ct) phases were measured by STE before the procedure. Patients were followed for 1 year using serial 4 to 7 day Holter ECG monitoring.Complete freedom from any AF recurrence was achieved in 44 (54%) patients. All patients had normal left ventricular systolic and diastolic function and 53 (65%) of them had not enlarged LA. In the multivariable logistic regression analysis, global left atrial reservoir strain (LASr) was identified as an independent predictor of CA efficacy (OR [95% CI]: 1.35 [1.17-1.55], P < .0001). The opportunity of CA success was 135 fold higher for each 1% increase in global LASr.The receiver operating characteristic (ROC) analysis identified global LASr and left atrial conduit strain (LAScd) as the most powerful parameters for predicting of CA outcome with an area under the curve of 0.896 and 0.860, respectively, in the whole study group, and 0.922 and 0.938, respectively, in patients with not enlarged LA.In patients with paroxysmal AF and normal standard echocardiographic assessment, parameters reflecting LA compliance - reservoir and conduit strain, are independent and strong predictors of CA outcome.
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21
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González-Salvado V, Iglesias-Álvarez D. "The essential and the accessory". Resuscitation 2021; 168:221-222. [PMID: 34509555 DOI: 10.1016/j.resuscitation.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, CIBER-CV, Santiago de Compostela, Spain; Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - Diego Iglesias-Álvarez
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, CIBER-CV, Santiago de Compostela, Spain; Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain
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22
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Xu B, Kocyigit D, Wang TKM, Tan CD, Rodriguez ER, Pettersson GB, Unai S, Griffin BP. Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management. Eur Heart J Cardiovasc Imaging 2021; 23:e111-e122. [PMID: 34591959 DOI: 10.1093/ehjci/jeab185] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
Mitral annular calcification (MAC) refers to calcium deposition in the fibrous skeleton of the mitral valve. It has many cardiovascular associations, including mitral valve dysfunction, elevated cardiovascular risk, arrhythmias, and endocarditis. Echocardiography conventionally is the first-line imaging modality for anatomic assessment, and evaluation of mitral valve function. Cardiac computed tomography (CT) has demonstrated importance as an imaging modality for the evaluation and planning of related procedures. It also holds promise in quantitative grading of MAC. Currently, there is no universally accepted definition or classification system of MAC severity. We review the multimodality imaging evaluation of MAC and associated valvular dysfunction and propose a novel classification system based on qualitative and quantitative measurements derived from echocardiography and cardiac CT.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Carmela D Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
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Labus J, Winata J, Schmidt T, Nicolai J, Uhlig C, Sveric K, Alexiou K, Scholz M, Fassl J. Perioperative Two-Dimensional Left Ventricular Global Longitudinal Strain in Coronary Artery Bypass Surgery: A Prospective Observational Pilot Study. J Cardiothorac Vasc Anesth 2021; 36:166-174. [PMID: 34526240 DOI: 10.1053/j.jvca.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There are limited data on perioperative left ventricular strain. The authors aimed to describe the entire perioperative course of two-dimensional left ventricular global longitudinal strain in patients undergoing coronary artery bypass graft (CABG) surgery and compare to common parameters of LV function assessment. DESIGN Prospective observational study. SETTING Single university hospital. PARTICIPANTS Forty patients scheduled for isolated on-pump CABG surgery with preserved left and right ventricular function with an unremarkable, complication-free perioperative course. INTERVENTIONS Two-dimensional strain analysis and standard echocardiographic assessment of left ventricular function were performed pre- (T1) and postoperatively (T4) by transthoracic echocardiography (TTE) and intraoperatively pre- (T2) and poststernotomy (T3) by transesophageal echocardiography (TEE). Echocardiography was performed under stable hemodynamics and predefined fluid management, in sinus rhythm without any vasoactive support. MEASUREMENTS AND MAIN RESULTS Analysis of two-dimensional LV global longitudinal strain (2D-LV GLS) was performed using Tomtec 2D Cardiac Performance Analysis software. Philips QLAB 10.8 was used to analyze left ventricular ejection fraction (LV EF) and tissue velocity of the lateral mitral annulus (LV S ́). There were no significant differences (median with interquartile range [IQR]) after induction of anesthesia in values of LV EF and 2D-LV GLS (T1 v T2; 59% [IQR, 52 to 64] v 56% [IQR, 51.75 to 63] and -15.2 [IQR, -18.05 to -13.08] v -15.6 [IQR, -17.65 to -13.88]; both not significant [ns]), while LV S´ declined (T1 v T2, 7 cm/s [IQR, 5.25 to 8] v 5.25 cm/s [IQR, 4.6 to 6.83]; p < 0.001). Bland-Altman analysis for this comparison of 2D-LV GLS (T1 v T2) showed that bias was not significant between both techniques; however, there were limits of agreement. After sternotomy (T2 v T3) neither LV EF nor 2D-LV GLS or LV S´ declined. 2D-LV GLS deteriorated significantly after CABG (T1 v T4; -15.2 [IQR, -18.05 to -13.08] v -11.3 [IQR, -15.8 to -9.78]; p < 0.001). In contrast, LV EF and LV S´ did not change significantly in the perioperative interval (T1 v T4; 59% [IQR, 52 to 64] v 56% [IQR, 51.5 to 64.25] and 7 cm/s [IQR, 5.25 to 8] v 7 cm/s [IQR, 6 to 8]; both ns). CONCLUSION Values of 2D-LV GLS did not differ in awake, spontaneously breathing patients assessed by TTE and in anesthetized and ventilated patients with stable hemodynamics measured by TEE. 2D-LV GLS did not change after sternotomy; however, it declined significantly after on-pump CABG, while LV EF and LV S´ remained unchanged.
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Affiliation(s)
- Jakob Labus
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne University, Cologne, Germany
| | - Johan Winata
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Torsten Schmidt
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Joachim Nicolai
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Christopher Uhlig
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Kunislav Sveric
- Department of Cardiology and Internal Medicine, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Konstantin Alexiou
- Department of Heart Surgery, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jens Fassl
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany.
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24
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Labus J, Uhlig C. Role of Echocardiography for the Perioperative Assessment of the Right Ventricle. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
This review aims to highlight the perioperative echocardiographic evaluation of right ventricular (RV) function with strengths and limitations of commonly used and evolving techniques. It explains the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and describes the perioperative changes of RV function echocardiographers should be aware of.
Recent Findings
RV dysfunction is an entity with strong influence on outcome. However, its definition and assessment in the perioperative interval are not well-defined. Moreover, values assessed by TTE and TEE are not interchangeable; while some parameters seem to correlate well, others do not. Myocardial strain analysis and three-dimensional echocardiography may overcome the limitations of conventional echocardiographic measures and provide further insight into perioperative cardiac mechanics.
