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1

[Echocardiography].  

PubMed

Assessment of ischemic mitral regurgitation( IMR) severity is important to stratify patients' management. Because IMR is influenced by loading condition seriously, it is difficult to evaluate severity of IMR in clinically stable condition at rest. Exercise stress echocardiography is useful tool to assess "true" severity of IMR. Recently, mitral valve plasty( undersized annuloplasty) creates a new problem, which is called "functional mitral stenosis". Exercise stress echocardiography also reveals this hemodynamics. Recent 3-dimensional (3D) echocardiography enables an intuitive understanding a valve anatomy by surgeon's view, and a more detailed quantitative evaluation. The 3D echocardiography can contribute to exact valve area calculation and can evaluate the forms of the valve ring which had difficulty in evaluation by 2D echocardiography. The treatment of structural heart disease with catheter has been introduced, and therefore the importance of the 3D echocardiography increases in this field. In this review, we describe the role of stress echocardiography on the assessment of IMR and the current status of 3D echocardiography. PMID:25138926

Kawata, Takayuki; Daimon, Masao

2014-07-01

2

Transesophageal echocardiography assessment of severe ostial left main coronary stenosis  

NASA Technical Reports Server (NTRS)

Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases.

Firstenberg, M. S.; Greenberg, N. L.; Lin, S. S.; Garcia, M. J.; Alexander, L. A.; Thomas, J. D.

2000-01-01

3

Mechanisms of regional ischaemic changes during dipyridamole echocardiography in patients with severe aortic valve stenosis and normal coronary arteries.  

PubMed Central

OBJECTIVE: Vasodilator stress echocardiography can cause myocardial ischaemia in patients with severe aortic valve stenosis and angiographically normal coronary arteries. The aim of the study was to determine the mechanism of ischaemia in this clinical model. METHODS: The study group comprised patients with severe aortic valve stenosis and normal coronary arteries: 25 patients (17 males, eight females; age 63 (SD 11) years) underwent a high dose (up to 0.84 mg/kg over 10 min) dipyridamole echocardiography test both before (2-4 d) and after (10-15 d) aortic valve replacement. Mean aortic pressure gradient was 96 (15) mm Hg, with a left ventricular mass index of 228 (49) g/m2. The dipyridamole echocardiography test was well tolerated and interpretable in all patients. RESULTS: Dipyridamole infusion induced chest pain in seven patients before and in no patient after surgery (28 v 0%, P < 0.01), ST segment depression in 12 patients before and two after surgery (48 v 8%, P < 0.01), and a transient regional dyssynergy in 10 patients before and two after surgery (40 v 8%, P < 0.01). In the preoperative evaluation, patients with an echocardiographically positive dipyridamole echocardiography test were comparable with patients with negative test as far as left ventricular mass index [240 (67) v 230 (64) g/m2, NS] and mean aortic pressure gradient [95 (22) v 92 (21) mm Hg, NS] were concerned. When compared to the preoperative assessment, the resting echo assessment in the postoperative evaluation showed unchanged values of left ventricular mass index [pre 228 (49) g/m2 v post 220 (36) g/m2, NS], but markedly decreased values of mean aortic gradient [pre 95 (15) mm Hg v post 22 (5) mm Hg, P < 0.01] and left ventricular wall stress index [pre 134 (30) g/cm2 v post 89 (19) g/cm2]. CONCLUSIONS: Dipyridamole echocardiography is a suitable clinical technique for assessing the ischaemic vulnerability of the left ventricle in severe aortic valve stenosis with angiographically normal coronary arteries. The frequent disappearance of the ischaemic response early after aortic valve replacement suggests that haemodynamic factors such as compressive diastolic wall stress or afterload reduction are important components of myocardial ischaemic vulnerability under these circumstances. Images PMID:8665343

Baroni, M.; Maffei, S.; Terrazzi, M.; Palmieri, C.; Paoli, F.; Biagini, A.

1996-01-01

4

Real Time Three-Dimensional Transesophageal Echocardiography Demonstration of Membranous Septal Aneurysm Causing Severe Right Ventricular Outflow Tract Obstruction.  

PubMed

In addition to infundibular muscular hypertrophy and anomalous muscle bundles in the right ventricular body, large membranous septal aneurysms (MSA), sinus of valsalva aneurysms, and aneurysms derived from the embryonic venous valve protruding through the tricuspid valve can cause right ventricular outflow obstruction in a patient with ventricular septal defect. Here we describe an adult with a small perimembranous ventricular septal defect complicated by a large MSA causing severe right ventricular outflow obstruction evaluated with real time three dimensional transesophageal echocardiography and cardiac catheterisation. The patient underwent surgical correction of the abnormality and is asymptomatic on follow up. PMID:25231415

Mahesh, Saktheeswaran K; Kumar, Senthil; Satheesh, Santhosh; Jayaraman, Balachander

2014-09-18

5

Increasing Severity of Aortic Atherosclerosis in Coronary Artery Bypass Grafting Patients Evaluated by Transesophageal Echocardiography  

PubMed Central

Background Atherosclerotic disease in coronary artery bypass grafting (CABG) patients is a potential contributor to complications in the perioperative periods. This study was undertaken to better define how the frequency of aortic atheromatous disease among patients coming for CABG has evolved over the last decade. Methods Data from elective patients coming for CABG who underwent transesophageal echocardiography (TEE) examinations following induction of anesthesia were obtained for the years 2002 and 2009. Aortas were graded according to the method of Kronzon, with the following interpretations: normal = grade I, intimal thickening = 2, atheroma of less than 5 mm = 3, atheroma of > 5 mm = 4, and any mobile atheroma = 5. The data of 124 patients who underwent comprehensive exam of the aorta by one cardiac anesthesiologist were gathered and assigned into two groups based on the year TEE was done. Student’s t-test was used for statistical analysis. A P value < 0.05 was considered significant. The data were presented as mean ± SD. Results There was significant difference between group 2002 (2.05 ± 1.28) and group 2009 (2.59 ± 1.11) in atheroma grade (P = 0.013). Conclusions Patients coming for CABG in group 2009 exhibited significantly higher grades of aortic atheroma on TEE, compared to group 2002. Understanding the risk of atheroma in the elderly CABG population may help in altering surgical approaches to lessen the risk of catastrophic stroke. Potential options needing further study include the off-pump approach and modification of cross-clamp site and technique as well as other modalities. PMID:25379067

Denny, John T.; Pantin, Enrique; Chiricolo, Antonio; Tse, James; Denny, Julia E.; Mungekar, Sagar S.; Chyu, Darrick; Solina, Alann

2015-01-01

6

Neuro-Behçet's disease showing severe atrophy of the cerebrum  

Microsoft Academic Search

A 38-year-old female died 6 years after the onset of what was, clinically and histopathologically, consistent with Neuro-Behçet's disease. Pathologically the cerebrum showed severe atrophy. The main changes were observed in the grey and white matter, the diencephalon and the basal ganglia by light microscopy. All these changes originated in softenings around blood vessels, especially small vessels or capillaries. These

Taihei Miyakawa; Eiichi Murayama; Motonori Deshimaru; Isao Shikai; Shiro K?zuma

1976-01-01

7

Detecting aortic valve bicuspidy in patients with severe aortic valve stenosis: high diagnostic accuracy of colour Doppler transoesophageal echocardiography  

PubMed Central

OBJECTIVES The diagnostic accuracy of multiplane bi-dimensional transoesophageal echocardiography (TEE) in detecting aortic valve bicuspidy is good, but is less reliable when the leaflets are moderately or severely calcified. We hypothesized that systolic colour Doppler analysis might improve the accuracy of diagnosing aortic bicuspidy by TEE in patients with severe symptomatic aortic stenosis (AS). METHODS Two colour Doppler images of a stenotic aortic valve were defined in a preliminary study using multiplane TEE. In type I, the valve opening had a linear, angular or ‘hanger-like’ configuration and in type II it was more star-like or ‘stellar’. The accuracy of this classification in detecting bicuspidy was evaluated. Fifty-one patients (mean age 71 years (range 40–90 years); 52% male) with severe symptomatic AS (defined as aortic valve area ?1 cm2), requiring surgical aortic valve replacement, were included in this prospective study. The surgical findings were compared with the echocardiographic data. RESULTS The incidence of aortic bicuspidy was 43%. The presence of type I colour Doppler configuration was significantly higher for bicuspid than for tricuspid aortic valves (95.5 vs 3.5%, respectively; P < 0.001). Diagnostic accuracy in detecting bicuspidy was high (sensitivity 95.5%; specificity 96.5%; positive predictive value 95.5%). Intra- and inter-observer agreements were excellent (Kappa coefficient = 0.88 and 0.92, respectively). CONCLUSIONS Aortic valve bicuspidy may be accurately diagnosed by colour Doppler valve analysis during TEE in patients with severe AS. Larger prospective studies are required to confirm our results. PMID:23054907

Zegdi, Rachid; Ciobotaru, Vlad; Huerre, Clémence; Allam, Bachir; Bouabdallaoui, Nadia; Berrebi, Alain; Florens, Emmanuelle; Fabiani, Jean-Noël

2013-01-01

8

[Problems in estimating the severity of aortic regurgitation by pulsed Doppler echocardiography: with special reference to its distribution pattern].  

PubMed

We categorized the findings of aortic regurgitation (AR) by aortography (AOG) into the following four types, and compared them with the corresponding findings obtained by pulsed Doppler echocardiography (PDE) in 30 patients, and assessed the ability of PDE to observe the distribution of an aortic regurgitant flow. Type 1: A wide regurgitant jet distributed within the entire left ventricle (5 cases). Type 2: A narrow regurgitant jet passing through the center of the left ventricular outflow tract (9 cases). Type 3: A regurgitant jet with the shift of its direction to the either side (10 cases). Type 4: A regurgitant jet which is localized below the aortic valve (6 cases). AOG findings in 40% of Type 1 cases, 78% of Type 2, 80% of Type 3 and 67% of Type 4 were well consistent with those of PDE (an average of 70%). Therefore, we could predict the distribution of AR by PDE, although a correlation between both methods was not complete. The reasons of the inconsistence of these two methods were discussed. PDE is an possible method for evaluating the severity of AR. PMID:6520420

Miyazawa, S; Suzuki, S; Sasaki, T; Nakamura, Y; Morita, K; Mizuno, A; Arai, T

1984-06-01

9

[Severity and non-uniformity of regional wall motion in dilated cardiomyopathy evaluated by two-dimensional echocardiography].  

PubMed

A two and a half year follow-up study of segmental left ventricular wall motion was performed by two-dimensional echocardiography for 26 patients with dilated cardiomyopathy (DCM). Segmental analysis of left ventricular wall motion abnormalities (WMA) was performed using 11 segments obtained by short- and long-axis views of the left ventricle. Wall motion in each segment was classified and assigned a numerical score as normal (0), hypokinetic (1), severely hypokinetic (2), and akinetic or dyskinetic (3). Based on this categorization, a wall motion abnormality index (WMAI) was derived as an overall assessment of left ventricular asynergy. The intersegmental standard deviation of the wall motion abnormality score was used as an index of left ventricular asynergy (non-uniformity index: NUI). During the follow-up period, the wall motion abnormality index increased in all of the 26 patients (from 1.23 to 1.82, p less than 0.001), but the non-uniformity index did not change (from 0.72 to 0.73). When comparing the non-uniformity index among three groups classified according to the grade of wall motion abnormality, both at the initial and during follow-up studies, the moderate wall motion abnormality group (1.0 less than or equal to WMAI less than 2.0) had larger non-uniformity indexes (0.83, 0.84) than the other groups, and the severe non-uniformity index (greater than or equal to 0.9) was observed solely in the moderate group. In the follow-up study, these 26 patients were categorized in two groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3782891

Takarada, A; Yokota, Y; Kumaki, T; Seo, T; Kubo, M; Maehashi, N; Nakanishi, O; Hayakawa, M; Inoh, T; Fukuzaki, H

1986-03-01

10

Planimetry of aortic valve area using multiplane transoesophageal echocardiography is not a reliable method for assessing severity of aortic stenosis.  

PubMed Central

OBJECTIVE: To assess the reliability of aortic valve area planimetry by multiplane transoesophageal echocardiography (TOE) in aortic stenosis. DESIGN: Study of the diagnostic value of aortic valve area planimetry using multiplane TOE, compared with catheterisation and the continuity equation, both being considered as criterion standards. SETTING: University hospital. PATIENTS: 49 consecutive patients (29 male, 20 female, aged 44 to 82 years, average 66.6 (SD 8.5)), referred for haemodynamic evaluation of an aortic stenosis, were enrolled in a prospective study. From this sample, 37 patients were eligible for the final analysis. METHODS: Transthoracic and multiplane transoesophageal echocardiograms were performed within 24 hours before catheterisation. At transthoracic echo, aortic valve area was calculated by the continuity equation. At TOE, the image of the aortic valve opening was obtained with a 30-65 degrees rotation of the transducer. Numerical dynamic images were stored on optical discs for off-line analysis and were reviewed by two blinded observers. Catheterisation was performed in all cases and aortic valve area was calculated by the Gorlin formula. RESULTS: Feasibility of the method was 92% (48/52). The agreement between aortic valve area measured at TOE (mean 0.88 (SD 0.35) cm2) and at catheterisation (0.79 (0.24) cm2) was very poor. The same discrepancies were found between TOE and the continuity equation (0.72 (0.26) cm2). TOE planimetry overestimated aortic valve area determined by the two other methods. Predictive positive and negative values of planimetry to detect aortic valve area < 0.75 cm2 were 62% (10/16) and 43% (9/21) respectively. CONCLUSIONS: Planimetry of aortic valve area by TOE is difficult and less accurate than the continuity equation for assessing the severity of aortic stenosis. Images PMID:9290405

Bernard, Y.; Meneveau, N.; Vuillemenot, A.; Magnin, D.; Anguenot, T.; Schiele, F.; Bassand, J. P.

1997-01-01

11

Stanford study shows anxiety increases cancer severity in mice  

Cancer.gov

In a new study led by researchers at the Stanford University School of Medicine, anxiety-prone mice developed more severe cancer then their calm counterparts. The study, published online April 25 in PLoS ONE, found that after hairless mice were dosed with ultraviolet rays, the nervous ones — with a penchant for reticence and risk aversion — developed more tumors and invasive cancer.

12

INTRODUCTION Several literature reviews show convincingly that pre-  

E-print Network

), although exceptions existed. Since most of the literature suggests that predation in tropical rain forests investigated in tropical rain forests (Springate & Basset 1996). The present study on several species of Ficus the niches of arthro- pods and that foraging by natural enemies may prevent successful use of resources

13

Echocardiography of the mitral valve.  

PubMed

Echocardiography is the primary imaging modality for assessment of the mitral valve (MV). It provides an accurate and non-invasive tool to assess the morphology, geometry and function of the MV apparatus, which form the basis of the mechanisms and classification of MV disease. This review highlights the mechanistic insights into MV dysfunction by echocardiography and the critical role of echocardiography in the quantitative assessment of the severity of mitral regurgitation and mitral stenosis. PMID:25081402

Zeng, Xin; Tan, Timothy C; Dudzinski, David M; Hung, Judy

2014-01-01

14

Digital echocardiography.  

PubMed

Continued improvement in the computer price-to-performance ratio and the adoption of international standards have enhanced the feasibility of completely digital echocardiographic laboratories that were initially described more than a decade ago. Digital archival has distinct advantages over analog recording, including improved laboratory efficiency, capability of side-by-side comparison of current and historical studies, streamlined image storage, and enhanced interinstitution image transfer. Studies have demonstrated that clinical and electronic image compression allows efficient storage of data, without affecting diagnostic accuracy. Finally, digital echocardiography has important telemedicine applications. PMID:9822872

Main, M L; Thomas, J D

1998-11-01

15

A case of acute aortic insufficiency due to severe rheumatoid arthritis, showing progression in two weeks  

PubMed Central

A 74-year-old woman with a history of myocardial infarction and severe rheumatoid arthritis on immunosuppressants was referred to our hospital because of nausea and tooth pain, but no abnormalities were detected on physical or laboratory examination. Two weeks after the first assessment, she was referred to our hospital again because of tooth pain and dyspnea. Her echocardiogram showed severe aortic regurgitation, which was not detected at the assessment 2 weeks previously. After the patient’s congestive heart failure showed improvement, she underwent aortic valve replacement; the aortic valve leaflets were severely shrunken and thickened, without any evidence of endocarditis. Pathological examination of the leaflets showed infiltration of inflammatory cells into the valve leaflets. Therefore, rheumatoid arthritis needs to be considered as an important risk factor for acute valvular disease. PMID:25009796

Kobayashi, Yutaka; Suzuki, Haruo

2014-01-01

16

Fall Schedule This fall we have several great shows for you and your  

E-print Network

Fall Schedule This fall we have several great shows for you and your family to enjoy! Our fall (APOD) on August 24. Check their website daily to see more great space photos! Try to see the Zodiacal lights in the sky. The zodiacal light is a pyramid-shaped glow in the east before dawn (or after twilight

Huang, Haiying

17

Basal Cell Nevus Syndrome Showing Several Histologic Types of Basal Cell Carcinoma  

PubMed Central

Basal cell nevus syndrome (BCNS), or Gorlin Syndrome, is an autosomal dominant disorder, characterized by multiple developmental abnormalities and associated with germline mutations in the PTCH gene. Patients show multiple and early onset basal cell carcinomas (BCCs) in skin, odontogeniccysts in the jaw, pits on palms and soles, medulloblastoma, hypertelorism, and calcification of the falx cerebri. Clinical features of BCCs in these patients are indistinguishable from ordinary BCCs. However, some patients show variable histologic findings in subtypes of BCCs, and only one case associated with several histologic types of BCCs in the syndrome has been reported in Korea. We present a case of BCNS characterized by multiple BCCs, odontogenic keratocysts, multiple palmar pits, and calcified falx cerebri. Histopathologic findings of BCCs showed several patterns, which were nodular, superficial, and pigmented types. PMID:22028568

Go, Jae Wan; Kim, Shin Han; Yi, Sang Yeop

2011-01-01

18

Stress echocardiography: safety and tolerability  

PubMed Central

Background Stress echocardiography is a valuable tool for the noninvasive diagnosis of ischemic heart disease. Despite its widely use in the clinical practice, safety and side effects profile have never been evaluated in Moroccans. The aim To assess the safety and tolerability of the two stress echo modalities in Moroccans. Methods The study was made by 311 patients with known or suspected coronary artery disease, 203 underwent exercise echocardiography and 108 underwent dobutamine echocardiography, major and minor rhythmic complications and side effects were recorded for the two groups. Results We registered 3 (2, 8%) major rhythmic events in the dobutamine group (2 sustained supraventricular tachycardia and 1 sustained ventricular tachycardia), there was no major rhythmic events in the exercise group. Minor rhythmic events were frequent (43, 5% in the dobutamine group and 19, 2% in the exercise group with a p?=?0, 0001). Severe hypotension occurs in 4 (3, 7%) patients during a dobutamine stress, there was no significant drop in the blood pressure during exercise stress procedures. Non cardiac side effects were more common among patients who underwent a dobutamine stress echo (13, 9% vs. 3, 4% with p?=?0,001). Conclusion Exercise is safer than dobutamine stress echocardiography, complications and adverse effects with the use of dobutamine are usually minor and self-limiting. PMID:23961806

2013-01-01

19

Dobutamine Stress Echocardiography and Tissue Synchronization Imaging  

PubMed Central

Dobutamine stress echocardiography has emerged as a reliable method for the diagnosis of coronary artery disease and the management of its treatment. Several studies have shown that that this technique works with 80–85% accuracy in comparison with other imaging methods. There are few studies aimed at developing the clinical utility of dobutamine stress echocardiography for the evaluation of normal and abnormal segments that result from dobutamine stress with Tissue Synchronization Imaging.

Tas, Hakan; Gundogdu, Fuat; Gurlertop, Yekta; Karakelleoglu, Sule

2008-01-01

20

The Origin of Echocardiography  

PubMed Central

The original description of M-mode echocardiography in 1953, by Inge Edler (1911–2001) and his physicist friend Hellmuth Hertz, marked the beginning of a new diagnostic noninvasive technique. Edler used this technique primarily for the preoperative study of mitral stenosis and diagnosis of mitral regurgitation. His work was carried forward by cardiologists all over the world, who developed Doppler, 2-dimensional, contrast, and transesophageal echocardiography. These are now standard in cardiologic examinations. Edler also influenced neurologists and obstetricians at Lund University (Sweden) to use ultrasound in their fields. For his landmark discovery, Edler is recognized as the “Father of Echocardiography.” PMID:18172524

Singh, Siddharth; Goyal, Abha

2007-01-01

21

MRI Shows More Severe Hippocampal Atrophy and Shape Deformation in Hippocampal Sclerosis Than in Alzheimer's Disease  

PubMed Central

While hippocampal atrophy is a key feature of both hippocampal sclerosis (HS) and Alzheimer's disease (AD), the pathology underlying this finding differs in these two conditions. In AD, atrophy is due primarily to loss of neurons and neuronal volume as a result of neurofibrillary tangle formation. While the etiology of HS is unknown, neuron loss in the hippocampus is severe to complete. We compared hippocampal volume and deformations from premortem MRI in 43 neuropathologically diagnosed cases of HS, AD, and normal controls (NC) selected from a longitudinal study of subcortical ischemic vascular disease (IVD Program Project). HS cases (n = 11) showed loss of neurons throughout the rostral-caudal extent of the hippocampus in one or both hemispheres. AD cases (n = 24) met NIA-Reagan criteria for high likelihood of AD. Normal control cases (n = 8) were cognitively intact and showed no significant AD or hippocampal pathology. The mean hippocampal volumes were significantly lower in HS versus AD groups (P < .001). Mean shape deformations in the CA1 and subiculum differed significantly between HS versus AD, HS versus NC, and AD versus NC (P < .0001). Additional study is needed to determine whether these differences will be meaningful for clinical diagnosis of individual cases. PMID:21547227

Zarow, C.; Wang, L.; Chui, H. C.; Weiner, M. W.; Csernansky, J. G.

2011-01-01

22

Diagnosis of celiac artery in-stent thrombosis by transesophageal echocardiography.  

PubMed

We present a case of a 70-year-old woman with severe peripheral arterial disease presenting with celiac artery in-stent thrombosis diagnosed by transesophageal echocardiography (TEE). Routine assessment of the visceral arteries is not performed in most TEE studies. A review of the literature shows that the celiac and superior mesenteric arteries can be successfully visualized during transgastric views of the abdominal aorta. We propose that two-dimensional and color Doppler echocardiography have several intrinsic advantages over computed tomography, magnetic resonance angiography and catheterization when assessing aortic and visceral arterial pathology. PMID:22931198

Biederman, Robert W W; Fakhri, Abid Ali; Young, Joseph C

2012-11-01

23

Microsatellites haplotyping of CF chromosomes shows linkage disequilibrium and several founder effects in Brittany (France)  

SciTech Connect

A large study on cystic fibrosis (CF) is underway in Brittany (France). It is based on 902 CF patients distributed in 795 families who were or are still followed at the {open_quotes}Centre Helio-Marin{close_quotes} in Roscoff and/or were subjected to a molecular analysis at the {open_quotes}Centre de Biogenetique{close_quotes} in Brest. At present, the CF mutations have been identified in 309 patients born in Brittany, most of them of Celtic origin. A microsatellite (MS) study using IVS 17b TA, IVS 17b CA and IVS 8 CA was also completed in 63 CF patients and their parents (carriers of the {Delta}F508 mutation or the G551D mutation or the 1078delT mutation or the W846X mutation). All the 21 chromosomes carrying the 1078delT mutation had the same MS haplotype (16-21-13), which was also found on 9 of the 83 non-CF chromosomes analyzed. All the 16 chromosomes with the G551D mutation carried another MS haplotype (16-7-17), which was also found on 13.3% of the non-CF chromosomes. All the 6 chromosomes with the W846X mutation carried the 16-32-13 haplotype, also found on 6.0% of the non-CF chromosomes. Sixteen different MS haplotypes were found among the 74 chromosomes carrying the{Delta}F508 mutation, three of them representing 74.3% (55/74) of the chromosomes. These were the 23-31-13 haplotype (31/74 - 41.9%), the 17-31-13 haplotype (11/74 - 14.9%), and the 17-32-13 haplotype (13/74 - 17.6%). These results show that the CF mutations observed in Brittany are in linkage disequilibrium with the MS haplotypes. They also suggest that their presence in Brittany is the consequence of several founder effects.

Raguenes, O.; Ferec, C.; Mercier, B. [Universite de Bordeaux II, Paris (France)] [and others

1994-09-01

24

The explosive outbreak and intercontinental spread of Severe Acute Respiratory Syndrome (SARS) shows  

E-print Network

The explosive outbreak and intercontinental spread of Severe Acute Respiratory Syndrome (SARS (Mills and Childs 1998). Monkeypox, hantavirus pulmonary syndrome (HPS), Lassa fever, Argentine evidence for top-down regulation of zoonotic disease reservoirs Richard S Ostfeld1 and Robert D Holt2

25

Pulmonary Arterial Hypertension: The Key Role of Echocardiography.  

PubMed

Echocardiography is a key screening tool in the diagnostic algorithm of pulmonary arterial hypertension (PAH). It provides an estimate of right ventricular function and pulmonary artery pressure, either at rest or during exercise, and is useful in ruling out secondary causes of pulmonary hypertension (PH) such as left heart disease or congenital heart disease. Several studies have showed that echocardiography is insufficiently precise as single tool for the ultimate diagnosis of PH respect to the right heart catheterization, considered the gold standard technique. Echocardiography is valuable in assessing prognosis and treatment options, monitoring the efficacy of specific therapeutic interventions, and detecting the preclinical stages of disease. The ideal imaging modality for accurate noninvasive assessment of the right heart should be accurate and precise, not influenced by loading conditions, routinely practicable and easily repeatable. For all such reasons and considering that PAH is a rare and severe condition, a complete noninvasive assessment of right heart function requires a deep knowledge of the disease and a multimodality approach. PMID:25244441

D'Alto, Michele; Romeo, Emanuele; Argiento, Paola; Di Salvo, Giovanni; Badagliacca, Roberto; Cirillo, Anna P; Kaemmerer, Harald; Bossone, Eduardo; Naeije, Robert

2014-09-19

26

Echocardiography-guided interventions.  

PubMed

A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. Echocardiograms can be recorded at the bedside, in the cardiac catheterization laboratory, in the cardiovascular intensive care unit, in the emergency room-indeed, any place that can accommodate a wheeled cart. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. The purpose of this report is to review the use of echocardiography to guide interventions. We provide information on the selection of patients for interventions, monitoring during the performance of interventions, and assessing the effects of interventions after their completion. In this document, we address the use of echocardiography in commonly performed procedures: transatrial septal catheterization, pericardiocentesis, myocardial biopsy, percutaneous transvenous balloon valvuloplasty, catheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), alcohol septal ablation for hypertrophic cardiomyopathy, and cardiac electrophysiology. A concluding section addresses interventions that are presently investigational but are likely to enter the realm of practice in the very near future: complex mitral valve repairs, left atrial appendage (LAA) occlusion devices, 3-dimensional (3D) echocardiographic guidance, and percutaneous aortic valve replacement. The use of echocardiography to select and guide cardiac resynchronization therapy has recently been addressed in a separate document published by the American Society of Echocardiography and is not further discussed in this document. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures. PMID:19258174

Silvestry, Frank E; Kerber, Richard E; Brook, Michael M; Carroll, John D; Eberman, Karen M; Goldstein, Steven A; Herrmann, Howard C; Homma, Shunichi; Mehran, Roxana; Packer, Douglas L; Parisi, Alfred F; Pulerwitz, Todd; Seward, James Bernard; Tsang, Teresa S M; Wood, Mark A

2009-03-01

27

Transthoracic echocardiography in mice.  

PubMed

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene expression. Transgenic and gene targeting methods can be used to generate mice with altered cardiac size and function, and as a result, in vivo techniques are needed to evaluate their cardiac phenotype. Transthoracic echocardiography, pulse wave Doppler (PWD), and tissue Doppler imaging (TDI) can be used to provide dimensional measurements of the mouse heart and to quantify the degree of cardiac systolic and diastolic performance. Two-dimensional imaging is used to detect abnormal anatomy or movements of the left ventricle, whereas M-mode echo is used for quantification of cardiac dimensions and contractility. In addition, PWD is used to quantify localized velocity of turbulent flow, whereas TDI is used to measure the velocity of myocardial motion. Thus, transthoracic echocardiography offers a comprehensive method for the noninvasive evaluation of cardiac function in mice. PMID:20517201

Respress, Jonathan L; Wehrens, Xander H T

2010-01-01

28

Integration of sec , csc , sec3 These notes show several ways to integrate sec , csc , sec3  

E-print Network

Integration of sec , csc , sec3 and csc3 These notes show several ways to integrate sec , csc , sec3 and csc3 . sec d -- by trickery The standard trick used to integrate sec is to multiply sin + 1 cos = ln | tan + sec | csc d -- by the x = tan 2 substitution The integral csc d may

Feldman, Joel

29

Our previous studies on G. dumetorum yielded several aporphine alkaloids that showed significant activity against Leishmania spp.  

E-print Network

Our previous studies on G. dumetorum yielded several aporphine alkaloids that showed significant conducted additional isolation efforts on the minor alkaloids of this species. A standard alkaloid on the identification of alkaloids 1±9 from G. dumetorum (Fig.1). All nine of these metabolites were tested against

Coley, Phyllis

30

Severe Septic Patients with Mitochondrial DNA Haplogroup JT Show Higher Survival Rates: A Prospective, Multicenter, Observational Study  

PubMed Central

Objective In a previous cohort study (n=96), we found an association between mitochondrial (mt) DNA haplogroup JT and increased survival of severe septic patients, after controlling for age and serum lactic acid levels. The aim of this research was to increase the predictive accuracy and to control for more confounder variables in a larger cohort (n=196) of severe septic patients, to confirm whether mtDNA haplogroup JT influences short and medium-term survival in these patients. Methods We conducted a prospective, multicenter, observational study in six Spanish Intensive Care Units. We determined 30-day and 6-month survival and mtDNA haplogroup in this second cohort of 196 patients and in the global cohort (first and second cohorts combined) with 292 severe septic patients. Multiple logistic regression and Cox regression analyses were used to test for the association of mtDNA haplogroups JT with survival at 30-days and 6-months, controlling for age, sex, serum interleukin-6 levels and SOFA score. Results Logistic and Cox regression analyses showed no differences in 30-day and 6-month survival between patients with mtDNA haplogroup JT and other haplogroups in the first cohort (n=96). In the second cohort (n=196), these analyses showed a trend to higher 30-day and 6-month survival in those with haplogroup JT. In the global cohort (n=292), logistic and Cox regression analyses showed higher 30-day and 6-month survival for haplogroup JT. There were no significant differences between J and T sub-haplogroups in 30-day and 6-month survival. Conclusions The global cohort study (first and second cohorts combined), the largest to date reporting on mtDNA haplogroups in septic patients, confirmed that haplogroup JT patients showed increased 30-day and 6-month survival. This finding may be due to single nucleotide polymorphism defining the whole haplogroup JT and not separately for J or T sub-haplogroups. PMID:24069186

Martín, María M.; López-Gallardo, Esther; Solé-Violán, Jordi; Blanquer, José; Labarta, Lorenzo; Díaz, César; Borreguero-León, Juan María; Jiménez, Alejandro; Montoya, Julio; Ruiz-Pesini, Eduardo

2013-01-01

31

Fragile (X)(q27) sites in a pedigree with female carriers showing mild to severe mental retardation.  

PubMed Central

A pedigree showing the fragile site at Xq27 in a severely retarded female and in other less retarded carriers is described. Two of the four moderately retarded males with the fra(X)(q27) show macro-orchidism, and a variety of other features usually used to support the effects of the fra(X)(q27) are also inconsistent. A second fragile site at (10)(q23) is also present and in the two oldest females its frequency is not decreased, whereas the fra(x)(q27) is not detectable in these females although probably present. It is concluded that pedigrees showing mentally retarded females and probable X linkage should be included in studies of the fra(X)(q27). Images PMID:7069746

Webb, G C; Halliday, J L; Pitt, D B; Judge, C G; Leversha, M

1982-01-01

32

Contrast echocardiography 1996. A review.  

PubMed Central

Remarkable advances in the field of contrast echocardiography have been made during the last decade. Interest in ultrasound contrast agents that strengthen the backscattered ultrasound signal and improve image display has stimulated further research. Echocardiographic contrast agents providing left ventricular cavity image enhancement after intravenous injection are now available. A role for contrast echocardiography in the assessment of myocardial perfusion has been established within the invasive clinical setting. With the development of newer contrast agents and new ultrasound technology, myocardial perfusion imaging using contrast echocardiography after venous injection is no longer the unattainable "holy grail," but is fast approaching clinical applicability. Images PMID:8792539

Villarraga, H R; Foley, D A; Mulvagh, S L

1996-01-01

33

Classification of left ventricular size: diameter or volume with contrast echocardiography?  

PubMed Central

Background Left ventricular (LV) size is an important clinical variable, commonly assessed at echocardiography by measurement of the internal diameter in diastole (IDD). However, this has recognised limitations and volumetric measurement from apical views is considered superior, particularly with the use of echocardiographic contrast. We sought to determine the agreement in classification of LV size by different measures in a large population of patients undergoing echocardiography. Methods and results Data were analysed retrospectively from consecutive patients (n=2008, 61% male, median 62?years) who received echocardiographic contrast for LV opacification over 3?years in a single institution. Repeat studies were not included. LVIDD was measured, and LV end-diastolic volume (LVEDV) calculated using Simpson's biplane method. Both measures were indexed (i) to body surface area and categorised according to the American Society of Echocardiography (ASE) guidelines as normal, mild, moderate or severely dilated. Of 320 patients with a severely dilated LVEDVi, only 95 (30%) were similarly classified by LVIDD, with 86 patients (27%) measuring in the normal range. LVIDDi agreement was poorer, with only 43 patients (13%) classified as being severely dilated, and 173 (54%) measuring in the normal range. Conclusions Currently recommended echocardiographic measures of LV size show limited agreement when classified according to currently recommended cut-offs. LV diameter should have a limited role in the assessment of LV size, particularly where a finding of LV dilation has important diagnostic or therapeutic implications. PMID:25525505

Gibson, Patrick H; Becher, Harald; Choy, Jonathan B

2014-01-01

34

Important Advances In Technology: Echocardiography  

PubMed Central

Echocardiography has evolved over the past 45 years from a simple M-mode tracing to an array of technologies that include two-dimensional imaging, pulsed and continuous wave spectral Doppler, color flow and tissue Doppler, and transesophageal echocardiography. Together, these modalities provide a comprehensive anatomic and functional evaluation of cardiac chambers and valves, pericardium, and ascending and descending aorta. The switch from analog to digital signal processing revolutionized the field of ultrasound, resulting in improved image resolution, smaller instrumentation that allows bedside evaluation and diagnosis of patients, and digital image storage for more accurate quantification and comparison with previous studies. It also opened the door for new advances such as harmonic imaging, automated border detection and quantification, 3-dimensional imaging, and speckle tracking. This article offers an overview of some newer developments in echocardiography and their promising applications.

Nagueh, Sherif F.; Quiñones, Miguel A.

2014-01-01

35

Assessment of electrocardiography, echocardiography, and heart rate variability in dynamic and static type athletes  

PubMed Central

Background: Over the last two decades, morphological cardiac changes induced by athletic conditioning have been of great interest. Therefore, several studies have been orchestrated to delineate electrocardiography (ECG), echocardiography, and heart rate variability (HRV) findings in athletes. Purpose: To assess the ECG, echocardiography, and HRV in a group of dynamic and static type athletes. Methods: Fifty professional athletes (20 static and 30 dynamic exercise athletes) and 50 healthy nonathletes (control group) were recruited. Standard 12-lead ECG and transthoracic echocardiography was performed on all athletes and the control group. Through echocardiography, variables including left ventricular (LV) end-diastolic/systolic diameter, LV mass, and left atrial volume index were measured. In addition, both the athletes and the control group underwent ECG Holter monitoring for 15 minutes and several parameters related to HRV (time and frequency domain) were recorded. Results: The most common ECG abnormalities among the athletes were sinus bradycardia and incomplete right bundle branch block. LV end-diastolic diameter and left atrial volume index were significantly greater in the dynamic athletes (P < 0.001). LV end-systolic diameter was significantly lower in the static group (P < 0.001). LV mass of the dynamic and static athletes was significantly greater than that of the controls (P < 0.001). Among the ECG Holter monitoring findings, the dynamic athletes had lower systolic blood pressure than the controls (P = 0.01). Heart rate was lowest in the control group (P < 0.001). Conclusion: The most common ECG abnormalities among adolescent Iranian athletes were sinus bradycardia and incomplete right bundle branch block. Static exercise seemed to reduce LV end-systolic diameter, while dynamic exercise resulted in increased LV end-diastolic diameter and left atrial volume index. Additionally, Iranian athletes showed no differences in HRV parameters, excluding heart rate and systolic blood pressure, compared with the nonathletes. PMID:22924010

Toufan, Mehrnoush; Kazemi, Babak; Akbarzadeh, Fariborz; Ataei, Amin; Khalili, Majid

2012-01-01

36

Role of Echocardiography in the Management of Cardiac Disease in Women  

PubMed Central

The widespread use of echocardiography has contributed to the early recognition of several distinct cardiac diseases in women. During pregnancy, safe monitoring of the disease process, as well as a better understanding of hemodynamics, is possible. During the use of potentially cardiotoxic drugs for breast cancer chemotherapy, echocardiographic patient monitoring is vital. Compared to men, the addition of an imaging modality to routine electrocardiogram monitoring during stress testing is more informative for diagnosing coronary disease in women. This review briefly discusses the role of echocardiography in the management of several women-specific cardiac diseases where echocardiography plays a pivotal role in disease management. PMID:25580190

2014-01-01

37

Transesophageal two-dimensional echocardiography in young patients with cerebral ischemic events.  

PubMed

Using transesophageal echocardiography, cardiac structures can be imaged with high resolution. The aim of our study was to evaluate whether transesophageal echocardiography is superior in detecting mitral valve prolapse and other cardiac abnormalities compared with transthoracic echocardiography in an age-matched control group and in young patients with cerebral ischemic events (patient group). Forty patients with cerebral ischemic events (mean age 35.2 years) and 29 controls (mean age 30.4 years) were examined using both methods. Transthoracic and transesophageal echocardiography showed a significantly higher incidence of mitral valve prolapse in the patient group compared with the control group (p less than 0.001). By means of transesophageal echocardiography, it was possible to measure highly significant bulging in both the anterior and the posterior mitral leaflet in the patient group compared with the control group (p less than 0.001), and the thickness of the mitral leaflets was significantly higher in the patient group. In 9 of 20 (45%) patients with normal transthoracic echocardiograms, transesophageal echocardiography showed pathologic findings. We found transesophageal echocardiography to be a sensitive method for detecting mitral valve prolapse as well as valve changes and other cardiac abnormalities not detectable by conventional echocardiography. Our study underlines the role of mitral valve prolapse in young stroke patients as a relevant risk factor and emphasizes the importance of changed mitral valve morphology. PMID:3354020

Zenker, G; Erbel, R; Krämer, G; Mohr-Kahaly, S; Drexler, M; Harnoncourt, K; Meyer, J

1988-03-01

38

Echocardiography in Pediatric Pulmonary Hypertension  

PubMed Central

Pulmonary hypertension (PH) can be a rapidly progressive and fatal disease. Although right heart catheterization remains the gold standard in evaluation of PH, echocardiography remains an important tool in screening, diagnosing, evaluating, and following these patients. In this article, we will review the important echocardiographic parameters of the right heart in evaluating its anatomy, hemodynamic assessment, systolic, and diastolic function in children with PH. PMID:25429362

Jone, Pei-Ni; Ivy, D. Dunbar

2014-01-01

39

Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis: comparison with transesophageal echocardiography  

Microsoft Academic Search

BACKGROUND: Although echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis (IE), systematic usage in clinical practice remains ill defined. To determine the diagnostic accuracy of detecting vegetations using harmonic transthoracic echocardiography (hTTE) as compared to transesophageal echocardiography (TEE) in patients with an intermediate likelihood of native valve IE. METHODS: Between 2004 and 2005, 36

Davinder S Jassal; Amin Aminbakhsh; Tielan Fang; Nasir Shaikh; John M Embil; Gordon S Mackenzie; James W Tam

2007-01-01

40

Oesophageal perforation following perioperative transoesophageal echocardiography.  

PubMed

Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality. PMID:10844846

Massey, S R; Pitsis, A; Mehta, D; Callaway, M

2000-05-01

41

The Safety of Contrast Echocardiography: Report of the Committee on Contrast Echocardiography for the American Society of Echocardiography  

NASA Technical Reports Server (NTRS)

The results of a survey of 363 physicians performing were evaluated to assess the relative safety of contrast echocardiography. Fifteen physicians reported a variety of transient side effects, including neurologic and respiratory symptoms. Although contrast echocardiography appeared to carry some risk for side effects, that risk was low (0.062%) and no residual side effects or complications were observed.

Bommer, W. J.; Shah, P. M.; Allen, H.; Meltzer, R.; Kisslo, J.

1984-01-01

42

[Real time 3D echocardiography  

NASA Technical Reports Server (NTRS)

Three-dimensional representation of the heart is an old concern. Usually, 3D reconstruction of the cardiac mass is made by successive acquisition of 2D sections, the spatial localisation and orientation of which require complex guiding systems. More recently, the concept of volumetric acquisition has been introduced. A matricial emitter-receiver probe complex with parallel data processing provides instantaneous of a pyramidal 64 degrees x 64 degrees volume. The image is restituted in real time and is composed of 3 planes (planes B and C) which can be displaced in all spatial directions at any time during acquisition. The flexibility of this system of acquisition allows volume and mass measurement with greater accuracy and reproducibility, limiting inter-observer variability. Free navigation of the planes of investigation allows reconstruction for qualitative and quantitative analysis of valvular heart disease and other pathologies. Although real time 3D echocardiography is ready for clinical usage, some improvements are still necessary to improve its conviviality. Then real time 3D echocardiography could be the essential tool for understanding, diagnosis and management of patients.

Bauer, F.; Shiota, T.; Thomas, J. D.

2001-01-01

43

Relationship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography  

PubMed Central

Background Mitral valve calcification is often incidentally detected on chest computed tomography (CT) scans obtained for a variety of noncardiac indications. In this study, we evaluated the association between mitral valve calcification incidentally detected on chest CT and the presence and severity of mitral valve disease on echocardiography. Methods Of 760 patients undergoing 64-row multidetector CT of the chest, 50 with mitral valve calcification and 100 controls were referred on for echocardiography. Calcifications of the mitral valve leaflet and annulus were assessed for length, Agatston score, and site, and were compared with echocardiographic findings. Results Mitral valve calcification was noted in 59 (7.7%) patients on multidetector CT. Fifty of these patients were assessed by echocardiography, and 32 (64%) were found to have mitral annular calcification. Nine patients (18%) had posterior mitral valve leaflet calcification, and both mitral valve leaflet and annular calcification were detected in nine (18%) cases. Nine (18%) patients had mild, three (6%) had moderate, and one (2%) had severe mitral stenosis. None of the patients with isolated mitral annular calcification had mitral stenosis; however, all the patients with mitral stenosis showed mitral valve leaflet calcification with or without mitral annular calcification (P < 0.001). Moreover, patients with mitral stenosis had a larger mitral calcification length and greater Agatston scores in comparison with those without mitral stenosis (P = 0.001). While 31 patients (62%) with mitral calcification had mitral regurgitation on echocardiography, 21 (21%) in the control group showed mitral regurgitation (P = 0.001). Conclusion Mitral valve leaflet calcification, with or without annular calcification, may be an indicator of mitral stenosis. Mitral calcification can also be considered as an indicator for mitral regurgitation in general. Therefore, patients with mitral valve calcification detected incidentally on chest CT scan may benefit from functional assessment of the valve using echocardiography. PMID:23077412

Toufan, Mehrnoush; Javadrashid, Reza; Paak, Neda; Gojazadeh, Morteza; Khalili, Majid

2012-01-01

44

Increasing detection of rheumatic heart disease with echocardiography.  

PubMed

Rheumatic heart disease (RHD) is estimated to affect over 20 million people worldwide, the vast majority being in developing countries. Screening for RHD has been recommended by the WHO since 2004. Conventionally, auscultation has been used for diagnosing RHD. Auscultation has its limitation and may not detect mild cases. A large number of studies have reported echocardiographic screening for RHD over the last several years. Most of these studies report an almost 10-fold higher prevalence of RHD by echocardiography as compared to conventional method of auscultation. Early diagnosis of such mild cases may be important as instituting secondary prophylaxis in such cases may reduce the burden of the disease. However, several concerns remain about the significance and natural history of these minor valvular changes detected by echocardiography. Whether secondary prophylaxis will reverse these abnormalities is also unclear. Long term follow up studies are required to answer some of these concerns. PMID:24934495

Saxena, Anita

2014-09-01

45

[Current status and indications for contrast echocardiography].  

PubMed

Due to newly developed techniques contrast echocardiography (CE) is less often applied today. As to reevaluate the usefulness and the indications for CE 7823 consecutive echocardiographic studies were analysed. In 638 (8%) of these studies CE was used. 379 patients showed signs of right ventricular overload, 58 due to a left-to-right shunt. Pressure overload due to pulmonary hypertension was found in 321 cases. CE enhanced doppler flow signals in tricuspid regurgitation and facilitated quantification of right heart dimensions. 259 patients were screened for patent foramen ovale (PFO), 94 after embolic events, and 165 because neurosurgical intervention in a sitting position was planned. So CE proved to be still indicated in the era of color flow doppler, especially for the detection of PFO. PMID:7701922

Weihs, W; Anelli-Monti, B; Picha, R; Schuchlenz, H; Harb, S; Harnoncourt, K

1994-01-01

46

Echocardiography in pericardial diseases: new developments.  

PubMed

Echocardiography is one of the most important clinical tools in the diagnosis and management of various pericardial diseases, including constrictive pericarditis, effusive constrictive pericarditis, pericardial effusion, tamponade, absence of the pericardium and cysts or tumors. During recent years, remarkable progress has been made in echocardiography: cardiac tissue Doppler analysis (TDI), strain and strain rate imaging by speckle tracking imaging (STE) and three-dimensional (3D) echocardiography. The assessment of early diastolic annulus velocity and annulus reversus by TDI improves the differentiation of constriction from restrictive myocardial disease, which can be further facilitated by STE as a complementary tool. 3D echocardiography may be useful for the more precise assessment of pericardial diseases, such as pericardial effusion or pericardial masses as it provides incremental value to 2D echocardiography by detecting anatomic structures with higher accuracy. Applications of these newer echocardiographic techniques in the assessment of pericardial diseases are discussed in this chapter. PMID:22752511

Veress, Gabriella; Feng, Dali; Oh, Jae K

2013-05-01

47

[Doppler echocardiography in chronic right ventricular pressure load].  