Summary
Echocardiography has become an essential part of modern anesthesiology in patients with RV dysfunction. It offers the opportunity to evaluate not only global but also regional RV function and distinguish alterations of RV contraction.
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Lee S, Kim IC, Kim YD, Nam HS, Kim SY, Choi SM, Chang HJ. The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke. Eur Radiol 2021; 31:8983-8990. [PMID: 34075451 DOI: 10.1007/s00330-021-08037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We explored the hypothesis that the diagnostic performance of cardiac computed tomography (CT) throughout the full cardiac cycle would be superior to single-phase CT and comparable to transesophageal echocardiography (TEE) in diagnosing patent foramen ovale (PFO). METHODS AND RESULTS From May 2011 to April 2015, 978 patients with stroke were diagnosed with PFO by TEE. In patients with stroke, cardiac CT was performed if the patients had more than two cardiovascular risk factors. We prospectively enrolled 70 patients with an indication for cardiac CT. Cardiac CT images were reconstructed at 10% increments of the R-R interval. The sensitivity of cardiac CT throughout the full cardiac cycle in diagnosing PFO was compared to that for TEE and single-phase cardiac CT. To evaluate the specificity of cardiac CT, we analyzed patients without PFO confirmed by TEE who underwent cardiac CT within 1 month of pre-cardiac surgery. Sixty-six patients with cardiac CT and TEE were included in the final analysis. Throughout the full cardiac cycle, cardiac CT had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing PFO, compared to TEE as a reference. PFO was primarily detected in the 60% and 70% intervals in 10-phase reconstructed images. The sensitivity of PFO diagnosis with cardiac CT was 81.8% when analyzing both the 60% and 70% intervals instead of the full cardiac cycle. CONCLUSION Cardiac CT throughout the full cardiac cycle outperforms single-phase cardiac CT in detecting PFO. Cardiac CT can be used as an alternative method to TEE for detecting PFO in stroke patients. KEY POINTS • Throughout the full cardiac cycle, cardiac computed tomography (CT) had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing patent foramen ovale (PFO), compared to transesophageal echocardiography. • The sensitivity of diagnosing patent foramen ovale with cardiac CT was 81.8% when analyzing 60% and 70% R-R intervals instead of the full cardiac cycle. • Cardiac CT with retrospective electrocardiographic gating throughout the full cardiac cycle can increase the detectability of PFO, compared to single-phase cardiac CT.
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Affiliation(s)
- Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - In-Cheol Kim
- Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Young Dae Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - So Yeon Kim
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Seon Mi Choi
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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A Case of Decompression Sickness Associated With PFO in a Dive Medical Officer. POLISH HYPERBARIC RESEARCH 2021. [DOI: 10.2478/phr-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Current medical guidelines and regulations do not require routine examinations for the right-to-left shunt at divers. We present the case of a Polish Navy Dive Medical Officer (DMO) who more than 20 years ago suffered from decompression ilness - bends accompanied by cutis marmorata, numbness in one limb and mild vertigo. After treatment in decompression chamber all symptoms entirely resolved. Since then, despite of continuing diving, he experienced no decompression ilness symptoms. Twenty years later, then 52 years-old, the DMO was admitted as a patient to the Neurology Department at the Gdańsk Naval Hospital due to episodes of transient ischemic attacks. Contrast-enhanced transcranial Doppler ultrasound and transesophageal echocardiography were performed and he was diagnosed with severe right-to-left shunt across a patent foramen ovale (PFO). Retrospectively analyzing incident of DCI he suffered 20 years earlier, we suppose that it may have been caused by paradoxical air embolism associated with the RLS across the PFO, which was not diagnosed at the time of this incident yet. We conclude that although the risk of severe neurological, cutaneous or vestibular forms of DCI is very low, in order to increase diving safety, it seems to be reasonable to develop standards for initial PFO screening in certain groups of divers - professional divers, military divers and medical diving personnel. Contrast-enhanced transcranial Doppler ultrasound seems to be useful in RLS screening in divers. Using multi-compartment chambers equipped with an entry lock should be preferred for safe recompression treatment of divers.
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Mauermann E, Bouchez S, Bove T, Vandenheuvel M, Wouters P. Assessing Left Ventricular Early Diastolic Velocities With Tissue Doppler and Speckle Tracking by Transesophageal and Transthoracic Echocardiography. Anesth Analg 2021; 132:1400-1409. [PMID: 33857980 DOI: 10.1213/ane.0000000000005469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Assessing diastolic dysfunction is essential and should be part of every routine echocardiography examination. However, clinicians routinely observe lower mitral annular velocities by transesophageal echocardiography (TEE) under anesthesia than described by awake transthoracic echocardiography (TTE). It would be important to know whether this difference persists under constant loading conditions. We hypothesized that mean early diastolic mitral annular velocity, measured by tissue Doppler imaging (TDI, JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic1/v/2021-04-15T211206Z/r/image-tiff) would be different in the midesophageal 4-chamber (ME 4Ch) than in the apical 4-chamber (AP 4Ch) view under unchanged or constant loading conditions. Secondarily we examined (1) JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic2/v/2021-04-15T211206Z/r/image-tiff in an alternative transesophageal view with presumed superior Doppler beam alignment, the deep transgastric view (DTG), compared to those in the AP 4Ch, and (2) early diastolic speckle tracking-based strain rate (JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic3/v/2021-04-15T211206Z/r/image-tiff), in the ME 4Ch and in the AP 4Ch. METHODS Twenty-five consecutive adult patients undergoing on-pump cardiac surgery from February 2017 to July 2017 were included. Both TTE and TEE measurements were obtained under anesthesia in a randomized order in the AP 4Ch, ME 4Ch, and DTG views. Within-patient average values were compared by paired t tests with a Bonferroni adjustment. Box plots, correlation, and agreement by Bland-Altman were examined for all 3 comparisons. A second echocardiographer independently acquired and analyzed images; images were reanalyzed after 4 weeks. Image quality and reproducibility were also reported. RESULTS Averaged JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic4/v/2021-04-15T211206Z/r/image-tiff measurements were lower in the ME 4Ch than in the AP 4Ch (6.6 ± 1.7 cm/s vs 7.0 ± 1.5 cm, P = .028; within-patient difference mean ± standard deviation: 0.6 ± 1.2 cm/s). An alternative TEE view for JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic5/v/2021-04-15T211206Z/r/image-tiff, the DTG, also exhibited lower mean values (6.0 ± 1.6 cm/s, P = .006; within-patient difference mean ± standard deviation: 1.1 ± 1.8 cm/s). JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic6/v/2021-04-15T211206Z/r/image-tiff strain rate showed a low degree of bias, but greater variability (ME 4Ch: 0.87 ± 0.32%/s vs AP 4Ch: 0.73 ± 0.18%/s, P = .078; within-patient difference mean ± standard deviation: -0.1 ± 0.2%/s). CONCLUSIONS This study confirms that TEE modestly underestimates JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic7/v/2021-04-15T211206Z/r/image-tiff but not to a clinically relevant extent. While JOURNAL/asag/04.03/00000539-202105000-00029/inline-graphic8/v/2021-04-15T211206Z/r/image-tiff in the DTG is not a promising alternative, the future role for speckle tracking-based early diastolic strain rate is unknown.