PubMed

Doppler-echocardiography (DEC) was performed before cardiac catheterization in 61 consecutive patients (25 women, 36 men; aged 59 +/- 10.6 years) with pulmonary hypertension. Chronic obstructive lung disease was its cause in 32, mitral valve disease in 16 and dilated cardiomyopathy in 13 patients. The subcostal approach was possible in all patients and a semiquantitative assessment into three degrees of severity determined from right ventricular wall thickness and size, as well as the diameter of the inferior vena cava. The severity grade was closely correlated with the level of pulmonary hypertension. In the absence of all signs of increased right ventricular load (grade 0) the mean pulmonary arterial pressure was 18.7 +/- 6.2 mm Hg, in grade I it was 15 and 22 mm Hg (only two patients), in grade II 29.9 +/- 11.9 and in grade III 41.1 +/- 8.6 mm Hg. 13 of the 21 patients in grade 0 or I had no manifest signs of pulmonary hypertension, but this was the case in only 6 of 22 in grade II and none in grade III. In 42 patients (69%) the systolic pulmonary artery pressure could be measured by DEC and it correlated well with the values obtained by cardiac catheterization (P < 0.001, r = 0.92). These findings show that DEC can provide semiquantitative and, in most cases, even exact evidence of chronic right ventricular overload. PMID:8055742

Weihs, W; Picha, R; Schuchlenz, H; Harb, S; Anelli-Monti, B; Harnoncourt, K

1994-08-01

48

Speckle tracking echocardiography in acute myocarditis.  

PubMed

To evaluate 2-dimensional speckle tracking echocardiography as a diagnostic and prognostic tool in patients with acute myocarditis. In this retrospective cohort study, 45 patients (age, 39 ± 15 years; 32 male) with suspected acute myocarditis and 83 healthy controls (age, 39 ± 13 years; 27 male) underwent 2-dimensional speckle tracking echocardiography. Main outcome measures were circumferential and longitudinal strain and strain rate as prognostic and diagnostic markers. Patients with myocarditis had lower circumferential strain (-13.3 ± 5.6 % vs. -22.3 ± 4 %), circumferential strain rate (-0.9 ± 0.3 vs. -1.4 ± 0.3 s(-1)), longitudinal strain (-11.7 ± 4 % vs. -17.7 ± 1.9 %), and longitudinal strain rate (-0.7 ± 0.2 vs. -1.0 ± 0.1 s(-1)) (all P < .001). For diagnostic purposes, longitudinal strain had the greatest area under the curve, 0.93 (optimal cutoff value, -15.1 %; sensitivity, 78 %; specificity, 93 %). Future events were defined as cardiac death, heart transplant, placement of left ventricular assist device or implantable cardioverter-defibrillator, pulmonary edema-related respiratory failure, cardiogenic shock, and rehospitalization due to cardiac events. For every 1 % decline in longitudinal or circumferential strain, the hazard ratios (95 % CIs) were 1.26 (1.10-1.47) and 1.34 (1.14-1.63), respectively; for every 0.1 s(-1) decline in longitudinal or circumferential strain rate, the hazard ratios (95 % CIs) were 1.43 (1.09-1.89) and 1.52 (1.19-2.01), respectively (P < .01). Kaplan-Meier curve and log-rank test showed event-free survival significantly related to these 4 measurements. In acute myocarditis, left ventricular strain and strain rate may be promising diagnostic and prognostic tools, even in patients with preserved left ventricular ejection fraction. Most importantly, this imaging technique had a role in predicting deterioration and overall event-free survival. PMID:22736428

Hsiao, Ju-Feng; Koshino, Yuki; Bonnichsen, Crystal R; Yu, Yang; Miller, Fletcher A; Pellikka, Patricia A; Cooper, Leslie T; Villarraga, Hector R

2013-02-01

49

Role of echocardiography in the treatment of cardiac tamponade.  

PubMed

Accumulation of fluid within the pericardial sac results in elevation of intrapericardial pressure with consequent cardiac compression or tamponade. Cardiac tamponade is a life-threatening condition which requires urgent evacuation of pericardial effusion (PE). Current pericardial evacuation techniques and approaches are varied. Echocardiography provides valuable insights into identifying patients who are suitable candidates and further facilitates pericardiocentesis by improving guidance techniques. Several previous publications have provided excellent reviews of the pathophysiology of cardiac tamponade. We review the clinical presentation and role of echocardiography for diagnosis of tamponade. We focus on medical and surgical approaches for the removal of PE. Moreover, as the clinical and hemodynamic consequences of PE depend on the volume and the rate of accumulation of PE, we review the various scenarios of "small" PE resulting in cardiac tamponade. PMID:24697811

Chandraratna, P A N; Mohar, Dilbahar S; Sidarous, Peter F

2014-08-01

50

Interventional Imaging: The Role Of Echocardiography  

PubMed Central

Interventional echocardiography is a rapidly evolving field requiring imaging expertise. An increasing number of structural heart interventions now require real-time imaging guidance for device placement and immediate functional evaluation. Continuous 2- and 3-dimensional transesophageal echocardiography are now required by many heart teams during complex structural interventions, including percutaneous closure of atrial septal defects, left atrial appendage occlusion, transcatheter aortic valve replacement (TAVR), transcatheter repair of paravalvular regurgitation, and percutaneous mitral valve repair. In this review, we describe the role of echocardiography during the initial structural evaluation, throughout the device placement procedure, and for the assessment of acute device function and complications. PMID:25574345

Maragiannis, Dimitrios; Little, Stephen H.

2014-01-01

51

Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients  

PubMed Central

Background The role of transesophageal echocardiography (TEE) in the evaluation of acute stroke patients is still ill-defined. We conducted a prospective observational study to find the prevalence of TEE findings that indicate anticoagulation as beneficial, in acute ischemic stroke patients without indication for anticoagulation based on clinical, electrocardiographic and transthoracic echocardiography (TTE) findings. Methods We prospectively studied all patients referred to our laboratory for TTE and TEE. Patients were excluded if the diagnosis was not acute ischemic stroke or if they had an indication for anticoagulation based on clinical, electrocardiographic, or TTE data. Patients with TEE findings that might indicate anticoagulation as beneficial were identified. Results A total of 84 patients with acute ischemic stroke and without indication for anticoagulation based on clinical and electrocardiographic or TTE data were included in the study. Findings indicating anticoagulation as beneficial were found in 32.1%: spontaneous echo contrast (1.2%), complex aortic atheroma (27.4%), thrombus (8.3%), and simultaneous patent foramen ovale and atrial septal aneurysm (2.4%). Conclusions The results of our study show that TEE can have therapy implications in 32.1% of ischemic stroke patients in sinus rhythm and with TTE with no indication for anticoagulation. PMID:18629351

de Abreu, Tiago Tribolet; Mateus, Sonia; Carreteiro, Cecilia; Correia, Jose

2008-01-01

52

Prosthesis-patient mismatch after transcatheter aortic valve implantation: impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography.  

PubMed

To investigate the role of 2D-transthoracic echocardiography (2D-TTE) and 3D-transesophageal echocardiography (3D-TEE) in the determination of aortic annulus size prior transcatheter aortic valve implantation (TAVI) and its' impact on the prevalence of patient prosthesis mismatch (PPM). Echocardiography plays an important role in measuring aortic annulus dimension in patients undergoing TAVI. This has great importance since it determines both eligibility for TAVI and selection of prosthesis type and size, and can be potentially important in preventing an inadequate ratio between the prosthetic valvular orifice and the patient's body surface area, concept known as prosthesis-patient mismatch (PPM). A total of 45 patients were studied pre-TAVI: 20 underwent 3D-TEE (men/women 12/8, age 84.8 ± 5.6) and 25 2D-TTE (men/women 9/16, age 84.4 ± 5.4) in order to measure aortic annulus diameter. The presence of PPM was assessed before hospital discharge and after a mean period of 3 months. Moderate PPM was defined as indexed aortic valve area (AVAi) ? 0.85 cm(2)/m(2) and severe PPM as AVAi < 0.65 cm(2)/m(2). Immediately post-TAVI, moderate PPM was present in 25 and 28 % of patients worked up using 3D-TEE and 2D-TTE respectively p value = n.s) and severe PPM occurred in 10 % of the patients who underwent 3D-TEE and in 20 % in those with 2D-TTE (p value = n.s). The echocardiographic evaluation 3 months post-TAVI showed 25 % moderate PPM in the 3D-TEE group compared with 24 % in the 2D-TTE group (p value = n.s) and no cases of severe PPM in the 3DTEE group comparing to 20 % in the 2D-TTE group (p = 0.032). Our results indicate a higher incidence of severe PPM in patients who performed 2DTTE compared to those performing 3DTEE prior TAVI. This suggests that the 3D technique should replace the 2DTTE analysis when investigating the aortic annulus diameter in patients undergoing TAVI. PMID:25102782

da Silva, Cristina; Sahlen, Anders; Winter, Reidar; Bäck, Magnus; Rück, Andreas; Settergren, Magnus; Manouras, Aristomenis; Shahgaldi, Kambiz

2014-12-01

53

Echocardiography in children with Down syndrome  

PubMed Central

Congenital heart disease is a common problem in children with Down syndrome (DS). Echocardiography plays an important role in the detection of both structural and functional abnormalities in this group of patients. Fetal echocardiography can help in the early recognition of DS by detecting soft markers of DS, but its main role is to define the exact nature of the suspected cardiac problem in the fetus. Postnatal echocardiography is mandatory in the first month of life for all neonates with DS. It is also indicated before any cardiac surgery and for serial follow-up after cardiac surgery. In this article, we discuss the types and mechanism of cardiac abnormalities in DS children and the role of both fetal and postnatal echocardiography in the detection of these abnormalities. PMID:25254173

Al-Biltagi, Mohammed A

2013-01-01

54

Echocardiography in Patients with Symptomatic Intracranial Stenosis  

PubMed Central

Background and Purpose Echocardiography is often performed in stroke patients, even when alterative stroke etiologies are identified. We evaluated the utility of echocardiography in patients with TIA or stroke due to stenosis of a major intracranial artery. Methods The Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial was an NIH-funded randomized, double-blinded, multicenter clinical trial in which 569 patients with TIA or ischemic stroke attributed to angiographically-proven 50–99% stenosis of a major intracranial artery were randomly assigned to warfarin or aspirin. Patients with unequivocal cardiac sources of embolism were excluded. The risk of ischemic stroke, myocardial infarction (MI), and vascular death was compared among patients who had or did not have echocardiography performed prior to enrollment, and Cox proportional hazards models were employed to determine whether echocardiographic abnormalities present in >5% of subjects were associated with these outcomes. Results 264 of 569 patients in WASID had echocardiograms; 37% were transesophageal. Of these 264 patients, 69 suffered subsequent ischemic stroke, MI, or vascular death. Patients who underwent echocardiography had similar event rates to those who did not (p=0.18). Common abnormalities identified on echocardiography were not associated with subsequent risk in this population. Conclusions Among patients with TIA or stroke due to intracranial arterial stenosis, echocardiography appears to offer limited diagnostic and prognostic value. PMID:17845919

Kasner, Scott E.; Lynn, Michael J.; Jackson, Bryon P.; Pullicino, Patrick M.; Chimowitz, Marc I.

2007-01-01

55

Limitations of transoesophageal echocardiography in patients with focal cerebral ischaemic events.  

PubMed Central

OBJECTIVE--To investigate the detection rate of cardiac sources of embolism by transoesophageal echocardiography in patients with focal cerebral ischaemic events and to relate the echocardiographic findings to other clinical findings. DESIGN--Prospective study with blinded analysis of the echocardiographic data and subsequent comparison with the other clinical findings. SETTING--Regional cardiothoracic unit based in a teaching hospital. PATIENTS--131 consecutive patients with focal ischaemic cerebral events (49 with a transient ischaemic attack, 77 with a cerebrovascular accident, and five with a retinal arterial embolus) referred for echocardiography. INTERVENTIONS--Full M mode, cross sectional, Doppler, and contrast echocardiography by both the precordial and transoesophageal techniques. RESULTS--Precordial echocardiography detected a cardiac abnormality in 72 patients. Transoesophageal echocardiography confirmed all the precordial findings (except left ventricular hypertrophy, which at present cannot be defined with this technique) and detected other abnormalities in a further 20 patients (18 with potential right-to-left shunts and two with valve vegetations). It also showed spontaneous contrast echoes in 27 of 28 patients with a large left atrium and showed atrial thrombus in three. Cardiac abnormalities were clinically detected in 53 patients, all of which were confirmed or documented by echocardiography. In the 78 patients with no clinically detectable cardiac abnormality six had mitral valve prolapse and one had a regional wall motion defect (identified by precordial echocardiography) and 17 had potential right-to-left shunts (11 of which were identified only by transoesophageal echocardiography). CONCLUSIONS--Transoesophageal echocardiography is more sensitive than precordial echocardiography in detecting potential sources of embolism in these patients. However, except for the detection of a potential right-to-left shunt, the yield in patients with no cardiac abnormality is low. Moreover, the abnormalities detected in those with previously detected cardiac disease merely confirm the clinical diagnosis. Patients with left atrial spontaneous contrast echoes may benefit from anticoagulation but this requires further study. Until more data are available on this feature and on the role of potential right-to-left shunts in this population, the contribution of echocardiography, precordial or transoesophageal, remains limited. Images PMID:1389703

de Belder, M A; Lovat, L B; Tourikis, L; Leech, G; Camm, A J

1992-01-01

56

Transesophageal echocardiography during MitraClip® procedure.  

PubMed

The percutaneous mitral valve (MV) repair procedure performed with the MitraClip delivery system is increasingly used to treat severe mitral regurgitation in high-risk patients. The treatment involves percutaneous insertion and positioning of a clip between the MV leaflets. Transesophageal echocardiography (TEE) plays a key role in the procedure by providing information regarding clip navigation, clip alignment to the MV coaptation line, transmitral advancement of the system, leaflet grasping, confirmation of valve tissue catching, and assessment of the final result. Real-time 3-dimensional TEE has increasing value in percutaneous MV repair providing high-quality visualization of both the heart and the intravascular devices. Optimal visualization by 3-dimensional TEE is obtained through both the atrial and ventricular aspects. In contrast to MV surgery, where TEE is involved in the prebypass assessment phase and in evaluation of the final repair, TEE is mandatory to guide management during MitraClip repair. Cardiac anesthesiologists may provide assistance to interventional cardiologists during the procedure itself in addition to their anesthetic-related tasks. PMID:24842173

Guarracino, Fabio; Baldassarri, Rubia; Ferro, Baldassare; Giannini, Cristina; Bertini, Pietro; Petronio, Anna Sonia; Di Bello, Vitantonio; Landoni, Giovanni; Alfieri, Ottavio

2014-06-01

57

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the European association of cardiovascular imaging.  

PubMed

The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines. PMID:25559473

Lang, Roberto M; Badano, Luigi P; Mor-Avi, Victor; Afilalo, Jonathan; Armstrong, Anderson; Ernande, Laura; Flachskampf, Frank A; Foster, Elyse; Goldstein, Steven A; Kuznetsova, Tatiana; Lancellotti, Patrizio; Muraru, Denisa; Picard, Michael H; Rietzschel, Ernst R; Rudski, Lawrence; Spencer, Kirk T; Tsang, Wendy; Voigt, Jens-Uwe

2015-01-01

58

Digital echocardiography 2002: now is the time  

NASA Technical Reports Server (NTRS)

The ability to acquire echocardiographic images digitally, store and transfer these data using the DICOM standard, and routinely analyze examinations exists today and allows the implementation of a digital echocardiography laboratory. The purpose of this review article is to outline the critical components of a digital echocardiography laboratory, discuss general strategies for implementation, and put forth some of the pitfalls that we have encountered in our own implementation. The major components of the digital laboratory include (1) digital echocardiography machines with network output, (2) a switched high-speed network, (3) a high throughput server with abundant local storage, (4) a reliable low-cost archive, (5) software to manage information, and (6) support mechanisms for software and hardware. Implementation strategies can vary from a complete vendor solution providing all components (hardware, software, support), to a strategy similar to our own where standard computer and networking hardware are used with specialized software for management of image and measurement information.

Thomas, James D.; Greenberg, Neil L.; Garcia, Mario J.

2002-01-01

59

Patients with Waldenström macroglobulinemia commonly present with iron deficiency and those with severely depressed transferrin saturation levels show response to parenteral iron administration.  

PubMed

Anemia often prompts therapy in Waldenström macroglobulinemia (WM), although is not fully explained by bone marrow disease involvement in many patients. Hepcidin regulates gut absorption and distribution of iron and is elevated and associated with anemia in WM. Since hepcidin evaluation remains experimental, we initiated an American Board of Internal Medicine (ABIM) practice improvement project to determine baseline transferrin saturation (TSAT) levels in untreated anemic patients with WM. Among 108 patients with WM evaluated, 56 (52%) had a TSAT level ? 20%, which included 25 (23%) patients with severely depressed TSAT levels (? 10%). Sixteen patients with TSAT levels ? 10% received parenteral iron, and 14 of these patients showed improved hematocrit values (28.75% to 32.75%; P < .0001), mean corpuscular volume (MCV) (84.7 to 89.9; P = .006), and TSAT levels (8.1% to 21.2%; P < .0001). Anemia in 8 of these patients was previously refractory to oral iron therapy. Routine screening of iron saturation levels may therefore identify patients with WM and severe iron deficiency who may be candidates for parenteral iron therapy. PMID:23523274

Treon, Steven P; Tripsas, Christina K; Ciccarelli, Bryan T; Manning, Robert J; Patterson, Christopher J; Sheehy, Patricia; Hunter, Zachary R

2013-04-01

60

Echocardiography in the Era of Multimodality Cardiovascular Imaging  

PubMed Central

Echocardiography remains the most frequently performed cardiac imaging investigation and is an invaluable tool for detailed and accurate evaluation of cardiac structure and function. Echocardiography, nuclear cardiology, cardiac magnetic resonance imaging, and cardiovascular-computed tomography comprise the subspeciality of cardiovascular imaging, and these techniques are often used together for a multimodality, comprehensive assessment of a number of cardiac diseases. This paper provides the general cardiologist and physician with an overview of state-of-the-art modern echocardiography, summarising established indications as well as highlighting advances in stress echocardiography, three-dimensional echocardiography, deformation imaging, and contrast echocardiography. Strengths and limitations of echocardiography are discussed as well as the growing role of real-time three-dimensional echocardiography in the guidance of structural heart interventions in the cardiac catheter laboratory. PMID:23878804

Shah, Benoy Nalin

2013-01-01

61

Update on new technologies in pediatric echocardiography.  

PubMed Central

Advances in ultrasound technology will continue to expand the utility of echocardiography in the assessment of structural and functional cardiac disease in children. Tissue Doppler imaging and dobutamine stress echocardiography are 2 promising clinical applications that are expected to become increasingly used with time. Advances in data compression technology, including JPEG and MPEG techniques, will significantly affect digital archival and transmission of echocardiograms, which also have clinical implications, particularly in the expanding use of telemedicine. Continued research and clinical experience will further define the ultimate roles of these technologies in the future. Images PMID:9456480

Bezold, L I; Lewin, M B; Vick, G W; Pignatelli, R

1997-01-01

62

The role of echocardiography in hypertrophic cardiomyopathy.  

PubMed

Hypertrophic cardiomyopathy (HCM) is a disease with a constellation of unique clinical, hemodynamic and echocardiographic features. Over the past decades, echocardiography has played a pivotal role in our understanding of the epidemiology, pathophysiology and prognosis of the condition. Recent advances in echocardiographic techniques have not only expanded our knowledge base but have also extrapolated the role of imaging from that of diagnosis, screening and non-invasive serial assessment to identification of poor prognostic markers, differentiation from phenocopies of HCM and guidance of intraprocedural decision-making in both septal ethanol ablation and surgical myectomy. This article summarizes the recent advances in echocardiography pertaining to HCM. PMID:25618305

Williams, Lynne K; Gruner, Christiane H; Rakowski, Harry

2015-02-01

63

Comparison of dobutamine stress echocardiography with dipyridamole stress echocardiography for detection of viable myocardium after myocardial infarction treated with thrombolysis.  

PubMed Central

OBJECTIVE: To compare the ability of dobutamine and dipyridamole stress echocardiography to detect functional recovery of stunned but viable myocardial regions early after acute myocardial infarction, and to predict late functional recovery of the reperfusion salvaged myocardium within the infarct area. METHODS: Within 10 d of acute myocardial infarction, 51 patients--30 anterior and 21 inferior, 44 Q wave and seven non-Q-wave infarction--were submitted to a dobutamine echocardiography test at low dose (5-10 micrograms/kg/min over 5 min) and high dose (20-40 micrograms/kg/min over 3 min) and to dipyridamole echocardiography test (0.56 mg/kg over 4 min + 0.28 mg/kg over 2 min) on different days and in random order, after interruption of any vasoactive drug. Resting echocardiography was repeated at two months in 41 of 51 patients (80%). Regional wall motion of the left ventricle was analysed in a semiquantitative manner on a 14-segment model. Viability was defined as improvement of one grade or more of at least two basally asynergic segments in the infarcted area. RESULTS: Regional functional recovery was detected by low dose dobutamine in 38/51 patients (75%) and in 147/308 (48%) of basally asynergic segments, compared to 25/51 patients (49%; P < 0.001) and 78/308 segments (25%; P < 0.001) only identified by dipyridamole. Late spontaneous functional recovery was detected in 24/41 patients (59%) and in 78/254 basally asynergic segments (31%). The sensitivity of dobutamine and dipyridamole echocardiography for predicting spontaneous functional recovery was 72% and 51% respectively (P < 0.001), specificity 68% and 82% (P < 0.001), positive predictive value 50% and 56%, and negative predictive value 85% and 79%. CONCLUSIONS: In comparison with dipyridamole in patients with thrombolysed myocardial infarction, dobutamine induces regional functional recovery. This suggests that dobutamine is more sensitive in showing the presence of viable myocardium within the infarct zone, though it has a lower specificity in predicting delayed spontaneous functional recovery of non-contractile but still viable areas. PMID:8800985

Poli, A.; Previtali, M.; Lanzarini, L.; Fetiveau, R.; Diotallevi, P.; Ferrario, M.; Mussini, A.; Specchia, G.; Montemartini, C.

1996-01-01

64

Contrast Echocardiography: Current and Future Applications  

Microsoft Academic Search

Recent updates in the field of echocardiography have resulted in improvements in image quality, especially in those patients whose ultrasonographic (ultrasound) evaluation was previously suboptimal. Intravenous contrast agents are now available in the United States and Europe for the indication of left ventricular opacification and enhanced endocardial border delineation. The use of contrast enables acquisition of ultrasound images of improved

Sharon L Mulvagh; Anthony N DeMaria; Steven B Feinstein; Peter N Burns; Sanjiv Kaul; James G Miller; Mark Monaghan; Thomas R Porter; Leslee J Shaw; Flordeliza S Villanueva

2000-01-01

65

Using a Robotic Arm for Echocardiography to X-ray Image Registration during Cardiac Catheterization  

E-print Network

context directly from these images. Also, fluoroscopy delivers a radiation dose to the patient and those of several approaches to overcome these limitations, and especially to reduce the X-ray radiation dose patients undergoing a pacing study. Keywords: 3D echocardiography, electrophysiology procedures, robotic

Boyer, Edmond

66

Assessment of coronary artery intimal thickening in patients with a previous diagnosis of Kawasaki disease by using high resolution transthoracic echocardiography: our experience  

PubMed Central

Background Kawasaki disease (KD) is a generalized systemic vasculitis of unknown etiology involving medium and small size blood vessels, particularly the coronary arteries. In these vessels a progressive stenosis may result from active remodeling with an intimal proliferation and neoangiogenesis. The aim of our study was to assess, by using high-resolution transthoracic 2D Echocardiography, if subjects with a previous diagnosis of Kawasaki disease after several years show a coronary intimal thickening, suggestive of a persistent cardiovascular risk. Methods We assessed measurement of thickening, inner diameter and outer diameter of coronary arteries using 2D Echocardiography (Philips E 33 with multy-frequency S8-3 and S12-4 probes) and examining the proximal portion of left main coronary artery just above the aortic valve with parasternal short axis view. Results We found a significant intimal thickening in patients with previous Kawasaki disease compared to healthy controls. In particular, we noticed that also subjects not suffering from coronary impairment in acute phase have higher values of thickening than healthy controls, and this wall thickening may confer a higher cardiovascular risk. Conclusions Therefore we concluded that the assessment of coronary artery thickening by high-resolution transthoracic 2D Echocardiography may become an essential instrument to evaluate late cardiovascular risk in subjects with a diagnosis of Kawasaki disease in childhood. PMID:25139118

2014-01-01

67

Echocardiography-based left ventricular mass estimation. How should we define hypertrophy?  

PubMed Central

Left ventricular hypertrophy is an important risk factor in cardiovascular disease and echocardiography has been widely used for diagnosis. Although an adequate methodologic standardization exists currently, differences in measurement and interpreting data is present in most of the older clinical studies. Variability in border limits criteria, left ventricular mass formulas, body size indexing and other adjustments affects the comparability among these studies and may influence both the clinical and epidemiologic use of echocardiography in the investigation of the left ventricular structure. We are going to review the most common measures that have been employed in left ventricular hypertrophy evaluation in the light of some recent population based echocardiographic studies, intending to show that echocardiography will remain a relatively inexpensive and accurate tool diagnostic tool. PMID:15963236

Foppa, Murilo; Duncan, Bruce B; Rohde, Luis EP

2005-01-01

68

Echocardiography Guided Therapy for Myocarditis after Scorpion Sting Envenomation  

PubMed Central

Objective: This study was to evaluate echocardiographic findings and its usefulness in clinical management of patients with scorpion sting envenomation. Material and Methods: A total of 84 consecutive patients were prospectively studied. The data included demographics, at the time of presentation to the hospital, the clinical features, echocardiographic findings, admission to intensive care unit, use of inotropic medication, time to discharge, and mortality. Results: Out of 84 patients studied 60 patients (71.4%) had echocardiographic evidence of myocarditis (LVEF <50%). Majority of patients had LVEF <40% (50 patients, 83.3%). Severe LV dysfunction (LVEF <30%) was noted in 20 patients (33.3%). No patient had significant valvular regurgitation. RV dysfunction was noted in half of the patients who had LV dysfunction. RV dysfunction was not seen in isolation. Twenty four patients without evidence of myocarditis on echocardiography were observed in general wards and were discharged in 24 to 48 hours of admission. Ten patients with mild LV dysfunction (LVEF 50-40%) and 20 patients with moderate LV dysfunction were observed in high dependency units with regular monitoring for 24 to 48 hours. Only 3 patients were put on inotropics support and others could be discharged in 72 to 96 hours. All the patients with severe LV dysfunction and moderate LV dysfunction with significant RV dysfunction were admitted in intensive care unit irrespective of symptoms (Total 30 patients). These patients were put on inotropics support. Among severe LV dysfunction group, 4 patients required ventilator support and 2 (2.3%) patients died with refractory shock and multi-organ failure. Tachycardia, muffled and or gallop heart sounds and hypertension didn’t predict presence of LV dysfunction. Persistent hypotension requiring inotropics support was a marker of severe LV dysfunction. Conclusion: Echocardiography is a useful tool in emergency to assess LV function in patients with scorpion sting envenomation. It can guide therapy by identifying patients with severe LV dysfunction. PMID:24551651

Sagarad, Suresh V; Kerure, Sudha Biradar; Thakur, Balaramsingh; Reddy, S S; K, Balasubramanya; Joshi, R M

2013-01-01

69

Role of modern 3D echocardiography in valvular heart disease  

PubMed Central

Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases. PMID:25378966

2014-01-01

70

Echocardiography in hemodialysis patients: uses and challenges.  

PubMed

Patients with end-stage renal disease undergoing hemodialysis have high rates of morbidity and mortality. Cardiovascular disease accounts for almost half of this mortality, with the single most common cause being sudden cardiac death. Early detection of abnormalities in cardiac structure and function may be important to allow timely and appropriate cardiac interventions. Echocardiography is noninvasive cardiac imaging that is widely available and provides invaluable information on cardiac morphology and function. However, it has limitations. Echocardiography is operator dependent, and image quality can vary depending on the operator's experience and the patient's acoustic window. Hemodialysis patients undergo regular hemodynamic changes that also may affect echocardiographic findings. An understanding of the prognostic significance and interpretation of echocardiographic results in this setting is important for patient care. There are some emerging techniques in echocardiographic imaging that can provide more detailed and accurate information compared with conventional 2-dimensional echocardiography. Use of these novel tools may further our understanding of the pathophysiology of cardiac disease in patients with end-stage renal disease undergoing hemodialysis. PMID:24751169

Chiu, Diana Y Y; Green, Darren; Abidin, Nik; Sinha, Smeeta; Kalra, Philip A

2014-11-01

71

How to relate diastolic left ventricular dysfunction to the results of stress echocardiography in aortic stenosis?  

PubMed

In aortic stenosis (AS), altered functional capacity may be not only a result of impaired systolic performance but likewise of diastolic left ventricular (LV) dysfunction. In asymptomatic severe AS, in borderline severe AS and in low flow, low gradient AS with reduced ejection fraction (EF), assessment of systolic and diastolic LV function should be completed by evaluation of functional capacity using low dose dobutamine stress echocardiography (SE). PMID:24400201

Bartel, Thomas; Müller, Silvana

2013-12-01

72

How to relate diastolic left ventricular dysfunction to the results of stress echocardiography in aortic stenosis?  

PubMed Central

In aortic stenosis (AS), altered functional capacity may be not only a result of impaired systolic performance but likewise of diastolic left ventricular (LV) dysfunction. In asymptomatic severe AS, in borderline severe AS and in low flow, low gradient AS with reduced ejection fraction (EF), assessment of systolic and diastolic LV function should be completed by evaluation of functional capacity using low dose dobutamine stress echocardiography (SE). PMID:24400201

Müller, Silvana

2013-01-01

73

Transcatheter Atrial Septal Defect Closure under Transthorasic Echocardiography in Children  

PubMed Central

Objective Atrial septal defect (ASD) device closure is routinely done under the guide of transesophageal or intracardiac echocardiography which are expensive techniques and not easily affordable in developing countries. Methods Using metallic devices, we attempted 32 ASD device closures under transthoracic echocardiography. Findings Of those, 30 procedures were successful (94 %). In two patients with relatively large ASD we encountered difficulty in positioning the device. These patients were referred for surgical closure. Conclusion ASD device closure can be carried out successfully in most patients under transthoracic echocardiography in situations where transesophageal or intravenous echocardiographies are not available or affordable. PMID:23056834

Zanjani, Keyhan Sayadpour; Zeinaloo, Aliakbar; Malekan-Rad, Elaheh; Kiani, Abdolrazagh; Bagheri, Mohammad-Mehdi

2011-01-01

74

Identification of Hibernating Myocardium: Comparative Accuracy of Myocardial Contrast Echocardiography, Rest-Redistribution Thallium201 Tomography and Dobutamine Echocardiography  

Microsoft Academic Search

Objectives. We sought to evaluate the comparative accuracy of myocardial contrast echocardiography (MCE), quantitative rest-redistribution thallium-201 (Tl-201) tomography and low and high dose (up to 40 ?g\\/kg body weight per min) dobutamine echocardiography (DE) in identifying myocardial hibernation.Background. Myocardial contrast echocardiography can assess myocardial perfusion and may therefore be useful in predicting myocardial hibernation. However, its accuracy in comparison to

Sherif F Nagueh; Periyanan Vaduganathan; Nadir Ali; Alvin Blaustein; Mario S Verani; William L Winters; William A Zoghbi

1997-01-01

75

Usefulness and limitations of transthoracic echocardiography in heart transplantation recipients  

Microsoft Academic Search

Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patient's discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular

Sergio Mondillo; Massimo Maccherini; Maurizio Galderisi

2008-01-01

76

Comparison of Left Atrial Dimensions by Transesophageal and Transthoracic Echocardiography  

Microsoft Academic Search

Left atrial (LA) size, as determined by transthoracic echocardiography (TTE), predicts the risk of atrial fibrillation and stroke and the success of cardio- version. Transesophageal echocardiography (TEE) is increasingly used in these clinical situations. How- ever, unlike TTE, measurement of LA size by TEE has not been standardized. To validate TEE measurement, we determined LA dimensions in 4 standard views

Matthew Block; Lisa Hourigan; Wayne H. Bellows; John Reeves; Joseph L. Romson; Michael Tran; Darwin Pastor; Nelson B. Schiller; Jacqueline M. Leung

77

Comparison of left atrial dimensions by transesophageal and transthoracic echocardiography  

Microsoft Academic Search

Left atrial (LA) size, as determined by transthoracic echocardiography (TTE), predicts the risk of atrial fibrillation and stroke and the success of cardioversion. Transesophageal echocardiography (TEE) is increasingly used in these clinical situations. However, unlike TTE, measurement of LA size by TEE has not been standardized. To validate TEE measurement, we determined LA dimensions in 4 standard views by TTE

Matthew Block; Lisa Hourigan; Wayne H. Bellows; John Reeves; Joseph L. Romson; Michael Tran; Darwin Pastor; Nelson B. Schiller; Jacqueline M. Leung

2002-01-01

78

Screening Echocardiography of Military Aircrew Candidates: Aeromedical Implications  

Microsoft Academic Search

Objectives: Cardiovascular evaluation has a significant aspect in the medical screening process of aircrew candidates. Echocardiography may identify asymptomatic cardiac abnormalities which can jeopardize the aviator and flight safety, as well as conditions which may progress and disqualify a trained aviator. We assessed the value of adding routine echocardiography to the aeromedical screening process. Methods: The study population consisted of

Ori Wand; Alex Prokupetz; Amit Assa; Erez Barenboim

2010-01-01

79

Transesophageal echocardiography: instrumentation and system controls.  

PubMed

Transesophageal echocardiography (TEE) is a semi-invasive, monitoring and diagnostic tool, which is used in the perioperative management of cardiac surgical and hemodynamically unstable patients. The low degree of invasiveness and the capacity to visualize and assimilate dynamic information that can change the course of the patient management is an important advantage of TEE. Although TEE is reliable, comprehensive, credible, and cost-effective, it must be performed by a trained echocardiographer who understands the indications and the potential complications of the procedure, and has the ability to achieve proper acquisition and interpretation of the echocardiographic data. Adequate knowledge of the physics of ultrasound and the TEE machine controls is imperative to optimize image quality, reduce artifacts, and prevent misinterpretation of diagnosis. Two-dimensional (2D) and Motion (M) mode imaging are used for obtaining anatomical information, while Doppler and Color Flow imaging are used for information on blood flow. 3D technology enables us to view the cardiac structures from different perspectives. Despite the recent advances of 3D TEE, a sharp, optimized 2D image is pivotal for the reconstruction. This article describes the relevant underlying physical principles of ultrasound and focuses on a systematic approach to instrumentation and use of controls in the practical use of transesophageal echocardiography. PMID:22508208

Prabhu, Mahesh; Raju, Dinesh; Pauli, Henning

2012-01-01

80

[Role of echocardiography in suspected pulmonary hypertension].  

PubMed

Echocardiography is the non-invasive method of choice for the study of patients with suspected pulmonary hypertension. This technique allows systolic pulmonary artery pressure to be estimated and can also provide additional information on the cause and effects of the disease. To estimate systolic pulmonary pressure, equivalent to right ventricular systolic pressure, maximal flow velocity of tricuspid regurgitation and right atrial pressure--estimated on the basis of the degree of inferior vena cava dilation--can be employed. Other parameters that should be evaluated are those related to right cavity size and right ventricular function. Unlike the left ventricle, the anatomy and geometry of the right ventricle is complex, hampering calculation of its systolic function. Consequently, over the years, various indirect methods have been developed to estimate right systolic function, the most commonly used being tricuspid annular plane systolic excursion (TAPSE) and the Tei index. New echocardiographic methods such as study of myocardial deformation (strain) and three-dimensional echocardiography may soon provide data suggesting poor clinical course in the short and medium term. Consequently, accurate determination and characterization of these data are essential. PMID:23351469

Guerra Ramos, Francisco Javier

2011-01-01

81

Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography  

Microsoft Academic Search

Background  The determination of coronary flow reserve (CFR) is an essential concept at the moment of decision-making in ischemic heart\\u000a disease. There are several direct and indirect tests to evaluate this parameter. In this sense, dobutamine stress echocardiography\\u000a is one of the pharmacological method most commonly used worldwide. It has been previously demonstrated that CFR can be determined\\u000a by this technique.

Ezequiel H Forte; Maria G Rousse; Jorge A Lowenstein

2011-01-01

82

Epicardial Fat from Echocardiography: A New Method for Visceral Adipose Tissue Prediction  

Microsoft Academic Search

Objective: To validate transthoracic echocardiography as an easy and reliable imaging method for visceral adipose tissue (VAT) prediction. VAT is recognized as an important indicator of high cardiovascular and metabolic risk. Several methods are applied to estimate VAT, with different results.Research Methods and Procedures: We selected 60 healthy subjects (29 women, 31 men, 49.5 ± 16.2 years) with a wide

Gianluca Iacobellis; Filippo Assael; Maria Cristina Ribaudo; Alessandra Zappaterreno; Giuseppe Alessi; Umberto Di Mario; Frida Leonetti

2003-01-01

83

Transoesophageal echocardiography as the sole diagnostic investigation in patients with suspected thoracic aortic dissection.  

PubMed Central

OBJECTIVES--To assess the value and limitations of using transoesophageal echocardiography as the sole diagnostic test in patients with suspected thoracic aortic dissection. DESIGN--Retrospective data review over a two year period. SETTING--A regional cardiothoracic centre. PATIENTS--Data were compiled from admission records, surgical records, and lists of patients undergoing diagnostic investigations in the hospital. Patient's notes were used to identify presentation, management, and outcome. INTERVENTIONS--Patients were managed according to the policy of our unit, which is to treat patients with dissection affecting the ascending aorta by an operation. Patients with uncomplicated dissection sparing the ascending aorta are initially managed medically. MAIN OUTCOME MEASURES--In hospital and two year follow-up of patients who were investigated by transoesophageal echocardiography alone. RESULTS--Of 48 patients referred, 45 underwent transoesophageal echocardiography. Dissection was confirmed in 22 patients. Transoesophageal echocardiography showed the proximal extent of the dissection in 21/22 (96%) and only one patient required a further diagnostic investigation. Ten patients with dissection of the ascending aorta underwent graft replacement of the ascending aorta; operative mortality was 10% and their two year survival was 80%. Of the eight patients with dissection of the descending aorta, six were discharged home, and five were alive at two years. No patient without evidence of dissection on their initial transoesophageal echocardiographic examination required re-investigation into possible dissection in the two years after discharge. CONCLUSIONS--In patients with suspected thoracic dissection transoesophageal echocardiography rapidly and safely gives all the necessary diagnostic information. Further investigations, including coronary angiography, before surgery are unnecessary. Images PMID:7818964

Banning, A P; Masani, N D; Ikram, S; Fraser, A G; Hall, R J

1994-01-01

84

Estimation of aortic valve effective orifice area by Doppler echocardiography: effects of valve inflow shape and flow rate  

Microsoft Academic Search

BackgroundThe effective orifice area (EOA) is the standard parameter for the clinical assessment of aortic stenosis severity. It has been reported that EOA measured by Doppler echocardiography does not necessarily provide an accurate estimate of the cross-sectional area of the flow jet at the vena contracta, especially at low flow rates. The objective of this study was to test the

Damien Garcia; Philippe Pibarot; Champlain Landry; Amélie Allard; Boris Chayer; Jean G Dumesnil; Louis-Gilles Durand

2004-01-01

85

History of echocardiography and its future applications in medicine.  

PubMed

This review concisely presents the chronology of events that shaped the development of echocardiography. The concept of "seeing" structures using "sound" dates back to the 1920s, when ultrasound produced by piezoelectric crystals was used to detect flaws in metals. In the early 1950s, Hertz and Edler described the use of ultrasound for assessing mitral-valve disease. Subsequently, Harvey Feigenbaum in the 1960s standardized the clinical use of M-mode echocardiography for quantitative assessment of left-ventricular dimensions. The advent of 2-dimensional echocardiography (1970s), pulsed Doppler (1970s), and color Doppler (1980s) introduced new methods for routine assessment of cardiac anatomy and hemodynamics at bedside. Flexible scopes and superior transducers further paved the way to the application of transesophageal echocardiography. Tissue Doppler and contrast echocardiography recently have emerged as important tools for evaluation of regional myocardial function and blood flow. Miniaturization and the ability to pack thousands of crystals in an electronic array have transformed the application of 3-dimensional echocardiography into a bedside tomographic tool. At the current pace of development, echocardiography will be able to provide complete assessment of the heart in terms of its anatomy, coronary flow, and physiology. Training people and making it available at every bedside may be the only remaining challenges. PMID:17667454

Krishnamoorthy, Vijay K; Sengupta, Partho P; Gentile, Federico; Khandheria, Bijoy K

2007-08-01

86

Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report  

PubMed Central

A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making. PMID:24567819

Jung, Hyun Ju; Yu, Ga-Yon; Seok, Jung-Ho; Oh, Chungsik; Kim, Seong-Hyop; Yoon, Tae-Gyoon

2014-01-01

87

A Novel Method for Quantification of Left Ventricular Noncompaction Using Two-Dimensional Echocardiography in Children  

PubMed Central

Objective Although there are several echocardiographic criteria, there is not yet a general consensus about the diagnosis of left ventricular noncompaction. The current criteria are mostly based on the areas with maximal noncompaction in the heart. The echocardiographer may miss this maximal point leading to a misdiagnosis. Accordingly, we suggested a new method to measure the percentage of myocardial noncompaction using two-dimensional echocardiography. Methods In this study, the new method was examined on 4 noncompaction and 26 dilated cardiomyopathies, and 25 normal subjects. The percentage of noncompaction was measured at 3 levels (apical, papillary muscle and mitral valve) and averaged. Findings The mean percentages of myocardial noncompaction were 3.59±2.27, 8.86±5.52 and 34.7±26.1 in the control, dilated cardiomyopathy and noncompaction groups, respectively. A value of 17% or greater could distinguish left ventricular noncompaction from dilated cardiomyopathy with 92% specificity and 100% sensitivity and from normal subjects with 100% specificity and sensitivity. This percentage had a statistically significant association with noncompacted to compacted myocardial thickness ratio (P<0.001). Conclusion This method showed good correlations with the existing echocardiographic and magnetic resonance criteria. However, it is not dependent on finding the area of maximal involvement. Being comparable to magnetic resonance imaging in accuracy, it is easier to perform and more available. PMID:24800010

Khosroshahi, Ahmad Ghamei; Zanjani, Keyhan Sayadpour; Kocharian, Armen; Zeinaloo, Aliakbar; Kiani, Abdolrazagh; Rad, Elaheh Malakan

2013-01-01

88

Clinical application and laboratory protocols for performing contrast echocardiography  

PubMed Central

Technically difficult echocardiographic studies with suboptimal images remain a significant challenge in clinical practice despite advances in imaging technologies over the past decades. Use of microbubble ultrasound contrast for left ventricular opacification and enhancement of endocardial border detection during rest or stress echocardiography has become an essential component of the operation of the modern echocardiography laboratory. Contrast echocardiography has been demonstrated to improve diagnostic accuracy and confidence across a range of indications including quantitative assessment of left ventricular systolic function, wall motion analysis, and left ventricular structural abnormalities. Enhancement of Doppler signals and myocardial contrast echocardiography for perfusion remain off-label uses. Implementation of a contrast protocol is feasible for most laboratories and both physicians and sonographers will require training in contrast specific imaging techniques for optimal use. Previous concerns regarding the safety of contrast agents have since been addressed by more recent data supporting its excellent safety profile and overall cost-effectiveness. PMID:23809394

Chong, Adrian; Haluska, Brian; Wahi, Sudhir

2013-01-01

89

Echocardiography as a Research and Clinical Tool in Veterinary Medicine  

PubMed Central

Echocardiography is the accepted term for the study of cardiac ultrasound. Although a relatively new tool for the study of the heart in man it has already found wide acceptance in the area of cardiac research and in the study of clinical cardiac disease. Animals had often been used in the early experiments with cardiac ultrasound, but only recently has echocardiography been used as a research and clinical tool in veterinary medicine. In this report echocardiography is used in the research of anesthetic effects on ventricular function and clinically in the diagnosis of congestive cardiomyopathy in a cat, ventricular septal defect in a calf, and pericardial effusion in a dog. Echocardiography is now an important adjunct to the field of veterinary cardiology. ImagesFigure 7.Figure 8.Figure 9.Figure 10. PMID:17422196

Allen, D. G.

1982-01-01

90

Value of echocardiography in an era of healthcare reform.  

PubMed

Considering the rising costs of healthcare and the availability of multiple types of cardiovascular imaging, careful consideration must be given to selection of the most appropriate imaging modality. The value equation, which considers the benefits relative to the cost, is described for echocardiography. As described in the articles in this issue, echocardiography has become central to the assessment of patients with a broad variety of cardiac conditions. PMID:25081396

Pellikka, Patricia A

2014-01-01

91

Figure 2 A reversed image of two regions from the groundbased flat field on detector segment 1A, showing typical features. The image on the left shows several large dead spots with bright rims, along with brush marks. The image on the right shows  

E-print Network

with brush marks. The image on the right shows the chicken wire pattern from the MCP hex boundaries. Shadows due to blocked pores, brush marks from cleaning of the MCPs before assembly, multifiber bundle hex a stretch and shift due to changes in detector electronics temperature (to the limits of the S

92

Figure 2 A reversed image of two regions from the ground-based flat field on detector segment 1A, showing typical features. The image on the left shows several large dead spots with bright rims, along with brush marks. The image on the right shows  

E-print Network

with brush marks. The image on the right shows the chicken wire pattern from the MCP hex boundaries. Shadows due to blocked pores, brush marks from cleaning of the MCPs before assembly, multifiber bundle hex a stretch and shift due to changes in detector electronics temperature (to the limits of the S

93

Head to head comparison of 2D vs real time 3D dipyridamole stress echocardiography.  

PubMed

Real-time three-dimensional (RT-3D) echocardiography has entered the clinical practice but true incremental value over standard two-dimensional echocardiography (2D) remains uncertain when applied to stress echo. The aim of the present study is to establish the additional value of RT-3D stress echo over standard 2D stress echocardiography. We evaluated 23 consecutive patients (age = 65 +/- 10 years, 16 men) referred for dipyridamole stress echocardiography with Sonos 7500 (Philips Medical Systems, Palo, Alto, CA) equipped with a phased - array 1.6-2.5 MHz probe with second harmonic capability for 2D imaging and a 2-4 MHz matrix-phased array transducer producing 60 x 70 volumetric pyramidal data containing the entire left ventricle for RT-3D imaging. In all patients, images were digitally stored in 2D and 3D for baseline and peak stress with a delay between acquisitions of less than 60 seconds. Wall motion analysis was interpreted on-line for 2D and off-line for RT-3D by joint reading of two expert stress ecocardiographist. Segmental image quality was scored from 1 = excellent to 5 = uninterpretable. Interpretable images were obtained in all patients. Acquisition time for 2D images was 67 +/- 21 sec vs 40 +/- 22 sec for RT-3D (p = 0.5). Wall motion analysis time was 2.8 +/- 0.5 min for 2D and 13 +/- 7 min for 3D (p = 0.0001). Segmental image quality score was 1.4 +/- 0.5 for 2D and 2.6 +/- 0.7 for 3D (p = 0.0001). Positive test results was found in 5/23 patients. 2D and RT-3D were in agreement in 3 out of these 5 positive exams. Overall stress result (positive vs negative) concordance was 91% (Kappa = 0.80) between 2D and RT-3D. During dipyridamole stress echocardiography RT-3D imaging is highly feasible and shows a high concordance rate with standard 2D stress echo. 2D images take longer time to acquire and RT-3D is more time-consuming to analyze. At present, there is no clear clinical advantage justifying routine RT-3D stress echocardiography use. PMID:18570640

Varnero, Silvia; Santagata, Patricia; Pratali, Lorenza; Basso, Massimiliano; Gandolfo, Alfredo; Bellotti, Paolo

2008-01-01

94

Cardiovascular assessment of fetal mice by in utero echocardiography  

PubMed Central

To establish a developmental profile of fetal mouse cardiovascular parameters, we analyzed a large body of ultrasound measurements obtained by in utero echocardiography of C57BL/6J fetal mice from embryonic day 12.5 to 19.5 (term). Measurements were obtained using 2D, spectral Doppler and M-mode imaging with standard clinical cardiac ultrasound imaging planes. As these studies were conducted as part of a large scale mouse mutagenesis screen, stringent filtering criteria were used to eliminate potentially abnormal fetuses. Our analysis showed heart rate increased from 190 to 245 bpm as the mouse fetus grew from 8 mm at embryonic day 12.5 to 18.7 mm at term. This was accompanied by increases in peak outflow velocity, E-wave, E/A ratio and ventricular dimensions. In contrast, the A-wave, myocardial performance index and isovolemic contraction time decreased gradually. Systolic function remained remarkably stable at 80% ejection fraction. Analysis of intra and interobserver variabilities showed these parameters were reproducible, with most comparing favorably to clinical ultrasound measurements in human fetuses. A comprehensive database was generated comprising 23 echocardiographic parameters delineating fetal mouse cardiovascular function from embryonic day 12.5 to term. This database can serve as a standard for evaluating cardiovascular pathophysiology in genetically altered and mutant mouse models. PMID:18328616

Yu, Qing; Leatherbury, Linda; Tian, Xin; Lo, C.W.

2008-01-01

95

Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography  

PubMed Central

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation. PMID:17254324

Galderisi, Maurizio; Marra, Francesco; Esposito, Roberta; Lomoriello, Vincenzo Schiano; Pardo, Moira; de Divitiis, Oreste

2007-01-01

96

Need for a standardized protocol for stress echocardiography in provoking subaortic and valvular gradient in various cardiac conditions.  

PubMed

(Semi) supine exercise testing has an established role in the evaluation of patients with valvular heart disease and can help clinical decision making. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. However, exercise-induced changes in valve hemodynamics, left ventricular outflow obstruction and pulmonary artery pressure depended on load variation. Changing position from supine to upright rapidly decreases load conditions for the ventricles. Therefore several cardiac centers have proposed exercise stress echocardiography in the upright position with gradient monitoring sometimes also in post-exercise recovery. Doppler measurement of subaortic gradient has been a very helpful and informative examination in several heart diseases (especially in hypertrophic cardiomyopathy, valve heart diseases, prosthesis dysfunction). PMID:25017422

Petkow Dimitrow, Pawel; Cotrim, Carlos; Cheng, Tsung O

2014-01-01

97

Need for a standardized protocol for stress echocardiography in provoking subaortic and valvular gradient in various cardiac conditions  

PubMed Central

(Semi) supine exercise testing has an established role in the evaluation of patients with valvular heart disease and can help clinical decision making. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. However, exercise-induced changes in valve hemodynamics, left ventricular outflow obstruction and pulmonary artery pressure depended on load variation. Changing position from supine to upright rapidly decreases load conditions for the ventricles. Therefore several cardiac centers have proposed exercise stress echocardiography in the upright position with gradient monitoring sometimes also in post-exercise recovery. Doppler measurement of subaortic gradient has been a very helpful and informative examination in several heart diseases (especially in hypertrophic cardiomyopathy, valve heart diseases, prosthesis dysfunction). PMID:25017422

2014-01-01

98

Three-dimensional echocardiography in congenital heart disease.  

PubMed

Three-dimensional (3D) echocardiography has improved dramatically due to technical advances in probe design and computer processing. Congenital heart disease demands a detailed understanding of the spatial relationships of cardiac structures to plan treatment, making 3D echocardiography highly attractive. Novel projections of cardiac structures can be achieved that are impossible by two-dimensional methods, and high frequency probes are now available to allow better 3D imaging in small children. The introduction of a 3D transoesophageal echo probe has extended the applications to real-time guidance of catheter procedures. All of these developments mean that 3D echocardiography is now an accepted complementary imaging technique to conventional cross-sectional echocardiography in congenital heart disease. In addition to morphology, 3D echocardiography can analyse ventricular volumes and function with fewer geometric assumptions than cross-sectional techniques. Analysis of myocardial motion, including 3D tracking of wall motion, is an emerging technique that may become important, particularly in long-term follow-up of operated congenital heart disease. Normal ranges of ventricular volumes and synchrony remain to be established in children. Further improvements in image processing, including automation of analyses and tailoring of software to ventricles of abnormal shape, may move such techniques from a research setting into more mainstream clinical practice. PMID:21276577

Simpson, John M; Miller, Owen

2011-01-01

99

Biventricular Tako-Tsubo cardiomyopathy: usefulness of 2D speckle tracking strain echocardiography.  

PubMed

Tako-Tsubo cardiomyopathy is a transient left ventricular apical ballooning syndrome also known as stress-induced cardiomyopathy. This reversible cardiomyopathy without epicardial coronary artery disease mimics acute myocardial infarction. Right ventricular involvement, which has been infrequently reported, is present in about a quarter of cases of Tako-Tsubo cardiomyopathy and is associated with a more severe clinical outcome. We report the case of a 55-year-old postmenopausal woman with transient biventricular apical ballooning. She recently had acute exacerbation of multiple sclerosis. Regional and global function of both ventricles was estimated using two-dimensional speckle tracking strain echocardiography. PMID:23765730

Vizzardi, Enrico; Bonadei, Ivano; Piovanelli, Barbara; Bugatti, Silvia; D'Aloia, Antonio

2014-02-01

100

Bringing MRI to the cardiologist: can we learn from echocardiography?  

PubMed

Cardiac MRI (CMR) is a low-risk, comprehensive diagnostic tool that has many similarities with echocardiography. It is noninvasive, lacks ionizing radiation, and the contrast material used to enhance various images does not have any renal toxicity. Although extremely valuable in the diagnosis of neurologic and musculoskeletal diseases for more than two decades, CMR has only recently become relevant for diagnosing the rapidly beating and constantly mobile heart. Through advances in cardiac gating and high-speed acquisition software, CMR is positioning itself as a critical utensil at the cardiovascular disease banquet. However, like echocardiography, currently celebrating its 50th birthday, CMR is likely to suffer occasional growing pains, along with its share of accomplishments. Therefore, those practicing CMR should learn from the past errors and achievements of echocardiography in an effort to deliver the most rewarding diagnostic instrument imaginable, without having to wait 50 years. PMID:15610651

Sorrell, Vincent L

2005-01-01

101

Echocardiography for patent ductus arteriosus including closure in adults.  

PubMed

Patent ductus arteriosus (PDA) represents at least 5-10% of all congenital heart defects (CHDs) making it a very important commonly diagnosed lesion. Although spontaneous closure of the PDA occurs within 24 to 48 hours after birth in the majority, those children who do not have natural or surgical closure may have a persistent PDA into adulthood. The diagnosis is most often confirmed by echocardiography that also guides catheter-based interventions and surgeries. Echocardiography continues to be the most important tool in long-term follow-up of residua and sequelae. PMID:24888537

Chugh, Reema; Salem, Morris M

2015-01-01

102

The Role of Transesophageal Echocardiography in the Intraoperative Period  

PubMed Central

The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate organ perfusion, a major prerequisite for adequate tissue oxygenation and thus, end-organ function. Further, hemodynamic monitoring should serve to prevent, detect, and to effectively guide treatment of potentially life-threatening hemodynamic events, such as severe hypovolemia due to hemorrhage, or cardiac failure. The ideal monitoring device does not exist, but some conditions must be met: it should be easy and operator-independently to use; it should provide adequate, reproducible information in real time. In this review we discuss in particular the role of intraoperative use of transesophageal echocardiography (TOE). Although TOE has gained special relevance in cardiac surgery, its role in major non cardiac surgery is still to be determined. We particularly focus on its ability to provide measurements of cardiac output (CO), and its role to guide fluid therapy. Within the last decade, concepts oriented on optimizing stroke volume and cardiac output mainly by fluid administration and guided by continuous monitoring of cardiac output or so called functional parameters of cardiac preload gained particular attention. Although they are potentially linked to an increased amount of fluid infusion, recent data give evidence that such pre-emptive concepts of hemodynamic optimization result in a decrease in morbidity and mortality. As TOE allows a real time direct visualization of cardiac structures, other potentially important advantages of its use also outside the cardiac surgery operation room can be postulated, namely the ability to evaluate the anatomical and functional integrity of the left and the right heart chambers. Finally, a practical approach to TOE monitoring is presented, based on a local experience. PMID:22758616

Gouveia, Verónica; Marcelino, Paulo; Reuter, Daniel A

2011-01-01

103

Transcranial Doppler Sonography: Atypical Dicrotic Pulse Waveforms in a Man with HIV Infection and Severe Cardiomyopathy.  

PubMed

A 27-year-old human immunodeficiency virus-positive man presented with abdominal pain. Computed tomography of the abdomen revealed large right pleural effusion, pericardial effusion and marked ascites with diffuse intra- and extraperitoneal lymphadenopathy. Echocardiography showed severely reduced left ventricular systolic function. After drainage of pleural and pericardial fluid, the patient developed severe hypotension and hypoxic respiratory failure. Extra- and intracranial neurovascular sonography demonstrated low carotid artery flow volume and dicrotic pulse waveforms in all vessels insonated bilaterally. This case report demonstrates an atypical dicrotic waveform pattern of transcranial Doppler in advanced ventricular dysfunction with shock. PMID:25289479

Suwatcharangkoon, Sureerat; Meads, Dana B; Tegeler, Charles H; Reynolds, Patrick S

2014-10-01

104

Assessment of Myocardial Function in Pediatric Patients with Operated Tetralogy of Fallot: Preliminary Results with 2D Strain Echocardiography  

Microsoft Academic Search

The global myocardial function in patients after repair of tetralogy of Fallot (TOF) can be assessed by cardiovascular magnetic\\u000a resonance (CMR) and measurement of B-type natriuretic peptides. Two-dimensional echocardiography-derived strain and strain\\u000a rate (2D strain) facilitate the assessment of regional myocardial function. We evaluated myocardial function in 16 children\\u000a with residual severe pulmonary valve regurgitation and right ventricular (RV) volume

Walter Knirsch; Ali Dodge-Khatami; Alexander Kadner; Oliver Kretschmar; Johannes Steiner; Petra Böttler; Deniz Kececioglu; Paul Harpes; Emanuela R. Valsangiacomo Buechel

2008-01-01

105

Irinotecan Plus S-1 Followed by Hepatectomy for a Patient with Initially Unresectable Colorectal Liver Metastases, Who Showed Severe Drug Rash with Oxaliplatin Plus 5-FU and Leucovorin (FOLFOX)  

PubMed Central

For unresectable colorectal liver metastases (CRLM), hepatic resection with or without chemotherapy is the only curative treatment that sufficiently achieves long-term survival. However, occasional severe allergic responses to anticancer drugs necessitate treatment discontinuation. A 45-year-old woman presented with metachronous unresectable colorectal liver metastases. Chemotherapy with oxaliplatin plus 5-FU and leucovorin (FOLFOX) was initiated, but severe allergic dermatitis developed after the second cycle. Although she reported no prior history of adverse reactions to tegafur-uracil, a drug lymphocyte stimulation test showed an allergic response to 5-FU. We subsequently replaced with Irinotecan plus S-1 (IRIS) chemotherapy which was well tolerated and resulted in a partial response after 3 cycles. As a result, right trisectionectomy was successfully performed and no recurrence was detected in the following 3 years. A severe allergic reaction to intravenous 5-FU-containing drug regimens can be successfully alleviated by switching to S-1-containing regimens such as IRIS or S-1 plus oxaliplatin (SOX). PMID:25031875

Komori, Hiroyuki; Beppu, Toru; Sakamoto, Yasuo; Miyamoto, Yuji; Hayashi, Hiromitsu; Imai, Katsunori; Nitta, Hidetoshi; Watanabe, Masayuki; Baba, Hideo

2014-01-01

106

Evaluation of Cardiac Function Using Transthoracic Echocardiography in Patients with Myocardial Injury Secondary to Methomyl Poisoning.  

PubMed

Generally, the mortality rate for cases of carbamate poisoning is low, but fatalities secondary to methomyl poisoning have been reported including a case report of cardiac toxicity following short-term exposure to methomyl. There have been no reports, however, regarding patterns of cardiac toxicity after exposure to methomyl. Therefore, we investigated the prevalence and patterns of myocardial injury using a biochemical marker, troponin I (TnI), and evaluated cardiac function using transthoracic echocardiography (TTE). We conducted a retrospective review of 14 consecutive methomyl poisoning cases that were diagnosed and treated at the emergency department of the Wonju Severance Christian Hospital between January 2009 and December 2013. On ECG analysis, ST depression and T-wave inversion were seen in five patients (35.7 %) and one patient (7.1 %), respectively. On cardiac biochemical marker analysis, initial TnI was elevated in 11 patients (78.6 %). TTE was performed in nine patients among the 11 patients in whom TnI was found to be elevated. Of the nine patients that underwent TTE, three patients (33.3 %) showed a reduced ejection fraction (EF), and RWMA was noted in two patients. There were two patients (22.2 %) that had both reduced systolic function and RWMA. One patient did not regain normal systolic function on admission. None of the three patients with reduced EF received any specific treatment to support cardiac function. One patient expired due to pneumonia, and one patient was transferred as moribund. We followed up on 12 patients who survived to discharge for 6-44 months. One patient (8.3 %) was died to follow-up, and 11 patients survived without any further complications. Methomyl exposure can cause direct myocardial injury and reversible cardiac dysfunction. Monitoring of TnI levels and TTE for evaluation of cardiac function may be useful in the workup of patients suffering from methomyl poisoning. PMID:25410938

Lee, Dong Keon; Cho, Nam Hyub; Kim, Oh Hyun; Go, Jin; Kim, Tae Hoon; Cha, Kyoung Chul; Kim, Hyun; Lee, Kang Hyun; Hwang, Sung Oh; Cha, Yong Sung

2014-11-20

107

Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism.  

PubMed

Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement. PMID:24676760

Ozdemir, Didem; Kalkan, Gulhan Yuksel; Bayram, Nihal Akar; Onal, Eda Demir; Ersoy, Reyhan; Bozkurt, Engin; Cakir, Bekir

2014-11-01

108

Lobar pulmonary edema due to mitral regurgitation: diagnosis by echocardiography.  

PubMed

One etiology of unilateral lobar pulmonary edema is mitral regurgitation. Echocardiography is able to demonstrate the retrograde flow of blood into the pulmonary veins and allows timely diagnosis and treatment planning. Correction of mitral regurgitation is followed by resolution of the radiographic abnormality. PMID:9690502

Dexter, E U; Snider, J M; Gordon, E E; Richenbacher, W E

1997-01-01

109

Detection and evaluation of intrapulmonary vascular shunt with "contrast Doppler" transesophageal echocardiography.  

PubMed

Contrast echocardiography is useful for detecting intrapulmonary right-to-left shunt lesions. In a patient with suspected pulmonary arteriovenous fistula, contrast transesophageal echocardiography was used to demonstrate the presence of a right-to-left shunt. By use of a combination of two-dimensional echocardiography, contrast injection, and pulsed Doppler echocardiography, each pulmonary vein was successfully interrogated for evidence of contrast shunting. This case demonstrates that contrast transesophageal echocardiography is useful for the detection of intrapulmonary fistulas and that it has the potential for localization of the shunt lesion. PMID:2003943

Nemec, J J; Davison, M B; Marwick, T H; Chimowitz, M I; Stoller, J K; Klein, A L; Salcedo, E E

1991-01-01

110

Double Negative (IgG+IgD-CD27-) B Cells are Increased in a Cohort of Moderate-Severe Alzheimer's Disease Patients and Show a Pro-Inflammatory Trafficking Receptor Phenotype.  

PubMed

Alzheimer's disease (AD) is a progressive, irreversible, and debilitating disease for which no effective preventive or disease modifying therapies or treatments have so far been detected. The crucial step in AD pathogenesis is the production of amyloid-?42 peptide, which causes chronic inflammation. Activated cells in the central nervous system (CNS) produce pro-inflammatory mediators that lead to the recruitment of myeloid or lymphocytic cells. As a consequence, the communication between the CNS and peripheral blood of AD subjects could influence the lymphocyte distribution and/or the expression of phenotypic markers. In the present paper, we show a significant decrease in total CD19+ B lymphocytes and a remodeling of the B cell subpopulations in moderate-severe AD patients, compared with their coeval healthy controls and mild AD subjects. In particular, we report a significant reduction in naïve B cells (IgD+CD27-) and a simultaneous increase in double negative (DN, IgD-CD27-) memory B lymphocytes. We have also evaluated the expression of the pro-inflammatory chemokine receptors CCR6 and CCR7 in total and naïve/memory B cells from mild and moderate-severe AD patients, with the aim to detect a possible relationship between the trafficking profile and the stage of the disease. Our results demonstrate that both the amount and the trafficking profile of B cells are related to the severity of AD. The results discussed in this paper suggest a well-selected antibody panel should be used as an additional test for the identification of early AD. PMID:25408215

Bulati, Matteo; Buffa, Silvio; Martorana, Adriana; Gervasi, Francesco; Camarda, Cecilia; Azzarello, Delia Maria; Monastero, Roberto; Caruso, Calogero; Colonna-Romano, Giuseppina

2014-11-18

111

Echocardiography Underestimates Stroke Volume and Aortic Valve Area: Implications for Patients With Small-Area Low-Gradient Aortic Stenosis  

PubMed Central

Background Discordance between small aortic valve area (AVA; < 1.0 cm2) and low mean pressure gradient (MPG; < 40 mm Hg) affects a third of patients with moderate or severe aortic stenosis (AS). We hypothesized that this is largely due to inaccurate echocardiographic measurements of the left ventricular outflow tract area (LVOTarea) and stroke volume alongside inconsistencies in recommended thresholds. Methods One hundred thirty-three patients with mild to severe AS and 33 control individuals underwent comprehensive echocardiography and cardiovascular magnetic resonance imaging (MRI). Stroke volume and LVOTarea were calculated using echocardiography and MRI, and the effects on AVA estimation were assessed. The relationship between AVA and MPG measurements was then modelled with nonlinear regression and consistent thresholds for these parameters calculated. Finally the effect of these modified AVA measurements and novel thresholds on the number of patients with small-area low-gradient AS was investigated. Results Compared with MRI, echocardiography underestimated LVOTarea (n = 40; ?0.7 cm2; 95% confidence interval [CI], ?2.6 to 1.3), stroke volumes (?6.5 mL/m2; 95% CI, ?28.9 to 16.0) and consequently, AVA (?0.23 cm2; 95% CI, ?1.01 to 0.59). Moreover, an AVA of 1.0 cm2 corresponded to MPG of 24 mm Hg based on echocardiographic measurements and 37 mm Hg after correction with MRI-derived stroke volumes. Based on conventional measures, 56 patients had discordant small-area low-gradient AS. Using MRI-derived stroke volumes and the revised thresholds, a 48% reduction in discordance was observed (n = 29). Conclusions Echocardiography underestimated LVOTarea, stroke volume, and therefore AVA, compared with MRI. The thresholds based on current guidelines were also inconsistent. In combination, these factors explain > 40% of patients with discordant small-area low-gradient AS. PMID:25151288

Chin, Calvin W.L.; Khaw, Hwan J.; Luo, Elton; Tan, Shuwei; White, Audrey C.; Newby, David E.; Dweck, Marc R.

2014-01-01

112

Speckle tracking echocardiography detects uremic cardiomyopathy early and predicts cardiovascular mortality in ESRD.  

PubMed

Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P<0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD. PMID:24700873

Kramann, Rafael; Erpenbeck, Johanna; Schneider, Rebekka K; Röhl, Anna B; Hein, Marc; Brandenburg, Vincent M; van Diepen, Merel; Dekker, Friedo; Marx, Nicolaus; Floege, Jürgen; Becker, Michael; Schlieper, Georg

2014-10-01

113

Feature extraction and wall motion classification of 2D stress echocardiography with support vector machines  

NASA Astrophysics Data System (ADS)

Stress echocardiography is a common clinical procedure for diagnosing heart disease. Clinically, diagnosis of the heart wall motion depends mostly on visual assessment, which is highly subjective and operator-dependent. Introduction of automated methods for heart function assessment have the potential to minimise the variance in operator assessment. Automated wall motion analysis consists of two main steps: (i) segmentation of heart wall borders, and (ii) classification of heart function as either "normal" or "abnormal" based on the segmentation. This paper considers automated classification of rest and stress echocardiography. Most previous approaches to the classification of heart function have considered rest or stress data separately, and have only considered using features extracted from the two main frames (corresponding to the end-of-diastole and end-of-systole). One previous attempt [1] has been made to combine information from rest and stress sequences utilising a Hidden Markov Model (HMM), which has proven to be the best performing approach to date. Here, we propose a novel alternative feature selection approach using combined information from rest and stress sequences for motion classification of stress echocardiography, utilising a Support Vector Machines (SVM) classifier. We describe how the proposed SVM-based method overcomes difficulties that occur with HMM classification. Overall accuracy with the new method for global wall motion classification using datasets from 173 patients is 92.47%, and the accuracy of local wall motion classification is 87.20%, showing that the proposed method outperforms the current state-of-the-art HMM-based approach (for which global and local classification accuracy is 82.15% and 78.33%, respectively).

Chykeyuk, Kiryl; Clifton, David A.; Noble, J. Alison

2011-03-01

114

Semi-supine Exercise Stress Echocardiography in Children and Adolescents: Feasibility and Safety.  

PubMed

Although exercise stress echocardiography (ESE) is a well-validated technique in adult population, its use in children is quite limited. We aimed to assess the feasibility, the safety and the reproducibility of ESE, using on-line scanning in semi-supine cyclo-ergometer protocol in a large pediatric population. Between July 2008 and January 2013, 42 patients (mean age 14 ± 3) were evaluated with a bicycle ESE performing 50 studies. ESE was successfully performed and well tolerated by all patients. None of the patients presented with adverse effects of stress-induced ischemia. HR was 82 ± 13 at rest, and 153 ± 19.1 during peak exercise. Among 544 views analyzed for grading of image quality, the visualization was optimal in 473 (87 %), suboptimal in 39, and inadequate in 32 (6 %). 37 tests were performed in patients with congenital or acquired coronary abnormality. Regional wall motion abnormalities (RWMA) were revealed in nine cases (24 %). The agreement between the two different observers showed a K index of 0.7276 (95 % CI 0.6497-0.8055) for the image quality and a K index of 0.5125 (95 % CI 0.4782-0.5468) for the RWMA analysis. Among ten patients with hypertrophic cardiomyopathy, we were able to demonstrate the new comparison of significant left ventricular outflow tract gradient (?30 mmHg) during exercise in three patients (30 %). Bicycle stress echocardiography performed by on-line scanning during exercise is a feasible, safe, and reproducible modality in children. Further data to assess its diagnostic accuracy are, however, needed. Stress echocardiography provides a dynamic assessment of the myocardial structure and function under conditions of physiologic or pharmacologic stress. PMID:25410823

Ciliberti, P; McLeod, I; Cairello, F; Kaski, J P; Fenton, M; Giardini, A; Marek, J

2014-11-20

115

Transesophageal Echocardiography for Coronary Sinus Imaging in Partially Unroofed Coronary Sinus  

PubMed Central

Background Partially unroofed coronary sinus (PUCS) is a rare congenital cardiac anomaly and prone to be misdiagnosed. The purpose of this study was to explore the value of transesophageal echocardiography (TEE) in CS imaging for the detection of PUCS and to develop a special two-dimensional TEE-based en face view of CS. Methods Twenty adult patients with suspected PUCS, showing a dilated coronary sinus and an enlarged right heart on transthoracic echocardiography (TTE), underwent TEE examination. In the mid-esophageal plane and close to an angle of 120°, the en face view of the CS successfully imaged the roof of the CS, which was beyond the realm of the atrial septum, and the interatrial septum was obtained simultaneously in the same view. Meanwhile, the 3D zoom mode could clearly display the comprehensive volume image and the adjacent structures of the PUCS. The results of TEE were compared with the findings of surgery or catheterization. Results En face view of the CS was obtained successfully by 2DTEE in 20 patients. In addition, 3DTEE was used for imaging of PUCS in 11 of the 20 patients. PUCS was ultimately confirmed in 13 patients either by surgery or catheterization. The TEE for PUCS diagnosis was consistent with the surgical findings. Conclusion Transesophageal echocardiography can be successfully applied to obtain the comprehensive view of CS and its surrounding structures. The en face view of CS provided by 2DTEE may be helpful in better understanding PUCS and discriminating it from associated atrial septal defects. PMID:23909710

Sun, Ting; Fei, Hong-Wen; Huang, Huan-Lei; Chen, Ou-Di; Zheng, Zhi-Chao; Zhang, Cao-Jin; Hou, Yue-Shuang

2014-01-01

116

Methodologic comparison of left ventricular stroke volumes in the early neonatal period by echocardiography.  

PubMed

Several methods for evaluating left ventricular stroke volume (SV) in neonates using echocardiography have been reported. However, no studies on methodologic comparison of SV with three-dimensional (3D) echocardiography are available. This is the first detailed report on a methodologic comparison of SV in the early neonatal period. The study group included 70 normal neonates (35 boys and 35 girls). An iE33 echocardiograph and Q-LAB supplied by Philips Electronics were used to examine and calculate volumes. Comparisons of SV were performed using Teichholz (T), the velocity time integral (VTI), Pombo (P), modified Simpson (MS), and 3D methods with normal neonates who had no persistent ductus arteriosus less than 7 days after birth. The mean SVs were 33.7 mL/m(2) (T), 30.6 mL/m(2) (VTI), 22.0 mL/m(2) (P), 17.5 mL/m(2) (3D), and 14.9 mL/m(2) (MS) using Haycock's formula of body surface area. The stroke volumes differed significantly depending on the different methods. The correlation coefficient was highest between the MS and 3D methods. The SVs of the T and VTI methods were significantly greater than those previously reported, and it seemed inappropriate to evaluate volumes in neonates. The 3D and MS methods were appropriate for measuring SV in neonates during the early neonatal period. PMID:24916967

Nagasawa, Hiroyuki; Kohno, Yoshinori; Yamamoto, Yutaka; Kondo, Masashi; Sugawara, Masami; Koyama, Toshinari; Terazawa, Daisuke; Miura, Ryosuke

2014-12-01

117

Transoesophageal echocardiography reduces invasiveness of cavoatrial tumour thrombectomy  

PubMed Central

The traditional approach to cavoatrial thrombus excision requires median sternotomy, cardiopulmonary bypass with or without hypothermia and circulatory arrest and is associated with significant morbidity and mortality. We describe a transoesophageal echocardiography guided balloon catheter assisted technique for cavoatrial thrombectomy that avoids thoracotomy, extracorporeal circulation and circulatory arrest as an alternative to traditional methods. A 74-year-old man presented with a right solid renal mass confined to the kidney with thrombus extension through the right renal vein and the inferior vena cava into the right atrium. A right radical nephrectomy with cavoatrial thrombectomy under transoesophageal echocardiography guidance was successfully achieved using a balloon catheter-assisted technique with minimal intra-and postoperative morbidity. Cavoatrial tumour thrombectomy can be successfully performed without cardiopulmonary bypass, hypothermia and circulatory arrest. PMID:25337178

Sobczy?ski, Robert; Mazur, Piotr; Ch?osta, Piotr

2014-01-01

118

Contrast echocardiography in detection of portopulmonary venous anastomosis.  

PubMed

Portopulmonary venous anastomosis is a potential channel for systemic arterial embolization during embolization procedures for bleeding esophageal varices. To document the presence of such anastomoses, 15 patients with esophageal varices were studied by real-time contrast echocardiography combined with transhepatic cineportography. Cinefluorographic technique, which was applied for this purpose, occasionally failed to demonstrate the dynamic events in the left atrium because of rapid dilution of contrast medium. Echocardiography after the injection of dextrose solution into the gastric coronary vein allowed two-dimensional real-time images of contrast echoes in the left cardiac chambers. By combining these two methods, more reliable diagnostic information was obtained in five of the 15 patients studied. PMID:6606947

Sano, A; Nishizawa, S; Sasai, K; Imanaka, K; Tanaka, K; Hashimura, T; Iida, A; Ban, N; Moriyasu, F; Takahashi, Y

1984-01-01

119

[Application fields of intraoperative transesophageal 3D echocardiography].  

PubMed

Intraoperative transesophageal echocardiography (TEE) is an established diagnostic tool and has to be regarded as the standard of care for intraoperative monitoring and cardiac surgical decision-making. Furthermore, intraoperative TEE is also used for monitoring and assessment of hemodynamic changes and the detection of previously unknown pathologies. In the past few years 3D-TEE has extended the spectrum of 2D-TEE by allowing pathomorphological features to be more easily and intuitively linked to the anatomy of the heart and the great vessels. Thus, a comprehensive 2D-TEE examination is favorably complemented by focused 3D-TEE. Especially during mitral valve surgery, 3D-TEE has proven its superiority in the diagnosis of the underlying pathology as demonstrated by a large number of studies in this field. This review presents the available data about the role of intraoperative 3D-TEE echocardiography and introduces practical fields of application. PMID:24994014

Magunia, H; Rosenberger, P

2014-09-01

120

Entropy-based straight kernel filter for echocardiography image denoising.  

PubMed

A new filter has been proposed with the aim of eliminating speckle noise from 2D echocardiography images. This speckle noise has to be eliminated to avoid the pseudo prediction of the underlying anatomical facts. The proposed filter uses entropy parameter to measure the disorganized occurrence of noise pixel in each row and column and to increase the image visibility. Straight kernels with 3 pixels each are chosen for the filtering process, and the filter is slided over the image to eliminate speckle. The peak signal-to-noise ratio (PSNR) is obtained in the range of 147 dB, and the root mean square error (RMSE) is very low of approximately 0.15. The proposed filter is implemented on 36 echocardiography images, and the filter has the competence to illuminate the actual anatomical facts without degrading the edges. PMID:24838117

Rajalaxmi, S; Nirmala, S

2014-10-01

121

On-Orbit Prospective Echocardiography on International Space Station  

NASA Technical Reports Server (NTRS)

A number of echocardiographic research projects and experiments have been flown on almost every space vehicle since 1970, but validation of standard methods and the determination of Space Normal cardiac function has not been reported to date. Advanced Diagnostics in Microgravity (ADUM) -remote guided echocardiographic technique provides a novel and effective approach to on-board assessment of cardiac physiology and structure using a just-in-time training algorithm and real-time remote guidance aboard the International Space Station (ISS). The validation of remotely guided echocardiographic techniques provides the procedures and protocols to perform scientific and clinical echocardiography on the ISS and the Moon. The objectives of this study were: 1.To confirm the ability of non-physician astronaut/cosmonaut crewmembers to perform clinically relevant remotely guided echocardiography using the Human Research Facility on board the ISS. 2.To compare the preflight, postflight and in-flight echocardiographic parameters commonly used in clinical medicine.

Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David; Garcia, Kathleen M.; Melton, Shannon; Feiverson, Alan; Dulchavsky, Scott A.

2010-01-01

122

The role of transesophageal echocardiography in aortic valve preserving procedures  

PubMed Central

In selected cases of aortic regurgitation, aortic valve (AV) repair and AV sparing root reconstruction viable alternatives to aortic valve replacement. Repair and preservation of the native valve avoids the use of long-term anticoagulation, lowers the incidence of subsequent thromboembolic events and reduces the risk of endocarditis. Additionally repair has a low operative mortality with reasonable mid-term durability. The success and longer term durability of AVPP has improved with surgical experience. An understanding of the mechanism of the AR is integral to determining feasibility and success of an AVPP. Assessment of AV morphology, anatomy of the functional aortic annulus (FAA) and the aortic root with transesophageal echocardiography (TEE) improves the understanding of the mechanisms of AR. Pre- and intra-operative TEE plays a pivotal role in guiding case selection, surgical planning, and in evaluating procedural success. Post-operative transthoracic echocardiography is useful to determine long-term success and monitor for recurrence of AR. PMID:24973839

Hall, Terri; Shah, Pallav; Wahi, Sudhir

2014-01-01

123

Comparison of adenosine echocardiography, with and without isometric handgrip, to exercise echocardiography in the detection of ischemia in patients with coronary artery disease  

Microsoft Academic Search

This study was undertaken to evaluate whether adenosine echocardiography is comparable to exercise echocardiography in the detection of ischemia in patients with suspected coronary artery disease and to assess whether the addition of handgrip exercise to adenosine enhances the induction of ischemia in these patients. Accordingly, 67 patients with suspected or known coronary artery disease referred for exercise testing underwent

Cyril B. Tawa; William B. Baker; Neal S. Kleiman; Anatole Trakhtenbroit; Ranley Desir; William A. Zoghbi

1996-01-01

124

The role of echocardiography in cardiac resynchronization therapy  

Microsoft Academic Search

Echocardiography is the most important imaging tool for managing heart failure patients. With the advent of cardiac resynchronization\\u000a therapy (CRT), its role has been broadened by data pertaining to patient selection, optimization of device settings, and outcome\\u000a assessment. Beyond ejection fraction determination, echocardiographic methods that measure tissue velocity and strain may\\u000a have the capability to determine degree of mechanical dyssynchrony

Wojciech Mazur; Eugene S. Chung

2009-01-01

125

Hemodynamic evaluation of the prone position by transesophageal echocardiography  

Microsoft Academic Search

Study Objective: To evaluate the hemodynamic response in the prone position in surgical patients by measuring the effects of prone positioning on cardiac function using transesophageal echocardiography (TEE).Design: Prospective study.Setting: Elective surgery at a university hospital.Patients: 15 adult ASA physical status I and II patients free of significant coexisting disease undergoing lumbar laminectomy.Interventions and Measurements: Approximately 15 minutes after the

Shigeyoshi Toyota; Yoshikiyo Amaki

1998-01-01

126

Visualization techniques for improved orientation in three-dimensional echocardiography  

NASA Astrophysics Data System (ADS)

Repair of a defect heart valve is of great advantage for the patient in comparison to replacement with a prosthesis. The applicability and the success of heart valve repair can be improved by an exact diagnosis of the valve's pathological modification. The best way for imaging heart valve insufficiencies is echocardiography, since it is fast, relatively cheap, can be used intraoperatively and provides information about morphology as well as blood flow. Three-dimensional echocardiography has been proven to be superior to conventional echocardiographic techniques. Although the overall structures are much better displayed by three-dimensional visualization methods, it is sometimes difficult to comprehend the orientation of the scene, since anatomical landmarks like the aortic outflow tract may be hidden by other structures. Also, such anatomical landmarks often are only partly contained in the acquired data set so that they are clearly visible in a few slices only, making them difficult to find in a three-dimensional visualization. The knowledge of the absolute orientation is of essential value for the surgeon to mentally transfer the preoperatively acquired data to the intraoperative situs. Therefore, it is desirable to have additional hints for orientation in the three-dimensional scene. We present methods that enable better and easier orientation and therefore improve the usability of three-dimensional echocardiography.

Wolf, Ivo; de Simone, Raffaele; Hastenteufel, Mark; Mottl-Link, Sibylle; Meinzer, Hans-Peter

2002-05-01

127

Comparison of myocardial contrast echocardiography with NC100100 and 99mTc sestamibi SPECT for detection of resting myocardial perfusion abnormalities in patients with previous myocardial infarction  

PubMed Central

OBJECTIVE—To determine whether myocardial contrast echocardiography (MCE) following intravenous injection of perfluorocarbon microbubbles permits identification of resting myocardial perfusion abnormalities in patients who have had a previous myocardial infarction.?PATIENTS AND INTERVENTIONS—22 patients (mean (SD) age 66 (11) years) underwent MCE after intravenous injection of NC100100, a novel perfluorocarbon containing contrast agent, and resting 99mTc sestamibi single photon emission computed tomography (SPECT). With both methods, myocardial perfusion was graded semiquantitatively as 1 = normal, 0.5 = mild defect, and 0 = severe defect.?RESULTS—Among the 203 normally contracting segments, 151 (74%) were normally perfused by SPECT and 145 (71%) by MCE. With SPECT, abnormal tracer uptake was mainly found among normally contracting segments from the inferior wall. By contrast, with MCE poor myocardial opacification was noted essentially among the normally contracting segments from the anterior and lateral walls. Of the 142 dysfunctional segments, 87 (61%) showed perfusion defects by SPECT, and 94 (66%) by MCE. With both methods, perfusion abnormalities were seen more frequently among akinetic than hypokinetic segments. MCE correctly identified 81/139 segments that exhibited a perfusion defect by SPECT (58%), and 135/206 segments that were normally perfused by SPECT (66%). Exclusion of segments with attenuation artefacts (defined as abnormal myocardial opacification or sestamibi uptake but normal contraction) by either MCE or SPECT improved both the sensitivity (76%) and the specificity (83%) of the detection of SPECT perfusion defects by MCE.?CONCLUSIONS—The data suggest that MCE allows identification of myocardial perfusion abnormalities in patients who have had a previous myocardial infarction, provided that regional wall motion is simultaneously taken into account.???Keywords: myocardial contrast echocardiography; NC100100; single photon emission computed tomography; perfusion PMID:10768900

Jucquois, I; Nihoyannopoulos, P; D'Hondt, A; Roelants, V; Robert, A; Melin, J; Glass, D; Vanoverschelde, J

2000-01-01

128

[A semiquantitative assessment of aortic valve insufficiency by cine-MR compared to Doppler color echocardiography and cardioangiography].  

PubMed

A simple, reliable semiquantitative method for evaluating aortic valve insufficiency by means of cine MR is described. Ten normal persons and 36 patients with aortic valve abnormalities were examined in a 1.5 Tesla apparatus using ECG-triggered gradient echo sequences. The heart was imaged along its short axis. Semiquantitative evaluation of aortic valve insufficiency was calculated from an MRI index, which depends on the diameter of the aortic regurgitant jet and on its length; the results were compared with colour Doppler echocardiography and cardioangiography. The MRI index showed better correlation with cardioangiography (r = 0.92) than the correlation between the colour Doppler echocardiography and cardioangiography (r = 0.78). Over and under estimates are less common with MRI than with colour Doppler echocardiography. MRI showed very little interobserver variability (r = 0.96, p less than 0.001). Cine MR is a reliable method for demonstrating aortic valve insufficiency. Using the short axis of the heart, rapid semiquantitative evaluation of the aortic regurgitant jet is regularly possible. PMID:2176311

Dulce, M C; Friese, K; Gast, D; Albrecht, A; Hamm, B; Wolf, K J

1990-12-01

129

Feasibility and clinical decision-making with 3D echocardiography in routine practice  

Microsoft Academic Search

Objective:To assess the feasibility and potential impact of routine three-dimensional (3D) echocardiographic assessment of left ventricular (LV) ejection fraction and volumes on clinical decision-making.Methods:Patients referred to three hospital-based echocardiography laboratories underwent 2D echocardiography (2DE) and 3D echocardiography (3DE). Feasibility was assessed in a group of 168 unselected patients and decision-making assessed within an expanded group of 220 patients. The time

J L Hare; C Jenkins; S Nakatani; A Ogawa; C-M Yu; T H Marwick

2008-01-01

130

[Utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy: When is it superior to echocardiography?].  

PubMed

The diagnosis of hypertrophic cardiomyopathy is usually established by echocardiography. Recently, there has been greatly increased use of cardiac magnetic resonance (CMR) because of its precise determination of myocardial anatomy and the depiction of myocardial fibrosis. In this review, we describe the role of echocardiography and magnetic resonance in the assessment of this complex disease. In conclusion, there is a complementarity between cardiovascular magnetic resonance imaging and echocardiography for the diagnosis and the management of HCM. PMID:24834991

Kammoun, I; Marrakchi, S; Zidi, A; Ibn ElHaj, Z; Naccache, S; Ben Amara, W; Jebri, F; Bennour, E; Kachboura, S

2015-02-01

131

[Measurement of left atrial and ventricular volumes in real-time 3D echocardiography. Validation by nuclear magnetic resonance  

NASA Technical Reports Server (NTRS)

The measurement of the left ventricular ejection fraction is important for the evaluation of cardiomyopathy and depends on the measurement of left ventricular volumes. There are no existing conventional echocardiographic means of measuring the true left atrial and ventricular volumes without mathematical approximations. The aim of this study was to test anew real time 3-dimensional echocardiographic system of calculating left atrial and ventricular volumes in 40 patients after in vitro validation. The volumes of the left atrium and ventricle acquired from real time 3-D echocardiography in the apical view, were calculated in 7 sections parallel to the surface of the probe and compared with atrial (10 patients) and ventricular (30 patients) volumes calculated by nuclear magnetic resonance with the simpson method and with volumes of water in balloons placed in a cistern. Linear regression analysis showed an excellent correlation between the real volume of water in the balloons and volumes given in real time 3-dimensional echocardiography (y = 0.94x + 5.5, r = 0.99, p < 0.001, D = -10 +/- 4.5 ml). A good correlation was observed between real time 3-dimensional echocardiography and nuclear magnetic resonance for the measurement of left atrial and ventricular volumes (y = 0.95x - 10, r = 0.91, p < 0.001, D = -14.8 +/- 19.5 ml and y = 0.87x + 10, r = 0.98, P < 0.001, D = -8.3 +/- 18.7 ml, respectively. The authors conclude that real time three-dimensional echocardiography allows accurate measurement of left heart volumes underlying the clinical potential of this new 3-D method.

Bauer, F.; Shiota, T.; Qin, J. X.; White, R. D.; Thomas, J. D.

2001-01-01

132

Two and three dimensional echocardiography for pre-operative assessment of mitral valve regurgitation.  

PubMed

Mitral regurgitation may develop when the leaflets or any other portion of the apparatus becomes abnormal. As the repair techniques for mitral valve disease evolved, so has the need for detailed and accurate imaging of the mitral valve prior to surgery in order to better define the mechanism of valve dysfunction and the severity of regurgitation. In patients with significant mitral valve disease who require surgical intervention, multiplane transesophageal echocardiogram (TEE) is invaluable for surgical planning. However, a comprehensive TEE in a patient with complex mitral valve disease requires great experience and skill. There is evidence to suggest that 3D echocardiography can overcome some of the limitations of 2D multiplane TEE and thus is crucial in evaluation of patients undergoing mitral valve surgery. In the following sections, we review some of the crucial 2D and 3D echo images necessary for evaluation of MR based on the Carpentier classification. PMID:25344779

Quader, Nishath; Rigolin, Vera H

2014-01-01

133

Left Atrium by Echocardiography in Clinical Practice: From Conventional Methods to New Echocardiographic Techniques  

PubMed Central

Although often referred to as “the forgotten chamber”, compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the clinical expression and prognosis of patients with heart and cerebrovascular disease, as demonstrated by several studies. Echocardiographers initially focused on early detection of atrial geometrical abnormalities through monodimensional atrial diameter quantification and then bidimensional (2D) areas and volume estimation. Now, together with conventional echocardiographic parameters, new echocardiographic techniques, such as strain Doppler, 2D speckle tracking and three-dimensional (3D) echocardiography, allow assessing early LA dysfunction and they all play a fundamental role to detect early functional remodelling before anatomical alterations occur. LA dysfunction and its important prognostic implications may be detected sooner by LA strain than by volumetric measurements. PMID:25009828

Caso, Pio; D'Andrea, Antonello; Di Salvo, Giovanni; Arenga, Fortunato; Coppola, Maria Gabriella; Sellitto, Vincenzo; Macrino, Maria; Calabrò, Raffaele

2014-01-01

134

Stress Echocardiography for the Diagnosis of Coronary Artery Disease  

PubMed Central

Executive Summary In July 2009, the Medical Advisory Secretariat (MAS) began work on Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease (CAD), an evidence-based review of the literature surrounding different cardiac imaging modalities to ensure that appropriate technologies are accessed by patients suspected of having CAD. This project came about when the Health Services Branch at the Ministry of Health and Long-Term Care asked MAS to provide an evidentiary platform on effectiveness and cost-effectiveness of non-invasive cardiac imaging modalities. After an initial review of the strategy and consultation with experts, MAS identified five key non-invasive cardiac imaging technologies for the diagnosis of CAD. Evidence-based analyses have been prepared for each of these five imaging modalities: cardiac magnetic resonance imaging, single photon emission computed tomography, 64-slice computed tomographic angiography, stress echocardiography, and stress echocardiography with contrast. For each technology, an economic analysis was also completed (where appropriate). A summary decision analytic model was then developed to encapsulate the data from each of these reports (available on the OHTAC and MAS website). The Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease series is made up of the following reports, which can be publicly accessed at the MAS website at: www.health.gov.on.ca/mas"> www.health.gov.on.ca/mas or at www.health.gov.on.ca/english/providers/program/mas/mas_about.html Single Photon Emission Computed Tomography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Stress Echocardiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Stress Echocardiography with Contrast for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis 64-Slice Computed Tomographic Angiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Cardiac Magnetic Resonance Imaging for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Pease note that two related evidence-based analyses of non-invasive cardiac imaging technologies for the assessment of myocardial viability are also available on the MAS website: Positron Emission Tomography for the Assessment of Myocardial Viability: An Evidence-Based Analysis Magnetic Resonance Imaging for the Assessment of Myocardial Viability: an Evidence-Based Analysis The Toronto Health Economics and Technology Assessment Collaborative has also produced an associated economic report entitled: The Relative Cost-effectiveness of Five Non-invasive Cardiac Imaging Technologies for Diagnosing Coronary Artery Disease in Ontario [Internet]. Available from: http://theta.utoronto.ca/reports/?id=7 Objective The objective of the analysis is to determine the diagnostic accuracy of stress echocardiography (ECHO) in the diagnosis of patients with suspected coronary artery disease (CAD) compared to coronary angiography (CA). Stress Echocardiography Stress ECHO is a non-invasive technology that images the heart using ultrasound. It is one of the most commonly employed imaging techniques for investigating a variety of cardiac abnormalities in both community and hospital settings. A complete ECHO exam includes M-mode, 2-dimensional (2-D) images and Doppler imaging. In order to diagnosis CAD and assess whether myocardial ischemia is present, images obtained at rest are compared to those obtained during or immediately after stress. The most commonly used agents used to induce stress are exercise and pharmacological agents such as dobutamine and dipyridamole. The hallmark of stress-induced myocardial ischemia is worsening of wall motion abnormalities or the development of new wall motion abnormalities. A major challenge for stress ECHO is that the interpretation of wall motion contractility and function is subjective. This leads to inter-observer variability and reduced reproducibility. Further, it is estimated that approximately 30% of patients have sub-

2010-01-01

135

Spatiotemporal directional analysis of 4D echocardiography  

NASA Astrophysics Data System (ADS)

Speckle noise corrupts ultrasonic data by introducing sharp changes in an echocardiographic image intensity profile, while attenuation alters the intensity of equally significant cardiac structures. These properties introduce inhomogeneity in the spatial domain and suggests that measures based on phase information rather than intensity are more appropriate for denoising and cardiac border detection. The present analysis method relies on the expansion of temporal ultrasonic volume data on complex exponential wavelet-like basis functions called Brushlets. These basis functions decompose a signal into distinct patterns of oriented textures. Projected coefficients are associated with distinct 'brush strokes' of a particular size and orientation. 4D overcomplete brushlet analysis is applied to temporal echocardiographic values. We show that adding the time dimension in the analysis dramatically improves the quality and robustness of the method without adding complexity in the design of a segmentation tool. We have investigated mathematical and empirical methods for identifying the most 'efficient' brush stroke sizes and orientations for decomposition and reconstruction on both phantom and clinical data. In order to determine the 'best tiling' or equivalently, the 'best brushlet basis', we use an entorpy-based information cost metric function. Quantitative validation and clinical applications of this new spatio-temporal analysis tool are reported for balloon phantoms and clinical data sets.