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Affiliation(s)
- Eckhard Mauermann
- From the Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium.,Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel University Hospital, Basel, Switzerland
| | - Stefaan Bouchez
- From the Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michael Vandenheuvel
- From the Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Patrick Wouters
- From the Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
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Kossaify A. Quality Assurance and Improvement Project in Echocardiography Laboratory: The Pivotal Importance of Organizational and Managerial Processes. Heart Views 2021; 22:35-44. [PMID: 34276887 PMCID: PMC8254161 DOI: 10.4103/heartviews.heartviews_112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/04/2021] [Indexed: 11/04/2022] Open
Abstract
Echocardiography plays a vital role in the diagnosis and management of cardiovascular conditions. Echocardiography use is progressively increasing nowadays, and this is correlated to the evolving echo indications, to the relatively new available echocardiography modes (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, etc.) and modalities (transthoracic, transesophageal, and intracardiac) along with the various available clinical approaches (point of care echo, portable echo, etc.). Quality assurance in echocardiography is correlated to appropriate use criteria, adequate equipment, standardization of performance and reporting, along with timely storage and archiving. Quality improvement plan must target strategic planning, with metrics and timeline for assessment and re-assessment of results. Improvement project aims to ensure and enhance conformity with appropriate use criteria and standardization, timely completion of exams and reports, detection of discrepancies, and continuous improvement of knowledge and skills. Strategic planning is essential in this context in order to develop organizational and managerial processes, with regular auditing for a highly professional and advanced level of echocardiography, while ensuring teamwork and standards of ethical values.
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Affiliation(s)
- Antoine Kossaify
- Division of Cardiology, University Hospital Notre Dame Des Secours, Byblos, Lebanon.,School of Medicine and Medical Sciences (SMMS), USEK University, Kaslik, Lebanon
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Bekouti JT, Rambolarimanana M, Adossou AC, Ranaivosoa MR, Prudencio R, Lawani PB, Ranjatson A, Diawara A, Roynard JL. [The role of transesophageal echocardiography (TEE): case study conducted at the Dax Hospital Center]. Pan Afr Med J 2021; 38:296. [PMID: 34178215 PMCID: PMC8197063 DOI: 10.11604/pamj.2021.38.296.22464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 02/20/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to assess the role of transesophageal echocardiography at the Dax Hospital Center based on indications, patients´ profile, results, cost-effectiveness and consistency with prescribers´ expectations. We conducted a retrospective, cross-sectional, descriptive and analytical study at the Cardiovascular Laboratory of the Dax Hospital Center from January 2016 to December 2018. The study included 434 exams out of 460 requested. The variables of interest were: demographic profile of the study population, indications, results, cost-effectiveness and consistency with prescribers´ expectations. The average age of patients undergoing the 434 exams included was 64.37 years, male patients accounted for 64.29%, with a sex ratio of 1.8. Stroke assessment (63.59%), the search for infective endocarditis (16.12%) and the assessment of the treatment of intracavitary thrombi (11.75%) were the main indications. Prescribers were mainly neurologists (60.83%). The examination was normal in 58.99% of cases. The pathological results (40,78%) were dominated by thrombi in the auricle (27.65%), altered auricle emptying (9.45%), the presence of foramen oval permeable (5.07%), interatrial septal aneurysm (2.53%) and infective endocarditis (2.76%). The exam was cost-effective in 40.78% of cases and the results were consistent with prescribers´ expectations in 39.86% of cases. Our study transesophageal echocardiography showed that the indications were dominated by stroke assessment. TEE is a cost-effective diagnostic test with a low rate of complications, and whose results are in line with practitioners' expectations.
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Affiliation(s)
- Jean Timnou Bekouti
- Service de Cardiologie, Centre Hospitalier de Dax-Côte d’Argent, Dax, 40100, France
| | | | | | | | - Roberto Prudencio
- Service de Médecine Interne, Centre Hospitalier de Dax-Côte d´Argent, Dax, 40100, France
| | | | - Alain Ranjatson
- Service de Cardiologie, Centre Hospitalier de Dax-Côte d’Argent, Dax, 40100, France
| | - Alpha Diawara
- Service de Neurologie, Centre Hospitalier de Dax-Côte d´Argent, Dax, 40100, France
| | - Jean Louis Roynard
- Service de Cardiologie, Centre Hospitalier de Dax-Côte d’Argent, Dax, 40100, France
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Billig S, Zayat R, Ebeling A, Steffen H, Nix C, Hatam N, Schnöring H, Derwall M. Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work. Int J Cardiovasc Imaging 2021; 37:835-846. [PMID: 33048268 PMCID: PMC7969559 DOI: 10.1007/s10554-020-02053-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
This study aimed to determine standard left (LV) and right ventricular (RV) transesophageal echocardiographic (TEE) measurements in swine. Additionally, global myocardial work index (GWI) was estimated using pressure-strain loops (PSL). A comprehensive TEE examination was conducted in ten anesthetized, intubated and mechanically ventilated healthy female German landrace swine, weighing 44 to 57 kg. For GWI calculation, we performed LV and RV segmental strain analysis and used invasively measured LV and RV pressure to obtain PSL. The GWI and further myocardial work indices were calculated from the area of the PSL using commercially available software. Furthermore, hemodynamic measurements were obtained using indwelling catheters. We obtained complete standardized baseline values for left and right ventricular dimensions and function. Biplane LV ejection fraction was 63 ± 7 % and the LV end-diastolic volume was 70.5 ± 5.9 ml. Tissue Doppler estimated peak tricuspid annular systolic velocity was 13.1 ± 1.8 cm/s. The Doppler estimated LV and RV stroke volume index were 75.6 ± 7.2 ml/m2 and 76.7 ± 7.8 ml/m2 respectively. Pulsed wave Doppler derived cardiac output correlated well with cardiac output estimated using the thermodilution method (7.0 ± 1.2 l/min vs. 7.0 ± 1.1 l/min, r = 0.812, p = 0.004). The LV global longitudinal strain was -21.3 ± 3.9 % and the RV global longitudinal strain was -15.4 ± 2.5 %. LV GWI was 1885(1281-2121) mmHg*% and 297 ± 62 mmHg*% for the RV. LV global myocardial work efficiency was 82.6 ± 4 % and 83(72-88) % for the RV. TEE offers sufficient morphological, functional and hemodynamic assessment of the heart in swine. Myocardial contractility and mechanics can be reliably evaluated with the non-invasive GWI derived from echocardiography without additional invasive measures.
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Affiliation(s)
- Sebastian Billig
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Rashad Zayat
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Andreas Ebeling
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Henning Steffen
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Christoph Nix
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
- Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, 52074, Germany
| | - Nima Hatam
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Heike Schnöring
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Matthias Derwall
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany.
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Labus J, Winata J, Schmidt T, Nicolai J, Tomko M, Sveric K, Wilbring M, Fassl J. Perioperative Course of Three-Dimensional-Derived Right Ventricular Strain in Coronary Artery Bypass Surgery: A Prospective, Observational, Pilot Trial. J Cardiothorac Vasc Anesth 2021; 35:1628-1637. [PMID: 33582011 DOI: 10.1053/j.jvca.2021.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Few data exist on perioperative three-dimensional-derived right ventricular strain. The authors aimed to describe the perioperative course of three-dimensional-derived right ventricular strain in coronary artery bypass graft (CABG) surgery patients. DESIGN Prospective, observational, pilot trial. SETTING Single university hospital. PARTICIPANTS The study comprised 40 patients with preserved left ventricular and right ventricular (RV) function undergoing isolated on-pump CABG surgery. INTERVENTIONS Three-dimensional strain analysis and standard echocardiographic evaluation of RV function were performed preoperatively (T1) and postoperatively (T4) with transthoracic echocardiography (TTE) and intraoperatively before sternotomy (T2) and after sternotomy (T3) with transesophageal echocardiography (TEE). All echocardiographic measurements were performed under stable hemodynamic conditions and predefined fluid management without any vasoactive support. MEASUREMENTS AND MAIN RESULTS The measurements of three-dimensional-derived RV free-wall strain (3D-RV FWS) and RV ejection fraction were performed using TomTec 4D RV-Function 2.0 software. Philips QLAB 10.8 was used to analyze tissue velocity of the tricuspid annulus, tricuspid annular systolic excursion, and RV fractional area change. There were no significant differences (median [interquartile range {IQR}]) between preoperative TTE and intraoperative TEE measurements for 3D-RV FWS (T1 v T2: -22.35 [IQR -17.70 to -27.22] v -24.35 [IQR -20.63 to -29.88]; not significant). 3D-RV FWS remained unchanged after sternotomy (T2 v T3: -24.35 [IQR -20.63 to -29.88] v -23.75 [IQR -20.25 to -29.28]; not significant) but deteriorated significantly after CABG (T1 v T4: -22.35 [IQR -17.70 to -27.22] v -18.5 [IQR -16.90 to -21.65]; p = 0.004). CONCLUSION In patients undergoing on-pump CABG, 3D-RV FWS values for awake, spontaneously breathing patients measured with TTE and values assessed in patients under general anesthesia with TEE did not significantly differ. Three-dimensional RV FWS did not change after sternotomy but deteriorated after on-pump CABG.
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Affiliation(s)
- Jakob Labus
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Johan Winata
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Torsten Schmidt
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Joachim Nicolai
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Matus Tomko
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Kunislav Sveric
- Department of Cardiology and Internal Medicine, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Manuel Wilbring
- Department of Heart Surgery, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Jens Fassl
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany.
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Visby L, Kristensen CB, Pedersen FHG, Sigvardsen PE, Kofoed KF, Hassager C, Møgelvang R. Assessment of left ventricular outflow tract and aortic root: comparison of 2D and 3D transthoracic echocardiography with multidetector computed tomography. Eur Heart J Cardiovasc Imaging 2020; 20:1156-1163. [PMID: 30879047 DOI: 10.1093/ehjci/jez045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
AIMS Accurate echocardiographic assessment of left ventricular outflow tract (LVOT) and the aortic root is necessary for risk stratification and choice of appropriate treatment in patients with pathologies of the aortic valve and aortic root. Conventional 2D transthoracic echocardiographic (TTE) assessment is based on the assumption of a circular shaped LVOT and aortic root, although previous studies have indicated a more ellipsoid shape. 3D TTE and multidetector computed tomography (MDCT) applies planimetry and are not dependent on geometrical assumptions. The aim was to test accuracy, feasibility, and reproducibility of 3D TTE compared to 2D TTE assessment of LVOT and aortic root areas, with MDCT as reference. METHODS AND RESULTS We examined 51 patients with 2D/3D TTE and MDCT at the same day. All patients were re-examined with 2D/3D TTE on a different day to evaluate 2D and 3D re-test variability. Areas of LVOT, aortic annulus, and sinus were assessed using 2D, 3D TTE, and MDCT. Both 2D/3D TTE underestimated the areas compared to MDCT; however, 3D TTE areas were significantly closer to MDCT-areas. 2D vs. 3D mean MDCT-differences: LVOT 1.61 vs. 1.15 cm2, P = 0.019; aortic annulus 1.96 vs. 1.06 cm2, P < 0.001; aortic sinus 1.66 vs. 1.08 cm2, P = 0.015. Feasibility was 3D 76-79% and 2D 88-90%. LVOT and aortic annulus areas by 3D TTE had lowest variabilities; intraobserver coefficient of variation (CV) 9%, re-test variation CV 18-20%. CONCLUSION Estimation of LVOT and aortic root areas using 3D TTE is feasible, more precise and more accurate than 2D TTE.