Angelini-Casadevall, Elsa D.; Laine, Andrew F.; Takuma, Shin; Homma, Shunichi

2000-12-01

136

Reliability of quantitative echocardiography in adult sheep and goats  

PubMed Central

Background Echocardiography is a non-invasive method for assessment of the ovine and caprine heart. Complete reference ranges for cardiac dimensions and time indices for both species are not currently available and reliability of these measurements has not been evaluated. The objectives for this study are to report reliability, normal cardiac dimensions and time indices in a large group of adult sheep and goats. Fifty-one adult sheep and forty adult goats were recruited. Full echocardiographic examinations were performed in the standing unsedated animal. All animals underwent echocardiography four times in a 72-hour period. Echocardiography was performed three times by one author and once by another. Images were stored and measured offline. Technique and measurement repeatability and reproducibility and any differences due to animal or day were evaluated. Reference ranges (mean?±?2 standard deviations) were calculated for both species. Results Majority of the images obtained were of good to excellent quality. Image acquisition was straightforward with 5.4% of animals demonstrating a small scanning window. Reliability was excellent for majority of dimensions and time indices. There was less variation in repeatability when compared with reproducibility and differences were greater for technique than for measurements. Dimensions that were less reliable included those for right ventricular diameter and left ventricular free wall. There were many differences in cardiac dimensions between sheep and goats. Conclusions This study has demonstrated that specific reference ranges are required for these two species. Repeatability and reproducibility were excellent for the majority of cardiac dimensions and time indices suggesting that this technique is reliable and valuable for examination of clinical cases over time and for longitudinal research studies. PMID:23017011

2012-01-01

137

[Transient apical ballooning syndrome during dobutamine stress echocardiography].  

PubMed

The transient left ventricular apical ballooning syndrome, also known as Tako-Tusbo syndrome, has an acute onset, is more common in postmenopausal women, and is characterized by transient left ventricular apical ballooning, chest pain, electrocardiographic abnormalities, and slight elevation of markers for myocardial injury, mimicking a myocardial infarction in patients with no significant coronary lesions. However, before making the diagnosis, other causes of reversible left ventricular dysfunction must be ruled out, such as subarachnoid hemorrhage, pheochromocytoma crisis, acute myocarditis, or the presence of tachycardiomyopathy. The case is presented of a patient who developed ST elevation electrocardiographic changes with apical transient dyskinesia during dobutamine stress echocardiography. PMID:24725681

Martínez-Quintana, Efrén; Miranda-García, Cristian; Gopar-Gopar, Silvia; Sáiz-Udaeta, Beatriz; Rodríguez-González, Fayna

2014-01-01

138

Two teenagers, traumatic aortic disruption, and transoesophageal echocardiography.  

PubMed Central

A report of two teenagers is presented who were passengers of the same vehicle when it was involved in a serious road traffic accident. Their vehicle was hit on the side at high speed by a second vehicle. Both teenagers sustained multiple injuries. On arrival at a district general hospital they required resuscitation, exploratory laparotomies, and postoperative intensive care. Neither had radiographic evidence to suggest any mediastinal injury, but transoesophageal echocardiography demonstrated aortic disruption in both patients. They were transferred to a regional cardiothoracic centre where their lesions were successfully repaired and both have made a full recovery. Images PMID:9391296

Absalom, A.; Burns, A.; Wells, F.; Stone, D.

1997-01-01

139

Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography.  

PubMed

Left ventricular assist devices (LVAD) are increasingly used for mechanical circulatory support of patients with severe heart failure, primarily as a bridge to heart transplantation. Transesophageal echocardiography (TEE) plays a major role in the clinical decision making during insertion of the devices and in the post-operative management of these patients. The detection of structural and device-related mechanical abnormalities is critical for optimal functioning of assist device. In this review article, we describe the usefulness of TEE for optimal perioperative management of patients presenting for HeartWare LVAD insertion. PMID:24107692

Patangi, Sanjay Orathi; George, Anthony; Pauli, Henning; O'Leary, Denis; Roysam, Chandrika; Butt, Tanveer; Schueler, Stephan; Prabhu, Mahesh; MacGowan, Guy

2013-01-01

140

The Diane Rehm Show  

NSDL National Science Digital Library

The Diane Rehm Show has its origins in a mid-day program at WAMU in Washington, D.C. Diane Rehm came on to host the program in 1979, and in 1984 it was renamed "The Diane Rehm Show". Over the past several decades, Rehm has played host to hundreds of guests, include Archbishop Desmond Tutu, Julie Andrews, and President Bill Clinton. This website contains an archive of her past programs, and visitors can use the interactive calendar to look through past shows. Those visitors looking for specific topics can use the "Topics" list on the left-hand side of the page, or also take advantage of the search engine. The show has a number of social networking links, including a Facebook page and a Twitter feed.

141

Comparison of contrast enhanced three dimensional echocardiography with MIBI gated SPECT for the evaluation of left ventricular function  

PubMed Central

Background In clinical practice and in clinical trials, echocardiography and scintigraphy are used the most for the evaluation of global left ejection fraction (LVEF) and left ventricular (LV) volumes. Actually, poor quality imaging and geometrical assumptions are the main limitations of LVEF measured by echocardiography. Contrast agents and 3D echocardiography are new methods that may alleviate these potential limitations. Methods Therefore we sought to examine the accuracy of contrast 3D echocardiography for the evaluation of LV volumes and LVEF relative to MIBI gated SPECT as an independent reference. In 43 patients addressed for chest pain, contrast 3D echocardiography (RT3DE) and MIBI gated SPECT were prospectively performed on the same day. The accuracy and the variability of LV volumes and LVEF measurements were evaluated. Results Due to good endocardial delineation, LV volumes and LVEF measurements by contrast RT3DE were feasible in 99% of the patients. The mean LV end-diastolic volume (LVEDV) of the group by scintigraphy was 143 ± 65 mL and was underestimated by triplane contrast RT3DE (128 ± 60 mL; p < 0.001) and less by full-volume contrast RT3DE (132 ± 62 mL; p < 0.001). Limits of agreement with scintigraphy were similar for triplane andfull-volume, modalities with the best results for full-volume. Results were similar for calculation of LV end-systolic volume (LVESV). The mean LVEF was 44 ± 16% with scintigraphy and was not significantly different with both triplane contrast RT3DE (45 ± 15%) and full-volume contrast RT3DE (45 ± 15%). There was an excellent correlation between two different observers for LVEDV, LVESV and LVEF measurements and inter observer agreement was also good for both contrast RT3DE techniques. Conclusion Contrast RT3DE allows an accurate assessment of LVEF compared to the LVEF measured by SPECT, and shows low variability between observers. Although RT3DE triplane provides accurate evaluation of left ventricular function, RT3DE full-volume is superior to triplane modality in patients with suspected coronary artery disease. PMID:19531259

Cosyns, Bernard; Haberman, David; Droogmans, Steven; Warzée, Sandrine; Mahieu, Philippe; Laurent, Eric; Moonen, Marie; Hernot, Sophie; Lancellotti, Patrizio

2009-01-01

142

Severe late failure of a porcine xenograft mitral valve: clinical, echocardiographic, and pathological findings.  

PubMed Central

A case of dysfunction of a Carpentier-Edwards porcine xenograft mitral prosthesis is presented. Valve failure was diagnosed by echocardiography and confirmed at operation. Histology showed valve tissue degeneration without evidence of prosthetic endocarditis. Images PMID:7189907

Crupi, G; Gibson, D; Heard, B; Lincoln, C

1980-01-01

143

6DoF catheter detection, application to intracardiac echocardiography.  

PubMed

Hybrid imaging systems, consisting of fluoroscopy and echocardiography, are increasingly selected for intra-operative support of minimally invasive cardiac interventions. Intracardiac echocardiograpy (ICE) is an emerging modality with the promise of removing sedation or general anesthesia associated with transesophageal echocardiography (TEE). We introduce a novel 6 degrees of freedom (DoF) pose estimation approach for catheters (equipped with radiopaque ball markers) in single X-Ray fluoroscopy projection and investigate the method's application to a prototype ICE catheter. Machine learning based catheter detection is implemented in a Bayesian hypothesis fusion framework, followed by refinement of ball marker locations through template matching. Marker correspondence and 3D pose estimation are solved through iterative optimization. The method registers the ICE volume to the C-arm coordinate system. Experiments are performed on synthetic and porcine in-vivo data. Target registration error (TRE), defined in the echo cone, is the basis of our preliminary evaluation. The method reached 8.06 ± 7.2 mm TRE on 703 cases. Potential uses of our hybrid system include structural heart disease interventions and electrophysiologycal mapping or catheter ablation procedures. PMID:25485433

Ralovich, Kristóf; John, Matthias; Camus, Estelle; Navab, Nassir; Heimann, Tobias

2014-01-01

144

Effect of color coding and subtraction on the accuracy of contrast echocardiography  

NASA Technical Reports Server (NTRS)

BACKGROUND: Contrast echocardiography may be used to assess myocardial perfusion. However, gray scale assessment of myocardial contrast echocardiography (MCE) is difficult because of variations in regional backscatter intensity, difficulties in distinguishing varying shades of gray, and artifacts or attenuation. We sought to determine whether the assessment of rest myocardial perfusion by MCE could be improved with subtraction and color coding. METHODS AND RESULTS: MCE was performed in 31 patients with previous myocardial infarction with a 2nd generation agent (NC100100, Nycomed AS), using harmonic triggered or continuous imaging and gain settings were kept constant throughout the study. Digitized images were post processed by subtraction of baseline from contrast data and colorized to reflect the intensity of myocardial contrast. Gray scale MCE alone, MCE images combined with baseline and subtracted colorized images were scored independently using a 16 segment model. The presence and severity of myocardial contrast abnormalities were compared with perfusion defined by rest MIBI-SPECT. Segments that were not visualized by continuous (17%) or triggered imaging (14%) after color processing were excluded from further analysis. The specificity of gray scale MCE alone (56%) or MCE combined with baseline 2D (47%) was significantly enhanced by subtraction and color coding (76%, p<0.001) of triggered images. The accuracy of the gray scale approaches (respectively 52% and 47%) was increased to 70% (p<0.001). Similarly, for continuous images, the specificity of gray scale MCE with and without baseline comparison was 23% and 42% respectively, compared with 60% after post processing (p<0.001). The accuracy of colorized images (59%) was also significantly greater than gray scale MCE (43% and 29%, p<0.001). The sensitivity of MCE for both acquisitions was not altered by subtraction. CONCLUSION: Post-processing with subtraction and color coding significantly improves the accuracy and specificity of MCE for detection of perfusion defects.

Pasquet, A.; Greenberg, N.; Brunken, R.; Thomas, J. D.; Marwick, T. H.

1999-01-01

145

Pericardial effusion following transcatheter aortic valve implantation: echocardiography and multi-detector row computed tomography evaluation.  

PubMed

Although pericardial effusion (PE) early after transcatheter aortic valve implantation (TAVI) has been reported in few registries, late PE at follow-up remains unexplored. Particularly, after transapical TAVI, diagnosis of PE with transthoracic echocardiography (TTE) may be challenging. The present evaluation assessed the incidence of PE early after TAVI and at 1 month follow-up using TTE and multi-detector computed tomography (MDCT). The agreement between TTE and MDCT to diagnose the presence and severity of PE at 1 month follow-up was evaluated. Overall 293 patients undergoing TAVI were included. Pre-discharge TTE was performed in all patients. At 1 month, repeat TTE was performed in 234 patients and additional MDCT evaluation in 143 patients. Pre-discharge small and moderate PE was observed in 74.1 and 4.1 % of patients, respectively, whereas significant PE was diagnosed in 8 (2.7 %) patients without differences between procedural access: 1.6 versus 3.6 % for transfemoral and transapical respectively, p = 0.474. At 1 month new-onset moderate PE was noted in 6 (2.5 %) patients all of who underwent transapical TAVI. MDCT and TTE disagreed on the grade of PE in 38 patients. Importantly, one patient with small PE on TTE was considered having moderate PE and two patients with small and moderate PE were considered having large PE. Also, two patients with moderate PE on echocardiography were considered small PE on MDCT. In conclusions, significant PE early after TAVI is infrequent. The prevalence of small and moderate PE remains stable at 1 month follow-up. MDCT refines the diagnosis of significant PE. PMID:25129473

Katsanos, Spyridon; van Rosendael, Philippe; Kamperidis, Vasileios; van der Kley, Frank; Regeer, Madelien; Al-Amri, Ibtihal; Karalis, Ioannis; Palmen, Meindert; de Weger, Arend; Marsan, Nina Ajmone; Bax, Jeroen J; Delgado, Victoria

2015-01-01

146

Radial Basis Functions for Combining Shape and Speckle Tracking in 4D Echocardiography  

PubMed Central

Quantitative analysis of left ventricular deformation can provide valuable information about the extent of disease as well as the efficacy of treatment. In this work, we develop an adaptive multi-level compactly supported radial basis approach for deformation analysis in 3D+time echocardiography. Our method combines displacement information from shape tracking of myocardial boundaries (derived from B-mode data) with mid-wall displacements from radio-frequency-based ultrasound speckle tracking. We evaluate our methods on open-chest canines (N=8) and show that our combined approach is better correlated to magnetic resonance tagging-derived strains than either individual method. We also are able to identify regions of myocardial infarction (confirmed by postmortem analysis) using radial strain values obtained with our approach. PMID:24893257

Compas, Colin B.; Wong, Emily Y.; Huang, Xiaojie; Sampath, Smita; Lin, Ben A.; Pal, Prasanta; Papademetris, Xenophon; Thiele, Karl; Dione, Donald P.; Stacy, Mitchel; Staib, Lawrence H.; Sinusas, Albert J.; O'Donnell, Matthew; Duncan, James S.

2014-01-01

147

Valvular heart disease and 3-dimensional echocardiography: ready for prime-time?  

PubMed Central

Significant advances in 3-dimensional echocardiography (3DE) technology have ushered its use into clinical practice. The recent advent of real-time 3DE using matrix array transthoracic and transesophageal transducers has resulted in improved image spatial resolution, and therefore, enhanced visualization of the patho-morphological features of the cardiac valves. Three-dimensional echocardiography provides unique perspectives of valvular structures by presenting “en face” views of valvular structures, allowing for a better understanding of the topographical aspects of pathology, and a refined definition of the spatial relationships of intracardiac structures. Three-dimensional echocardiography makes available indices not described by 2D echocardiography and has been demonstrated to be superior to 2D echocardiography in a variety of valvular disease scenarios. In this review, we discuss the incremental role of 3DE in evaluating valvular anatomic features, volumetric quantification, pre-surgical planning, intra-procedural guidance, and post-procedural assessment of valvular heart disease. PMID:23173101

Moura, Luis M; de Isla, Leopoldo Perez

2012-01-01

148

Non-Invasive Determination of Left Ventricular Workload in Patients with Aortic Stenosis Using Magnetic Resonance Imaging and Doppler Echocardiography  

PubMed Central

Early detection and accurate estimation of aortic stenosis (AS) severity are the most important predictors of successful long-term outcomes in patients. Current clinical parameters used for evaluation of the AS severity have several limitations including flow dependency. Estimation of AS severity is specifically challenging in patients with low-flow and low transvalvular pressure gradient conditions. A proper diagnosis in these patients needs a comprehensive evaluation of the left ventricle (LV) hemodynamic loads. This study has two objectives: (1) developing a lumped-parameter model to describe the ventricular-valvular-arterial interaction and to estimate the LV stroke work (SW); (2) introducing and validating a new index, the normalized stroke work (N-SW), to assess the global hemodynamic load imposed on the LV. N-SW represents the global hemodynamic load that the LV faces for each unit volume of blood ejected. The model uses a limited number of parameters which all can be measured non-invasively using current clinical imaging modalities. The model was first validated by comparing its calculated flow waveforms with the ones measured using Cardiovascular Magnetic Resonance (CMR) in 49 patients and 8 controls. A very good correlation and concordance were found throughout the cycle (median root mean square: 12.21 mL/s) and between the peak values (r?=?0.98; SEE?=?0.001, p<0.001). The model was then used to determine SW using the parameters measured with transthoracic Doppler-echocardiography (TTE) and CMR. N-SW showed very good correlations with a previously-validated index of global hemodynamic load, the valvular arterial impedance (), using data from both imaging modalities (TTE: r?=?0.82, SEE?=?0.01, p<0.001; CMR: r?=?0.74, SEE?=?0.01, p<0.001). Furthermore, unlike , N-SW was almost independent from variations in the flow rate. This study suggests that considering N-SW may provide incremental diagnostic and prognostic information, beyond what standard indices of stenosis severity and provide, particularly in patients with low LV outflow. PMID:24489786

Keshavarz-Motamed, Zahra; Garcia, Julio; Gaillard, Emmanuel; Capoulade, Romain; Le Ven, Florent; Cloutier, Guy; Kadem, Lyes; Pibarot, Philippe

2014-01-01

149

Intracardiac Echocardiography (ICE) Measurement of Dynamic Myocardial Stiffness with Shear Wave Velocimetry  

PubMed Central

Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum. Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum. PMID:22579544

Hollender, Peter J.; Wolf, Patrick D.; Goswami, Robi; Trahey, Gregg E.

2012-01-01

150

Clinical Utility of Guideline-Based Echocardiography: A Prospective Study of Outpatient Referral Patterns at a Tertiary Care Center  

Microsoft Academic Search

Background: The spread of echocardiography has increased the number of requests for echocardiography and the length of patient waiting lists in National Health Systems. This overuse of echocardiography may also result in a decrease in examination quality because of an excess in workload. The recommended use of guidelines for the requesting of echocardiograms could reduce the demand for this investigation

Paolo Barbier; Marina Alimento; Giovanni Berna

2008-01-01

151

Reliability of Noninvasive Assessment of Systolic Pulmonary Artery Pressure by Doppler Echocardiography Compared to Right Heart Catheterization: Analysis in a Large Patient Population  

PubMed Central

Background Pulmonary artery pressure (PAP) is an important marker in cardiovascular disorders, being closely associated with morbidity and mortality. Noninvasive assessment by Doppler echocardiography is recommended by current guidelines. So far, the reliability of this method has been assessed only in small studies with contradictory results. Therefore, the aim of this study was to analyze the reliability of noninvasive PAP assessment by Doppler echocardiography compared to invasive measurements in a large patient population. Methods and Results We retrospectively analyzed data from a large tertiary cardiology department over 6 years in order to compare invasively measured PAP to estimated PAP from echocardiography examinations. N=15 516 patients fulfilled inclusion criteria and n=1695 patients with timely matched examinations (within 5 days) were analyzed. In n=1221 (72%) patients, pulmonary hypertension (PH) was diagnosed invasively (postcapillary PH: n=1122 [66%]; precapillary PH: n=99 [6%]). Systolic pulmonary artery pressure (sPAP) was 45.3±15.5 mm Hg by Doppler echocardiography and 47.4±16.4 mm Hg by right heart catheterization. Pearson's correlation coefficient was r=0.87 (P<0.0001). Mean right atrial pressure (RAP) was 12.0±5.7 mm Hg by right heart catheterization and was estimated to be 12.1±6.6 mm Hg by echocardiography (r=0.82, P<0.0001). Bland–Altman analysis showed a bias of ?2.0 mm Hg for sPAP (95% limits of agreement ?18.1 to +14.1 mm Hg) and +1.0 mm Hg for RAP (95% limits of agreement +0.1 to +1.9 mm Hg). Noninvasive diagnosis of pulmonary hypertension with Doppler echocardiography had a good sensitivity (87%) and specificity (79%), positive and negative predictive values (91% and 70%), as well as accuracy (85%) for a sPAP cut?off value of 36 mm Hg (AUC 0.91, P<0.001, CI 0.90 to 0.93). Conclusions In this study, Doppler echocardiography proved to be a reliable method for the assessment of sPAP, being well suited to establish the noninvasive diagnosis of pulmonary hypertension in patients with cardiac diseases. PMID:25146706

Greiner, Sebastian; Jud, Andreas; Aurich, Matthias; Hess, Alexander; Hilbel, Thomas; Hardt, Stefan; Katus, Hugo A.; Mereles, Derliz

2014-01-01

152

Endurance and Strength Athlete's Heart: Analysis of Myocardial Deformation by Speckle Tracking Echocardiography  

PubMed Central

Background Intensive training induces two morphological myocardial typologies of athlete's heart. Endurance training (ET) induces eccentric remodeling, bradycardia and better diastolic filling. Strength training (ST) determines concentric chamber remodelling maintaining a normal heart rate (HR). Aim of the study was to compare ET and ST athletes' heart using speckle tracking echocardiography (STE). Methods 33 professional ET, 36 ST athletes, and 17 healthy controls (CT) were enrolled. All subjects underwent standard transthoracic echocardiography at rest and STE. Results In ET group, HR was lower than ST group and CT group (p < 0.001; p < 0.01). ET group had higher E/A ratio than ST group and CT group (p < 0.01; p < 0.001). The left ventricular apical circumferential strain in ET group was lower than ST group and CT group (-21.6 ± 4.1% vs. -26.8 ± 7.7%, p < 0.05; vs. -27.8 ± 5.6%, p < 0.01). ET group had lower left ventricular twist (LVT) and untwisting (UTW) than ST group (6.2 ± 0.1° vs. 12.0 ± 0.1°, p < 0.01; -67.3 ± 22.9°/s vs. -122.5 ± 52.8°/s, p < 0.01) and CT group (10.0 ± 0.1°, p < 0.01; -103.3 ± 29.3°/s, p < 0.01). The univariate analysis showed significant correlation between E/A ratio and HR (r = -0.54; p < 0.001), LVT (r = -0.45; p < 0.01), UTW (r = 0.24; p < 0.05). At the multivariate analysis only HR was confirmed as independent predictor of diastolic function in all groups (Beta -0.52; p < 0.001). Conclusion In ET there was a better global systolic and diastolic functional reserve at rest observed with strain analysis and it maybe depended on autonomic modulation. PMID:25580194

Santoro, Amato; Antonelli, Giovanni; Caputo, Maria; Padeletti, Margherita; Lisi, Matteo; Mondillo, Sergio

2014-01-01

153

[Detection of atrial septal defects using esophageal echocardiography].  

PubMed

By means of transoesophageal (oesophageal) echocardiography (TEE) the authors examined a group of 20 subjects. In 10 there was clinical suspicion (physical finding, ECG, X-ray) of an atrial septal defect. Common precordial echocardiographic examination (TTE) and dilution of indocyan green by means of an acustic sensing unit were negative or only marginally positive and did not provide a final decision. By means of TEE the defect was confirmed in 8 subjects by the finding of anatomical discontinuity of the septum and the presence of coloured Doppler shunt flow. In two subjects the finding was negative, in 10 controls no pathological findings were detected. The authors confirmed that TEE is a reliable method which proves even slight shunts in the area of the atrial septum. It is probably the most sensitive existing method. PMID:2219759

Novotný, J; Hlavácek, K; Sístek, M; Van?cek, T; Fiserová, J

1990-06-01

154

On-Orbit Prospective Echocardiography on International Space Station Crew  

NASA Technical Reports Server (NTRS)

Introduction A prospective trial of echocardiography was conducted on of six crewmembers onboard the International Space Station. The main objective was to determine the efficacy of remotely guided tele-echocardiography, including just-in-time e-training methods and determine what "space normal" echocardiographic data is. Methods Each crewmember operator (n=6) had 2-hour preflight training. Baseline echocardiographic data were collected 55 to 167days preflight. Similar equipment was used in each 60-minute in-flight session (mean microgravity exposure - 114 days (34 -- 190)). On Orbit ultrasound operators used an e-learning system within 24h of these sessions. Expert assistance was provided using ultrasound video downlink and two-way voice. Testing was repeated 5 to 16 days after landing. Separate ANOVA was used on each echocardiographic variable (n=33). Within each ANOVA, three tests were made: a) effect of mission phase (preflight, in-flight, post flight); b) effect of echo technician (two technicians independently analyzed the data); c) interaction between mission phase and technician. Results Nine rejections of the null hypothesis (mission phase or technician or both had no effect) were discovered and considered for follow up. Of these, six rejections were for significant technician effects, not as a result of space flight. Three rejections of the null hypothesis (Aortic Valve time velocity integral, Mitral E wave Velocity and heart rate) were attributable to space flight, however determined not to be clinically significant. No rejections were due to the interaction between technician and space flight. Conclusion No consistent clinically significant effects of long-duration space flight were seen in echocardiographic variables of the given group of subjects.

Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David S.; Garcia, Kathleen M.; Melton, Shannon L.; Feiveson, Alan; Dulchavsky, Scott A.

2010-01-01

155

[Improved diagnosis and therapy of pericardial effusion with two-dimensional echocardiography].  

PubMed

M-mode echocardiography has until now been the method of choice for the diagnosis of pericardial effusion in general clinical practice. Incidences of false positive and false negative findings have nonetheless been reported in the literature. A vastly simplified diagnosis with greater sensitivity and specificity has been achieved with the spatial orientation provided by a combination of two-dimensional echocardiography and M-mode echocardiography. With these two-dimensional techniques, pericardial puncture is rendered simpler and safer for the patient. PMID:6880217

Zenker, G; Harnoncourt, K; Forche, G

1983-06-15

156

INTRODUCTION Morphology and physiology of the gastrointestinal tract show several  

E-print Network

. Thus, natural selection is expected to match capacity of the digestive system to animals' needs of their dietary substrates (Karasov and Diamond, 1988). The avian digestive system is characterized by high digestive capacity involves costs of maintaining excess organs or enzymes. In contrast, insufficient

Mladenoff, David

157

A Study of the Adult Zebrafish Ventricular Function by Retrospective Doppler-Gated Ultrahigh-Frame-Rate Echocardiography  

PubMed Central

The zebrafish (Danio rerio) has become a preferred animal model for studying various human diseases, particularly those related to cardiovascular regeneration; therefore, a noninvasive imaging modality is needed for observing the cardiac function of zebrafish. Because of its high resolution, high-frequency ultrasound B-mode imaging has recently been used successfully to observe the heart of adult zebrafish. However, ultrahigh-frame-rate echocardiography combining B-mode imaging and color flow imaging is still needed to observe the detailed transient motions of the zebrafish ventricle. This study develops an 80-MHz ultrahigh-frame-rate echocardiography system for this purpose, based on retrospective Doppler- gated technology. B-mode and color flow images of the cardiovascular system of the zebrafish were reconstructed by two-dimensional autocorrelation at maximum frame rates of up to 40 000 and 400 fps, respectively. The timings of end diastole (ED) and end systole (ES) of ventricle can be determined by using this high-resolution image system. Two ventricular function parameters—fractional shortening (FS) and fractional area change (FAC)—were measured for evaluating the ventricular function by using ED and ES with their corresponding ventricular dimensions. The experimental results indicated that the measured FS values were 42 ± 4% (mean ± standard deviation) and 60 ± 13% for the long axis and short axis of the ventricle, respectively, and that FAC was 77 ± 9%. This is the first report of these ventricular function parameters for a normal adult zebrafish. The results showed that retrospective high-frequency echocardiography is a useful tool for studying the cardiac function of normal adult zebrafish. PMID:24658716

Liu, Ting-Yu; Lee, Po-Yang; Huang, Chih-Chung; Sun, Lei; Shung, K. Kirk

2014-01-01

158

Identification of congenital malformations of the great arteries in infants by real-time two-dimensional echocardiography.  

PubMed

Real-time, two dimensional echocardiography was used to identify great artery relations in 23 infants and small children, including 16 patients with angiography documented transposition of the great arteries, tetralogy of Fallot, or pulmonary aresia. Using this technique, the heart was scanned perpendicular to its long axis at the origin of the great arteries. Great arteries cross-sectioned perpendicular to their long axes appear as circles; when sectioned longitudinally these arteries appeared as elongated sausage-shaped structures. I- patients with normally related great arteries, a curcular structure (aorta) always was positioned posterior to an elongated, sausage-shaped structure (distal right ventricular outflow tract and proximal main pulmonary artery). In transposition of the great arteries, two adjacent circular structures were observed; the anterior circle (aorta) was located to the right, left or directly anterior to the posterior circle (pulmonary artery). In pulmonary atresia or hypoplasis, a large posterior circle (aorta) was associated with an anteriorly positioned structure that was either short and small (atretic right ventricular outflow tract) or elongated with an area of severe narrowing (hypoplastic right ventricular outflow tract). Thus, real-time two-dimensional echocardiography provides a rapid, noninvasive means of accurately identifying congenital malformations of the great arteries in infants and small children and may be a useful adjunct to cardiac catheterization in the diagnosis of cyanotic congenital heart disease. PMID:1157281

Maron, B J; Henry, W L; Griffith, J M; Freedom, R M; Kelly, D T; Epstein, S E

1975-10-01

159

Role of stress echocardiography in risk stratification early after an acute myocardial infarction. EPIC (Echo Persantin International Cooperative) and EDIC (Echo Dobutamine International Cooperative) Study Groups.  

PubMed

Resting and stress echocardiography is a 'one-stop shop', which enables a wide range of information to be collected on resting function, myocardial viability, and induced ischaemia, all of which are useful for prognostic stratification. Large scale, multicentre, prospectively collected data show the prognostic failure of resting function and inducible ischaemia, both independently and combined, which are especially effective in predicting cardiac death. The GISSI data show that the increment of risk as a result of reduction in ventricular function has a hyperbolic trend, with a relatively moderate increase in mortality for ejection fraction values between 50 and 30%, but with marked increases below 30%. The EPIC data show that the 1-year risk of cardiac death is as low as 2% in patients with negative dipyridamole stress echocardiography: it doubles if the test is positive at a high dose, and is almost four times higher if it is positive at a low dose. In the field of prognostic stratification, in the absence of carefully controlled studies, the choice between coronary angiography as the only essential study, or use of a non-invasive test to discriminate access to catheterization currently reflect alternate philosophical approaches rather than scientifically based decisions. In the invasive approach, stress echocardiography offers relief from the vicious circle of chest pain-coronary angiography revascularization. In the non-invasive and physiological approach, stress echo is capable of offering, in one sitting, an insight into the main determinants of survival: function, viability, and ischaemia. PMID:9183615

Picano, E; Lattanzi, F; Sicari, R; Silvestri, O; Polimeno, S; Pingitore, A; Petix, N; Margaria, F; Magaia, O; Mathias, W; Lowenstein, J; Minardi, G; Coletta, C; Borges, A

1997-06-01

160

Results of a Prospective Echocardiography Trial in International Space Station Crew  

NASA Technical Reports Server (NTRS)

In the framework of an operationally oriented investigation, we conducted a prospective trial of a standard clinical echocardiography protocol in a cohort of long-duration crewmembers. The resulting primary and processed data appear to have no precedents. Our tele-echocardiography paradigm, including just-in-time e-training methods, was also assessed. A critical review of the imaging technique, equipment and setting limitations, and quality assurance is provided, as well as the analysis of "space normal" data.

Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David; Garcia, Kathleen M.; Melton, Shannon; Feiverson, Alan; Dulchavsky, Scott A.

2009-01-01

161

Stress echocardiography pattern: a promising noninvasive test for detection of myocardial bridging with haemodynamic relevance.  

PubMed

We reported a case of a young athlete with an underlying myocardial bridging in the left anterior descending coronary artery (LAD) causing myocardial ischemia suspected by contrast exercise stress echocardiography and confirmed by computed tomography coronary angiography. Our report demonstrated that a specific stress echocardiography pattern consisting of reversible focal buckling in the end-systolic to early-diastolic motion of the septum may suggest the presence of an underlying myocardial bridging in the LAD. PMID:25469733

Siciliano, Mariachiara; Migliore, Federico; Piovesana, Piergiuseppe

2014-12-01

162

[Standardized findings in echocardiography using WWW: EchoBefundSystem].  

PubMed

As a non-invasive imaging system, ultrasound echocardiography has a very high impact on modern diagnosis and is widely used in clinical routine but without any structured and standardized documentation of the results. Thus, quality management (QM), statistics and comparison of the results are difficult. Therefore, a working group of the German Cardiac Society issued a consensus proposal. For evaluation and wide public distribution, we have developed the first internet-based application covering the full proposal: EchoBefundSystem. The EchoBefundSystem is a web based client-server application for standardized documentation of echocardiography results right at the workplace. The software leads the examiner by means of a user interface design and stored medical knowledge. The level of detail is scaled automatically to the ongoing examination. Every day clinical routine is performed on only two pages, one for general patient data and a second one covering the complete minimal data set called "minimum finding" in the standard. As the examiner discovers more and more special findings or might even enter a complete medical study, the interface offers more and more fields and checkboxes. One data set can contain up to 600 values and findings. The structured user interface reflects the organ structure as well as examination methods familiar to the examiner. Automatically calculated fields speed up the examination. Judgements, diagnoses, values and ranges are interrelated. If there is a difference between the entered data and the medical knowledge base, a warning will be issued but the doctor's decision is authoritative. Some values may be gathered by different methods and even different units are converted automatically. The final doctor's letter is generated automatically in clear text but still editable and can be given out to the patient right after the examination without any further delay. Beside the minimal data set, all abnormal findings will appear and findings will be summarized wherever possible. The report is intended for the referring general practitioner, your own documentation, expert witness as well as clinical studies. Interested examiners may test the full version online at http://echo.ma.uni-heidelberg.de PMID:11220082

Schweikart, O; Metzger, F

2001-01-01

163

The use of intracardiac echocardiography during percutaneous pulmonary valve replacement.  

PubMed

High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure. PMID:25070389

Awad, Sawsan M; Masood, Syed Asif; Gonzalez, Ismael; Cao, Qi-Ling; Abdulla, Ra-Id; Heitschmidt, Mary G; Hijazi, Ziyad M

2015-01-01

164

A Primer on the Methods and Applications for Contrast Echocardiography in Clinical Imaging  

PubMed Central

Contrast echocardiography is broadly described as a variety of techniques whereby the blood pool on cardiac ultrasound is enhanced with encapsulated gas-filled microbubbles or other acoustically active nano- or microparticles. The development of this technology has occurred primarily in response to the need improve current diagnostic applications of echocardiography such as the need to better define left ventricular cavity volumes, regional wall motion, or the presence or absence of masses and thrombi. A secondary reason for the development of contrast echocardiography has been to expand the capabilities of echocardiography. These new applications include myocardial perfusion imaging for detection of ischemia and viability, perfusion imaging of masses/tumors, and molecular imaging. The ability to fill all of these current and future clinical roles has been predicated on the ability to produce robust contrast signal which, in turn, has relied on technical innovation with regards to the microbubble contrast agents and the ultrasound imaging paradigms. In this review, we will discuss the basics of contrast echocardiography including the composition of microbubble contrast agents, the unique imaging methods used to optimize contrast signal-to-noise ratio, and the clinical applications of contrast echocardiography that have made a clinical impact. PMID:25309685

Seol, Sang-Hoon

2014-01-01

165

Thromboembolism Prevention via Transcatheter Left Atrial Appendage Closure with Transeosophageal Echocardiography Guidance  

PubMed Central

Atrial fibrillation (AF) is an independent risk factor for stroke. Anticoagulation therapy has a risk of intracerebral hemorrhage. The use of percutaneous left atrial appendage (LAA) closure devices is an alternative to anticoagulation therapy. Echocardiography has a leading role in LAA closure procedure in patient selection, during the procedure and during followup. A comprehensive echocardiography study is necessary preprocedural in order to identify all the lobes of the LAA, evaluate the size of the LAA ostium, look for thrombus or spontaneous echo contrast, and evaluate atrial anatomy, including atrial septal defect and patent foramen ovale. Echocardiography is used to identify potential cardiac sources of embolism, such as atrial septal aneurysm, mitral valve disease, and aortic debris. During the LAA occlusion procedure transeosophageal echocardiography provides guidance for the transeptal puncture and monitoring during the release of the closure device. Procedure-related complications can be evaluated and acceptable device release criteria such as proper position and seating of the occluder in the LAA, compression, and stability can be assessed. Postprocedural echocardiography is used for followup to assess the closure of the LAA ostium. This overview paper describes the emerging role of LAA occlusion procedure with transeosophageal echocardiography guidance as an alternative to anticoagulation therapy in patients with AF. PMID:24672720

Palios, John; Paraskevaidis, Ioannis

2014-01-01

166

Impact of Afterload on the Assessment of Severity of Aortic Stenosis  

PubMed Central

BACKGROUND Aortic stenosis (AS) is increasingly diagnosed in current aging society. Echocardiography is the most important tool in the assessment of AS and its severity. However, load-dependency of Doppler measurement could affect the accuracy of AS severity assessment. We tried to evaluate the impact of afterload on the assessment of AS severity by modification of afterload using pneumatic compression (Pcom). METHODS Forty patients diagnosed as moderate or severe AS [effective orifice area of aortic valve (EOAAV) by continuity equation of < 1.5 cm2] were consecutively enrolled. Patients with severely uncontrolled hypertension, severe left ventricular (LV) dysfunction, and other significant valve disease were excluded. Comprehensive echocardiography was performed at baseline to assess AS severity. Then, pneumatic compression of the lower extremities by 100 mmHg was applied to increase LV afterload. After 3 minutes, echocardiography was repeated to assess AS severity. RESULTS Mean blood pressure was significantly increased under Pcom (p < 0.001), while heart rate remained unchanged. Peak aortic valve velocity (Vmax) was slightly, but significantly decreased under Pcom (p = 0.03). However, Doppler velocity index and EOAAV by continuity equation were not affected by Pcom. CONCLUSION AS severity assessment by echocardiography was not dependent on the change of LV afterload imposed by Pcom. AV Vmax was slightly decreased with LV afterload increment, but these changes were too small to alter treatment plan of AS patients. EOAAV and Doppler velocity index are more stable parameters for AS severity assessment. PMID:22787524

Kim, Hyung-Kwan; Sohn, Dae-Won

2012-01-01

167

A patient with lung squamous cell carcinoma presenting with severe cardiac dysfunction similar to dilated cardiomyopathy with left bundle branch block induced by myocardial metastasis.  

PubMed

A patient with severe cardiac dysfunction similar to dilated cardiomyopathy expired because of lung squamous cell carcinoma. He was admitted with respiratory failure and was diagnosed with congestive heart failure due to dilated cardiomyopathy based on the chest X-ray, electrocardiography, echocardiography, and coronary angiography. Chest computed tomography showed a mass shadow in the right lower lobe, and the patient was diagnosed with lung squamous cell carcinoma by bronchoscopy. The patient expired, and the autopsy revealed that a myocardial metastasis disrupted the cardiac-conduction system without dilated cardiomyopathy in myocytes. Left bundle branch block caused by myocardial metastasis presumably induced left cardiac dysfunction. PMID:25318802

Ogino, Hirokazu; Nishimura, Naoki; Kitamura, Atsushi; Ishikawa, Genta; Okafuji, Kohei; Tomishima, Yutaka; Jinta, Torahiko; Yamazoe, Masahiro; Yang, Yang; Chohnabayashi, Naohiko

2014-01-01

168

Transthoracic echocardiography reference values in juvenile and adult 129/Sv mice  

PubMed Central

Background In the recent years, the use of Doppler-echocardiography has become a standard non-invasive technique in the analysis of cardiac malformations in genetically modified mice. Therefore, normal values have to be established for the most commonly used inbred strains in whose genetic background those mutations are generated. Here we provide reference values for transthoracic echocardiography measurements in juvenile (3 weeks) and adult (8 weeks) 129/Sv mice. Methods Echocardiographic measurements were performed using B-mode, M-mode and Doppler-mode in 15 juvenile (3 weeks) and 15 adult (8 weeks) mice, during isoflurane anesthesia. M-mode measurements variability of left ventricle (LV) was determined. Results Several echocardiographic measurements significantly differ between juvenile and adult mice. Most of these measurements are related with cardiac dimensions. All B-mode measurements were different between juveniles and adults (higher in the adults), except for fractional area change (FAC). Ejection fraction (EF) and fractional shortening (FS), calculated from M-mode parameters, do not differ between juvenile and adult mice. Stroke volume (SV) and cardiac output (CO) were significantly different between juvenile and adult mice. SV was 31.93?±?8.67 ?l in juveniles vs 70.61?±?24.66 ?l in adults, ??

2013-01-01

169

Visualization of the central pulmonary arteries by biplane transesophageal echocardiography  

PubMed Central

It is suggested that transesophageal echocardiography (TEE), by detecting thromboemboli in the proximal parts of the pulmonary arteries, is useful in the diagnosis of pulmonary embolism. However, the data on visualization of the pulmonary arteries are limited. The extent of the pulmonary arteries that can be precisely visualized during biplane TEE was assessed in 51 consecutive patients (23 female, 28 male, aged 56.6±12.5 years) without structural heart disease. The main pulmonary artery and the right pulmonary artery were detected in 96.1% and 94.1% of patients, respectively. Although the proximal part of the left pulmonary artery was found in only 47.0% of patients, its distal part was visualized in 92.2%. During TEE, proximal parts of the lobar arteries on both sides were visualized in 88.2% of patients. Thus, the central pulmonary arteries including proximal parts of the lobar branches can be precisely visualized by biplane TEE in the majority of patients. Only the proximal part of the left pulmonary artery is difficult to assess. PMID:20428260

Pruszczyk, P; Torbicki, A; Kuch-Wocial, A; Szulc, M; Styczynski, G; Bochowicz, A; Kostrubiec, M

2001-01-01

170

Use of Echocardiography Reveals Reestablishment of Ventricular Pumping Efficiency and Partial Ventricular Wall Motion Recovery upon Ventricular Cryoinjury in the Zebrafish  

PubMed Central

Aims While zebrafish embryos are amenable to in vivo imaging, allowing the study of morphogenetic processes during development, intravital imaging of adults is hampered by their small size and loss of transparency. The use of adult zebrafish as a vertebrate model of cardiac disease and regeneration is increasing at high speed. It is therefore of great importance to establish appropriate and robust methods to measure cardiac function parameters. Methods and Results Here we describe the use of 2D-echocardiography to study the fractional volume shortening and segmental wall motion of the ventricle. Our data show that 2D-echocardiography can be used to evaluate cardiac injury and also to study recovery of cardiac function. Interestingly, our results show that while global systolic function recovered following cardiac cryoinjury, ventricular wall motion was only partially restored. Conclusion Cryoinjury leads to long-lasting impairment of cardiac contraction, partially mimicking the consequences of myocardial infarction in humans. Functional assessment of heart regeneration by echocardiography allows a deeper understanding of the mechanisms of cardiac regeneration and has the advantage of being easily transferable to other cardiovascular zebrafish disease models. PMID:25532015

Marques, Inês João; Sánchez-Iranzo, Héctor; Jiménez-Borreguero, Luis Jesús; Mercader, Nadia

2014-01-01

171

Bicuspid aortic valve and severe aortic stenosis in a newborn exposed to carbamazapine during pregnancy  

PubMed Central

The use of antiepileptic drugs increases the risk of major congenital malformations during pregnancy. Here, we report an infant who had a history of in-utero carbamazepine exposure and who was born with a cardiac malformation. The infant was born at 39 weeks of gestation vaginally to an epileptic mother who had been treated with carbamazepine throughout her pregnancy. He was referred due to cardiac murmur in the second week of his life. The mother had not received folic acid supplementation. Transthoracic echocardiography revealed bicuspid aortic valve, mild aortic stenosis, patent ductus arteriosus, patent foramen ovale and the renal ultrasound revealed mild left hydronephrosis. Follow-up echocardiography performed 14 weeks later showed increased severity of aortic stenosis and percutaneous balloon aortic valvuloplasty was performed. To our knowledge, there is only one case report in the literature mentioning the association of a bicuspid aortic valve and aortic stenosis with oxcarbazepine exposure, which is a structural derivative of carbamazepine. However, there are no reports for association with carbamazepine itself. Bicuspid aorta and aortic stenosis may be among the cardiac malformations that result from the teratogenic effect of carbamazepine. PMID:25584038

Karata?, Zehra; Karata?, Ahmet; Özlü, Tülay; Goksugur, Sevil B.; Varan, Birgül

2014-01-01

172

Design of a Matrix Transducer for Three-Dimensional Second Harmonic Transesophageal Echocardiography  

NASA Astrophysics Data System (ADS)

Three-dimensional (3D) echocardiography visualizes the 3D anatomy and function of the heart. For 3D imaging an ultrasound matrix of several thousands of elements is required. To connect the matrix to an external imaging system, smart signal processing with integrated circuitry in the tip of the TEE probe is required for channel reduction. To separate the low voltage integrated receive circuitry from the high voltages required for transmission, our design features a separate transmit and receive subarray. In this study we focus on the transmit subarray. A 3D model of an individual element was developed using the finite element method (FEM). The model was validated by laser interferometer and acoustic measurements. Measurement and simulations matched well. The maximum transmit transfer was 3 nm/V at 2.4 MHz for both the FEM simulation of an element in air and the laser interferometer measurement. The FEM simulation of an element in water resulted in a maximum transfer of 43 kPa/V at 2.3 MHz and the acoustic measurement in 55 kPa/V at 2.5 MHz. The maximum pressure is ~1 MPa/120Vpp, which is sufficient pressure for second harmonic imaging. The proposed design of the transmit subarray is suitable for its role in a 3D 2H TEE probe.

Blaak, Sandra; van Neer, Paul L. M. J.; Prins, Christian; Bosch, Johan G.; Lancée, Charles T.; van der Steen, Antonius F. W.; de Jong, Nico

173

Initial experience of using intracardiac echocardiography (ICE) for guiding balloon mitral valvuloplasty (BMV)  

PubMed Central

Background and aims BMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram (ICE) guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures. Methods During BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography (TTE), and catheterization derived hemodynamic measurements (cath). Results Seventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 ± 21 years. The mean MV area increased from 0.9 ± 0.1 cm2 to 1.7 ± 0.2 cm2, P < 0.0001 and the mean gradient decreased from 12.6 ± 5.8 mmHg to 4.9 ± 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath. Conclusion ICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath. PMID:23960664

Ahmari, Saeed AL; Amro, Ahmed; Otabi, Mohammed AL; Abdullah, Moheeb AL; Kasab, Saad AL; Amri, Husien AL

2011-01-01

174

Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography  

NASA Technical Reports Server (NTRS)

Previous studies have shown that small intraventricular pressure gradients (IVPG) are important for efficient filling of the left ventricle (LV) and as a sensitive marker for ischemia. Unfortunately, there has previously been no way of measuring these noninvasively, severely limiting their research and clinical utility. Color Doppler M-mode (CMM) echocardiography provides a spatiotemporal velocity distribution along the inflow tract throughout diastole, which we hypothesized would allow direct estimation of IVPG by using the Euler equation. Digital CMM images, obtained simultaneously with intracardiac pressure waveforms in six dogs, were processed by numerical differentiation for the Euler equation, then integrated to estimate IVPG and the total (left atrial to left ventricular apex) pressure drop. CMM-derived estimates agreed well with invasive measurements (IVPG: y = 0.87x + 0.22, r = 0.96, P < 0.001, standard error of the estimate = 0.35 mmHg). Quantitative processing of CMM data allows accurate estimation of IVPG and tracking of changes induced by beta-adrenergic stimulation. This novel approach provides unique information on LV filling dynamics in an entirely noninvasive way that has previously not been available for assessment of diastolic filling and function.

Greenberg, N. L.; Vandervoort, P. M.; Firstenberg, M. S.; Garcia, M. J.; Thomas, J. D.

2001-01-01

175

A Hybrid Method for Endocardial Contour Extraction of Right Ventricle in 4-Slices from 3D Echocardiography Dataset  

PubMed Central

This paper presents a hybrid method to extract endocardial contour of the right ventricular (RV) in 4-slices from 3D echocardiography dataset. The overall framework comprises four processing phases. In Phase I, the region of interest (ROI) is identified by estimating the cavity boundary. Speckle noise reduction and contrast enhancement were implemented in Phase II as preprocessing tasks. In Phase III, the RV cavity region was segmented by generating intensity threshold which was used for once for all frames. Finally, Phase IV is proposed to extract the RV endocardial contour in a complete cardiac cycle using a combination of shape-based contour detection and improved radial search algorithm. The proposed method was applied to 16 datasets of 3D echocardiography encompassing the RV in long-axis view. The accuracy of experimental results obtained by the proposed method was evaluated qualitatively and quantitatively. It has been done by comparing the segmentation results of RV cavity based on endocardial contour extraction with the ground truth. The comparative analysis results show that the proposed method performs efficiently in all datasets with overall performance of 95% and the root mean square distances (RMSD) measure in terms of mean ± SD was found to be 2.21 ± 0.35?mm for RV endocardial contours. PMID:25371675

Dawood, Faten A.; Rahmat, Rahmita W.; Kadiman, Suhaini B.; Abdullah, Lili N.; Zamrin, Mohd D.

2014-01-01

176

A Hybrid Method for Endocardial Contour Extraction of Right Ventricle in 4-Slices from 3D Echocardiography Dataset.  

PubMed

This paper presents a hybrid method to extract endocardial contour of the right ventricular (RV) in 4-slices from 3D echocardiography dataset. The overall framework comprises four processing phases. In Phase I, the region of interest (ROI) is identified by estimating the cavity boundary. Speckle noise reduction and contrast enhancement were implemented in Phase II as preprocessing tasks. In Phase III, the RV cavity region was segmented by generating intensity threshold which was used for once for all frames. Finally, Phase IV is proposed to extract the RV endocardial contour in a complete cardiac cycle using a combination of shape-based contour detection and improved radial search algorithm. The proposed method was applied to 16 datasets of 3D echocardiography encompassing the RV in long-axis view. The accuracy of experimental results obtained by the proposed method was evaluated qualitatively and quantitatively. It has been done by comparing the segmentation results of RV cavity based on endocardial contour extraction with the ground truth. The comparative analysis results show that the proposed method performs efficiently in all datasets with overall performance of 95% and the root mean square distances (RMSD) measure in terms of mean ± SD was found to be 2.21 ± 0.35?mm for RV endocardial contours. PMID:25371675

Dawood, Faten A; Rahmat, Rahmita W; Kadiman, Suhaini B; Abdullah, Lili N; Zamrin, Mohd D

2014-01-01

177

The relationship between immediate relevant basic science knowledge and clinical knowledge: physiology knowledge and transthoracic echocardiography image interpretation.  

PubMed

Two major views on the relationship between basic science knowledge and clinical knowledge stand out; the Two-world view seeing basic science and clinical science as two separate knowledge bases and the encapsulated knowledge view stating that basic science knowledge plays an overt role being encapsulated in the clinical knowledge. However, resent research has implied that a more complex relationship between the two knowledge bases exists. In this study, we explore the relationship between immediate relevant basic science (physiology) and clinical knowledge within a specific domain of medicine (echocardiography). Twenty eight medical students in their 3rd year and 45 physicians (15 interns, 15 cardiology residents and 15 cardiology consultants) took a multiple-choice test of physiology knowledge. The physicians also viewed images of a transthoracic echocardiography (TTE) examination and completed a checklist of possible pathologies found. A total score for each participant was calculated for the physiology test, and for all physicians also for the TTE checklist. Consultants scored significantly higher on the physiology test than did medical students and interns. A significant correlation between physiology test scores and TTE checklist scores was found for the cardiology residents only. Basic science knowledge of immediate relevance for daily clinical work expands with increased work experience within a specific domain. Consultants showed no relationship between physiology knowledge and TTE interpretation indicating that experts do not use basic science knowledge in routine daily practice, but knowledge of immediate relevance remains ready for use. PMID:21952688

Nielsen, Dorte Guldbrand; Gotzsche, Ole; Sonne, Ole; Eika, Berit

2012-10-01

178

Multiplane transesophageal echocardiography. Imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array OmniPlane probe.  

PubMed

Multiplane transesophageal echocardiography is a new exciting development in echocardiography. We examined the methodology and echo-anatomic correlations of multiplane transesophageal echocardiography and its clinical applications in 100 patients. We used a 5-MHz phased array multiplane (OmniPlane) transesophageal probe. In this instrument, the transducer array can be steered through 180 degrees from any transducer location. This provides a vast assembly of imaging planes, allowing for detailed visualization of all dimensions of cardiac anatomy. This report presents our observations on the echocardiographic anatomy seen in various image planes and the unique clinical potential of multiplane transesophageal echocardiography in the diagnostic assessment of cardiovascular disorders. This technique appears to provide incremental diagnostic information that enhances the interpretative ability. Less esophageal probe manipulation is required with consequent decrease in patient discomfort. We conclude that multiplane transesophageal echocardiography enhances the versatility of transesophageal examination and offers many new avenues for developments such as three-dimensional echocardiography. PMID:10147803

Pandian, N G; Hsu, T L; Schwartz, S L; Weintraub, A; Cao, Q L; Schneider, A T; Gordon, G; England, M; Simonetti, J

1992-11-01

179

[Value of cine magnetic resonance imaging in the diagnosis and quantification of valvular regurgitation. Comparison with angiography and Doppler echocardiography].  

PubMed

Thirty-three patients presenting with regurgitation of the mitral valve (19 cases), tricuspid valve (14 cases) or aortic valve (11 cases) documented by angiography (n = 20) and/or doppler-echocardiography (n = 28) were examined by cine-MRI in order to test this method in valvular regurgitation. Sixteen ECG-synchronized cine-MRI images were acquired by the GRASS technique every 40 ms on appropriate projections, with a resistive 0.28 Tesla Bruker magnet. The semiology of normal and pathological blood flow images at cine-MRI is described. Valvular regurgitations present as "signal void" jets the chronology and spatial extension of which depend on the severity of the lesion. The differential diagnosis with physiological flows is discussed. The diagnostic sensitivity of the method was 29/29 when compared with angiography and 29/33 when compared with doppler-echocardiography (2 cases of 1/4 mitral regurgitation and 2 cases 1/4 tricuspid regurgitation were not visible at cine-MRI). The specificity of this method, as can be judged from 104 patients explored, also seems to be satisfactory. The severity of regurgitation was graded from 1 to 4 with the three methods, on the basis of strict criteria. The differences in grade evaluation exceeded +/- 1 point in only one case of mitral regurgitation which was greatly underestimated by the doppler method as compared with angiography and cine-MRI. Thus, cine-MRI is a reliable method to evaluate valvular regurgitations and their severity. It solves the practical problem raised by non-echogenic patients when catheterization is to be postponed or avoided. PMID:2512868

Germain, P; Baruthio, J; Roul, G; Mossard, J M; Bareiss, P; Wecker, D; Chambron, J; Sacrez, A

1989-10-01

180

Incremental prognostic value of stress echocardiography as an adjunct to exercise electrocardiography after uncomplicated myocardial infarction  

PubMed Central

OBJECTIVE—To assess the prognostic value of stress echocardiography as an adjunct to exercise electrocardiography in patients with uncomplicated acute myocardial infarction.?DESIGN—496 patients underwent a maximum exercise ECG and pharmacological stress echocardiography (406 dobutamine and 90 dipyridamole) within 15 days of uncomplicated acute myocardial infarction and were followed for a mean of 25 months (range 1-74 months) for reinfarction, unstable angina, and cardiac death. Patients undergoing revascularisation were omitted.?RESULTS—Exercise ECG was positive in 162 patients (32.6%) and low threshold positive (< 100 W) in 91 (18%). Stress echocardiography was positive in 239 patients (48%) (194 with dobutamine and 45 with dipyridamole stress). The agreement between the two tests was 63% (? = 0.24, 95% confidence interval 0.15 to 0.33). Sixty nine spontaneous events occurred (14 cardiac deaths, 26 reinfarctions, and 29 with unstable angina requiring hospital admission), and 126 patients underwent revascularisation (39 coronary angioplasty and 87 bypass surgery). By receiver operating characteristic curve analysis, stress echocardiography provided incremental prognostic information compared with clinical data. A low threshold positive exercise ECG was associated with a worse outcome, but there was a fivefold increase in risk in patients with positive stress echocardiography who also had a high threshold (> 100 W) positive exercise ECG. Event-free survival of patients with both tests positive was significantly less than in patients with only one positive test or with both tests negative.?CONCLUSIONS—Stress echocardiography provides additional prognostic information after uncomplicated acute myocardial infarction, but the greatest gain is found in patients with a high threshold positive exercise ECG.???Keywords: risk stratification; myocardial infarction; stress echocardiography; exercise stress testing PMID:11250968

Bigi, R; Desideri, A; Galati, A; Bax, J; Coletta, C; Fiorentini, C; Fioretti, P

2001-01-01

181

Assessment of Atrial Fibrillation and Vulnerability in Patients with Wolff-Parkinson-White Syndrome Using Two-Dimensional Speckle Tracking Echocardiography  

PubMed Central

Purpose The aim was to assess atrial fibrillation (AF) and vulnerability in Wolff-Parkinson-White (WPW) syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE). Methods All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls. Results Results showed significant differences in both body mass index (BMI) and supraventricular tachycardia (SVT) duration between WPW patients and DAVNP patients (both P<0.05). Echocardiography revealed that the maximum left atrial volume (LAVmax) and the left ventricular mass index (LVMI) in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05). Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA) in the WPW patients group compared with patients in the DAVNP group (all P<0.05). In the AF group, there were significant differences in the levels of systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) from the 4-chamber view (LA) both before and after ablation (all P<0.05). In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA) pre-ablation compared to post-ablation (all P<0.05). Conclusion Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period. PMID:25397668

Li, Jing-Jie; Wei, Fang; Chen, Ju-Gang; Yu, Yan-Wei; Gu, Hong-Yue; Jiang, Rui; Wu, Xiu-Li; Sun, Qian

2014-01-01

182

Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)  

PubMed Central

Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways – either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level – obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs. PMID:18837986

Price, Susanna; Via, Gabriele; Sloth, Erik; Guarracino, Fabio; Breitkreutz, Raoul; Catena, Emanuele; Talmor, Daniel

2008-01-01

183

Effectiveness of screening for abdominal aortic aneurysm during echocardiography.  

PubMed

Screening patients with abdominal aortic aneurysm (AAA) is associated with reduced AAA-related mortality, but population screening is poorly implemented. Opportunistic screening during imaging for other indications might be efficient. Single-center series reported AAA rates of 0.8% to 6.5% in patients undergoing transthoracic echocardiography (TTE), with disparities due to selection bias. In this first multicenter study, we aimed to assess the feasibility and criteria for screening AAA during TTE in real-life practice. During a week of May 2011, 79 centers participated in a nationwide survey. All patients aged ?65 years requiring TTE for any indication were eligible, except for those with operated abdominal aorta. We defined AAA by an anteroposterior diameter of the infrarenal aorta?30 mm. Of 1,382 consecutive patients, abdominal aorta imaging was feasible in 96.7%, with a median delay of 1.7 minutes (>3 minutes in 3.6% of cases). We found AAA in 50 patients (3.7%). Unknown AAA (2.7%) was more frequent in men than women (3.7% vs 1.3%, respectively, p=0.007) and increased by age at 2.2%, 2.5%, and 5.8% in age bands of 65 to 74, 75 to 84, and 85+ years, respectively. None of the female participants aged <75 years had AAA. Smoking status and family history of AAA were significantly more frequent among patients with AAA. The ascending aorta was larger in those with AAA (36.2±4.7 vs 34.0±5.2 mm, p=0.006), and bicuspid aortic valve and/or major aortic regurgitation were also more frequent (8% vs 2.6%, p=0.017). In conclusion, rapid AAA screening during TTE is feasible and should be limited to men ?65 years and women?75 years. PMID:25127549

Aboyans, Victor; Bataille, Vincent; Bliscaux, Pascale; Ederhy, Stéphane; Filliol, Didier; Honton, Benjamin; Kurtz, Baptiste; Messas, Emmanuel; Mohty, Dania; Brochet, Eric; Kownator, Serge

2014-10-01

184

Intracardiac Echocardiography Evaluation in Secundum Atrial Septal Defect Transcatheter Closure  

SciTech Connect

Purpose: This study was designed to assess the balloon sizing maneuvers and deployment of an Amplatzer Septal Occluder (ASO). In addition, intraprocedural balloon sizing was compared with off-line intracardiac echocardiographic measurements. Methods: The intracardiac echocardiography (ICE) measurements were: maximum transverse and longitudinal atrial septal defect (ASD) diameters in the aortic valve and four-chamber planes;area of the ASD and its equivalent circle diameter. Thirteen consecutive patients underwent transcatheter implantation of an ASO device using ICE guidance under local anesthesia. The device matching the balloon sizing diameter of the defect was implanted. Qualitative ICE assessment of the ASO devices implanted was performed off line. Results: The mean equivalent circle diameter predicted by ICE was 24.40 {+-} 5.61 mm and was significantly higher(p 0.027) than the ASD measured by balloonsizing (21.38 {+-} 5.28 mm). Unlike previous studies we did not find any correlation between the two measurements (correlation coefficient = 0.47). Only four of the 13 patients had optimal device positioning as shown by the qualitative ICE evaluation, whereas the remaining nine patients had inadequate device placement. This resulted in a waist diameter that was an average 26.1% undersized in seven patients and 12.7% oversized in two patients. Five of the seven patients with an undersized device had ASO-atrial septum misalignment with leftward device deviation. Conclusion: The ICE images allowed careful measurement of the dimensions of the ASD and accurately displayed the spatial relations of the ASO astride the ASD.Moreover, use of the ICE measurement led to selection of a different size of device in comparison with those of balloon sizing. The clinical benefit of this new approach needs to be rigorously tested.

Zanchetta, Mario; Pedon, Luigi; Rigatelli, Gianluca; Carrozza, Antonio; Zennaro, Marco; Di Martino, Roberta [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy); Onorato, Eustaquio [Operative Unit ofCardiology, Clinica S. Rocco, Ome, Brescia (Italy); Maiolino, Pietro [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy)

2003-02-15

185

Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters  

PubMed Central

Background: Tissue Doppler imaging (TDI) is a method that determines the tissue motion and velocity within the myocardium. Aims: To characterize acute haemodialysis (HD)-induced changes in TDI-derived indices for patients that have end-stage renal disease (ESRD). Study Design: Cross sectional study. Methods: Conventional echocardiography and TDI methods were applied to study ESRD patients (n=58) before and after HD. Pulmonary venous flow, mitral inflow, and TDI signals of the lateral and septal mitral annulus were examined for the determination of altered left-ventricular diastolic filling parameters. Flow velocities from early- (E) and late-atrial (A) peak transmitral; peak pulmonary vein systolic (S) and diastolic (D); and myocardial peak systolic (Sm) and peak early (Em) and late (Am) diastolic mitral annular velocities were also assessed for changes. Results: Transmitral E and A velocities and the E/A ratio decreased significantly after HD (p<0.001). Pulmonary vein S (p<0.001) and D (p<0.001) velocities decreased, and S/D ratios increased significantly (p=0.027). HD led to a reduction in septal Em (p<0.001), lateral Em (p=0.006), and Am (p<0.001) velocities. Contrary to the decreases in Em and Am, the Em/Am ratio remained unchanged. Conclusion: A single HD session was associated with an acute deterioration in the diastolic parameters. Since the Em/Am ratio remained unchanged, we conclude that this index is a relatively load-independent measure of diastolic function in HD patients. PMID:25337420

Sa?, Saim; Ye?ilbursa, Dilek; Y?ld?z, Abdulmecit; Dilek, Kamil; ?entürk, Tunay; Serdar, Osman Ak?n; Ayd?nlar, Ali

2014-01-01

186

Congestive hepatic fibrosis score: a novel histologic assessment of clinical severity.  

PubMed

Chronic right heart failure predisposes to hepatic passive congestion and centrizonal necrosis that may lead to hepatic fibrosis (cardiac sclerosis). Although there have been several studies on the histologic features of congestive hepatopathy, there is no available grading system. In this study we developed a novel grading system for congestive hepatic fibrosis. Liver biopsies were examined in patients with chronic heart failure of various etiologies including congenital heart disease, idiopathic cardiomyopathy, ischemic heart disease, and valvular heart disease. The cases with available echocardiography and/or right heart catheterization were included. Cases with other types of underlying chronic liver diseases, alcoholic liver disease, significant steatosis (>20%), malignant neoplasm, and acute heart failure or shock were excluded. After exclusion, 42 cases were included in the study. We herein proposed a novel congestive hepatic fibrosis score and correlated it with the right heart structure and function obtained by echocardiography and/or right heart catheterization. Our results showed that congestive hepatic fibrosis score is well correlated with the right atrial pressure (P for trend <0.001). The presence of portal fibrosis (congestive hepatic fibrosis scores 2 and 3) is associated with significantly higher right atrial pressure than those with no fibrosis (P<0.001) or with centrizonal fibrosis only (P=0.02). Congestive hepatic fibrosis score is also significantly associated with increasing severity of right atrial dilatation (P=0.03) and right ventricular dilatation (P=0.02), indicators for chronic volume and/or pressure overload. Other histopathologic features include sinusoidal dilatation and centrizonal hepatocyte atrophy. In summary, although sinusoidal dilatation and centrizonal fibrosis are the hallmarks of hepatic passive congestion, the presence of portal fibrosis is suggestive of more advanced disease, as it correlates with more severe impairment of right heart function, regardless of the etiologies of right heart failure. Congestive hepatic fibrosis score is a useful indicator of clinical severity. PMID:24925051

Dai, Dao-Fu; Swanson, Paul E; Krieger, Eric V; Liou, Iris W; Carithers, Robert L; Yeh, Matthew M

2014-12-01

187

A practical approach to goal-directed echocardiography in the critical care setting.  

PubMed

Urgent cardiac ultrasound examination in the critical care setting is clinically useful. Application of goal-directed echocardiography in this setting is quite distinct from typical exploratory diagnostic comprehensive echocardiography, because the urgent critical care setting mandates a goal-directed approach. Goal-directed echocardiography most frequently aims to rapidly identify and differentiate the cause(s) of hemodynamic instability and/or the cause(s) of acute respiratory failure. Accordingly, this paper highlights 1) indications, 2) an easily memorized differential diagnostic framework for goal-directed echocardiography, 3) clinical questions that must be asked and answered, 4) practical issues to allow optimal image capture, 5) primary echocardiographic views, 6) key issues addressed in each view, and 7) interpretation of findings within the differential diagnostic framework. The most frequent indications for goal-directed echocardiography include 1) the spectrum of hemodynamic instability, shock, and pulseless electrical activity arrest and 2) acute respiratory failure. The differential diagnostic categories for hemodynamic instability can be remembered using the mnemonic 'SHOCK' (for Septic, Hypovolemic, Obstructive, Cardiogenic, and (K) combinations/other kinds of shock). RESP-F (for exacerbation of chronic Respiratory disease, pulmonary Embolism, ST changes associated with cardiac or pericardial disease, Pneumonia, and heart Failure) can be used for acute respiratory failure. The goals of goal-directed echocardiography in the unstable patient are: assessing global ventricular systolic function, identifying marked right ventricular and left ventricular enlargement, assessing intravascular volume, and the presence of a pericardial effusion. In an urgent or emergent setting, it is recommended to go directly to the best view, which is frequently the subcostal or apical view. The five views are the subcostal four-chamber view, subcostal inferior vena cava view, parasternal long axis view, parasternal short axis view, and the apical four chamber view. Always interpret goal-directed echocardiographic findings in the context of clinically available hemodynamic information. When goal-directed echocardiography is insufficient or when additional abnormalities are appreciated, order a comprehensive echocardiogram. Goal-directed echocardiography and comprehensive echocardiography are not to be used in conflict with each other. PMID:25672460

Walley, Patricia E; Walley, Keith R; Goodgame, Ben; Punjabi, Vivek; Sirounis, Demetrios

2014-01-01

188

Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study  

PubMed Central

The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm2/m2; p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings. PMID:22254204

Giannini, Cristina; Petronio, Anna Sonia; Talini, Enrica; De Carlo, Marco; Guarracino, Fabio; Grazia, Maria; Donne, Delle; Nardi, Carmela; Conte, Lorenzo; Barletta, Valentina; Marzilli, Mario; Di Bello, Vitantonio

2011-01-01

189

Cardiac output by Doppler echocardiography in the premature baboon: Comparison with radiolabeled microspheres  

SciTech Connect

Pulsed-Doppler echocardiography (PDE) is a useful noninvasive method for determining left ventricular output (LVO). However, despite increasingly widespread use in neonatal intensive care units, validation studies in prematures with cardiopulmonary disease are lacking. The purpose of this study was to compare radiolabeled microsphere (RLM) and PDE measurements of LVO, using the critically ill premature baboon as a model of the human neonate. Twenty-two paired RLM and PDE measurements of LVO were obtained in 14 animals between 3 and 24 h of age. Average PDE LVO was 152 ml/min/kg (range, 40-258 ml/min/kg) compared to 158 ml/min/kg (range, 67-278 ml/min/kg) measured by RLM. Linear regression analysis of the paired measurements showed good correlation with a slope near unity (gamma = 0.94x + 4.20, r = 0.91, SEE = 25.7 ml). The authors conclude that PDE determinations of LVO compare well with those measured by RLM in the premature baboon. PDE appears to provide a valid estimate of LVO and should be useful in human prematures with cardiopulmonary distress.

Kinsella, J.P.; Morrow, W.R.; Gerstmann, D.R.; Taylor, A.F.; deLemos, R.A. (Wilford Hall U.S.A.F. Medical Center, San Antonio, TX (USA))

1991-04-01

190

Intraoperative assessment of coronary bypass graft to posterior descending artery by means of transesophageal echocardiography.  

PubMed

Intraoperative transesophageal echocardiography (TEE) assessment of coronary artery graft anastomosed to posterior descending artery (PDA) was evaluated. Twenty-one patients with a saphenous vein (SV) graft (n=17) or right gastroepiploic artery (RGEA) graft (n=4) anastomosed to the PDA were examined. In the transgastric mid short-axis view, the graft was depicted as an echo-free zone between the right ventricle and diaphragm. The depth, diameter, angle for Doppler measurement, and angle-corrected blood flow velocity were determined. The graft was visualized in 20 cases (95.2%). The diameter of the SV graft was 3.0-6.5 mm (mean 4.0 mm), while that of RGEA graft was 2.2-2.9 mm (mean 2.5 mm), at the depth of 1.2-4.4 cm (mean 2.4 mm) with incident angle of 14-57 degrees (mean 38.6 degrees ). Blood flow was detected in 17 cases but was difficult to detect in three cases (velocity <10 cm/s). Postoperative coronary angiography showed patent graft in 16 of former cases (one case of operative death excluded) but occluded graft in all of latter cases. Intraoperative TEE assessment was feasible nearly consistently. Diastolic blood flow velocity <10 cm/s suggests an early occlusion of the graft. PMID:19246496

Orihashi, Kazumasa; Okada, Kenji; Imai, Katsuhiko; Kurosaki, Tatsuya; Takasaki, Taiichi; Takahashi, Shinya; Morifuji, Kiyohiko; Sueda, Taijiro

2009-05-01

191

Television Quiz Show Simulation  

ERIC Educational Resources Information Center

This article explores the simulation of four television quiz shows for students in China studying English as a foreign language (EFL). It discusses the adaptation and implementation of television quiz shows and how the students reacted to them.

Hill, Jonnie Lynn

2007-01-01

192

The Great Cometary Show  

NASA Astrophysics Data System (ADS)

The ESO Very Large Telescope Interferometer, which allows astronomers to scrutinise objects with a precision equivalent to that of a 130-m telescope, is proving itself an unequalled success every day. One of the latest instruments installed, AMBER, has led to a flurry of scientific results, an anthology of which is being published this week as special features in the research journal Astronomy & Astrophysics. ESO PR Photo 06a/07 ESO PR Photo 06a/07 The AMBER Instrument "With its unique capabilities, the VLT Interferometer (VLTI) has created itself a niche in which it provide answers to many astronomical questions, from the shape of stars, to discs around stars, to the surroundings of the supermassive black holes in active galaxies," says Jorge Melnick (ESO), the VLT Project Scientist. The VLTI has led to 55 scientific papers already and is in fact producing more than half of the interferometric results worldwide. "With the capability of AMBER to combine up to three of the 8.2-m VLT Unit Telescopes, we can really achieve what nobody else can do," added Fabien Malbet, from the LAOG (France) and the AMBER Project Scientist. Eleven articles will appear this week in Astronomy & Astrophysics' special AMBER section. Three of them describe the unique instrument, while the other eight reveal completely new results about the early and late stages in the life of stars. ESO PR Photo 06b/07 ESO PR Photo 06b/07 The Inner Winds of Eta Carinae The first results presented in this issue cover various fields of stellar and circumstellar physics. Two papers deal with very young solar-like stars, offering new information about the geometry of the surrounding discs and associated outflowing winds. Other articles are devoted to the study of hot active stars of particular interest: Alpha Arae, Kappa Canis Majoris, and CPD -57o2874. They provide new, precise information about their rotating gas envelopes. An important new result concerns the enigmatic object Eta Carinae. Using AMBER with its high spatial and spectral resolution, it was possible to zoom into the very heart of this very massive star. In this innermost region, the observations are dominated by the extremely dense stellar wind that totally obscures the underlying central star. The AMBER observations show that this dense stellar wind is not spherically symmetric, but exhibits a clearly elongated structure. Overall, the AMBER observations confirm that the extremely high mass loss of Eta Carinae's massive central star is non-spherical and much stronger along the poles than in the equatorial plane. This is in agreement with theoretical models that predict such an enhanced polar mass-loss in the case of rapidly rotating stars. ESO PR Photo 06c/07 ESO PR Photo 06c/07 RS Ophiuchi in Outburst Several papers from this special feature focus on the later stages in a star's life. One looks at the binary system Gamma 2 Velorum, which contains the closest example of a star known as a Wolf-Rayet. A single AMBER observation allowed the astronomers to separate the spectra of the two components, offering new insights in the modeling of Wolf-Rayet stars, but made it also possible to measure the separation between the two stars. This led to a new determination of the distance of the system, showing that previous estimates were incorrect. The observations also revealed information on the region where the winds from the two stars collide. The famous binary system RS Ophiuchi, an example of a recurrent nova, was observed just 5 days after it was discovered to be in outburst on 12 February 2006, an event that has been expected for 21 years. AMBER was able to detect the extension of the expanding nova emission. These observations show a complex geometry and kinematics, far from the simple interpretation of a spherical fireball in extension. AMBER has detected a high velocity jet probably perpendicular to the orbital plane of the binary system, and allowed a precise and careful study of the wind and the shockwave coming from the nova. The stream of results from the VLTI and AMBER

2007-01-01

193

[Echocardiography in emergency admissions. Recognition of cardiac low-output failure].  

PubMed

Detection of acute cardiac dysfunction and differential diagnosis of low cardiac output syndrome is challenging for emergency physicians. For the critical ill patient it is essential to rapidly identify the underlying disease to initiate the correct therapy and optimize patient outcome. Echocardiography is the diagnostic tool of choice for the evaluation of low cardiac output states. In the setting of the emergency department the use of focused echocardiography instead of detailed echocardiographic studies of cardiologists is appropriate and should be provided for emergency care. The differentiation in preserved versus reduced left ventricular ejection fraction as a first assessment is helpful, particularly for physicians not well trained in echocardiography. The structured and focused approach to evaluate or exclude differential diagnoses of cardiac dysfunction is the key for optimal management of acute and critically ill patients with low cardiac output. PMID:23052991

Schmidt, J; Maier, A; Christ, M

2012-10-01

194

Rupture of a submitral ventricular aneurysm into the left atrium diagnosed by transesophageal echocardiography.  

PubMed

Submitral ventricular aneurysm is a thoroughly studied pathology but is not well known due to its rarity. Clinically, it is manifested by symptoms and signs of heart failure, mitral regurgitation and/or ventricular arrhythmias, and may be associated with thromboembolic phenomena and myocardial ischemia due to compression of the coronary arteries by the aneurysm. A rare complication of this type of aneurysm is rupture into the left atrium. Transthoracic echocardiography plays an important role in the definitive diagnosis of this pathology, although the role of transesophageal echocardiography in the evaluation of these patients is less known. We report a case of a submitral ventricular aneurysm complicated by rupture into the left atrium, which was diagnosed by transesophageal echocardiography. PMID:17695731

Morais, Humberto; Branco, Luísa Moura; Cunha, Rosa; Martins, Telmo

2007-04-01

195

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography  

PubMed Central

Background A coronary flow velocity reserve (CFVR) ? 2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease. Objective To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE). Methods 100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of ?-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was < 2 and, in group II, CFVR was ? 2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values < 0.05 were considered statistically significant. Results At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53±31 vs. 45±32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9±9.3 vs. 61.2±10.8 years; p=0.04), had lower ejection fraction (61±10 vs. 66±6%; p=0.005), higher DPV-Rest (36.81±08 vs. 25.63 ± 06cm/s; p<0.0001) and lower CFVR (1.67 ± 0.24 vs. 2.53 ± 0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40±16 vs. 64.23±16cm/s; p=0.42). ?-blocker discontinuation was associated with a 4-fold higher chance of a CFVR < 2 (OR= 4; 95% CI [1.171-13.63], p=0.027). Conclusion DPV-Rest was the main parameter to determine an adequate CFVR. ?-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology. PMID:24676368

de Abreu, José Sebastião; Lima, José Wellington Oliveira; Diógenes, Tereza Cristina Pinheiro; Siqueira, Jordana Magalhães; Pimentel, Nayara Lima; Gomes, Pedro Sabino; de Abreu, Marília Esther Benevides; Paes, José Nogueira

2014-01-01

196

Pulmonary Atresia With Intact Ventricular Septum Impact of Fetal Echocardiography on Incidence at Birth and Postnatal Outcome  

Microsoft Academic Search

Background—Fetal echocardiography is widely established in the United Kingdom for prenatal diagnosis of congenital heart disease. This may result in a substantial reduction in incidence at birth because of selected termination of pregnancy. The objective of this population-based study was to determine the incidence of pulmonary atresia with intact ventricular septum (PAIVS) at birth, the impact of fetal echocardiography on

P. E. F. Daubeney; G. K. Sharland; A. C. Cook; B. R. Keeton

197

Intraobserver and Interobserver Reproducibility for Radial, Circumferential and Longitudinal Strain Echocardiography  

PubMed Central

Objectives: Strain echocardiography (StE) promises to be a new tool for quantitative assessment of cardiac function. Analysis of intra- and interobserver reliability is an important aspect in the process of developing these novel techniques from theory to the implementation into daily routine diagnostics.The purpose of the study was to estimate reliability of the segmental StE. Methods: Left ventricular strain analysis for radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was performed in 21 healthy volunteers. RS and CS values were obtained in the parasternal short axis at the level of the papillary muscles. LS values were determined in the apical 2-, 3- and 4-chamber views. Cine-loops were recorded and quantitative analyses were conducted on an off-line workstation. Results: Intraobserver reproducibility was highest using LS in the 4-chamber view (9 ± 13.6 % mean deviation, rho = 0.624, p = 0.003), followed by CS (13.3 ± 8.3 %, rho = 0.406, p = 0.068) and lowest in RS (26.3 ± 30.1 %, rho = 0.391, p = 0.080). Interobserver analyses of LS derived from 3-chamber view showed lowest deviation (11.9 ± 9.5 %, rho = 0.513, p = 0.017), followed by CS (15.2 ± 12.0 %, 0.263, p = 0.249) and the least consistent measurements in RS (35.9 ± 46.3 %, rho 0.382, p = 0.088). Conclusion: This study shows that the clinical utility of StE depends on the regional differences of LV wall motion and image quality. LS-values showed promising intra- and interobserver reproducibility values. For quantitative follow-up studies LS should be preferred. PMID:25356089

R, Leischik; B, Dworrak; K, Hensel

2014-01-01

198

Quantitative detection of myocardial ischaemia by stress echocardiography; a comparison with SPECT  

PubMed Central

Aims Real-time perfusion (RTP) adenosine stress echocardiography (ASE) can be used to visually evaluate myocardial ischaemia. The RTP power modulation technique angio-mode (AM), provides images for off-line perfusion quantification using Qontrast® software, generating values of peak signal intensity (A), myocardial blood flow velocity (?) and myocardial blood flow (Ax?). By comparing rest and stress values, their respective reserve values (A-r, ?-r, Ax?-r) are generated. We evaluated myocardial ischaemia by RTP-ASE Qontrast® quantification, compared to visual perfusion evaluation with 99mTc-tetrofosmin single-photon emission computed tomography (SPECT). Methods and Results Patients admitted to SPECT underwent RTP-ASE (SONOS 5500) using AM during Sonovue® infusion, before and throughout adenosine stress, also used for SPECT. Visual myocardial perfusion and wall motion analysis, and Qontrast® quantification, were blindly compared to one another and to SPECT, at different time points off-line. We analyzed 201 coronary territories (left anterior descendent [LAD], left circumflex [LCx] and right coronary [RCA] artery territories) in 67 patients. SPECT showed ischaemia in 18 patients and 19 territories. Receiver operator characteristics and kappa values showed significant agreement with SPECT only for ?-r and Ax?-r in all segments: area under the curve 0.678 and 0.665; P < 0.001 and < 0.01, respectively. The closest agreements were seen in the LAD territory: kappa 0.442 for both ?-r and Ax?-r; P < 0.01. Visual evaluation of ischaemia showed good agreement with SPECT: accuracy 93%; kappa 0.67; P < 0.001; without non-interpretable territories. Conclusion In this agreement study with SPECT, RTP-ASE Qontrast® quantification of myocardial ischaemia was less accurate and less feasible than visual evaluation and needs further development to be clinically useful. PMID:19534829

Gudmundsson, Petri; Shahgaldi, Kambiz; Winter, Reidar; Dencker, Magnus; Kitlinski, Mariusz; Thorsson, Ola; Willenheimer, Ronnie B; Ljunggren, Lennart

2009-01-01

199

[Evaluation of regurgitant fraction of aortic regurgitation by means of pulsed Doppler echocardiography as compared with cine angiography].  

PubMed

The regurgitant fraction (RF) of aortic regurgitation (AR) was calculated using pulsed Doppler echocardiography (PDE), and the results were compared with those of aortography. Two-dimensional echocardiography (2DE), PDE and cine angiography were performed for 33 patients, including nine in whom aortic regurgitation (AR) was ruled out by contrast 2DE and 24 in whom AR was confirmed by aortography (AOG). The latter were subdivided into six of Sellers' degree I, seven of degree II, eight of degree III and three of degree IV. Sampling was obtained from the main pulmonary artery, the left ventricular outflow tract, and the mean circulation velocity (f1) was calculated from the power spectrum wave pattern obtained from each source. With the following formula, Qp (pulmonary arterial blood flow), Qs (left ventricular ejection blood flow) and RF [= (Qs--Qp)/Qs] were calculated, and compared with the findings obtained from invasive methods: (formula; see text) (L = vascular diameter; theta = angle of incidence; C = velocity of sound; fo = oscillating frequency; ET = ejection time; HR = heart rate) A correlation of r = 0.81 was found between Qp calculated with PDE and right cardiac output (CO) by the thermodilution method. A correlation of r = 0.66 was observed between Qs and left ventricular ejection volume obtained from left ventriculography using Dodge's method. Comparison of RF using Sellers' classification with AOG revealed that the RF in the group uncomplicated with AR was 0.14 +/- 0.10, and Sellers' degrees I, 0.27 +/- 0.08; II, 0.36 +/- 0.04; III, 0.53 +/- 0.05; and IV, 0.64 +/- 0.06, indicating consistency with severity and RF.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4067337

Morita, K; Suzuki, S; Sasaki, T; Miyazawa, S; Mizuno, A; Horiguchi, T; Kubouchi, Y; Arai, T

1985-03-01

200

Clinical aspects of left ventricular diastolic function assessed by Doppler echocardiography following acute myocardial infarction.  

PubMed

LV systolic function and dilation after Ml have been extensively studied and have been related to heart failure and cardiac mortality. In recent years, it has been increasingly apparent that LV diastolic dysfunction contributes to signs and symptoms of heart failure and LV diastolic dysfunction is associated with increased mortality rates in patients chronic heart failure independent of systolic function. LV diastolic dysfunction is difficult to assess on basis of clinical examination including chest radiography and electrocardiography. LV diastolic filling has traditionally been evaluated by cardiac catherization with direct measurement of filling pressures and relaxation. However, the invasive approach describing LV compliance and relaxation as the major determinants of LV diastolic function, is not feasible and suitable for routine investigations of diastolic function. Two-dimensional and Doppler echocardiography has become a well accented practical and safe non-invasive method for diagnosis of LV diastolic dysfunction. Combined invasive and echocardiographic studies have shown that analysis of mitral and pulmonary venous flow velocities relate to invasively measured filling pressures and relaxation rate in cardiac diseases. Based on Doppler analysis of mitral and pulmonary venous flow three abnormal LV filling patterns are identified: impaired relaxation, "pseudonormalization" and restrictive. These LV filling patterns have been related to symptoms, relaxation rate, filling pressure and prognosis in patients with restrictive and dilated cardiomyopathy. The Doppler flow profiles are influenced by several factors including age, heart rate, load conditions and valve heart diseases which must be taken into consideration during evaluation. During the last decade information about LV diastolic function assessed non-invasively by Doppler echocardiography has gained in patients with CAD. Myocardial ischemia induced by brief coronary artery occlusion or pacing leads to abnormal myocardial relaxation which can be reversed to normal by restoring normal myocardial blood flow. The diastolic abnormality is present within seconds and a characteristic impaired relaxation filling pattern are identified by mitral and pulmonary venous flow analysis. Diastolic dysfunction has been recognized during the early as well during the post-MI phase with or without LV systolic dysfunction. In the acute phase both an abnormal relaxation pattern and restrictive LV filling pattern are present which has been related to in-hospital heart failure. The identification of a pseudonormal or restrictive LV filling pattern are associated with later readmission to hospital with heart failure and cardiac death. Abnormal relaxation filling is the most pronounced filling pattern after one year which might be related to the remodeling process including compensatory hypertrophy, scarring of the infarct zone leading to a non-uniform relaxation of the LV. Remodeling of the LV following a MI is subject to several factors which might involve diastolic function. This is supported by the presence of an impaired relaxation and restrictive filling pattern are associated with progressive LV dilatation following Ml. Furthermore, the LV remodeling process following the very early phase includes the scarring process with collagen deposition in the infarcted and non-infarcted myocardium. The extent and quality of the repair process involving collagen deposition are believed to influence the remodeling process. Increased collagen deposition in the subacute phase of Ml indicated by elevated values of the collagen marker PIIINP is found to be related to LV dilation, depressed systolic function and restrictive LV filling. Development of a restrictive filling in patients with increased collagen deposition might be due to increasing LV volume but also to increased myocardial stiffness. Regarding prognosis diastolic dysfunction seems to be an important marker of outcome as abnormal diastolic properties are related to progressive LV dilatation, development of heart failure

Poulsen, S H

2001-11-01

201

Obstructed bi-leaflet prosthetic mitral valve imaging with real-time three-dimensional transesophageal echocardiography.  

PubMed

Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85-year-old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D-TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D-TEE were compatible with those measured by fluoroscopy. Moreover, RT3D-TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D-TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:64-67, 2015. PMID:24796869

Shimbo, Mai; Watanabe, Hiroyuki; Kimura, Shunsuke; Terada, Mai; Iino, Takako; Iino, Kenji; Ito, Hiroshi

2015-01-01

202

Automated Classification of Disease Patterns from Echo-cardiography Images Based on Shape Features of the Left Ventricle  

SciTech Connect

Computer assisted diagnosis using analysis of medical images is an area of active research in health informatics. This paper proposes a technique for indication of heart diseases by using information related to shapes of the left ventricle (LV). LV boundaries are tracked from echo-cardiography images taken from LV short axis view, corresponding to two disease conditions viz. dilated cardiomyopathy and hypertrophic cardiomyopathy, and discriminated from the normal condition. The LV shapes are modeled using shape histograms generated by plotting the frequency of normalized radii lengths drawn from the centroid to the periphery, against a specific number of bins. A 3-layer neural network activated by a log-sigmoid function is used to classify the shape histograms into one of the three classes. Experimentations on a dataset of 240 images show recognition accuracies of the order of 80%.

Das, Shaoli; Parekh, Ranjan [School of Education Technology, Jadavpur University, Kolkata 700032 (India)

2010-10-26

203

Noninvasive mapping of left ventricular electromechanical asynchrony by three-dimensional echocardiography and semi-automatic contour detection.  

PubMed

A system for analyzing left ventricular (LV) electromechanical asynchrony based on transesophageal 3-dimensional echocardiography (3-DE) and semi-automatic endocardial contour detection is described. Eighteen consecutive patients underwent 3-DE. Using TomTec 4DLV software, a 3-dimensional endocardial surface was reconstructed throughout the cardiac cycle. Matlab software generated color-coded polar maps, displaying regional LV displacement and its timing. At the segmental level, Bland-Altmann assessment showed intraobserver variability of LV displacement of 0.1 +/- 3.0 mm and timing of -5.6 +/- 160 ms (bias +/- 2 SD) for all segments and -1.6 +/- 94 ms for the nonapical segments. The combination of 3-DE and semi-automatic contour detection is feasible and provides unique information for assessing regional LV endocardial displacement and electromechanical asynchrony. PMID:15566925

van der Heide, Johannes A; Mannaerts, Herman F; Spruijt, Hugo J; van Campen, Linda M; de Cock, Carel; Visser, Cees A; Kamp, Otto

2004-12-01

204

Persistent left superior vena cava: diagnosed by bedside echocardiography in a liver transplant patient: a case report  

PubMed Central

In most cases, persistent left superior vena cava (PLSVC) is asymptomatic and discovered accidentally. This case involves a 43-year-old male who underwent an emergency cadaveric liver transplantation. Postoperatively, the left internal jugular vein was cannulated using a sono-guided Seldinger technique in the intensive care unit. But the chest X-ray showed that the catheter followed the left paramediastinal course instead of crossing midline to the right to enter the superior vena cava. In consideration of the patient's status, an intra-arterial or extra-vascular placement could be excluded. For a diagnosis, we performed a bed-side transthoracic echocardiography with an agitated saline micro-bubble test. When agitated saline was injected through the catheter, the coronary sinus was initially opacified, and then the right atrium followed. In conclusion, we were able to make a diagnosis of PLSVC by a bedside test without radiation exposure.

Kim, Hyerim; Kim, Jin Hee

2014-01-01

205

Automated Classification of Disease Patterns from Echo-cardiography Images Based on Shape Features of the Left Ventricle  

NASA Astrophysics Data System (ADS)

Computer assisted diagnosis using analysis of medical images is an area of active research in health informatics. This paper proposes a technique for indication of heart diseases by using information related to shapes of the left ventricle (LV). LV boundaries are tracked from echo-cardiography images taken from LV short axis view, corresponding to two disease conditions viz. dilated cardiomyopathy and hypertrophic cardiomyopathy, and discriminated from the normal condition. The LV shapes are modeled using shape histograms generated by plotting the frequency of normalized radii lengths drawn from the centroid to the periphery, against a specific number of bins. A 3-layer neural network activated by a log-sigmoid function is used to classify the shape histograms into one of the three classes. Experimentations on a dataset of 240 images show recognition accuracies of the order of 80%.

Das, Shaoli; Parekh, Ranjan

2010-10-01

206

Screening for Abdominal Aortic Aneurysm during Transthoracic Echocardiography in Patients with Significant Coronary Artery Disease  

PubMed Central

Purpose Coronary artery disease (CAD) shares several risk factors with abdominal aortic aneurysm (AAA). We evaluated the prevalence during transthoracic echocardiography (TTE) and risk factors of AAA in patients with CAD. Materials and Methods A total of 1300 CAD patients were screened from August 2009 to May 2010, and measurement of abdominal aorta size was feasible in 920 patients (71%) at the end of routine TTE. An AAA was defined as having a maximal diameter of ?30 mm. Results Of the 920 patients, 22 (2.4% of the study population) were diagnosed with AAA; of these AAA patients, 86% were male, and 82% were over 65 years-old. Abdominal aortic size was weakly correlated with aortic root diameter (r=0.22, p<0.01). Although the proportions of male gender, hypertension, and dyslipidemia were higher in AAA patients, such differences were not statistically significant. Advanced age [odds ratio (OR)=1.07; 95% confidence interval (CI): 1.01-1.12; p<0.01], smoking (OR=3.44; 95% CI: 1.18-10.04; p=0.02), and peripheral arterial disease (OR=5.88; 95% CI: 1.38-25.05; p=0.01) were found to be associated with AAA. Conclusion Although prevalence of AAA is very low in the Asian population, the prevalence of AAA in Asian CAD patients is higher than the general population. Therefore, opportunistic examination of the abdominal aorta during routine TTE could be effective, especially for male CAD patients over 65 years with a history of smoking or peripheral arterial disease. PMID:25510745

Lee, Sung Ho; Chang, Sung-A; Jang, Shin Yi; Lee, Sang-Chol; Song, Young Bin; Park, Seung Woo; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol; Oh, Jae K.