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Affiliation(s)
- Lasse Visby
- The Heart Center, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | | | | | | | | | | | - Rasmus Møgelvang
- The Heart Center, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). ACTA ACUST UNITED AC 2020; 67:446-480. [PMID: 32948329 DOI: 10.1016/j.redar.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
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Affiliation(s)
- P Carmona García
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Coordinadora del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SEDAR
| | - R García Fuster
- Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, España. Coordinador del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SECCE.
| | - E Mateo
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - S Badía Gamarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Trías y Pujol, Badalona, España
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España
| | - E Gutiérrez Carretero
- Servicio de Cirugía Cardiaca, Hospital, Universitario Virgen del Rocío, Sevilla, España
| | - M L Maestre
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - V Legname
- Servicio de Cirugía Cardiaca, Centro Médico Teknon, Barcelona, España
| | - G Fita
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación. Hospital Clínic, Barcelona, España
| | - M Vives
- EDAIC. PhD. Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Universitario Dr Josep Trueta de Girona, España. Representante de España en la EACTA. Co-director del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Representante del subcomité de Educación de EACTA. Co-director grupo EchoSim
| | - T Koller Bernhard
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Sánchez Pérez
- EDAIC. Sección de Cirugía Cardiaca, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR
| | - J Miralles Bagán
- Sección Cardiotorácica, Servicio Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - S Italiano
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - B Darias-Delbey
- Servicio Anestesiología y Reanimación, Proceso del Paciente, Cardioquirúrgico, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, España
| | - J M Barrio
- Sección Anestesia y Reanimación Cardiovascular, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General. Universitario Gregorio Marañón, Madrid, España
| | - J I Sáez de Ibarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - A Hernández
- Departamento de Anestesia y Cuidados Intensivos, Grupo Policlínica, Ibiza, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos, de la SEDAR Representante del subcomité de Educación de EACTA, EDAIC, Codirector grupo EchoSim
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The Predictive Value of Growth Differentiation Factor-15 in Recurrence of Atrial Fibrillation after Catheter Ablation. Mediators Inflamm 2020; 2020:8360936. [PMID: 32904560 PMCID: PMC7456492 DOI: 10.1155/2020/8360936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022] Open
Abstract
The mechanisms underlying the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are not well concerned. The study sought to explore the association between growth differentiation factor-15 (GDF-15) and the incidence of recurrent events among AF patients after the ablation procedure. We prospectively included 150 consecutive AF patients who underwent RFCA. Clinical information about the patients was collected. Blood samples on the second morning of hospital admission and three months after RFCA were collected, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of GDF-15. All participants were followed up at specific times (1st/3rd/6th/12th/18th/24th months) after RFCA to record recurrences events. During a median follow-up of 14.0 months, AF recurrence occurred in 37(24.7%) patients. Baseline serum GDF-15 level in the persistent AF group was significantly higher than the paroxysmal AF group [1140(854~1701)ng/L vs. 1062(651~1374)ng/L, P = 0.039]. Baseline serum GDF-15 level in the recurrence group was significantly higher than the nonrecurrence group [1287(889~1768) ng/L vs. 1062(694~1373)ng/L, P = 0.022]. Serum GDF-15 level at three months after RFCA was significantly lower than the baseline [870 (579~1270) ng/L vs. 1155 (735~1632)ng/L, P < 0.001]. The baseline GDF-15 correlated significantly with LAP (r = 0.296, P < 0.001) and LAAV(r = −0.235, P = 0.003). Kaplan-Meier analysis showed a significantly lower event-free survival time in the high baseline GDF-15 (≥1287.3 ng/L) group than the low baseline GDF-15 (<1287.3 ng/L) group (17.1 months vs. 20.4 months, Log Rank P = 0.017). In the multivariate Cox regression, baseline GDF-15(HR 1.053, 95% CI 1.007-1.100, P = 0.022) and LAD (HR 1.124, 95% CI 1.011-1.250, P = 0.030) were independent predictors of AF recurrence after RFCA. Our study indicated increased preprocedural GDF-15 is associated with left atrial remodeling and acts as a predictor of AF recurrence after ablation.
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bouchez S, De Somer F. The evolving role of the modern perfusionist: insights from transesophageal echocardiography. Perfusion 2020; 36:222-232. [PMID: 32729372 DOI: 10.1177/0267659120944094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transesophageal echocardiography is a relatively non-invasive, mobile, safe imaging technique that is ideal for providing real-time information on cardiac anatomy and function during heart surgery. The technology has evolved from two-dimensional to real-time three-dimensional imaging during cardiac procedures, which has significantly benefited preoperative planning, intraoperative guidance, evaluation, and postoperative follow-up. Transesophageal echocardiography may serve the clinical perfusionist by providing imaging guidance for identifying potential problems before cardiopulmonary bypass, guiding the proper placement of cannulas, monitoring cardiac performance on cardiopulmonary bypass, and providing useful feedback during weaning from cardiopulmonary bypass. Although the perfusionist should be able to understand all echocardiographic images and measurements in depth, perfusion-related echocardiographic information can or should be used to optimize the clinical practice of the modern perfusionist. Vice versa, whenever the perfusionist suspects a problem, the surgical team including the sonographer should verify this "clinical treat" by echocardiography whenever possible.
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Affiliation(s)
- Stefaan Bouchez
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Filip De Somer
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
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Left atrial mechanical remodelling assessed as the velocity of left atrium appendage wall motion during atrial fibrillation is associated with maintenance of sinus rhythm after electrical cardioversion in patients with persistent atrial fibrillation. PLoS One 2020; 15:e0228239. [PMID: 31995607 PMCID: PMC6988946 DOI: 10.1371/journal.pone.0228239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/11/2020] [Indexed: 11/19/2022] Open
Abstract
The velocity of left atrium appendage (LAA) wall motion during atrial fibrillation (AF) is a potential marker of mechanical remodelling. In this study, we investigated whether the velocity of LAA wall motion during AF predicted the success of electrical cardioversion and long-term sinus rhythm maintenance. Standard echocardiographic data were obtained by transthoracic echocardiography, and LAA wall motion velocities were measured by transoesophageal echocardiography. With logistic regression and receiver operating characteristic curve analyses, we related echocardiographic and clinical data to cardioversion outcomes and sinus rhythm maintenance at 12 months. Of 121 patients prospectively included in the study, electrical cardioversion restored sinus rhythm in 97 (81.2%), and 51 (42%) patients maintained sinus rhythm at 12 months. Patients in whom cardioversion restored sinus rhythm had higher LAA wall motion velocities than did the patients with failed cardioversions (p <0.001). Compared to patients with AF at 12 months, patients who maintained sinus rhythm had lower maximum and end-diastolic left atrial volumes (p ≤ 0.01), lower E/e’ ratios (p = 0.005), higher s’ values (p = 0.013), and higher LAA motion velocities (p < 0.001). On multivariate logistic regression, only LAA wall motion velocity and E/e’ ratios remained significant predictors of sinus rhythm maintenance at 12 months (p ≤ 0.04). LAA wall motion velocity was also a significant predictor of sinus rhythm maintenance when corrected for clinical variables (p = 0.039). Conclusion: LAA wall motion velocity, as a marker of mechanical remodelling, can predict short-term and long-term sinus rhythm maintenance after electrical cardioversion in AF.