2015-01-01

207

Dobutamine stress echocardiography for assessing the role of dynamic intraventricular obstruction in left ventricular ballooning syndrome  

PubMed Central

Background Dynamic intraventricular obstruction has been observed in patients with left ventricular ballooning syndrome (LVBS) and has been hypothesized as a possible mechanism of the syndrome. The aim of this study was to assess the prevalence and significance of dynamic intraventricular obstruction in patients with LVBS. Methods and Results Dobutamine stress echocardiography was carried out in 22 patients with LVBS (82% apical), all women, aged 68 ± 9 years. At baseline 1 patient had a > 30 mmHg LV gradient; during stress a LV gradient > 30 mm Hg developed in 6/21 patients (28%) and was caused by systolic anterior motion of the mitral valve in the 3 patients with severe gradient (mean 116 ± 29 mmHg), who developed mitral regurgitation and impaired apical wall motion and by obstruction at mid-ventricular level in the other 3 with a moderate gradient (mean 46 ± 16 mmHg). Compared with patients without obstruction those with obstruction had a greater mean septal thickness (11.6 ± .6 vs 9.8. ± 3, p < .01), a higher prevalence of septal hypertrophy (71% vs 7%, p < .005) and a higher peak wall motion score index (1.62 ± .4 vs 1.08 ± .4, p < .01). Conclusion Spontaneous or dobutamine-induced dynamic LV obstruction is documented in 32% of patients with LVBS, is correlated with the presence of septal hypertrophy and may play a role in the development of LVBS in this subset of patients. In those without septal hypertrophy a dynamic obstruction is rarely induced with dobutamine and is unlikely to be a major pathogenetic factor of the syndrome. PMID:20380731

2010-01-01

208

Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography  

PubMed Central

Objective: To assess the prevalence, mechanisms, and significance of paraprosthetic regurgitation detected incidentally by transoesophageal echocardiography (TOE) in patients after heart valve replacement. Design: Prospective observational study. Setting: Tertiary referral centre. Patients: 360 consecutive patients (mean (SD) age 65.8(9.5) years, 193 women) undergoing elective first ever valve replacement. Methods: Postoperative and follow up TOE, and tests for haemolysis and anaemia. Results: There were 243 aortic, 90 mitral, and 27 double valve replacements, using 316 mechanical and 44 tissue valves, giving 270 aortic and 117 mitral valves. One patient with severe paraprosthetic mitral regurgitation underwent immediate reoperation and was excluded from subsequent analyses. Paraprosthetic jets were detected around 16 (6%) of the aortic and 38 (32%) of the mitral valves (p < 0.05) at the postoperative study. Follow up TOE was available for 151 aortic and 67 mitral valves, 0.9 (0.5) years after operation. Paraprosthetic jets were present in 15 (10%) of the aortic and 10 (15%) of the mitral valves (NS). Two thirds of the aortic and a fifth of the mitral jets were new. Paraprosthetic jets were more common in aortic valves in a supra-annular (12 of 88, 14%) than in an intra-annular position (4 or 182, 2%; p < 0.005) and in mitral valves inserted with continuous (36 of 88, 41%) rather than interrupted sutures (2 of 28, 7%; p < 0.001). Lactate dehydrogenase concentration was higher in patients with paraprosthetic jets than in those without (752 (236) v 654 (208) IU/l, p < 0.001). Haemoglobin and haptoglobin concentrations were not different. Conclusions: Small paraprosthetic leaks are common, are related to surgical factors, are not associated with increased subclinical haemolysis, and are benign during the first year after heart valve replacement. PMID:14594888

Ionescu, A; Fraser, A G; Butchart, E G

2003-01-01

209

Early transoesophageal echocardiography in cryptogenic and lacunar stroke and transient ischaemic attack  

PubMed Central

OBJECTIVES—To test the hypothesis that transoesophageal echocardiography (TOE) carried out within three days of a first stroke or transient ischaemic attack of cryptogenic or lacunar type may disclose more thrombi or spontaneous echo contrast (SEC) than previously reported. This finding may help early treatment decisions.?METHODS—Patients aged between 40 and 80 years, admitted for transient ischaemic attack or ischaemic stroke during a 40 month period, were prospectively considered. TOE was carried out within 72 hours of symptom onset with a 5 MHz biplanar transducer. Subjects with recurring events, very severe strokes, large artery obstructions, or obvious cardiac sources of embolism were excluded.?RESULTS—Sixty five patients were studied, 43 with a cryptogenic stroke or transient ischaemic attack (66.2%), and 22 with a lacunar stroke (33.8%). The mean (SD) interval between symptom onset and TOE was 43.4 (17.2) hours for cryptogenic, and 48.5 (19.5) hours for lacunar patients. Atrial thrombi were found in one patient with a cryptogenic stroke (2.32% of cryptogenic events; 95% confidence interval 0.06-12.29), whereas SEC was found in five patients (7.7% overall), two with a lacunar and three with a cryptogenic stroke.?CONCLUSIONS—An early TOE does not seem to increase substantially the detection of atrial thrombi or SEC in patients with a first stroke or transient ischaemic attack of cryptogenic or lacunar nature. Therefore, this examination can be carried out when the patients' conditions are stable, and without overloading the cardiovascular laboratory daily schedule.?? PMID:9598678

Censori, B.; Colombo, F.; Valsecchi, M. G.; Clivati, L.; Zonca, A.; Camerlingo, M.; Casto, L.; De Tommasi, M. S.; Mamoli, A.

1998-01-01

210

[Doppler echocardiography in assessing mechanical and biological heart valve prostheses].  

PubMed

The study was performed to assess Doppler echocardiographic features of mitral and aortic prosthetic valves of different types with both normal and abnormal function. Two hundred and twenty-three patients with 250 prostheses were studied. Two hundred eight valves (111 mitral, 95 aortic and 2 tricuspid) were considered to be functioning normally after clinical examination, phonocardiography and M-mode and 2D echocardiography. This group enabled us to define normal Doppler echocardiographic findings for different types of prosthesis. In mitral position, peak (p) and mean (m) gradients were lower for disc prostheses and higher for ball and biological prosthetic valves; values of effective orifice area (A), calculated by pressure half-time method, were lower for biological and ball prostheses and higher in disc valves. Results were as follows: St. Jude (p 10.6 mmHg, m 3.9 mmHg, A 2.7 cm2), Duromedics (p 10.6, m 4.3, A 2.8), Björk-Shiley (p 10.4, m 4, A 2.3), Omniscience (p 14.2, m 6.2, A 2.1), Starr-Edwards (p 15.9, m 5.4, A 2.1), Hancock (p 14.7, m 6, A 2), Carpentier (p 13.2, m 5.4, A 1.9). Mild regurgitation, considered "physiological", was found in 2/8 Carpentier valves and in 3/34 St. Jude prostheses. In aortic valves lower peak gradients were found in Lillehei (18.3 mmHg), St. Jude (23.8 mmHg), Björk-Shiley (26 mmHg), Duromedics (27 mmHg) and higher values in Starr-Edwards (30.2 mmHg), Hancock (30 mmHg) and Omniscience (35.5 mmHg) prostheses. Mild regurgitation, considered "physiological", was found in 17% of Omniscience valves, 21% of Hancock, 33% of Duromedics, 45% of St. Jude, 60% of Björk-Shiley prostheses. Hancock mitral valves implanted for over 7 years had a mean gradient higher than valves with a shorter period of implantation (7.6 vs 4.85 mmHg, p less than 0.1), whereas the effective orifice area was similar. Hancock aortic valves implanted for over 7 years had a peak gradient slightly higher than the other group (implantation less than 7 years previously), but the difference was not statistically significant. Forty-two valves (19 aortic and 23 mitral) were considered to be malfunctioning. Regurgitation Doppler signals of malfunctioning valves appeared different from those of "physiological" reverse flow; in the former cases forward gradient was higher than normal prostheses. In stenotic aortic prostheses, peak systolic gradient was greatly increased; in stenotic mitral prostheses, a very significant increase in mean gradient and a great decrease in effective orifice area were found. In 14 patients who underwent surgical re-operation and in the patient who died before operation, Doppler echocardiographic findings were confirmed.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3410201

Minardi, G; Di Segni, M; Boccardi, L; Ferrari, O; Giovannini, E

1988-02-01

211

Accessory mitral papillary muscle causing severe aortic insufficiency.  

PubMed

Accessory mitral papillary muscle originating from the interventricular septum is a rare congenital anomaly. A 20-year-old male patient presented with a complaint of exertional dyspnea. On cardiac examination, a grade 3/4 diastolic murmur was heard over the right upper parasternal area, and the apical pulsations were easily palpable over the precordium. Transthoracic echocardiography showed severe aortic regurgitation, dilatation of the left ventricle, and an accessory papillary muscle with its chordae, extending from the interventricular septum to the anterior mitral leaflet in the left ventricular outflow tract (LVOT). There was no mitral regurgitation. Color Doppler imaging showed turbulence set up by the abnormal mitral attachment and an associated mild pressure gradient of 20 mmHg across the LVOT. At surgery for aortic valve replacement, degenerative changes in the aortic leaflets were noted. The accessory papillary muscle was spared to maintain mitral valve functions and an aortic bileaflet mechanical prosthetic valve was implanted. During eight months of follow-up, he was well without any signs of left ventricular systolic dysfunction and mitral regurgitation, with a functioning prosthetic valve. PMID:21248456

Ucak, Alper; Onan, Burak; Alp, Ibrahim; Y?lmaz, Ahmet Turan

2010-12-01

212

The Ozone Show.  

ERIC Educational Resources Information Center

Uses a talk show activity for a final assessment tool for students to debate about the ozone hole. Students are assessed on five areas: (1) cooperative learning; (2) the written component; (3) content; (4) self-evaluation; and (5) peer evaluation. (SAH)

Mathieu, Aaron

2000-01-01

213

Demonstration Road Show  

NSDL National Science Digital Library

The Idaho State University Department of Physics conducts science demonstration shows at S. E. Idaho schools. Four different presentations are currently available; "Forces and Motion", "States of Matter", "Electricity and Magnetism", and "Sound and Waves". Information provided includes descriptions of the material and links to other resources.

2009-04-06

214

Do Elephants Show Empathy?  

Microsoft Academic Search

Elephants show a rich social organization and display a number of unusual traits. In this paper, we analyse reports collected over a thirty-five year period, describing behaviour that has the potential to reveal signs of empathic understanding. These include coalition formation, the offering of protection and comfort to others, retrieving and 'babysitting' calves, aiding individuals that would otherwise have difficulty

Lucy A. Bates; Phyllis C. Lee; Norah Njiraini; Joyce H. Poole; Katito Sayialel; Soila Sayialel; Cynthia J. Moss; Richard W. Byrne

2008-01-01

215

ISU Demonstration Road Show  

NSDL National Science Digital Library

The Idaho State University Department of Physics conducts science demonstration shows at SE Idaho schools. Four different presentations are currently available; "Forces and Motion", "States of Matter", "Electricity and Magnetism", and "Sound and Waves". Student activities and descriptions of the demonstrated material are also provided.

Shropshire, Steven

2004-04-06

216

Stage a Water Show  

ERIC Educational Resources Information Center

In the author's book titled "The Incredible Water Show," the characters from "Miss Alaineus: A Vocabulary Disaster" used an ocean of information to stage an inventive performance about the water cycle. In this article, the author relates how she turned the story into hands-on science teaching for real-life fifth-grade students. The author also…

Frasier, Debra

2008-01-01

217

[The value and limitation of two-dimensional transesophageal echocardiography in diagnosis of dissecting aortic aneurysm].  

PubMed

The diagnostic value of two-dimensional transesophageal echocardiography (TEE) was evaluated in 29 patients with dissecting aortic aneurysm (DeBakey type I; 4, type II; 1, type IIIa; 6, type IIIb; 18) who were studied consecutively from May 1987 to August 1988. An intimal flap was demonstrated in all 29 cases. DeBakey type classification could be recognized in 26 of 29 patients (89.7%). The entry of aortic dissection could be identified in 26 of 29 patients (89.7%). The differentiation between true and false lumen could be performed in all 29 cases. The introduction of color Doppler and pulsed Doppler echocardiography has opened up an additional possibility, in particular an analysis of flow pattern of the lumen was valuable in differentiation between true and false lumen. TEE was also valuable in evaluation of operative procedure by means of intraoperative-TEE. The capability to visualize the lesion of descending aorta was superior to any other conventional diagnostic method such as CT, MRI, AOG. However, there were difficulties in scanning the distal part of the ascending aorta and aortic arch, and in identifying the reentry of arotic dissection except for DeBakey type IIIa dissection. Since transthoracic echocardiography was valuable in diagnosis of cardiac tamponade, aortic regurgitation, and DeBakey type I dissection, the diagnostic method of a combination of transthoracic and transesophageal echocardiography seems to be more valuable.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2625562

Sasaki, S; Matsui, Y; Gouda, T; Sakuma, M; Yasuda, K; Sakai, K; Tanabe, T

1989-12-01

218

Safety of Dobutamine-Atropine Stress Echocardiography: A Prospective Experience of 4033 Consecutive Studies  

Microsoft Academic Search

Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless

Wilson Mathias; Adelaide Arruda; Fábio C. Santos; Ana L. Arruda; Eloisa Mattos; Altamiro Osório; Orlando Campos; Manoel Gil; José L. Andrade; Antonio C. Carvalho

1999-01-01

219

Coronary Segmentation from Echocardiography using Fuzzy Connectedness A.F.L. Souza1  

E-print Network

echocardiography images and results are discussed. Using Watershed 2D by IFT and Generalized Fuzzy Connectedness 2D). This approach transforms the image into an oriented and weighted graph; therewith a graph-based algorithm can algorithm. So far, we have tested two filters: linear scaling mean variance (LSMV) and another one with edge

Lewiner, Thomas (Thomas Lewiner)

220

Reduced neuropsychological dysfunction using epiaortic echocardiography and the exclusive Y graft  

Microsoft Academic Search

Background. To examine the effect of screening the aorta for atheroma before aortic manipulation and use of exclusive Y graft revascularization on the incidence of neuropsychological dysfunction after coronary artery bypass.Methods. Aortic atheroma was detected using epiaortic and transesophageal echocardiography. Atheroma avoidance was facilitated by use of the exclusive Y graft technique, which has no aortic coronary anastomoses. In the

Alistair G Royse; Colin F Royse; Andrew E Ajani; Emma Symes; Paul Maruff; Steven Karagiannis; Richard P Gerraty; Leeanne E Grigg; Stephen M Davis

2000-01-01

221

APPLICATION OF TEXTURE ANALYSIS IN ECHOCARDIOGRAPHY IMAGES FOR MYOCARDIAL INFARCTION TISSUE  

Microsoft Academic Search

Texture analysis is an important characteristic for surface and object identification from medical images and many other types of images. This research has developed an algorithm for texture analysis using medical images do trained from echocardiography in identifying heart with suspected myocardial infarction problem. A set of combination of wavelet extension transform with gray level co-occurrence matrix is proposed. In

N. AGANI; S. A. R. ABU-BAKAR; S. H. SHEIKH SALLEH

2007-01-01

222

Effects of MPEG compression on the quality and diagnostic accuracy of digital echocardiography studies  

Microsoft Academic Search

The advantages of digital echocardiography studies include ease of retrieval, review, comparison, duplication, and quantitation as well as the potential for moving studies over networks. However, the large amounts of data associated with digital echocardigraphy studies have posed new problems. Reduction of the amount of data can be accomplished with image compression, in particular MPEG-1 (Moving Pictures Expert Group), which

Kirk Spencer; Lawrence Solomon; Victor Mor-Avi; Kathie Dean; Lynn Weinert; Martha Gulati; Aravind Herle; Alan Spiegel; Beth Balasia; Thomas Pionke; Larry Sieb; Roberto M. Lang

2000-01-01

223

Reduced Neuropsychological Dysfunction Using Epiaortic Echocardiography and the Exclusive Y Graft  

Microsoft Academic Search

Background. To examine the effect of screening the aorta for atheroma before aortic manipulation and use of exclusive Y graft revascularization on the incidence of neuropsychological dysfunction after coronary artery bypass. Methods. Aortic atheroma was detected using epiaortic and transesophageal echocardiography. Atheroma avoid- ance was facilitated by use of the exclusive Y graft technique, which has no aortic coronary anastomoses.

Alistair G. Royse; Colin F. Royse; Andrew E. Ajani; Emma Symes; Paul Maruff; Steven Karagiannis; Richard P. Gerraty; Leeanne E. Grigg; Stephen M. Davis

2010-01-01

224

[Importance of echocardiography as a screening study method for patients with ischemic insult].  

PubMed

From 113 patients with ischemic stroke in 14.3% a direct and in 30.1% an indirect connection between cardiac diseases and ischemic stroke could be considered. The one and two dimensional echocardiography is a useful noninvasive method to identify possible cardiac causes of the ischemic stroke. PMID:6516424

Zenker, G; Boné, G; Kandlhofer, B; Forche, G; Harnoncourt, K

1984-11-15

225

The feasibility of dobutamine stress echocardiography in the emergency department with telemedicine interpretation  

Microsoft Academic Search

Dobutamine stress echocardiography (DSE) was performed on 26 patients admitted for chest pain deemed at low risk for mycoardial infarction. Pharmacologic stress in the emergency department on a 24-hour basis was administered by nurses and echocardiographic ultrasonographers with electrocardiograms and echocardiograms being interpreted through telemedicine relay by an off-site cardiologist. Target heart rate was achieved in 84% of patients with

James A. Trippi; Greg Kopp; Kamthorn S. Lee; Howard Morrison; Gregory Risk; James H. Jones; William H. Cordell; Margaretha Chrapla; David Nelson

1996-01-01

226

Show-Me Magazine  

NSDL National Science Digital Library

Come along as the folks at the University of Missouri show you the history of their college days through the Show Me magazine. It's a wonderful collection of college humor published from 1946 to 1963. First-time visitors would do well to read about the magazine's colorful past, courtesy of Jerry Smith. A good place to start is the November 1920 issue (easily found when you browse by date), which contains a number of parody advertisements along with some doggerels poking good natured fun at the football team and an assortment of deans. Also, it's worth noting that visitors can scroll through issues and save them to an online "bookbag" for later use.

2008-01-01

227

Mars Slide Show  

NASA Technical Reports Server (NTRS)

15 September 2006 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a landslide that occurred off of a steep slope in Tithonium Chasma, part of the vast Valles Marineris trough system.

Location near: 4.8oS, 84.6oW Image width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Autumn

2006-01-01

228

Optimal method for early detection of cardiac disorders in thalassemia major patients: magnetic resonance imaging or echocardiography?  

PubMed Central

Background Heart failure resulting from myocardial iron deposition is the most important cause of death in ?-thalassemia major (TM) patients. Cardiac T2*magnetic resonance imaging (MRI), echocardiography, and serum ferritin level serve as diagnostic methods for detecting myocardial iron overload. In this study, we aimed to evaluate the relationship between the above-mentioned methods. Methods T2*MRI and echocardiographic measurement of left ventricular (LV) systolic and diastolic function were performed in 63 patients. Serum ferritin level was measured. The relationships between all assessments were evaluated. Results There were 40 women and 23 men with a mean age of 23.7±5.1 years (range, 15-35 years). There was no statistically significant correlation between serum ferritin level and LV systolic and diastolic function (P=0.994 and P=0.475, respectively). T2*MRI results had a significant correlation with ferritin level; 63.6% of patients with serum ferritin level >2,000 ng/mL had abnormal cardiac MRI, while none of the patients with ferritin level <1,000 ng/mL had abnormal cardiac MRI (P=0.001). There was no significant correlation between MRI findings and LV systolic function (P=1.00). However, we detected a significant difference between LV diastolic function and cardiac siderosis (P=0.03) Conclusion MRI findings are a good predictor of future cardiac dysfunction, even in asymptomatic TM patients; however, diastolic dysfunction may happen prior to cardiac siderosis in some patients, and echocardiography is able to diagnose this diastolic dysfunction while T2*MRI shows normal findings. PMID:25325038

Moussavi, Farideh; Roodpeyma, Shahla; Alavi, Samin; Shakiba, Majid; Gheiratmand, Riaz; Omidghaemi, Maryam

2014-01-01

229

Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism  

PubMed Central

Introduction: Pulmonary embolism (PE) is a life-threatening illness with high morbidity and mortality. Echocardiography (ECG) plays an important role in the early identification of right ventricular (RV) dysfunction, making it a helpful tool in identifying hemodynamically stable patients affected by PE with a higher mortality risk. The purpose of this study was to evaluate if one or more ECG indexes could predict a short-term evolution towards RV dysfunction. Methods: We selected all patients consecutively admitted to the Careggi Hospital Emergency Department with the clinical suspicion of PE, confirmed by computed tomography angiography prior to enrollment. Subsequently, properly trained emergency physicians acquired a complete ECG to measure RV morphological and functional indices. For each patient, we recorded if he or she received a fibrinolytic treatment, a surgical embolectomy or heparin therapy during the emergency department (ED) stay. Then, every patient was re-evaluated with ECG, by the same physician, after 1 week in our intensive observation unit and 1 month as outpatient in our ED regional referral center for PE. Results: From 2002 to 2007, 120 consecutive patients affected by PE were evaluated by echocardiography at the Careggi Hospital ED. Nine patients (8%) were treated with thrombolytic therapy. Six died within 1 week and 4 abandoned the study, while the remaining 110 survived and were re-evaluated by ECG after 1 week and 1 month. The majority of the echocardiographic RV indexes improve mostly in the first 7 days: Acceleration Time (AT) from 78±14 ms to 117±14 ms (p<0.001), Diameter of Inferior Vena Cava (DIVC) from 25±6 mm to 19±5 mm (p<0.001), Tricuspid Annular Plane Systolic Excursion (TAPSE) from 16±6 mm to 20±6 mm (p<0.001). Pulmonary Artery Systolic Pressure (PASP) showed a remarkable decrease from 59±26 mmHg to 37±9 mmHg, (p<0.001). The measurements of the transverse diameters of both ventricles and the respective ratio showed a progressive normalization with a reduction of RV diameter, an increase of Left Ventricular (LV) diameter and a decrease of RV/LV ratio over time. To evaluate the RV function, the study population was divided into 3 groups based on the TAPSE and PASP mean values at the admission: Group 1 (68 patients) (TAPSE+/ PASP?), Group 2 (12 patients) (TAPSE?/PASP?), and Group 3 (30 patients) (TAPSE?/PASP+). Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE in the Group 2. Instead, in Group 3 the only parameter associated with short-term improvement of TAPSE and PASP was the treatment with thrombolytic therapy (p<0.0001). Conclusion: Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE?/PASP? values. Patients with evidence of RV dysfunction (TAPSE?/PASP+), may benefit from thrombolytic therapy to improve a short- term RV function. After 1 month, also a decreased DIVC predicted improved RV function. PMID:24106551

Zanobetti, Maurizio; Converti, Cristiano; Conti, Alberto; Viviani, Gabriele; Guerrini, Elisa; Boni, Vanessa; Vicidomini, Sonia; Poggioni, Claudio; Guzzo, Aurelia; Coppa, Alessandro; Bigiarini, Sofia; Innocenti, Francesca; Pini, Riccardo

2013-01-01

230

Pathophysiological findings in a model of persistent atrial fibrillation and severe congestive heart failure  

Microsoft Academic Search

Objective: Develop and evaluate a model of persistent atrial fibrillation (AF) and severe congestive heart failure (CHF). Methods: A single-chamber atrial pacemaker was implanted in pigs (20-30 kg). Burst atrial pacing at 42 Hz led to development of persistent AF. Immediately and 20 days after activation of the burst pacing protocol, animals underwent echocardiography. Heart rate, rhythm and general condition

Alexander Bauer; Amy D. McDonald; J. Kevin Donahue

231

Left Ventricular Hypertrophy in Severe Obesity Interactions Among Blood Pressure, Nocturnal Hypoxemia, and Body Mass  

Microsoft Academic Search

Obese subjects have a high prevalence of left ventricular (LV) hypertrophy. It is unclear to what extent LV hypertrophy results directly from obesity or from associated conditions, such as hypertension, impaired glucose homeostasis, or obstructive sleep apnea. We tested the hypothesis that LV hypertrophy in severe obesity is associated with additive effects from each of the major comorbidities. Echocardiography and

Erick Avelar; Tom V. Cloward; James M. Walker; Robert J. Farney; Michael Strong; Robert C. Pendleton; Nathan Segerson; Ted D. Adams; Richard E. Gress; Steven C. Hunt; Sheldon E. Litwin

2010-01-01

232

Intraoperative Echocardiography in Valvular Heart Disease: An Evidence-Based Appraisal  

PubMed Central

Intraoperative (IO) transesophageal echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. We found no randomized trials or studies with control groups assessing the impact of IOTEE in VHD surgery. Pooled analysis of 8 observational studies including 15,540 patients showed an average incidence of 11% for prebypass surgical changes and 4% for second pump runs, suggesting that patients undergoing VHD surgery may benefit significantly from IOTEE, particularly from postcardiopulmonary bypass IOTEE in aortic repair and mitral repair and replacement, but less so in isolated aortic replacement. Further available indirect evidence was satisfactory in the test accuracy and surgical quality control aspects, with low complication rates for IOTEE. The data supporting EAU included 12,687 patients in 2 prospective randomized studies and 4 nonrandomized, controlled studies, producing inconsistent outcome-related results. Despite low-quality scientific evidence supporting IOTEE in VHD surgery, we conclude that indirect evidence supporting its use is satisfactory and suggests that IOTEE may offer considerable benefit in valvular repairs and mitral replacements. The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications. PMID:20592170

Michelena, Hector I.; Abel, Martin D.; Suri, Rakesh M.; Freeman, William K.; Click, Roger L.; Sundt, Thoralf M.; Schaff, Hartzell V.; Enriquez-Sarano, Maurice

2010-01-01

233

Two-dimensional intraventricular flow mapping by digital processing conventional color-Doppler echocardiography images.  

PubMed

Doppler echocardiography remains the most extended clinical modality for the evaluation of left ventricular (LV) function. Current Doppler ultrasound methods, however, are limited to the representation of a single flow velocity component. We thus developed a novel technique to construct 2D time-resolved (2D+t) LV velocity fields from conventional transthoracic clinical acquisitions. Combining color-Doppler velocities with LV wall positions, the cross-beam blood velocities were calculated using the continuity equation under a planar flow assumption. To validate the algorithm, 2D Doppler flow mapping and laser particle image velocimetry (PIV) measurements were carried out in an atrio-ventricular duplicator. Phase-contrast magnetic resonance (MR) acquisitions were used to measure in vivo the error due to the 2D flow assumption and to potential scan-plane misalignment. Finally, the applicability of the Doppler technique was tested in the clinical setting. In vitro experiments demonstrated that the new method yields an accurate quantitative description of the main vortex that forms during the cardiac cycle (mean error for vortex radius, position and circulation). MR image analysis evidenced that the error due to the planar flow assumption is close to 15% and does not preclude the characterization of major vortex properties neither in the normal nor in the dilated LV. These results are yet to be confirmed by a head-to-head clinical validation study. Clinical Doppler studies showed that the method is readily applicable and that a single large anterograde vortex develops in the healthy ventricle while supplementary retrograde swirling structures may appear in the diseased heart. The proposed echocardiographic method based on the continuity equation is fast, clinically-compliant and does not require complex training. This technique will potentially enable investigators to study of additional quantitative aspects of intraventricular flow dynamics in the clinical setting by high-throughput processing conventional color-Doppler images. PMID:20562044

Garcia, Damien; Del Alamo, Juan C; Tanne, David; Yotti, Raquel; Cortina, Cristina; Bertrand, Eric; Antoranz, José Carlos; Perez-David, Esther; Rieu, Régis; Fernandez-Aviles, Francisco; Bermejo, Javier

2010-10-01

234

Detection of quiescent cardiac phases in echocardiography data using nonlinear filtering and boundary detection techniques.  

PubMed

We describe an algorithm to detect cardiac quiescence within a heartbeat using nonlinear filtering and boundary detection techniques in echocardiography images. The motivation for detection of these quiescent phases is to provide improved cardiac gating to obtain motion-artifact-free images of the heart at cardiac computed tomography (CT). Currently, cardiac gating is provided through electrocardiography (ECG), which does not provide information about the instantaneous mechanical state of the heart. Our goal is to test if information about the actual mechanical motion of the heart obtained from B-mode echocardiographic data could potentially be used for gating purposes. The nonlinear filtering algorithm presented involves anisotropic diffusion to smoothen the homogeneous regions of the B-mode images while preserving image edges that represent myocardial boundaries. Following this, we detect the boundary of a particular region of interest (ROI) using a thresholding step. The positional changes of this ROI are then observed for quiescent phases over multiple cardiac cycles using the ECG's R-R interval. In a pilot study, seven subjects were imaged in the apical, four-chamber view, and quiescence of the interventricular septum was primarily observed in the diastolic region of the ECG signal. However, the position and length of quiescence vary across multiple heartbeats for the same individual and for different individuals as well. The center of quiescence for the seven patients ranged from 51 to 84 % and did not show a trend with heart rates, which ranged from 54 to 83 beats per minute. The gating intervals based on such analysis of echocardiographic signals could potentially optimize cardiac CT gating. PMID:24859726

Ravichandran, Lakshminarayan; Wick, Carson A; McClellan, James H; Liu, Tian; Tridandapani, Srini

2014-10-01

235

Assesment of Myocardial Ischemia by Combination of Tissue Synchronisation Imaging and Dobutamine Stress Echocardiography  

PubMed Central

Background and Objectives Dobutamine stress echocardiography (DSE) is an important non-invasive imaging method for evaluating ischemia. However, wall motion interpretation can be impaired by the experience level of the interpreter and the subjectivity of the visual assessment. In our study we aimed to combine DSE and tissue syncronisation imaging to increase sensitivity for detecting ischemia. Subjects and Methods 50 patients with indications for DSE were included in the study. In 25 patients we found DSE positive for ischemia and in the other 25 patients we found it to be negative. The negative group was accepted as the control group. There was no significant difference in terms of risk factors and echocardiographic parameters between the two groups, except for wall motion scores. In both groups, left ventricular dyssychrony was accepted as the difference between time to peak systolic velocity (Ts) in the reciprocal four couple of non-apical segments at rest and during peak stress. Timings were corrected for heart rate. We compared the differences of the dyssynchronisation value at rest and during peak stress to determine the distinctions within the groups and between the groups of DSE positive and negative patients. Results We found that stress and ischemia did not create any significant difference over the left intraventricular dyssynchrony with DSE, although at the segmenter level it prolonged the time to peak systolic velocity (p<0.05). These alterations did not show any significant difference between positive and negative DSE groups. Conclusion As a result, this segmenter dyssynchrony and the time to peak systolic velocity, which is corrected for heart rate, did not enhance any new value over DSE for detecting ischemia. PMID:23882287

Aksakal, Enbiya; Gurlertop, Yekta; Simsek, Ziya; Gundogdu, Fuat; Sevimli, Serdar; Bakirci, Eftal Murat; Karakelleoglu, Sule

2013-01-01

236

Severe Storms  

NSDL National Science Digital Library

Part of the University of Illinois Weather World 2010 project, this guide uses multimedia technology and the dynamic capabilities of the web to incorporate text, colorful diagrams, animations, computer simulations, audio, and video to introduce topics and concepts in the atmospheric sciences. This module is a combination of two elements. The first is the National Oceanic and Atmospheric Administration (NOAA) Severe Storms Spotters Guide. The second is a section discussing the efforts and results of modeling severe storms. The Spotters Guide contains supplemental instructional resources and a program designed to familiarize meteorologists and advanced severe storm spotters with the building blocks of convective storm structure. The focus of the training series is the development of a thunderstorm spectrum and a discussion of the physical characteristics and severe weather potential of the various storm types in the spectrum.

2010-01-01

237

Contrast and harmonic imaging improves accuracy and efficiency of novice readers for dobutamine stress echocardiography  

NASA Technical Reports Server (NTRS)

BACKGROUND: Newer contrast agents as well as tissue harmonic imaging enhance left ventricular (LV) endocardial border delineation, and therefore, improve LV wall-motion analysis. Interpretation of dobutamine stress echocardiography is observer-dependent and requires experience. This study was performed to evaluate whether these new imaging modalities would improve endocardial visualization and enhance accuracy and efficiency of the inexperienced reader interpreting dobutamine stress echocardiography. METHODS AND RESULTS: Twenty-nine consecutive patients with known or suspected coronary artery disease underwent dobutamine stress echocardiography. Both fundamental (2.5 MHZ) and harmonic (1.7 and 3.5 MHZ) mode images were obtained in four standard views at rest and at peak stress during a standard dobutamine infusion stress protocol. Following the noncontrast images, Optison was administered intravenously in bolus (0.5-3.0 ml), and fundamental and harmonic images were obtained. The dobutamine echocardiography studies were reviewed by one experienced and one inexperienced echocardiographer. LV segments were graded for image quality and function. Time for interpretation also was recorded. Contrast with harmonic imaging improved the diagnostic concordance of the novice reader to the expert reader by 7.1%, 7.5%, and 12.6% (P < 0.001) as compared with harmonic imaging, fundamental imaging, and fundamental imaging with contrast, respectively. For the novice reader, reading time was reduced by 47%, 55%, and 58% (P < 0.005) as compared with the time needed for fundamental, fundamental contrast, and harmonic modes, respectively. With harmonic imaging, the image quality score was 4.6% higher (P < 0.001) than for fundamental imaging. Image quality scores were not significantly different for noncontrast and contrast images. CONCLUSION: Harmonic imaging with contrast significantly improves the accuracy and efficiency of the novice dobutamine stress echocardiography reader. The use of harmonic imaging reduces the frequency of nondiagnostic wall segments.

Vlassak, Irmien; Rubin, David N.; Odabashian, Jill A.; Garcia, Mario J.; King, Lisa M.; Lin, Steve S.; Drinko, Jeanne K.; Morehead, Annitta J.; Prior, David L.; Asher, Craig R.; Klein, Allan L.; Thomas, James D.

2002-01-01

238

Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients.  

PubMed

Diastolic dysfunction is a recognized complication in heart transplant (HTx) recipients that limits exercise capacity and is a risk factor for mortality. We investigated the ability of echocardiography to detect elevated pulmonary capillary wedge pressure (mean PCWP>15 mmHg) in HTx recipients. This retrospective study comprised HTx recipients with echocardiography and right heart catheterization within 24 hours (n = 100, 113 investigations). Echocardiographic assessment was performed using mitral inflow (E/A ratio, deceleration time [DT], isovolumic relaxation time [IVRT]), tissue Doppler (E/E' lateral) parameters, and the Doppler-estimated pulmonary artery systolic pressure (Doppler PASP). The right atrial pressure (RAP) was estimated based on size and the effect of respiration or sniffing on the inferior vena cava diameter. Cutoff values were determined from a derivation group (n = 57, receiver operator characteristic curve analysis) and evaluated in a test group (n = 56). Elevated PCWP were found in 38%. The RAP and PCWP were both normal in 58 investigations and elevated in 39 investigations (concordance rate of 86.6%). The presence of signs of increased RAP by echocardiography or with three of five parameters (E/A, DT, IVRT, E/E' lateral, and Doppler PASP) reaching the cutoff values ruled in elevated PCWP with positive likelihood ratios ranging from 15.3 to 9. With normal RAP by echocardiography or none of the other parameters reaching cutoff values elevated PCWP can be ruled out with negative likelihood ratios ranging from 0.07 to 0.19. In conclusion, elevated PCWP in HTx recipients can be assessed using echocardiography. PMID:24995376

Bech-Hanssen, Odd; Al-Habeeb, Waleed; Ahmed, Waqas; Di Salvo, Giovanni; Pergola, Valeria; Al-Admawi, Mohammed; Al-Amri, Mohammed; Al-Shahid, Maie; Al-Buraiki, Jehad; Fadel, Bahaa M

2014-07-01

239

[Quantification of mitral regurgitation by cine-MRI. Comparison with transesophageal echocardiography in 45 patients].  

PubMed

Cine-MRI demonstrates the presence of mitral regurgitation by a signal void. This study was undertaken to assess the value of this method for quantification of mitral regurgitation in a population not excluding either patients with mitral valve prostheses or those with atrial fibrillation. The subjects included had a mean age of 59 years and were referred for transoesophageal echocardiography, either for assessment of valvular heart disease (38 patients), or for detection of atrial thrombosis before external electrical cardioversion (7 patients). Eight patients had mitral valve prostheses and 19 were in atrial fibrillation. Cine-MRI was performed within 12 days of the transoesophageal echocardiography study with a 1.5 tesla magnet, using a sequence of gradient echo in 3 parallel planes in the 4 chamber view. The regurgitation was quantified by MRI from the extension of the signal void in the left atrium. The transoesophageal Doppler echocardiographic criteria were the width of the regurgitant jet at its origin, the intensity of the regurgitation signal recorded by continuous wave Doppler and the extension of the jet within the left atrium. The quantification by degrees 1 to 4 did not differ by more than 1 degree between the 2 techniques in 43 of the 45 patients. Out of 4 left atrial thrombus detected by transoesophageal echocardiography, only 1 was visible by MRI. The authors concluded that quantification of mitral regurgitation by cine-MRI provides similar results to those obtained by transoesophageal echocardiography and that the correlation remains valid in cases of atrial fibrillation. However, Doppler echocardiography provides further valuable information for the clinician. PMID:9539819

Ambrosi, P; Habib, G; Ferracci, A; Faugère, G; Luccioni, R; Bernard, P J

1997-11-01

240

NPR: The Picture Show  

NSDL National Science Digital Library

National Public Radio's "The Picture Show" photo blog is a great way to avoid culling through the thousands of less interesting and engaging photographs on the web. With a dedicated team of professionals, this blog brings together different posts that profile various sets of photographs that cover 19th century war in Afghanistan, visual memories of WWII, unpublished photographs of JFK's presidential campaign, and abandoned buildings on the islands in Boston Harbor. Visitors can search through previous posts, use social media features to share the photo features with friends, and also sign up to receive new materials via their RSS feed. There's quite a nice mix of material here, and visitors can also comment on the photos and recommend the collection to friends and others.

241

Solar Light Show  

NSDL National Science Digital Library

Over the last few days, the Earth has been buffeted by a geomagnetic storm caused by a major solar flare. In addition to disruptions in radio, telecommunications, and electric service, the flare may also produce a dramatic light show as it peaks tonight. Weather permitting, the aurora borealis, or northern lights, may be visible as far south as Washington, D.C. The best viewing time will be local midnight. The sun is currently at the peak of its eleven-year solar cycle, spawning flares and "coronal mass ejections" (CME), violent outbursts of gas from the sun's corona that can carry up to 10 billion tons of electrified gas traveling at speeds as high as 2000 km/s. Geomagnetic storms result when solar winds compress the magnetosphere, sometimes interfering with electric power transmission and satellites, but also creating beautiful aurorae, as many stargazers hope will occur tonight.

de Nie, Michael Willem.

242

Egg: the Arts Show  

NSDL National Science Digital Library

"Egg is a new TV show about people making art across America" from PBS. This accompanying Website presents excerpts from sixteen episodes of the series, with three more "hatching soon," such as Close to Home, profiling three photographers: Jeanine Pohlhaus, whose pictures document her father's struggle with mental illness; Gregory Crewdson's photos of Lee, Massachusetts; and Joseph Rodriguez's photos of Hispanics in New York City. Excerpts include video clips, gallery listings where the artists' work can be seen, and short interviews with artists. Some episodes also offer "peeps," glimpses of material not shown on TV, such as the Space episode's peep, Shooting Stars, that provides directions for astrophotography, taking photographs of star trails. Other sections of the site are airdates, for local listings; see and do usa, where vacationers can search for art events at their destinations; and egg on the arts, a discussion forum.

243

Public medical shows.  

PubMed

In the second half of the 19th century, Jean-Martin Charcot (1825-1893) became famous for the quality of his teaching and his innovative neurological discoveries, bringing many French and foreign students to Paris. A hunger for recognition, together with progressive and anticlerical ideals, led Charcot to invite writers, journalists, and politicians to his lessons, during which he presented the results of his work on hysteria. These events became public performances, for which physicians and patients were transformed into actors. Major newspapers ran accounts of these consultations, more like theatrical shows in some respects. The resultant enthusiasm prompted other physicians in Paris and throughout France to try and imitate them. We will compare the form and substance of Charcot's lessons with those given by Jules-Bernard Luys (1828-1897), Victor Dumontpallier (1826-1899), Ambroise-Auguste Liébault (1823-1904), Hippolyte Bernheim (1840-1919), Joseph Grasset (1849-1918), and Albert Pitres (1848-1928). We will also note their impact on contemporary cinema and theatre. PMID:25273491

Walusinski, Olivier

2014-01-01

244

Early Left Ventricular Dysfunction in Children after Hematopoietic Stem Cell Transplantation for Acute Leukemia: A Case Control Study Using Speckle Tracking Echocardiography  

PubMed Central

Background and Objectives Cardiovascular complications are the leading cause of morbidity and mortality in childhood cancer survivors. Hematopoietic stem cell transplantation (HSCT) is a curable therapy for pediatric cancer. However, changes in cardiac function in children after HSCT are not well known. We assessed left ventricular (LV) function in children after HSCT using speckle tracking echocardiography (STE). Subjects and Methods Forty consecutive patients with median age of 11.9 years (range, 1.5-16 years) who received HSCT for acute leukemia and had comprehensive echocardiography before and after (median 9.2 month) HSCT were included in this study. The LV function parameters including conventional tissue Doppler imaging (TDI) and STE data were collected from pre- and post-HSCT echocardiography. These data were compared to those of 39 age-matched normal controls. Results Compared to normal controls, post HSCT patients had similar (p=0.06) LV ejection fraction. However, the following three LV function parameters were significantly decreased in post HSCT patients: rate-corrected velocity of circumferential fiber shortening (p=0.04), mitral inflow E velocity (p<0.001), and mitral septal annular E' velocity (p=0.03). The following four STE parameters were also significantly decreased in post HSCT patients: LV global circumferential systolic strain (p<0.01), strain rate (SR, p=0.01), circumferential diastolic SR (p<0.01), and longitudinal diastolic SR (p<0.001). There was no significant change in TDI or STE parameters after HSCT compared to pre-HSCT. Patients with anthracycline cumulative dose >400 mg/m2 showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR. Conclusion Subclinical cardiac dysfunction is evident in children after HSCT. It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens. Serial monitoring of cardiac function is mandatory for all children following HSCT. PMID:25653704

Yoon, Ji-Hong; Kim, Hye Jin; Lee, Eun-Jung; Moon, Sena; Lee, Jae Wook; Chung, Nack Gyun; Cho, Bin; Kim, Hack Ki

2015-01-01

245

A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness  

PubMed Central

Introduction The accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients. Non-invasive evaluation of fluid responsiveness by the rapid infusion of a very limited amount of volume is an important clinical goal. This study aimed to test whether echocardiographic parameters could predict fluid responsiveness in critically ill patients following a low-volume (50-ml crystalloid solution) infusion over 10?seconds. Methods We prospectively studied 55 mechanically ventilated patients. Echocardiography was performed during a 50-ml infusion of crystalloid solution over 10?seconds and a further 450?ml over 15?minutes. Cardiac output (CO), stroke volume (SV), aortic velocity time index (VTI), and left ventricular ejection fraction (LVEF) were recorded. Patients were classified as responders (Rs) if CO increased by at least 15% following the 500-ml volume expansion or were classified as non-responders (NRs) if CO increased by less than 15%. Area under the receiver operating characteristic curves (AUC) compared CO variations after 50?ml over 10?seconds (?CO50) and 500?ml over 15?minutes (?CO500) and the variation of VTI after infusion of 50?ml of fluid over 10?seconds (?VTI50). Results In total, 50 patients were enrolled, and 27 (54%) of them were Rs. General characteristics, LVEF, heart rate, and central venous pressure were similar between Rs and NRs. In the Rs group, the AUC for ?CO50 was 0.95?±?0.03 (P <0.01; best cutoff value, 6%; sensitivity, 93%; specificity, 91%). Moreover, ?CO50 and ?CO500 were strongly correlated (r?=?0.87; P <0.01). The AUC for ?VTI50 was 0.91?±?0.04 (P <0.01; best cutoff value, 9%; sensitivity, 74%; specificity, 95%). ?VTI50 and ?CO500 were positively correlated (r?=?0.72; P <0.01). Conclusion In critically ill patients, the variation of CO and VTI after the administration of 50-ml crystalloid solution over 10?seconds (?CO50 and ?VTI50) can accurately predict fluid responsiveness. Trial registration Current Controlled Trials ISRCTN10524328. Registered 12 December 2013. PMID:24886990

2014-01-01

246

Preoperative scallop-by-scallop assessment of mitral prolapse using 2D-transthoracic echocardiography  

PubMed Central

Background This study was conducted to assess the accuracy of harmonic imaging 2D-transthoracic echocardiography (2D-TTE) segmental analysis compared to surgical findings, in degenerative mitral regurgitation (MR). Methods Seventy-seven consecutive patients with severe degenerative MR were prospectively enrolled. Preoperative 2D-TTE with precise localization of prolapsing or flailing scallops/segments was performed. All patients underwent mitral valve surgical repair. Surgical reports (SR), including valve description, were used as references for comparisons. A postoperative control 2D-TTE was performed. Results Out of 462 scallops/segments studied, surgical inspection identified 102 prolapses or flails (22%), 92 of which had previously been detected by 2D-TTE (90.2% sensitivity, 100% specificity). Agreement between preoperative 2D-TTE segmental analysis and SR was 97.8% (k = 0.93; p < 0.0001). Sixty-nine out of 77 2D-TTE reports were completely concordant with SR (89.6% diagnostic accuracy). None of the 8 non-concordant 2D-TTE reports were in complete disagreement with SR. P2 scallop was always involved in posterior leaflet prolapse or flail and was described correctly by 2D-TTE in 68 out of 69 patients (98,7% agreement, k = 0,93; 98.5% sensitivity). The anterior leaflet was involved in 14 patients (18%); A2 segment was involved in all of those cases and was correctly detected by 2D-TTE in 13 (98,7% agreement, k = 0,95; 92,8% sensitivity). Antero-lateral and postero-medial para-commissural prolapse or flail had a lower prevalence (14% and 10% respectively), with 2D-TTE sensitivity respectively of 64% and 50%. Conclusions 2D-TTE, performed by an experienced echo-lab, has very good diagnostic accuracy in localizing the scallops/segments involved in degenerative MR, particularly for the middle ones (P2-A2), which represent almost the totality of prolapses. More invasive, time consuming and expensive exams should be reserved to selected cases. PMID:20044927

2010-01-01

247

Transoesophageal echocardiography during removal of a caval filter in a patient at high risk of massive pulmonary thromboembolism.  

PubMed

A new type of vena caval filter was to be removed from a woman who had a high risk of massive pulmonary thromboembolism because of extensive thrombus in the iliac vein incorporating the filter. The removal was performed under general anaesthesia in the cardiac operating theatre using transoesophageal echocardiography to monitor the right heart and the pulmonary artery during the critical phase of removal. The manoeuvre succeeded with only insignificant embolisation occurring, and that was identified by transoesophageal echocardiography. PMID:1489033

Metzler, H; Lammer, J; Berger, J; Rigler, B; Gombotz, H

1992-12-01

248

Effect of infarcted myocardium on diagnostic accuracy of exercise echocardiography for detecting noninfarct-related coronary artery lesions  

Microsoft Academic Search

Background The utility of exercise echocardiography for evaluating remote ischemia due to noninfarct-related artery (n-IRA) lesions in patients with prior myocardial infarction has not been established.Methods Quantitative coronary angiography and treadmill exercise echocardiography were performed within 2 weeks in 115 patients with prior myocardial infarction (>6 weeks) and 224 patients without myocardial infarction. Coronary lumen diameter stenosis ?50% (by angiography)

Toshihiko Nishioka; Hideki Mitani; Akimi Uehata; Hiroyuki Hikita; Tomoo Nagai; Shuichi Katsushika; Bonpei Takase; Kazushige Isojima; Fumitaka Ohsuzu; Akira Kurita; Shingo Ohtomi; Robert J. Siegel

2003-01-01

249

The Contemporary Role of Echocardiography in Improving Patient Response to Cardiac Resynchronization Therapy  

PubMed Central

Cardiac resynchronization therapy (CRT) is an important therapy for heart failure patients with widened electrocardiographic QRS complexes and depressed ejection fractions, however, approximately one-third do not respond. This article presents a practical contemporary approach to the utility of echocardiography to improve CRT patient response by assessing mechanical dyssynchrony, optimizing left ventricular lead positioning, and performing appropriate echo-Doppler optimization, along with future potential roles. Specifically, recent long-term outcome data are presented that demonstrates that baseline dyssynchrony is a powerful marker associated with CRT response, in particular for patients with narrower QRS duration or non left bundle branch block morphology. Advances in speckle tracking echocardiography to tailor delivery of CRT by guiding LV lead position is discussed, including data from randomized clinical trials supporting targeting the LV lead toward the site of latest activation. In addition, an update on the current role of Doppler echocardiographic device optimization after CRT implantation is reviewed. PMID:24741393

Gorcsan, John; Marek, Josef J.; Onishi, Tetsuari

2014-01-01

250

Real-time three-dimensional intracardiac echocardiography: an early single-center experience.  