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Resen MS, Poulsen MB, Overgaard K, Rasmussen RS, Soja AMB, Nilsson B, Kristensen MO, Kruuse C, Ulriksen PS. Cardiovascular computed tomography versus transoesophageal echocardiography after cryptogenic ischaemic stroke – a pilot study of 12 patients. J Int Med Res 2020; 48:300060518764220. [PMID: 29848127 PMCID: PMC7287197 DOI: 10.1177/0300060518764220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Transoesophageal echocardiography (TEE) is the gold standard for the detection of cardiac emboli sources in ischaemic stroke patients, but new computed tomography (CT) scanners are able to visualize the heart. This pilot study aimed to compare findings on TEE with combined cardiovascular scan and cerebral CT angiography in cryptogenic ischaemic stroke patients. Methods This pilot study enrolled patients with cryptogenic ischaemic stroke who underwent a combined cardiovascular and cerebral CT angiography scan and a TEE examination, which were interpreted in a blinded manner. Results Twelve patients with cryptogenic ischaemic stroke were included (mean age 56 years). Of these, 10 patients underwent both a combined cardiovascular and cerebral CT angiography and a TEE examination. All cardiovascular CT scans were readable at sinus rhythm. None of the simultaneous cerebral angiograms were compromised. Thrombi were not detected in any patients. Patent foramen ovale was visualized in five patients by TEE, while cardiovascular CT only identified three. Cardiovascular CT revealed in addition an X-ray negative pulmonary metastasis in one patient, aortic coarctation in another and significant coronary stenosis in four patients. Conclusion The sensitivity for detecting patent foramen ovale was considerably lower for cardiovascular CT than for TEE, however the cardiovascular CT revealed several other very important clinical findings.
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Affiliation(s)
- Mette Sørensen Resen
- Department of Neurology, Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
| | - Mai Bang Poulsen
- Department of Neurology, Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
| | - Karsten Overgaard
- Department of Neurology, Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
| | | | - Anne Merete Boas Soja
- Department of Cardiology, Hvidovre Hospital, University Hospital of Copenhagen, Hvidovre, Denmark
| | - Brian Nilsson
- Department of Cardiology, Hvidovre Hospital, University Hospital of Copenhagen, Hvidovre, Denmark
| | | | - Christina Kruuse
- Department of Neurology, Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
| | - Peter Sommer Ulriksen
- Department of Radiology, Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
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Piotrowski R, Zaborska B, Pilichowska-Paszkiet E, Sikora-Frąc M, Baran J, Kułakowski P. RIVAroxaban TWICE daily for lysis of thrombus in the left atrial appendage in patients with non-valvular atrial fibrillation: the RIVA-TWICE study. Arch Med Sci 2020; 16:289-296. [PMID: 32190138 PMCID: PMC7069443 DOI: 10.5114/aoms.2019.86616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/22/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Rivaroxaban is a direct factor Xa inhibitor used once a day for prevention of thrombotic events in patients with atrial fibrillation (AF). However, in a small proportion of subjects thrombus in the left atrial appendage (LAA) is present despite this treatment. The aim of this study was assess the efficacy of increased dose of rivaroxaban (15 mg twice daily) treatment for lysis of thrombus in the LAA. MATERIAL AND METHODS In the RIVA-TWICE prospective, open label study, with non-blinded patients and blinded outcome assessors, rivaroxaban 15 mg twice daily for 8 weeks was administered in patients with AF who had LAA thrombus despite standard 20 mg once a day therapy. Transesophageal echocardiography was performed at baseline and after 8 weeks. Blood samples were taken to measure the activity of the anti-Xa factor. RESULTS Fifteen patients (9 males, mean age: 63 ±10 years) were enrolled. Following 8 weeks of rivaroxaban 15 mg twice daily, complete resolution of thrombus in the LAA was observed in 7 (46.7%) patients. The mean activity of anti-Xa factor was significantly higher during rivaroxaban twice daily therapy compared with the standard dose. However, there were no significant differences between effectively and non-effectively treated patients. CONCLUSIONS Rivaroxaban 15 mg twice daily seems to be safe and may dissolve LAA thrombus when standard rivaroxaban therapy is ineffective. Lower CHA2DS2-VASc and HAS-BLED as well as preserved LAA emptying function identified responders.
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Affiliation(s)
- Roman Piotrowski
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Beata Zaborska
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | | | - Małgorzata Sikora-Frąc
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
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Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers. POLISH HYPERBARIC RESEARCH 2019. [DOI: 10.2478/phr-2019-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.
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Mauermann E, Vandenheuvel M, François K, Bouchez S, Wouters P. A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular Velocities in TEE. J Cardiothorac Vasc Anesth 2019; 33:2636-2644. [DOI: 10.1053/j.jvca.2019.05.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 11/11/2022]
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Farinha JM, Parreira L, Marinheiro R, Fonseca M, Mesquita D, Gonçalves S, Miranda C, Silvestre I, Caria R. A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow-up. Echocardiography 2019; 36:1859-1868. [PMID: 31503373 DOI: 10.1111/echo.14478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Silent atrial fibrillation is a frequent etiology of cryptogenic stroke. Spontaneous conversion of atrial fibrillation to sinus rhythm results in atrial stunning. OBJECTIVE To evaluate if the presence of a lower left atrial appendage peak emptying velocity (LAAV) after a cryptogenic stroke is associated with the occurrence of atrial fibrillation (AF). METHODS We retrospectively selected consecutive patients with an acute ischemic stroke that had a transoesophageal echocardiogram (TEE) performed in the first 30 days of the acute event. Documented AF or potential cardioembolic sources in the TEE were considered exclusion criteria. We assessed the LAAV. During follow-up, we evaluated the occurrence of new-onset AF and the combined endpoint of death or new ischemic stroke. RESULTS We studied 73 consecutive patients, during a mean follow-up period of 54.9 ± 19.3 months. Seven developed AF, and 13 had the combined endpoint. LAAV was independently associated with AF occurrence (HR: 0.93, 95% CI: 0.88-0.99; P = .016). Patients with a LAAV ≤ 46.5 cm/s (AUC: 0.766, 95% CI: 0.579-0.954; P = .021) had a lower survival rate free from AF occurrence (Log-rank, P < .001) and free from the combined endpoint of death or ischemic stroke (Log-rank, P = .010). CONCLUSION A lower LAAV was associated with AF occurrence and the combined endpoint of death or ischemic stroke after an initial episode of cryptogenic stroke. Patients with this finding could eventually benefit from long-term cardiac rhythm monitoring.
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Affiliation(s)
| | - Leonor Parreira
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Rita Marinheiro
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Marta Fonseca
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Dinis Mesquita
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Sara Gonçalves
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Carla Miranda
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Isabel Silvestre
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Rui Caria
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
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Shojaei Fard M, Rezaeian N, Pourafkari L, Erami S, Nader ND. Level of agreement in three-dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography. Echocardiography 2019; 36:1501-1508. [PMID: 31287583 DOI: 10.1111/echo.14431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Echocardiographic measurement of mitral valve area (MVA) is critical prior to percutaneous transmitral commissurotomy (PTMC). This study aimed to compare the agreement between transthoracic (TTE) and transesophageal echocardiography (TEE) in three-dimensional (3D) planimetric measurement of the MVA among patients with severe mitral stenosis. METHODS MVA was measured with planimetry in 105 patients before undergoing PTMC. 3D reconstruction was applied to both TTE and TEE examinations. The MVA values from four different methods of 3D reconstruction were compared to the average values of 3D methods in TEE as the gold standard measurement method for the MVA in this study. The agreement levels between the two examinations were evaluated and analyzed for various reconstruction methods. RESULTS The mean age was 49 ± 12 years for 28 men and 77 women who were enrolled. The image quality was graded as "excellent" in 57% of 3D images obtained by TTE, while it was graded as "excellent" in 81% of 3D images obtained by TEE. The ventricular zooming method in TTE with a bias of -0.006 ± 0.065 cm2 (P < 0.0001) had the highest agreement with the 3D-MVA in TEE. While 2D-TTE and 3D-TEE measurements of the MVA (R = 0.91; P < 0.0001) were significantly correlated, 2D-TTE overestimated the MVA by 0.19 cm2 . CONCLUSION Although the quality of 3D images was significantly better in TEE than those in TTE, a good agreement existed between the measured 3D-TTE and 3D-TEE studies. We also demonstrated that 2D-TTE overestimated the MVA compare to 3D-TEE.
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Affiliation(s)
- Maryam Shojaei Fard
- Department of Cardiology, Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Rezaeian
- Department of Cardiology, Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leili Pourafkari
- Department of Cardiology, Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Sajad Erami
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nader D Nader
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Ashworth AD, Greenhalgh DL. Strategies for the prevention of peri‐operative transoesophageal echocardiography‐related complications. Anaesthesia 2019; 75:3-6. [DOI: 10.1111/anae.14772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 12/31/2022]
Affiliation(s)
- A. D. Ashworth
- Department of Cardiothoracic Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust Manchester UK
| | - D. L. Greenhalgh
- Department of Cardiothoracic Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust Manchester UK
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Kosmalska K, Rzyman M, Miękus P, Gilis-Malinowska N, Nowak R, Fijałkowski M. Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias. Cardiol J 2019; 28:101-109. [PMID: 31225630 DOI: 10.5603/cj.a2019.0056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although many thromboembolism risk factors are well defined, formation of thrombus or dense spontaneous contrast (sludge) in the left atrium remains enigmatic and confounding. Exclusion of the thrombus is extremely important with respect to planned reversal of sinus rhythm. Data regarding the routine transesophagal echocardiography (TEE) before cardioversion are inconclusive. The authors focused on analyzing the usefulness of TEE before cardioversion by assessment of factors influencing the risk of thrombus and/or dense spontaneous echo contrast with the intention of extending indications for TEE in the group with a high risk of thrombus or to forgo TEE in the low risk group. METHODS Two hundred sixty-nine consecutive patients with persistent (> 48 h) atrial fibrillation or atrial flutter, in whom a direct current cardioversion was planned, were undergoing TEE for the detection of the left atrial thrombus or dense spontaneous echo contrast. Additional clinical and echocardiographic data were collected. The relationship between both thrombus and dense spontaneous echo contrast and covariates was analyzed with the use of binary logistic regression. RESULTS Left atrium (LA) appendage (LAA) thrombus and/or sludge were detected in 79 (29%) patients. Signs of dementia in mini-mental state examination (hazard ratio [HR]: 1.16; p = 0.005), low velocities in LAA (HR: 3.38; p = 0.032); presence of spontaneous echo contrast in LA (HR: 3.38; p = 0,003) consecutive episode of AF (HR: 2.27; p = 0,046); longer duration of atrial fibrillation (HR: 1.009; p = 0.022); were significant predictors of thrombus and/or dense spontaneous echo contrast. None of the patients with a CHA2DS2VASc score ≤ 1 had thrombus or sludge in the LAA. Among patients with a CHA2DS2VASc score > 1, the prevalence of thrombus or sludge in LAA was independent of the CHA2DS2VASc score value. CONCLUSIONS Amongst many factors, including an established as risk for thromboembolism only a few of them increased the risk for the presence of thrombus in LAA: low velocities in LAA, presence of spontaneous echo contrast, longer duration of arrhythmia, consecutive (not first) arrhythmia episode and signs of dementia from a mini-mental state examination questionnaire. It was believed that there could be a need for an extension of indications of TEE in vast majority of the patients with atrial arrhythmias, due most often to an unpredictable occurrence of thrombus and potentially disastrous thromboembolism. The only exception could have been the group of the patients with a CHA2DS2VASc score ≤ 1.
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Affiliation(s)
| | - Małgorzata Rzyman
- St Vincent Hospital in Gdynia, Wójta Radtkego1, 81-348 Gdynia, Poland
| | - Paweł Miękus
- St Vincent Hospital in Gdynia, Wójta Radtkego1, 81-348 Gdynia, Poland
| | - Natasza Gilis-Malinowska
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Radosław Nowak
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Fijałkowski
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Tan Z, Roscoe A, Rubino A. Transesophageal Echocardiography in Heart and Lung Transplantation. J Cardiothorac Vasc Anesth 2019; 33:1548-1558. [DOI: 10.1053/j.jvca.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 02/04/2023]
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Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Andreini D, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini EM, Gripari P, Guaricci AI, Rabbat MG, Pepi M, Pontone G. Multimodality imaging of left atrium in patients with atrial fibrillation. J Cardiovasc Comput Tomogr 2019; 13:340-346. [PMID: 30952613 DOI: 10.1016/j.jcct.2019.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/11/2019] [Accepted: 03/19/2019] [Indexed: 01/10/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide associated with significant morbidity and mortality and represents a significant health care burden. Goals of AF treatment include prevention of cardioembolic stroke using anticoagulation and device therapy and restoration of sinus rhythm using antiarrhythmic drugs or catheter ablation techniques. A comprehensive assessment of cardiac chamber size and function is often started with echocardiography as a first line diagnostic imaging strategy. Recently, innovations in advanced imaging using cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) provide a detailed characterization of atrial anatomy and have been shown to accurately exclude thrombus and guide left atrial appendage (LAA) closure or catheter ablation (CA) of atrial fibrillation. Compared to echocardiography, CCT offers an uncompromised spatial resolution and a fast dataset acquisition, with the disadvantages of the need of iodine contrast agent and radiation exposure. CMR, conversely, can rely on very high temporal resolution, the unique feature of tissue characterization and the absence of radiation exposure. However, the main drawbacks of this diagnostic tool are long scan times and low availability. This review will illustrate the vital role of multimodality cardiac imaging in the accurate identification of left atrial, pulmonary vein and LAA size and function, discuss advanced imaging techniques to rule out thrombus and highlight novel CMR and CCT techniques to guide catheter ablation of AF and LAA occlusion.