PubMed

As interventional procedures in structural heart diseases are coming of age, there is a significant lag in the periinterventional imaging development for these procedures to become safe, expedient, accurate, and well tolerated by this patient population. Currently, transesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D), has been used for monitoring and guidance for these procedures. Accurate identification of the pathology, its anatomy, and its relationship with the adjoining structures along with spatial resolution is of paramount importance for wire and catheter placement, device deployment, evaluation of the results, and any potential complications. Two-dimensional intracardiac echocardiography (ICE) has been used extensively for a variety of interventional procedures that undergo conscious sedation of monitored anesthesia. RT-3D ICE has recently become available; we describe our initial experience with this new imaging technology. PMID:25589706

Maini, Brijeshwar

2015-01-01

251

Clinical applications of exercise stress echocardiography in the treadmill with upright evaluation during and after exercise  

PubMed Central

Exercise stress echocardiography is the most frequently used stress test in our laboratory. Exercise echocardiography is used mainly in the study of patients with coronary artery disease. However, the technique is increasingly being used to study other diseases. In our centre, we use an original methodology, published by us in 2000, in which we evaluate heart function during exercise in the treadmill. After the exercise, patients are maintained in orthostatic position when appropriate or lying down in left lateral decubitus for further evaluation. Since this method seems to increase the quality and the quantity of information obtained in so many clinical arenas, we now present a detailed review of this methodology and its applications. PMID:23875614

2013-01-01

252

Combination of contrast with stress echocardiography: A practical guide to methods and interpretation  

PubMed Central

Contrast echocardiography has an established role for enhancement of the right heart Doppler signals, the detection of intra-cardiac shunts, and most recently for left ventricular cavity opacification (LVO). The use of intravenously administered micro-bubbles to traverse the myocardial microcirculation in order to outline myocardial viability and perfusion has been the source of research studies for a number of years. Despite the enthusiasm of investigators, myocardial contrast echocardiography (MCE) has not attained routine clinical use and LV opacification during stress has been less widely adopted than the data would support. The purpose of this review is to facilitate an understanding of the involved imaging technologies that have made this technique more feasible for clinical practice, and to guide its introduction into the practice of the non-expert user. PMID:15331015

Moir, Stuart; Marwick, Thomas H

2004-01-01

253

Novel strategies in the ablation of typical atrial flutter: role of intracardiac echocardiography.  

PubMed

Radiofrequency ablation (RFA) of the cavo-tricuspid isthmus (CTI) is one of the most frequently performed procedures in electrophysiology. Despite a high success rate, ablation of the CTI can be unusually difficult in some cases. Multiple tools like angiography, 3D mapping, remote navigation and intracardiac echocardiography (ICE) have been introduced to facilitate typical flutter ablation. This review article summarizes the clinical value of different strategies and tools used for CTI ablation focusing on the importance of approaches utilizing ICE. PMID:25308811

Bencsik, Gabor

2015-01-01

254

Incidence of bacteremia in transesophageal echocardiography: a prospective study of 140 consecutive patients.  

PubMed

The incidence of bacteremia related to transesophageal echocardiography was studied in 140 consecutive patients (71 women and 69 men with a mean age of 53.7 +/- 15 years). Thirty-four patients had one or more prosthetic heart valves. Blood cultures were obtained from each patient through separate venipuncture sites immediately before and after transesophageal echocardiography. An additional late blood culture was obtained in 114 patients 1 h later. The skin was cleaned with povidone-iodine and venipunctures were performed with separate butterfly needles with use of sterile gloves and drapes. Blood samples were drawn into separate syringes, transferred to aerobic and anaerobic culture bottles and processed with use of a semiautomated system. The overall incidence of blood cultures positive for bacteremia was 2% (8 of 394 bottles) and all positive cultures grew in a single blood culture bottle. Positive cultures occurred in 4 (1.4%) of 280 bottles before the procedure, in 2 (0.7%) of 280 bottles immediately after the procedure and in 2 (0.9%) of 228 late (1-h) blood culture bottles. Bacterial isolates were coagulase-negative staphylococci (n = 5), Propionibacterium (n = 2) and Moraxella (n = 1). All were considered contaminants. Mean endoscopic time in these patients was not significantly different from that in the other patients. Follow-up of patients with a blood culture positive for bacteremia revealed no clinical evidence of systemic infection. It is concluded that 1) the incidence of bacteremia related to transesophageal echocardiography is very low, and 2) the incidence of blood cultures positive for bacteremia after transesophageal echocardiography is indistinguishable from the anticipated contamination rate. PMID:1960310

Melendez, L J; Chan, K L; Cheung, P K; Sochowski, R A; Wong, S; Austin, T W

1991-12-01

255

Non-invasive determination of cardiac output by Doppler echocardiography and electrical bioimpedance  

Microsoft Academic Search

Cardiac output measured by thermodilution in 25 patients within 24 hours of acute myocardial infarction was compared with cardiac output measured by Doppler echocardiography (24 patients) and electrical bioimpedance (25 patients). The mean (range) cardiac outputs measured by Doppler (4.03 (2.2-6.0) 1\\/min) and electrical bioimpedance (3.79 (1.1-6.2) 1\\/min) were similar to the mean thermodilution value (3.95 (2.1-6.2) 1\\/min). Both non-invasive

D B Northridge; I N Findlay; J Wilson; E Henderson; H J Dargie

1990-01-01

256

Experience with Intracardiac Echocardiography for Guiding Transcatheter Device Closure of Atrial Septal Defects  

Microsoft Academic Search

Background and Objectives:Phased-array intracardiac echocardiography (ICE) is a novel method for monito- ring intracardiac procedures. We report our initial experience with ICE for guiding transcatheter device closure of atrial septal defects (ASD). Subjects and Methods:From April 2004 to March 2005, ICE was performed in 27 consecutive patients during percutaneous device closure of ASDs. The procedural feasibility, the procedure time, the

Sang-Chol Lee; Seung Woo Park; Seol Hwa Kim; Jin-Oh Choi

257

Comprehensive assessment of patent ductus arteriosus by echocardiography before transcatheter closure  

Microsoft Academic Search

Background: Anatomic type and angiographic measurements of patent ductus arteriosus (PDA) are used to determine the suitability of transcatheter closure (TCC). The purpose of this study is to evaluate whether these PDA features can be obtained by 2-dimensional echocardiography (2DE).Methods: We retrospectively compared PDA measurements and type from 36 patients submitted to TCC between November 1995 and October 2000.Results: The

Claudio Ramaciotti; Matthew S. Lemler; Lindy Moake; Thomas M. Zellers

2002-01-01

258

Prognostic Value of Dobutamine–Atropine Stress Echocardiography Early After Acute Myocardial Infarction  

Microsoft Academic Search

Objectives. The aim of this multicenter, multinational, prospective, observational study was to assess the relative value of myocardial viability and induced ischemia early after uncomplicated myocardial infarction.Background. Dobutamine–atropine stress echocardiography allows evaluation of rest function (at baseline), myocardial viability (at low dose) and residual ischemia (peak dose, up to 40 ?g with atropine up to 1 mg) in one test.Methods.

Rosa Sicari; Eugenio Picano; Patrizia Landi; Alessandro Pingitore; Riccardo Bigi; Claudio Coletta; Joanna Heyman; Franco Casazza; Mario Previtali; Wilson Mathias; Claudio Dodi; Giovanni Minardi; Jorge Lowenstein; Xenya Garyfallidis; Lauro Cortigiani; Maria Aurora Morales; Mauro Raciti

1997-01-01

259

Transesophageal Echocardiography of the Edge-to-Edge Technique of Mitral Valve Repair  

Microsoft Academic Search

A 66-year-old man with a history of a large an- teroapical myocardial infarction presented to the op- erating room for three-vessel coronary artery bypass grafting and left ventricular (LV) reconstructive sur- gery (Dor procedure). His baseline intraoperative transesophageal echocardiography demonstrated a di- lated LV with an end diastolic diameter 7 cm and an ejection fraction 20%. A central jet of

Stephen O. Bader; Omar M. Lattouf; Roman M. Sniecinski

2007-01-01

260

Three-Dimensional Imaging in Aortic Disease by Lighthouse Transesophageal Echocardiography Using Intravascular Ultrasound Catheters  

Microsoft Academic Search

Two-dimensional (2D) transesophageal echocardiography (TEE) and 2D intravascular ultrasound (IVUS) imaging face their greatest limitation in visualizing aortic disease in patients. With the aid of three-dimensional (3D) image reconstruction, TEE and IVUS can potentially overcome this limitation but still provide only limited spatial appreciation in aortic disease because 3D imaging of the thoracic aorta requires a broader spatial visualization of

Thomas Buck; Günter Görge; Peter Hunold; Raimund Erbel

1998-01-01

261

Open access echocardiography in management of the heart failure in the community  

Microsoft Academic Search

AbstractObjective: To assess the value of an open access echocardiography service.Design: Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction.Setting: Regional cardiology centre.Subjects: 259 consecutive patients.Main outcome measures: Presence

C. M. Francis; L. Caruana; P. Kearney; M. Love; G. R. Sutherland; I. R. Starkey; T. R. D. Shaw; J. J. V. McMurray; J. R. Hampton; A. R. Barlow

1995-01-01

262

First Experience with Three-Dimensional Speckle Tracking (3D Wall Motion Tracking) in Fetal Echocardiography.  

PubMed

Objectives: Fetal cardiac function can be quantified by different methods. This is the first approach of real three-dimensional(3?D)-based speckle tracking echocardiography in the fetus to assess different cardiac strain parameters. Methods: We present preliminary results of fetal global myocardial strain analyses. For fetal echocardiography a Toshiba Artida system was used. Based on an apical or basal four-chamber view of the fetal heart, raw data volumes with a high temporal resolution were acquired and digitally stored. Results: 8 individual healthy fetuses with an echocardiogram performed between 21 and 37 weeks of gestation were included. The mean temporal resolution was 31.2?±?4.3 volumes per second (vps). Basic parameters such as longitudinal and circumferential strain as well as advanced 3?D myocardial motion patterns such as area strain, rotation, twist and torsion were assessed. Conclusion: Currently the assessment of fetal myocardial deformation parameters by 3?D speckle tracking seems to be technically feasible only in individual cases. In the future further development of this technique is necessary to improve its application in fetal echocardiography. PMID:25140494

Enzensberger, C; Degenhardt, J; Tenzer, A; Doelle, A; Axt-Fliedner, R

2014-12-01

263

Implementation of Ultraportable Echocardiography in an Adolescent Sudden Cardiac Arrest Screening Program  

PubMed Central

BACKGROUND Over a 12-month period, adolescent heart-screening programs were performed for identifying at-risk adolescents for sudden cardiac death (SCD) in our community. Novel to our study, all adolescents received an abbreviated, ultraportable echocardiography (UPE). In this report, we describe the use of UPE in this screening program. METHODS AND RESULTS Four hundred thirty-two adolescents underwent cardiac screening with medical history questionnaire, physical examination, 12-lead electrocardiogram (ECG), and an abbreviated transthoracic echocardiographic examination. There were 11 abnormalities identified with uncertain/varying clinical risk significance. In this population, 75 adolescents had a murmur or high ECG voltage, of which only three had subsequent structural abnormalities on echocardiography that may pose risk. Conversely, UPE discovered four adolescents who had a cardiovascular structural abnormality that was not signaled by the 12-lead ECG, medical history questionnaire, and/or physical examination. CONCLUSIONS The utilization of ultraportable, handheld echocardiography is feasible in large-scale adolescent cardiovascular screening programs. UPE appears to be useful for finding additional structural abnormalities and for risk-stratifying abnormalities of uncertain potential of adolescents’ sudden death. PMID:25249762

Vanhecke, Thomas E; Weber, James E; Ebinger, Matthew; Bonzheim, Kimberly; Tilli, Frank; Rao, Sunilkumar; Osman, Abdulfatah; Silver, Marc; Fliegner, Karsten; Almany, Steve; Haines, David

2014-01-01

264

The utility of transoesophageal echocardiography for estimating right ventricular systolic pressure.  

PubMed

With the reduction in use of the pulmonary artery catheter, alternative methods of pulmonary pressure estimation are required. The use of echocardiographically-derived right ventricular systolic pressure has recently been questioned, but this technique has not been validated in anaesthetised surgical patients with transoesophageal echocardiography. One hundred measurements of right ventricular systolic pressure with transoesophageal echocardiography were compared with the pulmonary artery systolic pressure obtained simultaneously from a pulmonary artery catheter in patients undergoing cardiac surgery. Simultaneous right ventricular systolic pressure and pulmonary artery systolic pressure measurements were possible in all patients, and these measurements were strongly correlated (r = 0.98, p < 0.001), with minimal bias and narrow limits of agreement (approximately -5 to +5 mmHg), across a broad range of pulmonary pressures. Measurement of right ventricular systolic pressure using tranoesophageal echocardiography is readily achievable and closely correlates with pulmonary artery systolic pressure, with minimal bias, in cardiac surgical patients undergoing general anaesthesia and positive pressure mechanical ventilation of the lungs. PMID:25388528

Cowie, B; Kluger, R; Rex, S; Missant, C

2015-03-01

265

Quantitative assessment of left ventricular systolic function using 3-dimensional echocardiography  

PubMed Central

Assessment of left ventricular systolic function is the commonest and one of the most important indications for performance of echocardiography. It is important for prognostication, determination of treatment plan, for decisions related to expensive device therapies and for assessing response to treatment. The current methods based on two-dimensional echocardiography are not reliable, have high degree of inter-observer and intra-observer variability and are based on presumptions about the geometry of left ventricle (LV). Real-time three-dimensional echocardiography (RT3DE) on the other hand is fast, easy, accurate, relatively operator independent and is not based on any assumptions related to the shape of LV. Owing to these advantages, it is the Echocardiographic modality of choice for assessment of systolic function of the LV. We describe here a step by step approach to evaluation of LV volumes, ejection fraction, regional systolic function and Dyssynchrony analysis based on RT3DE. It has been well validated in clinical studies and is rapidly being incorporated in routine clinical practice. PMID:24206890

Mehrotra, Rahul; Alagesan, R.; Srivastava, Sameer

2013-01-01

266

Current Status of 3-Dimensional Speckle Tracking Echocardiography: A Review from Our Experiences  

PubMed Central

Cardiac function analysis is the main focus of echocardiography. Left ventricular ejection fraction (LVEF) has been the clinical standard, however, LVEF is not enough to investigate myocardial function. For the last decade, speckle tracking echocardiography (STE) has been the novel clinical tool for regional and global myocardial function analysis. However, 2-dimensional imaging methods have limitations in assessing 3-dimensional (3D) cardiac motion. In contrast, 3D echocardiography also has been widely used, in particular, to measure LV volume measurements and assess valvular diseases. Joining the technology bandwagon, 3D-STE was introduced in 2008. Experimental studies and clinical investigations revealed the reliability and feasibility of 3D-STE-derived data. In addition, 3D-STE provides a novel deformation parameter, area change ratio, which have the potential for more accurate assessment of overall and regional myocardial function. In this review, we introduced the features of the methodology, validation, and clinical application of 3D-STE based on our experiences for 7 years. PMID:25031794

Ishizu, Tomko; Aonuma, Kazutaka

2014-01-01

267

Pathological and physiological left ventricular hypertrophy: echocardiography for differentiation.  

PubMed

Distinguishing physiological left ventricular hypertrophy of an athlete's heart from that of pathological left ventricular (hypertrophic cardiomyopathy) can be difficult despite the advent of new imaging techniques. Nevertheless, the final diagnosis is of utmost importance as it will have a profound impact on an individual's life. A diagnosis of hypertrophic cardiomyopathy essentially excludes an individual from sport and strenuous exertion and necessitates the need for further tests and treatment, as well as the screening of family members. Hypertrophic cardiomyopathy remains the most common cause of a pathologically hypertrophied heart in young athletes, with a prevalence of one in 500. The issue of sudden death in athletes due to pathological left ventricular hypertrophy and hypertrophic cardiomyopathy has recently gained recognition owing to the death of several word class athletes during sporting participation. What compounds this further is the fact that a proportion of athletes fall into the 'grey zone' (ventricular wall thickness of 13-16 mm) where the increase in cardiac size overlaps with the phenotypic variation of hypertrophic cardiomyopathy - making echocardiographic differentiation of the two entities challenging. This review discusses the echocardiographic differentiation of the athlete's heart, including physiological left ventricular hypertrophy from pathological left ventricular hypertrophy. Although several of the cardiomyopathies cause pathological left ventricular hypertrophy, focus will be given to hypertrophic cardiomyopathy, for reasons mentioned above. Discussion will also focus on the newer and emerging echocardiographic techniques for this purpose. The term 'hypertrophic cardiomyopathy' is used to describe the nonobstuctive form of hypertrophic cardiomyopathy as this review article focuses on distinguishing the 'mild' form of hypertrophic cardiomyopathy from an athlete's heart. When the more severe obstructive form is being described, the term 'hypertrophic obstructive cardiomyopathy' is used. PMID:19715413

Chelliah, Rajesh K; Senior, Roxy

2009-09-01

268

Is tissue Doppler echocardiography the Holy Grail for the intensivist?  

PubMed Central

Assessment of left ventricular diastolic function in the critically ill patient remains a difficult issue in clinical practice. Combined use of routine transmitral and pulmonary venous Doppler patterns in conjunction with tissue Doppler imaging have been claimed to allow bedside diagnosis of diastolic dysfunction. Although in the previous issue of Critical Care it was clearly demonstrated there might be a difference in load dependency of the early myocardial tissue Doppler velocity between lateral and septal placed sample volume, there remain still several unanswered questions, particularly with respect to the preload dependency of these indices. PMID:17567926

Poelaert, Jan; Roosens, Carl

2007-01-01

269

Quantitative assessment of tricuspid regurgitation using pulsed Doppler echocardiography.  

PubMed Central

Tricuspid valve regurgitation was assessed quantitatively by measuring blood flow velocity in the vena cava using a pulsed Doppler velocimeter. A non-invasive index of regurgitation was obtained by calculating the ratio between the maximum amplitudes of the systolic and diastolic components of the velocity curves. The index was compared with the angiographic grading of regurgitation in 70 patients after right heart catheterisation; the results were closely correlated. Using the Doppler index the differences between the groups defined according to their angiographic grade were significant. Thus measurement of blood flow velocity in the vena cava appears to quantify accurately the severity of tricuspid regurgitation. Images PMID:6639815

Diebold, B; Touati, R; Blanchard, D; Colonna, G; Guermonprez, J L; Peronneau, P; Forman, J; Maurice, P

1983-01-01

270

Long-term prognostic significance of M mode echocardiography in young men after myocardial infarction.  

PubMed Central

OBJECTIVE--To evaluate the power of measurements of left ventricular size and function for predicting long term (82 month) mortality by performing echocardiography in 97 men who had survived an acute myocardial infarction. SETTING--University hospital specialising in cardiology. PARTICIPANTS--97 consecutive male patients who had survived a myocardial infarction. MAIN OUTCOME MEASURES--The additive prognostic value of functional measurements to that provided by primary risk factors (smoking habits and lipoprotein levels), radiological heart size, exercise capacity, and number of major coronary arteries with haemodynamically significant stenoses was evaluated. An echo index was calculated from three echocardiographic variables (yielding one score point each if: left ventricular diameter at the end of diastole (LVDD) > or = 5.7 cm, left ventricular fractional shortening < or = 24%, and E point-separation (EPSS) > or = 10 mm). MAIN OUTCOME--17 cardiac deaths occurred during follow up. RESULTS--Univariate analysis showed that treatment with loop diuretics for heart failure (P < 0.01), LVDD (P < 0.01), left ventricular diameter at the end of systole (LVDS) (P < 0.001), left atrial diameter (P < 0.001), fractional shortening (P < 0.05), and echo index (P < 0.001) were all associated with cardiac death. Angiographically determined regional wall motion disturbances (P < 0.005) and angiographic ejection fraction (P < 0.001) were also associated with cardiac death, as was the number of major coronary arteries with significant stenosis (P < 0.05). When all significant echocardiographic variables from univariate analysis were entered into Cox proportional hazards survival analysis, LVDS and left atrial diameter contributed independently to the prediction of cardiac death. If angiographic data were also entered into the model, the echo index made an independent contribution to the prediction of cardiac death. CONCLUSIONS--Among young male patients with a previous myocardial infarction, a simple M mode echocardiographic examination can identify high and low risk patients and improve the prediction of cardiac death made from clinical information, exercise test, chest x ray and angiographically determined ejection fraction. PMID:7546989

Eriksson, S. V.; Caidahl, K.; Hamsten, A.; de Faire, U.; Rehnqvist, N.; Lindvall, K.

1995-01-01

271

Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke  

PubMed Central

OBJECTIVE: To develop guidelines for the use of echocardiography in the investigation of patients with stroke. OPTIONS: (1) Routine transthoracic echocardiography (TTE); (2) routine transesophageal echocardiography (TEE); (3) routine TTE followed by TEE if the TTE findings are noncontributory; (4) selective TTE or TEE in patients with cardiac disease who would not otherwise receive anticoagulant therapy. OUTCOMES: This article reviews the available evidence on the yield of TTE and TEE in detecting cardiac sources of cerebral emboli in patients with stroke, the effectiveness of treatment for cardiac sources of emboli and the effectiveness of screening echocardiography for secondary stroke prevention. EVIDENCE: MEDLINE was searched for relevant articles published from January 1966 to April 1998; also reviewed were additional articles identified from the bibliographies and citations obtained from experts. BENEFITS, HARMS AND COSTS: Echocardiography can detect intracardiac masses (thrombus, vegetation or tumour) in about 4% (with TTE) to 11% (with TEE) of stroke patients. The yield is lower among patients without clinical evidence of cardiac disease by history, physical examination, electrocardiography or chest radiography (less than 2%) than among patients with clinical evidence of cardiac disease (less than 19%). The risks of echocardiography to patients are small. TTE has virtually no risks, and TEE is associated with cardiac, pulmonary and bleeding complications in 0.18%. Patients with an identified intracardiac thrombus are at increased risk for embolic events (absolute risk uncertain, range 0%-38%), and this appears to be reduced with anticoagulant therapy (absolute risk reduction uncertain). Anticoagulant therapy carries a risk of major hemorrhage of 1% to 3% per year. The overall effectiveness of echocardiography in the prevention of recurrent stroke is unknown. VALUES: The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care. RECOMMENDATIONS: There is fair evidence to recommend echocardiography in patients with stroke and clinical evidence of cardiac disease by history, physical examination, electrocardiography or chest radiography (grade B recommendation). There is insufficient evidence to recommend for or against TEE in patients with normal results of TTE (grade C recommendation). There is insufficient evidence to recommend for or against routine echocardiography in patients (including young patients) without clinical cardiac disease (grade C recommendation). Routine echocardiography is not recommended for patients with clinical cardiac disease who have independent indications for or contraindications to anticoagulant therapy (grade D recommendation). There is fair evidence to recommend anticoagulant therapy in patients with stroke and intracardiac thrombus (grade B recommendation). There is insufficient (no) evidence to recommend for or against any specific therapy for patent foramen ovale (grade C recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care. PMID:10551199

Kapral, M K; Silver, F L

1999-01-01

272

Effectiveness of Myocardial Contrast Echocardiography Quantitative Analysis during Adenosine Stress versus Visual Analysis before Percutaneous Therapy in Acute Coronary Pain: A Coronary Artery TIMI Grading Comparing Study  

PubMed Central

The study aim was to compare two different stress echocardiography interpretation techniques based on the correlation with thrombosis in myocardial infarction (TIMI ) flow grading from acute coronary syndrome (ACS) patients. Forty-one patients with suspected ACS were studied before diagnostic coronary angiography with myocardial contrast echocardiography (MCE) at rest and at stress. The correlation of visual interpretation of MCE and TIMI flow grade was significant. The quantitative analysis (myocardial perfusion parameters: A, ?, and A × ?) and TIMI flow grade were significant. MCE visual interpretation and TIMI flow grade had a high degree of agreement, on diagnosing myocardial perfusion abnormality. If one considers TIMI flow grade <3 as abnormal, MCE visual interpretation at rest had 73.1% accuracy with 58.2% sensitivity and 84.2% specificity and at stress had 80.4% accuracy with 76.6% sensitivity and 83.3% specificity. The MCE quantitative analysis has better accuracy with 100% of agreement with different level of TIMI flow grading. MCE quantitative analysis at stress has showed a direct correlation with TIMI flow grade, more significant than the visual interpretation technique. Further studies could measure the clinical relevance of this more objective approach to managing acute coronary syndrome patient before percutaneous coronary intervention (PCI). PMID:22778555

Yang, Lixia; Mu, Yuming; Quaglia, Luiz Augusto; Tang, Qi; Guan, Lina; Wang, Chunmei; Shih, Ming Chi

2012-01-01

273

Comparison of transcranial Doppler ultrasound and transesophageal contrast echocardiography in the detection of interatrial right-to-left shunts.  

PubMed

Transesophageal contrast echocardiography is an effective but semiinvasive technique for the detection of interatrial right-to-left shunts. Transcranial Doppler ultrasound is an alternative noninvasive method, but may be limited by false-positive diagnoses due to intrapulmonary shunting. This study examined the accuracy of transcranial Doppler for the detection of shunt lesions. Transcranial Doppler of the right middle cerebral artery was performed simultaneously with transesophageal and transthoracic contrast echocardiography in 32 patients using agitated saline contrast during normal respiration and Valsalva. Transesophageal contrast echocardiography diagnosed an interatrial right-to-left shunt in 13 patients and intrapulmonary shunting in 6 patients. Transcranial Doppler identified all 13 interatrial right-to-left shunts and an intrapulmonary shunt in 3 of 6 patients. Absence of a shunt was confirmed by transcranial Doppler in 12 of 12 patients. Transcranial Doppler had a sensitivity of 100% (13 of 13), specificity of 100% (18 of 18) and accuracy of 100% (31 of 31) for prediction of an interatrial right-to-left shunt by transesophageal contrast echocardiography. In comparison, transthoracic contrast echocardiography had a sensitivity of 54% (7 of 13), specificity of 94% (17 of 18) and accuracy of 77% (24 of 31). Thus, transcranial Doppler is highly accurate for detection of an interatrial right-to-left shunt and not compromised by physiologic intrapulmonary shunts, whereas transthoracic contrast echocardiography lacks sensitivity. Transcranial Doppler may be useful as an alternative to transesophageal study, where the primary indication for transesophageal echocardiography is exclusion of an interatrial right-to-left shunt. PMID:1746433

Nemec, J J; Marwick, T H; Lorig, R J; Davison, M B; Chimowitz, M I; Litowitz, H; Salcedo, E E

1991-12-01

274

A coupled deformable model for tracking myocardial borders from real-time echocardiography using an incompressibility constraint  

PubMed Central

Real-time three-dimensional (RT3D) echocardiography is a new image acquisition technique that allows instantaneous acquisition of volumetric images for quantitative assessment of cardiac morphology and function. To quantify many important diagnostic parameters, such as ventricular volume, ejection fraction, and cardiac output, an automatic algorithm to delineate the left ventricle (LV) from RT3D echocardiographic images is essential. While a number of efforts have been made towards segmentation of the LV endocardial (ENDO) boundaries, the segmentation of epicardial (EPI) boundaries remains problematic. In this paper, we present a coupled deformable model that addresses this problem. The idea behind our method is that the volume of the myocardium is close to being constant during a cardiac cycle and our model uses this coupling as an important constraint. We employ two surfaces, each driven by the image-derived information that takes into account ultrasound physics by modeling the speckle statistics using the Nakagami distribution while maintaining the coupling. By simultaneously evolving two surfaces, the final segmentation of the myocardium is thus achieved. Results from 80 sets of synthetic data and 286 sets of real canine data were evaluated against the ground truth and against outlines from three independent observers, respectively. We show that results obtained with our incompressibility constraint were more accurate than those obtained without constraint or with a wall thickness constraint, and were comparable to those from manual segmentation. PMID:20350833

Zhu, Yun; Papademetris, Xenophon; Sinusas, Albert J.; Duncan, James S.

2014-01-01

275

The utility of intra-operative three-dimensional transoesophageal echocardiography for dynamic measurement of stroke volume.  

PubMed

Measurement of left ventricular stroke volume and cardiac output is very important for managing haemodynamically unstable or critically ill patients. The aims of this study were to compare stroke volume measured by three-dimensional transoesophageal echocardiography with stroke volume measured using a pulmonary artery catheter, and to examine the ability of three-dimensional transoesophageal echocardiography to track stroke volume changes induced by haemodynamic interventions. This study included 40 cardiac surgery patients. Haemodynamic variables were measured before and 2 min after haemodynamic interventions, which consisted of phenylephrine 100 ?g or ephedrine 5 mg. We used Bland-Altman analysis to assess the agreement between the stroke volume measured by three-dimensional transoesophageal echocardiography and by the pulmonary artery catheter. Polar-plot and 4-quadrant plot analyses were used to assess the trending ability of three-dimensional transoesophageal echocardiography compared with the pulmonary artery catheter. Bias and percentage error were -1.2 ml and 20%, respectively. The concordance rate in the 4-quadrant analysis after phenylephrine and ephedrine administration was 75% and 84%, respectively. In the polar-plot analysis, the angular concordance rate was 66% and 73% after phenylephrine and ephedrine administration, respectively. Three-dimensional transoesophageal echocardiography was clinically acceptable for measuring stroke volume; however, it was not sufficiently reliable for tracking stroke volume changes after haemodynamic interventions. PMID:25265890

Suehiro, K; Tanaka, K; Yamada, T; Matsuura, T; Funao, T; Mori, T; Nishikawa, K

2015-02-01

276

Statistical agreement of left ventricle measurements using cardiac magnetic resonance and 2D echocardiography in ischemic heart failure  

PubMed Central

Summary Background The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional echocardiography (2D echo) in the assessment of left ventricle (LV) function parameters and mass in patients with ischemic heart disease and severely depressed LV function. Although 2D echo is commonly used to assess LV indices, CMR is the state-of-the-art technique. Agreement between these 2 methods in these patients has not been well established. Material/Methods LV indexed end systolic and diastolic volumes (EDVi and ESVi), indexed mass (LVMi) and ejection fraction (EF) were assessed in 67 patients (12 women), using 2D echo and CMR. Results According to statistical analysis (Bland-Altman), 2D echo underestimated LV EDV and ESV and overestimated EF and LVMi compared to CMR. The highest correlation between 2D echo and CMR was found for EDVi (R2=0.73, p<0.0001) and ESVi (R2=0.69, p<0.0001) and the lowest for EF (R2=0.21, p=0.001) and LVMi (R2=0.20, p=0.002). The maximal differences between 2D echo and CMR were found for highest mesurements of LV volumes and mass, and for lowest EF values. Conclusions There is moderate to strong correlation between CMR and 2D echo in the assessment of LV function parameters and mass in patients with ischemic heart failure. Between-method agreement depends on the degree of LV dysfunction. The results of assessment of the severely damaged LV obtained by the use of 2D echo should be interpreted with caution. PMID:22367134

Gruszczy?ska, Katarzyna; Krzych, ?ukasz J.; Go?ba, Krzysztof S.; Biernat, Jolanta; Roleder, Tomasz; Deja, Marek A.; Ulbrych, Piotr; Malinowski, Marcin; Janusiewicz, Piotr; Wo?, Stanis?aw; Baron, Jan

2012-01-01

277

Bedside echocardiography is useful in assessing children with fluid and inotrope resistant septic shock  

PubMed Central

Objective: To report changes in the cardiovascular management of fluid and inotropic resistant septic shock in children based on echocardiography. Design: Retrospective case series. Setting: Tertiary care Pediatric Intensive Care Unit (PICU), Chennai. Patients: Twenty-two patients with unresolved septic shock after 60 ml/kg fluid plus inotropic agents in the first hour. Interventions: Bedside echocardiography (echo) within 6 h of admission to the PICU. Results: Over a 28-month period, of 37 patients with septic shock, 22 children remained in shock despite 60 ml/kg fluid and dopamine and/or dobutamine infusions as per guidelines. On clinical exam, 12 patients had warm shock and ten had cold shock, however, six exhibited an unusual pattern of cold shock with wide pulse pressures on invasive arterial monitoring. The most common echocardiographic finding was uncorrected hypovolemia in 12/22 patient while ten patients had impaired left ± right ventricular function. Echocardiography permitted an appreciation of the underlying disordered pathophysiology and a rationale for adjustment of treatment. Shock resolved in 17 (77%) and 16 patients (73%) survived to discharge. Conclusions: Bedside echo provided crucial information that was not apparent on clinical assessment and affords a simple noninvasive tool to determine the cause of low cardiac output in patients who remain in shock despite 60 ml/kg fluid and inotropic support. Most patients in our series had vasodilatory shock with wide pulse pressures and most common finding on echo was uncorrected hypovolemia. The echo findings allowed adjustment of therapy which was not possible based on clinical examination alone. PMID:24133330

Ranjit, Suchitra; Kissoon, Niranjan

2013-01-01

278

Variations in the referral patterns to stress nuclear imaging and stress echocardiography scans  

Microsoft Academic Search

Background  Stress myocardial perfusion imaging (MPI) and stress echocardiography (Echo) are commonly used for the noninvasive evaluation\\u000a of patients with suspected coronary artery disease (CAD). Very few studies have compared the referral patterns to these imaging\\u000a modalities in terms of the clinical profile of patients, reasons for referral, and type of referring physicians.\\u000a \\u000a \\u000a \\u000a \\u000a Methods and Results  This was a prospective study of

Salam Itani; Walid Gharzuddine; Samir Arnaout; Mukbil Hourani; Samir Alam; Habib A. Dakik

2009-01-01

279

Is transesophageal echocardiography useful in planning surgery of mediastinal thymomas? Transesophageal investigation of a mediastinal thymoma.  

PubMed

Thymomas are the commonest tumors arising in the anterior mediastinum, sometimes representing an incidental finding at radiological examination. Surgery of these neoplasms must be planned after accurately assessing the invasive or non-invasive nature of the mass. In the present case this could be achieved also by submitting the patient to transesophageal echocardiography which could accurately exclude infiltration of heart walls. We therefore think that this technique can be considered a useful complement to radiological ones in defining the surgical strategy of mediastinal thymomas. PMID:17188379

Oneglia, Carlo; Di Fabio, Domenico; Bonora-Ottoni, Daniele; Rusconi, Cesare

2007-10-18

280

Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery  

PubMed Central

The role of intraoperative transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today intraoperative TEE is a class I indication for surgical mitral valve reconstruction for evaluation of mitral valve pathology, graduation of mitral regurgitation and detection of potential risk factors as well as post-repair assessment. Real-time three-dimensional TEE offers anatomical visualization of the mitral valve apparatus, fundamental for virtual surgical planning of proper annuloplasty ring size. As minimally invasive and even off-pump techniques for mitral valve repair become more popular, image guidance by intraoperative TEE will play an essential role. PMID:24349984

Sgouropoulou, Sophia

2013-01-01

281

Paradoxical gas embolism after SCUBA diving: hemodynamic changes studied by echocardiography.  

PubMed

Hemodynamic changes induced by self-contained underwater breathing apparatus diving were investigated using Doppler echocardiography. We detected circulating bubbles in both right and left cavities of the heart and in the cerebral circulation in two divers with a large patent foramen ovale. A reduction in the left ventricular preload was suggested by echocardiographic measurements. The decreased cardiac preload was paralleled to a lower stroke volume and cardiac output. These findings were also observed in divers with no evidence of circulating bubbles. In these subjects, pulmonary vascular resistances remained unchanged while an increase was observed in the two divers with arterial bubbles. This increase could promote right-to-left shunting. PMID:22612401

Boussuges, A; Pontier, J M; Schmid, B; Dussault, C

2014-02-01

282

[Detection of bone marrow embolism in femoral intramedullary nailing using transesophageal echocardiography].  

PubMed

Cardiopulmonary complications are known in intramedullary nailing, especially of the femur. Transesophageal echocardiography now allow intraoperative detection of embolized bone-marrow, recognizable as reflecting particles in the right atrium. In intramedullary nailing of a femoral fracture with a closed distal fragment bone-marrow embolism was detectable in the right atrium during reaming of the medullary canal. This technique should permit further research on the pathophysiology of pulmonary alterations during intramedullary nailing and also testing the effectiveness of pressure-relief in the medullary canal as proposed by drilling a bone-hole. PMID:2734960

Wenda, K; Henrichs, K J; Biegler, M; Erbel, R

1989-04-01

283

Anatomy of the Mitral Valve Apparatus – Role of 2D and 3D Echocardiography  

PubMed Central

The mitral valve apparatus is a complex three–dimensional functional unit that is critical to unidirectional heart pump function. This review details the normal anatomy, histology and function of the main mitral valve apparatus components 1) mitral annulus, 2) mitral valve leaflets, 3) chordae tendineae and 4) papillary muscles. 2 and 3 dimensional Echocardiography is ideally suited to examine the mitral valve apparatus and has provided insights into the mechanism of mitral valve disease. An overview of standardized image acquisition and interpretation is provided. Understanding normal mitral valve apparatus function is essential to comprehend alterations in mitral valve disease and the rationale for repair strategies. PMID:23743068

Dal-Bianco, Jacob P.; Levine, Robert A.

2013-01-01

284

Casimir experiments showing saturation effects  

SciTech Connect

We address several different Casimir experiments where theory and experiment disagree. First out is the classical Casimir force measurement between two metal half spaces; here both in the form of the torsion pendulum experiment by Lamoreaux and in the form of the Casimir pressure measurement between a gold sphere and a gold plate as performed by Decca et al.; theory predicts a large negative thermal correction, absent in the high precision experiments. The third experiment is the measurement of the Casimir force between a metal plate and a laser irradiated semiconductor membrane as performed by Chen et al.; the change in force with laser intensity is larger than predicted by theory. The fourth experiment is the measurement of the Casimir force between an atom and a wall in the form of the measurement by Obrecht et al. of the change in oscillation frequency of a {sup 87}Rb Bose-Einstein condensate trapped to a fused silica wall; the change is smaller than predicted by theory. We show that saturation effects can explain the discrepancies between theory and experiment observed in all these cases.

Sernelius, Bo E. [Division of Theory and Modeling, Department of Physics, Chemistry and Biology, Linkoeping University, SE-581 83 Linkoeping (Sweden)

2009-10-15

285

Utility and limitation of treadmill exercise echocardiography for detecting significant coronary stenosis in infarct-related arteries in patients with healed myocardial infarction  

Microsoft Academic Search

This clinical study examines the diagnostic accuracy of exercise echocardiography for detecting significant coronary stenoses in infarct-related arteries in patients with healed myocardial infarction. Quantitative coronary angiography and exercise echocardiography using treadmill testing were performed within 2 weeks of each other in 123 patients with a prior myocardial infarction. Coronary lumen diameter stenosis ?50% by quantitative coronary angiography and the

Toshihiko Nishioka; Hideki Mitani; Akimi Uehata; Bonpei Takase; Kazushige Isojima; Tomoo Nagai; Fumitaka Ohsuzu; Akira Kurita; Shingo Ohtomi; Robert J Siegel

2002-01-01

286

Real-Time, Interactive Echocardiography Over High-Speed Networks: Feasibility and Functional Requirements  

NASA Technical Reports Server (NTRS)

Real-time, Interactive Echocardiography Over High Speed Networks: Feasibility and Functional Requirements is an experiment in advanced telemedicine being conducted jointly by the NASA Lewis Research Center, the NASA Ames Research Center, and the Cleveland Clinic Foundation. In this project, a patient undergoes an echocardiographic examination in Cleveland while being diagnosed remotely by a cardiologist in California viewing a real-time display of echocardiographic video images transmitted over the broadband NASA Research and Education Network (NREN). The remote cardiologist interactively guides the sonographer administering the procedure through a two-way voice link between the two sites. Echocardiography is a noninvasive medical technique that applies ultrasound imaging to the heart, providing a "motion picture" of the heart in action. Normally, echocardiographic examinations are performed by a sonographer and cardiologist who are located in the same medical facility as the patient. The goal of telemedicine is to allow medical specialists to examine patients located elsewhere, typically in remote or medically underserved geographic areas. For example, a small, rural clinic might have access to an echocardiograph machine but not a cardiologist. By connecting this clinic to a major metropolitan medical facility through a communications network, a minimally trained technician would be able to carry out the procedure under the supervision and guidance of a qualified cardiologist.

Bobinsky, Eric A.

1998-01-01

287

The Clinical Benefits of Adding a Third Dimension to Assess the Left Ventricle with Echocardiography  

PubMed Central

Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management. PMID:24959374

Badano, Luigi P.

2014-01-01

288

[Echocardiography in patients with malignant metastatic neoplasms of the heart and great vessels].  

PubMed

Two-dimensional echocardiography was used to study malignant metastatic neoplasms of the heart and great vessels in 20 patients, 13 males and seven females, whose ages ranged from 15 to 72 years. Five patients had lung cancer; two each had breast cancer, malignant melanoma, hepatoma and one each had gastric cancer, urinary bladder cancer, adrenocortical carcinoma, malignant lymphoma, angiosarcoma, fibrosarcoma, leiomyosarcoma; and two had cancers with unknown primaries. Tumor invasion was demonstrated echocardiographically in the left atrium in one each with breast cancer, fibrosarcoma and gastric cancer; in the right atrium in two with hepatomas; in the right atrium and right ventricle in one patient with adrenocortical carcinoma; in the left ventricle in one with lung cancer; and in the pulmonary artery in one with malignant melanoma. Massive pericardial effusion was observed in 11 of 20 patients; two with pericardial tumors including malignant lymphoma and lung cancer. We conjectured that metastatic tumors in the right cardiac cavities came through the inferior vena cava, and other tumors in the left atrium, left ventricle and pericardium developed from direct extension of the primary lesions. There was an 80% mortality of the patients during the observation period, and the average survival period after the diagnosis of cardiac metastases was 5.5 months. However, one patient was still living after two years of radiation therapy and chemotherapy. Echocardiography proved a useful, non-invasive means for the detection and follow-up observation of metastatic cardiac tumors. PMID:2104413

Ohnishi, M; Niwayama, H; Miyazawa, Y; Kondo, N; Imai, H; Nishimoto, Y; Morooka, N; Watanabe, S; Masuda, Y; Inagaki, Y

1990-01-01

289

Non-Invasive Imaging for Congenital Heart Disease: Recent Innovations in Transthoracic Echocardiography  

PubMed Central

Transthoracic echocardiography (TTE) is an important tool for diagnosis and follow-up of patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive and complex modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged for the assessment of ventricular systolic and diastolic function: Tissue Doppler imaging, tissue tracking, strain and strain rate imaging, vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic contraction (IVA), the ratio of systolic to diastolic duration (S/D ratio), and other measurements of systolic right ventricular (RV) function like tricuspid annular plane systolic excursion (TAPSE). These modalities may become valuable indicators of ventricular performance, compliance and disease progression, with the caveat of preload-dependency of the variables measured. In addition, three-dimensional (3D) echocardiography for the assessment of cardiac anatomy, valvular function, device position, ventricular volumes and ejection fraction is integrated into routine clinical care. In this review, we discuss the potential use and limitations of these new echocardiographic techniques in patients with CHD. A particular focus is on the echocardiographic assessment of right ventricular (RV) function by means of tissue Doppler imaging, tissue tracking, and three-dimensional imaging, in conditions associated with increased right ventricular volume or pressure load. PMID:24163784

Koestenberger, Martin; Friedberg, Mark K.; Ravekes, William; Nestaas, Eirik; Hansmann, Georg

2013-01-01

290

Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn  

PubMed Central

Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac echocardiography (ICE) complements and has in part replaced transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative. PMID:24144789

Bartel, Thomas; Müller, Silvana; Biviano, Angelo; Hahn, Rebecca T.

2014-01-01

291

Stress echocardiography  

MedlinePLUS

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 71. Connolly HM, Oh JK. ...

292

Severe infective endocarditis after MitraClip implantation treated by cardiac surgery.  

PubMed

Aims: To report the first described case of a mitral valve infective endocarditis (IE) post MitraClip®. Methods and results: An 88-year-old patient at high surgical risk (log. EuroSCORE 30.4%) underwent a MitraClip procedure for severe eccentric organic mitral regurgitation (MR) due to prolapse with a flail leaflet of the P2 segment (flail gap 6 mm). After one month, the patient was readmitted to our department for fever and recurrence of shortness of breath. An echocardiogram demonstrated severe MR recurrence due to ulceration in the region of the posterior leaflet despite good insertion of both clips, and a large vegetation of 15x13 mm within the clip region. Blood cultures were positive for staphylococcus aureus. The patient was treated by cardiac surgery with mitral valve replacement due to IE despite a very high logistic EuroSCORE of 56.8%. Histological and bacteriological analysis of the clip devices confirmed active IE. After cardiac surgery, transthoracic echocardiography showed no mitral regurgitation and a mean gradient across the mitral valve bioprosthesis of about 5 mmHg. The patient was discharged to a rehabilitation department 15 days after cardiac surgery. Conclusions: Surgical treatment as bail-out therapy for MR recurrence secondary to IE after MitraClip can be successfully carried out despite a high surgical risk. PMID:25136886

Frerker, Christian; Kuck, Karl-Heinz; Schmidt, Tobias; Kreidel, Felix; Bader, Ralf; Schmoeckel, Michael; Geidel, Stephan

2014-08-20

293

Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study  

PubMed Central

Background Real-time myocardial contrast echocardiography (MCE) is a novel method for assessing myocardial perfusion. The aim of this study was to evaluate the feasibility of a very low-power real-time MCE for quantification of regional resting myocardial blood flow (MBF) velocity in normal human myocardium. Methods Twenty study subjects with normal left ventricular (LV) wall motion and normal coronary arteries, underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during constant IV. infusion of SonoVue®. Following transient microbubble destruction, the contrast replenishment rate (?), reflecting MBF velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function; y (t) =A (1-e-?(t-t0)) + C. Results Quantification was feasible in 82%, 49% and 63% of four-chamber, two-chamber and apical long-axis view segments, respectively. The LAD (left anterior descending artery) and RCA (right coronary artery) territories could potentially be evaluated in most, but contrast detection in the LCx (left circumflex artery) bed was poor. Depending on localisation and which frames to be analysed, mean values of were 0.21–0.69 s-1, with higher values in medial than lateral, and in basal compared to apical regions of scan plane (p = 0.03 and p < 0.01). Higher ?-values were obtained from end-diastole than end-systole (p < 0.001), values from all-frames analysis lying between. Conclusion Low-power real-time MCE did have the potential to give contrast enhancement for quantification of resting regional MBF velocity. However, the technique is difficult and subjected to several limitations. Significant variability in ? suggests that this parameter is best suited for with-in patient changes, comparing values of stress studies to baseline. PMID:15958173

Malm, Siri; Frigstad, Sigmund; Helland, Frode; Oye, Kjetil; Slordahl, Stig; Skjarpe, Terje

2005-01-01

294

2013 Goat Shows Show Date Show Name Entries Due Eligibility Weigh In Show Time Contact Phone Extra Info  

E-print Network

2013 Goat Shows Show Date Show Name Entries Due Eligibility Weigh In Show Time Contact Phone Extra/13/2013 Cannon Co. Day of Show Youth Must 8 a.m. to 12 p.m. Carol 615-563-5260 Bring own Jr. Goat $1.00 a head Control 10 a.m. Melton Bedding Association Goat 7/20/2013 Overton Co. Day of Show Youth Before 5 p.m. 6

Grissino-Mayer, Henri D.