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Affiliation(s)
| | | | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Rome, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | - Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital, Policlinico of Bari, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA; Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Previously published drug interaction models predict loss of response for transoesophageal echocardiography sedation well but not response to oesophageal instrumentation. Sci Rep 2019; 9:3806. [PMID: 30846741 PMCID: PMC6405922 DOI: 10.1038/s41598-019-40366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/15/2019] [Indexed: 11/15/2022] Open
Abstract
Response surface models (RSMs) were used to predict effects of multiple drugs interactions. Our study was aimed to validate accuracy of the previous published volunteer models during transoesophageal echocardiography (TEE). This is a cross-sectional study with 20 patients scheduled for transesophageal echocardiography in Taipei Veterans General Hospital, Taiwan. Effect-site concentration pairs of alfentanil and propofol were recorded and converted to equivalent remifentanil and propofol effect-site concentrations. Observer’s Assessment of Alertness/Sedation (OAA/S) scores were assessed every 2 minutes. Using these data, previous published models of loss of response (LOR), intolerable ventilatory depression (IVD), and loss of response to esophageal instrumentation (LREI) were then estimated. Accuracy of prediction is assessed by calculating the difference between the true response and the model-predicted probability. Clinical events such as interruption of TEE were recorded. The average procedure time was 11 minutes. Accuracy for prediction of LOR and LREI is 63.6% and 38.5%, respectively. There were four patients experienced desaturation for less than 1 minute, which were not predicted by IVD model, and one interruption of TEE due to involuntary movement. The previous published drug-interaction RSMs predict LOR well but not LREI for TEE sedation. Further studies using response surface methodology are needed to improve quality for TEE sedation and clinical implementation.
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Milhem A, Ingrand P, Tréguer F, Cesari O, Da Costa A, Pavin D, Rivat P, Badenco N, Abbey S, Zannad N, Winum PF, Mansourati J, Maury P, Bader H, Savouré A, Sacher F, Andronache M, Allix-Béguec C, De Chillou C, Anselme F, Al Arnaout A, Amara W, Amelot M, Bars C, Becoulet L, Bru P, Chevalier P, Darmon JP, Deharo JC, Dompnier A, Duplantier-Duchene C, Extramiana F, Faugier JP, Guenancia C, Horvilleur J, Jourda F, Laurent G, Lellouche N, Magnin Poull I, Piot O, Roux A, Saludas Y, Seitz J, Taieb J. Exclusion of Intra-Atrial Thrombus Diagnosis Using D-Dimer Assay Before Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2019; 5:223-230. [DOI: 10.1016/j.jacep.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/20/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
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Hryniewiecki T, Zatorska K, Abramczuk E, Zakrzewski D, Szymański P, Kuśmierczyk M, Michałowska I. The usefulness of cardiac CT in the diagnosis of perivalvular complications in patients with infective endocarditis. Eur Radiol 2019; 29:4368-4376. [PMID: 30643945 PMCID: PMC6611057 DOI: 10.1007/s00330-018-5965-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/27/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022]
Abstract
Objectives The aim of the study was to compare the usefulness of cardiac CT to transthoracic (TTE) and transesophageal (TEE) echocardiography in the diagnosis of infective endocarditis (IE) and perivalvular complications using surgical inspection as the gold standard. Material and methods Fifty-three consecutive patients (42 men, mean age 58.3 ± 12.5) with IE requiring surgical procedures were enrolled in the study. All patients underwent preoperative TTE, TEE, and CT. The presence of vegetations, perivalvular abscess/pseudoaneurysm, leaflet perforation, inflammatory infiltration, and prosthesis dehiscence was assessed. Results We analyzed 71 affected valves (58 native, 13 prosthetic). Intraoperative assessment revealed 11 abscesses/pseudoaneurysms. Sensitivity and specificity of echocardiography (TTE + TEE) and CT were 63%, 90% and 81%, 90%, respectively. The combination of CT and echocardiography allowed diagnosing all abscesses/pseudoaneurysms. Inflammatory infiltration was found intraoperatively in 15 patients. Sensitivity and specificity of TEE and CT were 53%, 94% and 46%, 100%, respectively. Intraoperative assessment revealed leaflet perforation in 16 patients. Sensitivity and specificity of TEE and CT were 75%, 79% and 43%, 89%. The sensitivity of the combination of TTE + TEE + CT was 81%. Perivalvular leakage was found in eight patients with a prosthetic valve. Sensitivity and specificity of echocardiography and CT were 100%, 100% and 88%, 100%, respectively. TEE showed higher sensitivity (97%) than CT (89%) in the diagnosis of vegetations. Conclusions The combination of TTE, TEE, and CT increased the sensitivity for the detection of valvular and perivalvular complications of IE. Key Points • CT is a useful modality in the diagnosis of IE and its local complications in addition to echocardiography. • For the detection of abscesses and pseudoaneurysms, CT is superior to echocardiography. Combining these two modalities can increase the sensitivity of diagnosing abscess/pseudoaneurysm up to 100%. • Adding CT to TEE increases the sensitivity for detection of inflammatory infiltrate. CT is not superior to echocardiography in diagnosing vegetations, valvular leaflet perforations, and perivalvular leaks, but it can be a useful tool when echocardiography is indeterminate.
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Affiliation(s)
- Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, 42 Alpejska St., 04-081, Warsaw, Poland
| | - Karina Zatorska
- Department of Acquired Cardiac Defects, Institute of Cardiology, 42 Alpejska St., 04-081, Warsaw, Poland.
| | - Elżbieta Abramczuk
- Department of Acquired Cardiac Defects, Institute of Cardiology, 42 Alpejska St., 04-081, Warsaw, Poland
| | - Dariusz Zakrzewski
- Department of Acquired Cardiac Defects, Institute of Cardiology, 42 Alpejska St., 04-081, Warsaw, Poland
| | - Piotr Szymański
- Department of Acquired Cardiac Defects, Institute of Cardiology, 42 Alpejska St., 04-081, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery and Transplantology, Institute of Cardiology, Warsaw, Poland
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