295

Racial Differences in the Prevalence of Severe Aortic Stenosis  

PubMed Central

Background In an era of expanded treatment options for severe aortic stenosis, it is important to understand risk factors for the condition. It has been suggested that severe aortic stenosis is less common in African Americans, but there are limited data from large studies. Methods and Results The Synthetic Derivative at Vanderbilt University Medical Center, a database of over 2.1 million de?identified patient records, was used to identify individuals who had undergone echocardiography. The association of race with severe aortic stenosis was examined using multivariable logistic regression analyses adjusting for conventional risk factors. Of the 272 429 eligible patients (mean age 45 years, 44% male) with echocardiography, 14% were African American and 82% were Caucasian. Severe aortic stenosis was identified in 106 (0.29%) African?American patients and 2030 (0.91%) Caucasian patients (crude OR 0.32, 95% CI [0.26, 0.38]). This difference persisted in multivariable?adjusted analyses (OR 0.41 [0.33, 0.50], P<0.0001). African?American individuals were also less likely to have severe aortic stenosis due to degenerative calcific disease (adjusted OR 0.47 [0.36, 0.61]) or congenitally bicuspid valve (crude OR 0.13 [0.02, 0.80], adjusted OR dependent on age). Referral bias against those with severe valvular disease was assessed by comparing the prevalence of severe mitral regurgitation in Caucasians and African Americans and no difference was found. Conclusions These findings suggest that African Americans are at significantly lower risk of developing severe aortic stenosis than Caucasians. PMID:24870936

Patel, Devin K.; Green, Kelly D.; Fudim, Marat; Harrell, Frank E.; Wang, Thomas J.; Robbins, Mark A.

2014-01-01

296

Soccer Tournament ELI Talent Show  

E-print Network

Highlights Soccer Tournament ELI Talent Show Notes from your Teachers Notes from the Office very quickly! ELI Talent Show As you probably already know, the ELI is going to have its second annual Talent Show. The talent show is open to ELI students, faculty, staff, and LAs. Acts can include

Pilyugin, Sergei S.

297

Impact of culprit lesion morphology on prevalence of provoked myocardial ischaemia in patients with old myocardial infarction. A dipyridamole stress echocardiography, exercise electrocardiography and angiographic study.  

PubMed

We have recently shown that in patients with single vessel disease and no myocardial infarction, a complex plaque morphology makes myocardium more vulnerable to ischaemia during dipyridamole echocardiography testing. Whether coronary lesion morphology in the infarct-related artery in a chronic phase may also modulate prevalence of ischaemia in the same territory remains unknown. In order to determine the possible relationship between culprit lesion morphology in the infarct-related artery and the prevalence of homotopic ischaemia during stress tests, data from high dose dipyridamole echocardiography tests (up to 0.84 mg.kg-1 over 10 min), exercise electrocardiography and coronary angiography from 73 in-hospital patients with a previous myocardial infarction and patent infarct-related single-vessel disease (> or = 50% diameter reduction) were analysed. An angiographic culprit lesion was considered complex (Ambrose classification) when irregular borders, ulcers, thrombus and/or intraluminal lucencies were present. According to angiographic lesion morphology, two groups were identified: Group I, with simple-type culprit lesions; Group II, with complex type culprit lesions. Number of patients (I = 36; II = 37), age (I = 57 +/- II vs II = 55 +/- 9 years), ejection fraction (I = 58.8 +/- II 3 vs II = 56.5 +/- 10.2%), number of Q or non-Q wave myocardial infarctions, prevalence of rest angina (I = 9; II = II) or effort angina (I = 10; II = 10), culprit lesion stenosis severity (I = 57.9 +/- 7.2% vs II = 57.7 +/- 6.2% by computer analysis) and degree of infarct artery anterograde flow (I = 2.64 +/- 0.48 vs II = 2.56 +/- 0.50 by Thrombolysis in Myocardial Infarction definition) did not differ between the two groups (P = ns for all intergroup differences). Dipyridamole echocardiography test-induced ischaemia (considered as new or worsening abnormal wall motion) in the infarct-related artery territory was 25% in Group I and 59% in Group II (P < 0.01). Among positive dipyridamole echocardiography tests, low dose (0.56 mg.kg-1 over the 4 min) positivity occurred in two out of nine Group I patients and in 16 out of 22 Group II patients (22 vs 73%, P < 0.05). Exercise electrocardiography was positive in seven out of 32 Group I patients, and in 16 out of 35 Group II patients (22 vs 46%, P < 0.05). The peak rate pressure product tended to be higher in Group I than in Group II patients (282 +/- 65 vs 257 +/- 65 mmHg x beats.min x 10(2), P = 0.07). Thus, in patients with previous myocardial infarction and a patent infarct-related artery, complex culprit lesion morphology is associated with a higher prevalence of ischaemia and a lower ischaemic threshold during both exercise and dipyridamole stress testing. The morphology of culprit stenosis is important in modulating different stress responses in the chronic phase of myocardial infarction. PMID:9129888

Lu, C; Distante, A; Marzilli, M; DeNes, M; Wang, Y; Biagini, A; L'Abbate, A

1997-04-01

298

Systemic vascular resistance in cirrhosis: a predictor of severity?  

PubMed Central

Background The aim of this study was to investigate whether systemic vascular resistance (SVR) correlates with validated prospective scoring systems such as Model for End-stage Liver Disease (MELD) and its modifications. Methods Patients with cirrhosis, who were admitted to hospital with decompensation (as defined by development of ascites, hepatic encephalopathy, and variceal bleeding) and underwent echocardiography were included in this study. Laboratory data required for computing MELD score, serum bilirubin, serum creatinine, international normalized ratio, and serum sodium were collected for every patient. We tabulated hemodynamic and echocardiography parameters that enabled calculation of SVR. We analyzed the correlation between SVR and each of the individual prognostic scores. Results A total of 771 patients with a diagnosis of decompensated cirrhosis were included in the study. Two hundred and sixty-two patients were found to have a low sodium level (<135 mEq/L) and 509 were found to have a normal sodium level (>135 mEq/L). In the patients with hyponatremia, we found statistically significant inverse correlations between SVR and validated liver severity models. However, these correlations were not seen in patients with normonatremia. Conclusion We observed a statistically significant inverse correlation between SVR and all the validated liver disease severity models used in this study among patients with hyponatremia but not in those with normonatremia. PMID:25187743

Gaduputi, Vinaya; Abdulsamad, Molham; Sakam, Sailaja; Abbas, Naeem; Tariq, Hassan; Ihimoyan, Ariyo

2014-01-01

299

A systematic analysis of the feasibility of four-dimensional ultrasound imaging using spatiotemporal image correlation in routine fetal echocardiography  

Microsoft Academic Search

Objectives To investigate the feasibility of incorporating spatiotemporal image correlation (STIC) into a tertiary fetal echocardiography program. Methods During the study period all pregnant women fitting our inclusion criteria were enrolled consecutively. Four sonographers participated in the study, one of whom had substantial previous experience of STIC volume acquisition and three of whom did not. STIC volumes were acquired within

L. B. Uittenbogaard; M. C. Haak; M. D. Spreeuwenberg; J. M. G. Van Vugt

2008-01-01

300

Comparison of exercise and dobutamine echocardiography in the haemodynamic assessment of small size mechanical aortic valve prostheses  

Microsoft Academic Search

Objective: Doppler echocardiographic evaluation of prosthetic heart valve function is usually performed at rest although this situation is not representative of patients' daily activities. Following aortic valve replacement, patients most likely to remain symptomatic are those with a small aortic root and dobutamine or exercise echocardiography has been proposed to elicit the presence of abnormal haemodynamics or persistently elevated transvalvular

Isaac Kadir; Catherine Walsh; Peter Wilde; Alan J. Bryan; Gianni D. Angelini

2002-01-01

301

Comparison of exercise and dobutamine echocardiography in the haemodynamic assessment of small size mechanical aortic valve prostheses  

Microsoft Academic Search

Objective: Doppler echocardiographic evaluation of prosthetic heart valve function is usually performed at rest although this situation is not representative of patients' daily activities. Following aortic valve replacement, patients most likely to remain symptomatic are those with a small aortic root and dobutamine or exercise echocardiography has been proposed to elicit the presence of abnormal haemodynamics or persistently elevated transvalvular

Isaac Kadir; Catherine Walsh; Peter Wilde; Alan J. Bryan; Gianni D. Angelini

2010-01-01

302

[Three-dimensional speckle-tracking echocardiography -- a further step in non-invasive three-dimensional cardiac imaging].  

PubMed

Three-dimensional speckle-tracking echocardiography is a new cardiac imaging methodology, which allows three-dimensional non-invasive evaluation of the myocardial mechanics. The aim of this review is to present this new tool emphasizing its diagnostic potentials and demonstrating its limitations, as well. PMID:23022880

Nemes, Attila; Kalapos, Anita; Domsik, Péter; Forster, Tamás

2012-10-01

303

Biophysical characteristics of radiofrequency lesion formation in vivo: Dynamics of catheter tip–tissue contact evaluated by intracardiac echocardiography  

Microsoft Academic Search

During clinical radiofrequency catheter ablation a wide range of delivered power may be necessary to achieve success despite an apparently stable catheter position on fluoroscopy. The purpose of this study was to use intracardiac echocardiography to characterize the relation between catheter tip–tissue contact and the efficiency of heating during applications of radiofrequency energy in vivo and to determine whether intracardiac

Jonathan M. Kalman; Adam P. Fitzpatrick; Jeffrey E. Olgin; Michael C. Chin; Randall J. Lee; Melvin M. Scheinman; Michael D. Lesh

1997-01-01

304

What Do Blood Tests Show?  

MedlinePLUS

... page from the NHLBI on Twitter. What Do Blood Tests Show? Blood tests show whether the levels ... changes may work best. Result Ranges for Common Blood Tests This section presents the result ranges for ...

305

Validation of real-time three-dimensional echocardiography for quantifying left ventricular volumes in the presence of a left ventricular aneurysm: in vitro and in vivo studies  

NASA Technical Reports Server (NTRS)

OBJECTIVES: To validate the accuracy of real-time three-dimensional echocardiography (RT3DE) for quantifying aneurysmal left ventricular (LV) volumes. BACKGROUND: Conventional two-dimensional echocardiography (2DE) has limitations when applied for quantification of LV volumes in patients with LV aneurysms. METHODS: Seven aneurysmal balloons, 15 sheep (5 with chronic LV aneurysms and 10 without LV aneurysms) during 60 different hemodynamic conditions and 29 patients (13 with chronic LV aneurysms and 16 with normal LV) underwent RT3DE and 2DE. Electromagnetic flow meters and magnetic resonance imaging (MRI) served as reference standards in the animals and in the patients, respectively. Rotated apical six-plane method with multiplanar Simpson's rule and apical biplane Simpson's rule were used to determine LV volumes by RT3DE and 2DE, respectively. RESULTS: Both RT3DE and 2DE correlated well with actual volumes for aneurysmal balloons. However, a significantly smaller mean difference (MD) was found between RT3DE and actual volumes (-7 ml for RT3DE vs. 22 ml for 2DE, p = 0.0002). Excellent correlation and agreement between RT3DE and electromagnetic flow meters for LV stroke volumes for animals with aneurysms were observed, while 2DE showed lesser correlation and agreement (r = 0.97, MD = -1.0 ml vs. r = 0.76, MD = 4.4 ml). In patients with LV aneurysms, better correlation and agreement between RT3DE and MRI for LV volumes were obtained (r = 0.99, MD = -28 ml) than between 2DE and MRI (r = 0.91, MD = -49 ml). CONCLUSIONS: For geometrically asymmetric LVs associated with ventricular aneurysms, RT3DE can accurately quantify LV volumes.

Qin, J. X.; Jones, M.; Shiota, T.; Greenberg, N. L.; Tsujino, H.; Firstenberg, M. S.; Gupta, P. C.; Zetts, A. D.; Xu, Y.; Ping Sun, J.; Cardon, L. A.; Odabashian, J. A.; Flamm, S. D.; White, R. D.; Panza, J. A.; Thomas, J. D.

2000-01-01

306

Early myocardial deformation changes in hypercholesterolemic and obese children and adolescents: a 2D and 3D speckle tracking echocardiography study.  

PubMed

Dyslipidemia and obesity are considered strong risk factors for premature atherosclerotic cardiovascular disease and increased morbidity and mortality and may have a negative impact on myocardial function.Our purpose was to assess the presence of early myocardial deformation abnormalities in dyslipidemic children free from other cardiovascular risk factors, using 2-dimensional speckle tracking echocardiography (2DSTE) and 3-dimensional speckle tracking echocardiography (3DSTE).We studied 80 consecutive nonselected patients (6-18 years of age) with hypercholesterolemia (low-density lipoprotein [LDL] cholesterol levels >95th percentile for age and sex). Forty of them had normal weight and 40 were obese (body mass index >95th percentile for age and sex). Forty healthy age-matched children were selected as controls. Left ventricular (LV) global longitudinal, circumferential, and radial strains were calculated by 2DSTE and 3DSTE. Global area strain (GAS) was calculated by 3DSTE as percentage of variation in surface area defined by the longitudinal and circumferential strain vectors. Right ventricular (RV) global and free-wall longitudinal strain and LV and RV diastolic strain rate parameters were obtained. Data analysis was performed offline.LV global longitudinal strain and GAS were lower in normal-weight and obese dyslipidemic children compared with normal controls and reduced in obese patients compared with normal-weight dyslipidemic children. LV early diastolic strain rate was lower compared with normals. RV global and free-wall longitudinal strain was significantly reduced in obese patients when compared with the control group. A significant inverse correlation was found between LV strain, LDL cholesterol levels, and body mass index.2DSTE and 3DSTE show LV longitudinal strain and GAS changes in dyslipidemic children and adolescents free from other cardiovascular risk factors or structural cardiac abnormalities. Obesity causes an additive adverse effect on LV strain parameters and RV strain impairment. PMID:25211047

Vitarelli, Antonio; Martino, Francesco; Capotosto, Lidia; Martino, Eliana; Colantoni, Chiara; Ashurov, Rasul; Ricci, Serafino; Conde, Ysabel; Maramao, Fabio; Vitarelli, Massimo; De Chiara, Stefania; Zanoni, Cristina

2014-09-01

307

Comparison of accuracy of aortic root annulus assessment with cardiac magnetic resonance versus echocardiography and multidetector computed tomography in patients referred for transcatheter aortic valve implantation.  

PubMed

The evaluation of the aortic root in patients referred for transcatheter aortic valve implantation is crucial. The aim of the present study was to compare the accuracy of cardiac magnetic resonance (CMR) evaluation of the aortic annulus (AoA) with transthoracic and transesophageal echocardiography and multidetector computed tomography (MDCT) in patients referred for transcatheter aortic valve implantation. In 50 patients, maximum diameter, minimum diameter and AoA, length of the left coronary, right coronary, and noncoronary aortic leaflets, degree (grades 1 to 4) of aortic leaflet calcification, and distance between AoA and coronary artery ostia were assessed. AoA maximum diameter, minimum diameter, and area by CMR were 26.4 ± 2.8 mm, 20.6 ± 2.3 mm, 449.8 ± 86.2 mm(2), respectively. The length of left coronary, right coronary, and noncoronary leaflets by CMR were 13.9 ± 2.2, 13.3 ± 2.1, and 13.4 ± 1.8 mm, respectively, whereas the score of aortic leaflet calcifications was 2.9 ± 0.8. Finally, the distances between AoA and left main and right coronary artery ostia were 16.1 ± 2.8 and 16.1 ± 4.4 mm, respectively. Regarding AoA area, transthoracic and transesophageal echocardiography showed an underestimation (p <0.01), with a moderate agreement (r: 0.5 and 0.6, respectively, p <0.01) compared with CMR. No differences and excellent correlation were observed between CMR and MDCT for all parameters (r: 0.9, p <0.01), except for aortic leaflet calcifications that were underestimated by CMR. In conclusion, aortic root assessment with CMR including AoA size, aortic leaflet length, and coronary artery ostia height is accurate compared with MDCT. CMR may be a valid imaging alternative in patients unsuitable for MDCT. PMID:24045059

Pontone, Gianluca; Andreini, Daniele; Bartorelli, Antonio L; Bertella, Erika; Mushtaq, Saima; Gripari, Paola; Loguercio, Monica; Cortinovis, Sarah; Baggiano, Andrea; Conte, Edoardo; Beltrama, Virginia; Annoni, Andrea; Formenti, Alberto; Tamborini, Gloria; Muratori, Manuela; Guaricci, Andrea; Alamanni, Francesco; Ballerini, Giovanni; Pepi, Mauro

2013-12-01

308

Validation of Noninvasive Indices Of Global Systolic Function in Patients with Normal and Abnormal Loading Conditions: A Simultaneous Echocardiography Pressure-Volume Catheterization Study  

PubMed Central

Background Noninvasive indices based on Doppler-echocardiography are increasingly used in clinical cardiovascular research to evaluate LV global systolic chamber function. Our objectives were 1) to clinically validate ultrasound-based methods of global systolic chamber function to account for differences between patients in conditions of abnormal load, and 2) to assess their sensitivity to load confounders. Methods and Results Twenty-seven patients (8 dilated cardiomyopathy, 10 normal ejection fraction [EF], and 9 end-stage liver disease) underwent simultaneous echocardiography and left heart catheterization with pressure-conductance instrumentation. The reference index, maximal elastance (Emax) was calculated from pressure-volume loop data obtained during acute inferior vena cava occlusion. A wide range of values was observed for LV systolic chamber function (Emax: 2.8 ± 1.0 mmHg/ml), preload, and afterload. Amongst the noninvasive indices tested, the peak ejection intraventricular pressure difference (peak-EIVPD) showed the best correlation with Emax (R=0.75). A significant but weaker correlation with Emax was observed for EF (R=0.41), mid-wall fractional shortening (R=0.51), global circumferential strain(R=?0.53), and strain-rate (R=?0.46). Longitudinal strain and strain-rate failed to correlate with Emax, as did noninvasive single-beat estimations of this index. Principal component and multiple regression analyses demonstrated that peak-EIVPD was less sensitive to load, whereas EF and longitudinal strain and strain-rate were heavily influenced by afterload. Conclusions Current ultrasound methods have limited accuracy to characterize global LV systolic chamber function in a given patient. The Doppler-derived peak-EIVPD should be preferred for this purpose because it best correlates with the reference index and is more robust in conditions of abnormal load. PMID:24173273

Yotti, Raquel; Bermejo, Javier; Benito, Yolanda; Sanz, Ricardo; Ripoll, Cristina; Martínez-Legazpi, Pablo; Péerez del Villar, Candela; Elízaga, Jaime; González-Mansilla, Ana; Barrio, Alicia; Bañares, Rafael; Fernández-Avilés, Francisco

2014-01-01

309

ELI Talent Show Final Exams  

E-print Network

Highlights ELI Talent Show Final Exams Scholarship Nominees Graduate Admissions Workshop Reminders from the Office Manners, Cultures, & Grammar TheELIWeekly ELI Talent Show It's going to be a blast! Come one, come all! The 2nd Annual ELI Talent Show will be on Tuesday, April 15th

Pilyugin, Sergei S.

310

High-frequency speckle tracking echocardiography in the assessment of left ventricular function and remodeling after murine myocardial infarction.  

PubMed

The objectives of this study were to assess the feasibility and accuracy of high-frequency speckle tracking echocardiography (STE) in a murine model of myocardial infarction (MI). STE is used clinically to quantify global and regional cardiac function, but its application in mice is challenging because of the small cardiac size and rapid heart rates. A high-frequency micro-ultrasound system with STE (Visualsonics Vevo 2100) was compared against magnetic resonance imaging (MRI) for the assessment of global left ventricular (LV) size and function after murine MI. Animals subjected to coronary ligation (n = 46) or sham ligation (n = 27) were studied 4 wk postoperatively. Regional and global deformation were also assessed. STE-derived LV ejection fraction (EF) and mass correlated well with MRI indexes (r = 0.93, 0.77, respectively; P < 0.001), as did STE-derived mass with postmortem values (r = 0.80, P < 0.001). Higher STE-derived volumes correlated positively with MRI-derived infarct size (P < 0.01). Global strain parameters were significantly reduced after MI (all P < 0.001) and strongly correlated with LV mass and MRI-derived infarct size as promising surrogates for the extent of remodeling and infarction, respectively (both P < 0.05). Regional strain analyses showed that radial strain and strain rate were relatively preserved in anterior basal segments after MI compared with more apical segments (P < 0.001); however, longitudinal strain and strain rate were significantly impaired both basally and distally (P < 0.001). Strain-derived parameters of dyssynchrony were significantly increased in the MI group (P < 0.01). Analysis time for STE was 210 ± 45 s with acceptable inter- and intraobserver variability. In conclusion, high-frequency STE enables quantitative assessment of regional and global function in the remodeling murine LV after MI. PMID:24531814

Bhan, Amit; Sirker, Alexander; Zhang, Juqian; Protti, Andrea; Catibog, Norman; Driver, William; Botnar, Rene; Monaghan, Mark J; Shah, Ajay M

2014-05-01

311

Feasibility and Safety of Transthoracic Echocardiography-Guided Transcatheter Closure of Atrial Septal Defects with Deficient Superior-Anterior Rims  

PubMed Central

Although previous studies showed that transthoracic echocardiography (TTE) can be used to guide transcatheter closure of atrial septal defect (ASD), whether TTE can be used to guide transcatheter closure of secundum ASD with a deficient superior-anterior rim is unknown and this critical issue was addressed in the present study. A total of 280 patients with secundum ASD who underwent transcatheter ASD closure were recruited and divided into groups A and B depending on ASD superior-anterior rim>4 mm (n?=?118) or ?4 mm (n?=?162). TTE was used to guide Amplatzer-type septal occluder (ASO) positioning and assess residual shunt. Procedure success was defined as no, trivial and small residual shunt immediately after the procedure as assessed by color Doppler flow imaging. Group A and group B did not differ in complication rate (8.55% vs.7.55%), procedure success rate (98.3% vs. 95.0%) or complete closure rate immediately after the procedure (89.7% vs. 89.3%) or at 6-month follow-up (98.3% vs. 96.8%). The mean procedure and fluoroscopy time in group B were much longer than those in group A. In conclusion, the absence of a sufficient superior-anterior rim in patients undergoing percutaneous closure of secundum-type ASDs using fluoroscopic and TTE guidance is associated with slightly greater device malposition and migration as well as increased procedural and fluoroscopic times, but the overall complication rate did not differ with TTE guidance when compared to historical controls that used TEE guidance. PMID:23284660

Li, Gui-Shuang; Li, Hai-De; Yang, Jie; Zhang, Wen-Quan; Hou, Zong-Shen; Li, Qing-Chen; Zhang, Yun

2012-01-01

312

Effect of scanline orientation on ventricular flow propagation: assessment using high frame-rate color Doppler echocardiography  

NASA Technical Reports Server (NTRS)

Color M-mode echocardiography has recently been utilized to describe diastolic flow propagation velocity (Vp) in the left ventricle. While increasing temporal resolution from 15 to 200 Hz, this M-mode technique requires the user to select a single scanline, potentially limiting quantification of Vp due to the complex three-dimensional inflow pattern. We previously performed computational fluid dynamics simulations to demonstrate the insignificance of the scanline orientation, however geometric complexity was limited. The purpose of this study was to utilize high frame-rate 2D color Doppler images to investigate the importance of scanline selection in patients for the quantification of Vp. 2D color Doppler images were digitally acquired at 50 frames/s in 6 subjects from the apical 4-chamber window (System 5, GE/Vingmed, Milwaukee, WI). Vp was determined for a set of scanlines positioned through 5 locations across the mitral annulus (from the anterior to posterior mitral annulus). An analysis of variance was performed to examine the differences in Vp as a function of scanline position. Vp was not effected by scanline position in sampled locations from the center of the mitral valve towards the posterior annulus. Although not statistically significant, there was a trend to slower propagation velocities on the anterior side of the valve (60.8 +/- 16.7 vs. 54.4 +/- 13.6 cm/s). This study clinically validates our previous numerical experiment showing that Vp is insensitive to small perturbations of the scanline through the mitral valve. However, further investigation is necessary to examine the impact of ventricular geometry in pathologies including dilated cardiomyopathy.

Greenberg, N. L.; Castro, P. L.; Drinko, J.; Garcia, M. J.; Thomas, J. D.

2000-01-01

313

Quantification of congenital aortic valve stenosis in pediatric patients: comparison between cardiac magnetic resonance imaging and transthoracic echocardiography.  

PubMed

Previous studies showed the reliability of cardiac magnetic resonance imaging (cMRI) in the quantification of aortic valve stenosis in adults. The aim of this retrospective study was to assess the ability of cMRI in the quantification of congenital aortic valve stenosis (CAS) in children. Nineteen patients (mean age 14.0 ± 3.2 years, 15 boys and 4 girls) with CAS were imaged by cMRI and transthoracic echocardiography (TTE). cMRI was performed on a 1.5-Tesla MR scanner (Magnetom Avanto; Siemens Healthcare, Erlangen, Germany) using cine steady-state free precession sequences for the assessment of the aortic valve area (AVA) by MR planimetry and left-ventricular function. Phase-contrast measurement was used in cMRI to assess peak flow velocity above the aortic valve. A positive correlation was found between maximum systolic pressure gradient (MPG) as assessed by cMRI and TTE (28.9 ± 21.2 vs. 41.3 ± 22.7 mmHg, r = 0.84, p = 0.001) with a mean underestimation of 12.4 mmHg by cMRI. Only a weak correlation could be observed between AVA by cMRI and MPG at the aortic valve by TTE (r = -0.50, p = 0.029) and cMRI (r = -0.27, p = 0.40). Furthermore, a positive correlation between myocardial mass (cMRI) and MPG (TTE, r = 0.57, p = 0.01), but not between myocardial mass (cMRI) and AVA (cMRI, r = 0.07, p = 0.77), was found. The assessment of MPG by cMRI in patients with CAS is feasible with a trend toward underestimatation compared with TTE. Moreover, MPG seems to be a more accurate parameter than AVA regarding the prediction of myocardial hypertrophy. PMID:24343730

Sirin, Selma; Nassenstein, Kai; Neudorf, Ulrich; Jensen, Christoph J; Mikat, Christian; Schlosser, Thomas

2014-06-01

314

Two-Dimensional Echocardiography in the Assessment of Long-Term Prognosis in Patients with Pulmonary Arterial Hypertension  

PubMed Central

Objective To investigate the relationship between cardiac diastolic dysfunction and outcomes in patients with pulmonary arterial hypertension (PAH) and to clarify the potential effect of two-dimensional echocardiography (2D-echo) on prognostic value in patients with PAH. Methods Patients diagnosed with PAH (as WSPH (World Symposia on Pulmonary Hypertension) classification I) confirmed by right heart catheterization (RHC), received targeted monotherapy or combination therapy. 2D-echo parameters, World Health Organization (WHO) functional classification and 6-minute walking distance (6MWD) were recorded. The clinical prognosis of patients was assessed by the correlation between echo parameters and clinical 6MWD using receiver operating characteristic (ROC) curve analysis. Results Fifty-eight patients were included. Left and right ventricular diastolic dysfunction (LVDD and RVDD) scores measured by 2D-echo had good correlation with 6MWD at baseline (rLVDD ?=??0.699; rRVDD ?=??0.818, both P<0.001) and at last follow-up (rLVDD ?=??0.701; rRVDD ?=??0.666, both P<0.001). Furthermore, bi-ventricular (LVDD+RVDD) scores measured by 2D-echo had a better correlation with 6MWD at baseline and last follow-up (r?=??0.831; r?=??0.771, both P<0.001). ROC curve analysis showed that the area under curves (AUCs) for LVDD score, RVDD score and (LVDD+RVDD) scores were 0.823 (P<0.0001), 0.737 (P?=?0.0002), and 0.825 (P<0.0001), respectively. Compared with ROC analysis of other single parameters, cardiac diastolic function score was more accurate in predicting survival in patients with PAH. Conclusion LVDD score, RVDD score and (LVDD+RVDD) scores yielded a comprehensive quantitative assessment of LV and RV diastolic function that correlated moderately with clinical functional parameters and might be useful in the assessment of PAH. PMID:25485890

Sun, Ling-yue; Zhao, Hang; Kang, Yu; Shen, Xue-dong; Cai, Zong-ye; Shen, Jie-yan; He, Ben; Yang, Cheng-de

2014-01-01

315

Key role of Doppler echocardiography in the emergency management of elderly patients.  

PubMed

Owing to modern epidemiology in Western countries, ageing represents a growing health burden. In general, because of age itself and comorbid conditions, all clinical cardiovascular manifestations have a higher mortality rate and a worse outcome in older people compared with in younger individuals. Diagnosis of the disease in the elderly in an emergency setting is particularly challenging for the practitioner. Age-related cardiovascular changes and comorbid conditions may alter signs, symptoms and adaptation to the disease and response to treatment. Bedside Doppler echocardiography is likely to play a major role in guiding diagnosis, therapeutic strategies and prognosis. The purpose of this review is to appraise the application of echocardiographic examination in helping the clinician facing emergency situations that involve the cardiovascular system in the older population. PMID:20226431

Ennezat, Pierre Vladimir; Logeart, Damien; Berrebi, Alain; Vincentelli, André; Maréchaux, Sylvestre

2010-02-01

316

Prognostic significance of predischarge 2D-echocardiography after first transmural myocardial infarction.  

PubMed

Predischarge two dimensional echocardiography (2D Echo) was performed in 45 survivors of first transmural myocardial infarction to assess its value in predicting major cardiac complications (MCC) during convalescence. Wall motion score was derived for each patient by analysing endocardial motion in 11 left ventricular segments. In 18 months follow up 11 of 14 patients (78%) who had major cardiac complications had wall motion score of at least 5. Wall motion score of less than 5 was present in 29 of the 31 (94%) of patients in asymptomatic group. Non-invasively obtained wall motion score helps in risk stratification of survivors of AMI. Wall motion score at predischarge 2D Echo or more identifies high risk cases from a relatively asymptomatic group (Killip Class I & II). PMID:2632534

Kumbla, D K; Parikh, J A; Shah, V K; Gandhi, M J

1989-11-01

317

[Automation of ambulatory Doppler color echocardiography using a relational data base in a personal computer].  

PubMed

Office automation in echocardiography is necessary linked to the need of speeding up the reporting which is generally done, to date, in a subsequent phase and it is time consuming With the present work we suggest a software made with the dBASE III Plus applied package, on a PS/2 IBM computer which makes it possible to quickly calculate the bodily surface and at the same time having instantaneous presentation of the normality ranges of the cardiac structures, of the myocardiac kinesis and the Doppler-color appraisal of valvular flows. The speed of reporting is greatly increased and all the data taken make up a database standardized for future statistical elaborations, besides providing an electronic file of echocardiographical reports. PMID:2342642

Ballerini, P; Corti, E; Ariotti, G; Leccardi, E; Allosia, G; Bertoglio, C; Rubin, M; Leggiardi, E

1990-01-01

318

Transoesophageal cross-sectional echocardiography with a phased array transducer system. Technique and initial clinical results.  

PubMed Central

Cardiac imaging by transthoracic two dimensional echocardiography is impaired in patients with chronic lung disease, those with obesity, and those with abnormal chest wall configuration. In order to overcome these limitations, a miniature phased array ultrasound transducer fitted to the tip of a commercially available gastroscope was developed. Transducer position and orientation can be adjusted completely by external control of vertical displacement inside the oesophagus, rotation, and angulation. Introduction and operation of the transducer gastroscope system are usually well tolerated by the patients, since no mechanical vibrations are generated and there is no need for an oil bag to secure oesophageal wall contact. Cardiac images of high quality are obtained even from structures and regions that are poorly or not at all imaged from external transducer positions. Images PMID:7082516

Schlüter, M; Langenstein, B A; Polster, J; Kremer, P; Souquet, J; Engel, S; Hanrath, P

1982-01-01

319

A proposed method to visualize the ductus arteriosus on transesophageal echocardiography.  

PubMed

The ductus arteriosus occupies a uniquely privileged position in the management of heart disease; it initiated not only the surgical management of congenital lesions but also the percutaneous management of this subset. During trans-thoracic echocardiography (TTE) the ductus is often visualized using 'high' parasternal (or the 'ductal' view) or suprasternal windows. It is generally agreed that imaging ductus during transesophageal echo (TEE) can be sub-optimal. During TEE imaging, visualization of the ductus arteriosus is obscured by the acoustic impedance offered by the left main bronchus; adjunct techniques such as insertion of a saline filled balloon in this airway have been used. We describe a simple maneuver that allows visualization of the patent ductus arteriosus during TEE imaging without the use of any adjuncts. PMID:25281628

Gogia, Raviraj; Kumar, Bhupesh; Jayant, Aveek

2014-01-01

320

Transoesophageal echocardiography for monitoring liver surgery: data from a pilot study.  

PubMed

A pilot study aimed to introduce intraoperative monitoring of liver surgery using transoesophageal echocardiography (TEE) is described. A set of TEE measurements was established as a protocol, consisting of left atrial (LA) dimension at the aortic valve plane; mitral velocity flow integral, calculation of stroke volume and cardiac output (CO); mitral annular plane systolic excursion; finally, right atrial area. A total of 165 measurements (on 21 patients) were performed, 31 occurring during hypotension. The conclusions reached were during acute blood loss LA dimension changed earlier than CVP, and, in one patient, a dynamic left ventricular (LV) obstruction was observed; in 3 patients a transient LV systolic dysfunction was documented. The comparison between 39 CO paired measurements obtained by TEE and PiCCO2 revealed a statistically significant correlation (P < 0.001, r = 0.83). In this pilot study TEE successfully answered the questions raised by the anesthesiologists. Larger cohort studies are needed to address this issue. PMID:22611514

Pissarra, Filipe; Oliveira, Antonio; Marcelino, Paulo

2012-01-01

321

Midterm follow-up dynamic echocardiography evaluation after aortic valve repair for aortic valve insufficiency  

PubMed Central

We prospectively evaluated 46 patients who underwent aortic valve repair (AVR) for AV regurgitation. Rest/stress echocardiography follow-up was performed. Follow-up duration was 30.7 months, age 56 ± 14 years, ejection fraction% 57.5 ± 10.5%. Preoperative bicuspid AV was present in 14 (30.4%), leaflets calcifications in 8 (17.4%), thickening in 17 (37.0%) and prolapse in 22 (47.8%). Surgical technique included commissuroplasty (22, 47.8%), leaflet remodelling (17, 37.0%), decalcification (7, 15.2%) and raphe removal (14, 30.4%). At follow-up, rest/stress echocardiography median AV regurgitation (rest 1.0 vs. stress 1.0) and mean indexed AV area (IAVA) (rest 2.6 ± 0.74 cm2/m2 vs. stress 2.8 ± 0.4 cm2/m2) were unchanged (P = ns). Mean (rest 4.7 ± 3.9 mmHg vs. stress 9.7 ± 5.8 mmHg) and peak (rest 9.5 ± 7.2 mmHg vs. stress 19.0 ± 10.5 mmHg) transvalvular gradients were significantly increased (P < 0.0001). At linear regression, there was an independent inverse correlation between commissuroplasty and AV gradients during stress (B = ?9.9, P = 0.01, confidence interval= ?17.7 to ?2.1). Although follow-up haemodynamics of repaired AVs are satisfactory, there was a fixed IAVA and significant increase in AV gradients. We were not able to identify any pre-existing anatomical condition independently related to this non-physiological behaviour under stress. Moreover, commissuroplasty seems to prevent abnormal increase of the AV gradients. PMID:22368109

D'Ancona, Giuseppe; Amaducci, Andrea; Prodromo, John; Pirone, Francesco; Follis, Marco; Falletta, Calogero; Pilato, Michele

2012-01-01

322

Cocaine-Induced Vasoconstriction in the Human Coronary Microcirculation: New Evidence from Myocardial Contrast Echocardiography  

PubMed Central

Background Cocaine is a major cause of acute coronary syndrome (ACS), especially in young adults; however, the mechanistic underpinning of cocaine-induced ACS remains limited. Previous studies in animals and in patients undergoing cardiac catheterization suggest that cocaine constricts coronary microvessels, yet direct evidence is lacking. Methods and Results We used myocardial contrast echocardiography (MCE) to test the hypothesis that cocaine causes vasoconstriction in the human coronary microcirculation. Measurements were performed at baseline and after a low non-intoxicating dose of intranasal cocaine (2 mg/kg) in 10 healthy cocaine-naïve young men (median age 32 years). Post-destruction time-intensity MCE kinetic data were fit to the equation: y = A(1-e- ? t) to quantify functional capillary blood volume (A), microvascular flow velocity (?), and myocardial perfusion (A × ?). Heart rate (HR), mean arterial pressure (MAP), and LV work (two-dimensional echocardiography) were measured before and 45 minutes after cocaine. Cocaine increased MAP (+14±2 mmHg; mean ± SE), HR (+8±3 beats/min), and LV work (+50±18 mmHg·mL-1·bpm-1). Despite increasing these determinants of myocardial oxygen demand, myocardial perfusion decreased by 30% (103.7±9.8 to 75.9±10.8 a.u/s, p<0.01) due mainly to decreased capillary blood volume (133.9±5.1 to 111.7±7.7 a.u., p<.05) with no significant change in microvascular flow velocity (0.8±0.1 to 0.7±0.1 a.u.). Conclusions In healthy cocaine-naïve young adults, a low-dose cocaine challenge evokes a sizeable decrease in myocardial perfusion. Moreover, the predominant effect is to decrease myocardial capillary blood volume rather than microvascular flow velocity, suggesting a specific action of cocaine to constrict terminal feed arteries. PMID:23812179

Gurudevan, Swaminatha V.; Nelson, Michael D.; Rader, Florian; Tang, Xiu; Lewis, Joshua; Johannes, Jimmy; Belcik, J. Todd; Elashoff, Robert M.; Lindner, Jonathan R.; Victor, Ronald G.

2013-01-01

323

The Value of Assessing Myocardial Deformation at Recovery after Dobutamine Stress Echocardiography  

PubMed Central

Background The purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort. Methods DSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 µg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a ? 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group]. Results There were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 ± 3.4% vs. -21.0 ± 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%). Conclusion Assessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD. PMID:25309689

Hwang, Hui-Jeong; Lee, Hyae-Min; Yang, In-Ho; Lee, Jung Lok; Pak, Hyun Young; Park, Chang-Bum; Jin, Eun-Sun; Cho, Jin-Man; Kim, Chong-Jin

2014-01-01

324

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction  

PubMed Central

OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for near-normal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a management strategy. PMID:17985005

Schnell, Gregory B; Kryski, Albert J; Mann, Luana; Anderson, Todd J; Belenkie, Israel

2007-01-01

325

Planning a Successful Tech Show  

ERIC Educational Resources Information Center

Tech shows are a great way to introduce prospective students, parents, and local business and industry to a technology and engineering or career and technical education program. In addition to showcasing instructional programs, a tech show allows students to demonstrate their professionalism and skills, practice public presentations, and interact…

Nikirk, Martin

2011-01-01

326

Definitions for a Common Standard for 2D Speckle Tracking Echocardiography: Consensus Document of the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging.  

PubMed

Recognizing the critical need for standardization in strain imaging, in 2010, the European Association of Echocardiography (now the European Association of Cardiovascular Imaging, EACVI) and the American Society of Echocardiography (ASE) invited technical representatives from all interested vendors to participate in a concerted effort to reduce intervendor variability of strain measurement. As an initial product of the work of the EACVI/ASE/Industry initiative to standardize deformation imaging, we prepared this technical document which is intended to provide definitions, names, abbreviations, formulas, and procedures for calculation of physical quantities derived from speckle tracking echocardiography and thus create a common standard. PMID:25623220

Voigt, Jens-Uwe; Pedrizzetti, Gianni; Lysyansky, Peter; Marwick, Tom H; Houle, Hélène; Baumann, Rolf; Pedri, Stefano; Ito, Yasuhiro; Abe, Yasuhiko; Metz, Stephen; Song, Joo Hyun; Hamilton, Jamie; Sengupta, Partho P; Kolias, Theodore J; d'Hooge, Jan; Aurigemma, Gerard P; Thomas, James D; Badano, Luigi Paolo

2015-02-01

327

The Maths File Game Show  

NSDL National Science Digital Library

The British Broadcasting Corporation offers this great collection of fun, educational games that help children learn basic concepts of mathematics. Twelve interactive games are available in all, illustrating principles of data handling, numbers, algebra, and measurement. Children can practice interpreting Cartesian coordinates by guiding a space ship across a grid, or compete with an animated character in a test of fractions and percentages. In addition to the online games, several other activities are presented in one-page documents for easy printing.

2007-12-12

328

Successful treatment of severe heart failure in an infant with Hurler syndrome.  

PubMed

Hurler syndrome (MPS IH) is the most severe form of mucopolysaccharidosis type I. It is caused by deficiency or absence of the enzyme alpha-L-iduronidase. Cardiac involvement includes cardiomyopathy and valve and coronary pathology. Cardiomyopathy causing symptoms in an infant with MPS IH carries a very poor prognosis. We describe a previously healthy 10-week-old boy who was admitted to hospital critically ill with severe heart failure. Echocardiography on admission showed severe dilatation of the left ventricle and moderate insufficiency of the left-sided cardiac valves. Accumulation of heparan sulfate and dermatan sulfate substrates in the urine and leukocyte analysis confirmed the diagnosis of MPS IH. Enzyme replacement therapy (ERT) with intravenous laronidase at a standard dosage of 100 U/kg weekly was started soon after. This improved the child's general clinical wellbeing dramatically. His cardiac function improved steadily over a period of months. Stem cell transplantation from cord blood is not available in Norway and he underwent successful transplantation from an unrelated bone marrow donor at the age of 11 months. ERT was stopped four months later. At the age of 26 months his heart function is close to normal and he is currently on no medication. This report highlights three important clinical issues: (1) MPS IH must be considered in infants with cardiomyopathy; (2) early ERT may have a significant impact on short-term outcome in children less than 18 months old with severe cardiomyopathy; (3) our report confirms that patients in poor condition benefit from ERT before stem cell transplantation. PMID:17768668

Hirth, A; Berg, A; Greve, G

2007-10-01

329

Using Graphs to Show Connections  

NSDL National Science Digital Library

The purpose of this resource is to show how graphs of GLOBE data over time show the interconnectedness of Earth's system components at the local level. Students visit a study site, where they observe and recall their existing knowledge of air, water, soil, and living things to make a list of interconnections among the four Earth system components. They make predictions about the effects of a change in a system, inferring ways these changes affect the characteristics of other related components.

The GLOBE Program, University Corporation for Atmospheric Research (UCAR)

2003-08-01

330

Comparison of left ventricular functional parameters measured by gated single photon emission tomography and by two-dimensional echocardiography.  

PubMed

The aim of the present study was to evaluate the correlation amongst left ventricular (LV) functional parameters estimated by gated single photon emission tomography (GSPET) and two-dimensional (2D) M-mode, echocardiography (ECHOC). GSPET was performed in a single day stress/rest protocol by using either technetium-99m methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) or technetium-99m tetrofosmin ((99m)Tc-myoview) in 36 consecutive patients, 21 males and 15 females; mean age 57.6+/-11.8 y, range 32-82 y. The various LV parameters studied were: ejection fraction (EF), end systolic volume (ESV), end diastolic volume (EDV), stroke volume (SV) and LV mass (LVM). The GSPET data were reconstructed using an automatic algorithm employing filtered back projection (FBP) and further analyzed by Emory cardiac (EC) toolbox versions EO-00369 and EO-00733 for the quantitative determinations of these parameters. All patients underwent ECHOC within 1-2 h of the post-stress data acquisition of GSPET. Our results showed that the LV volumes and the LVM showed good correlation (r=0.749 to 0.952, P=0.01). These values could thus be used interchangeably. The assessment of these parameters by GSPET therefore does not seem to be affected by the dose of the radioactivity administered as the dose of the (99m)Tc-labeled myocardial agents for acquiring rest study was approximately four times higher than that for the stress study. Our results also showed that the mean +/- SD values of the volumes and the EF of the LV evaluated by the two techniques, differed significantly except significant correlations for ESV, EDV and LVEF were observed between the two methods: r=0.574 to 0.954; 0.347 to 0.952 and 0.516 to 0.876 respectively. On the other hand, a wide disagreement was observed in estimating the LVM by the two techniques. The LVM measurements by 2D ECHOC were approximately double the values estimated by GSPET. Despite the large disagreement, a small correlation (r=0.33, P=0.05) was observed for LVM between the two techniques. In conclusion, although we observed a good correlation for LV volumes and LVM between the GSPET and the ECHOC techniques, yet these two techniques cannot be used interchangeably. PMID:16894412

Singh, Baljinder; Manoj, Rohit; Vikas, Prasad; Bhattacharya, Anish; Sharma, Yashpaul; Mittal, Bhagwant Rai

2006-01-01

331

Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect  

PubMed Central

Background This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD). Methods 12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.2 kg) after surgical closure of VSD were included in the study. The data sets were analysed as two-dimensional (2D) images on the screen of the ultrasound system as well as holograms in an I-space virtual reality (VR) system. The 2D images were assessed for tricuspid valve function. In the I-Space, a 6 degrees-of-freedom controller was used to create the necessary projectory positions and cutting planes in the hologram. The holograms were used for additional assessment of tricuspid valve leaflet mobility. Results All data sets could be used for 2D as well as holographic analysis. In all data sets the area of interest could be identified. The 2D analysis showed no tricuspid valve stenosis or regurgitation. Leaflet mobility was considered normal. In the virtual reality of the I-Space, all data sets allowed to assess the tricuspid leaflet level in a single holographic representation. In 3 holograms the septal leaflet showed restricted mobility that was not appreciated in the 2D echocardiogram. In 4 data sets the posterior leaflet and the tricuspid papillary apparatus were not completely included. Conclusion This report shows that dynamic holographic imaging of intraoperative postoperative echocardiographic data regarding tricuspid valve function after VSD closure is feasible. Holographic analysis allows for additional tricuspid valve leaflet mobility analysis. The large size of the probe, in relation to small size of the patient, may preclude a complete data set. At the moment the requirement of an I-Space VR system limits the applicability in virtual reality 3D echocardiography in clinical practice. PMID:17306019

Bol Raap, Goris; Koning, Anton HJ; Scohy, Thierry V; ten Harkel, A Derk-Jan; Meijboom, Folkert J; Kappetein, A Pieter; van der Spek, Peter J; Bogers, Ad JJC

2007-01-01

332

Map showing of UT's Main,  

E-print Network

$ $ Map showing locations of UT's Main, Scott Park, and Health Science Campuses Student Parking HEALTH SCIENCE CAMPUS GLENDALE BANCROFT NEBRASKA DETROIT FERI A NG BUILDING DIRECTORY AC Scott Park..........................................WBReceiving..........................................WB Minority Business Development Ctr....FAMinority Business Development Ctr....FA NorthwestNorthwest State

Viola, Ronald

333

The OOPSLA trivia show (TOOTS)  

Microsoft Academic Search

OOPSLA has a longstanding tradition of being a forum for discussing the cutting edge of technology in a fun and participatory environment. The type of events sponsored by OOPSLA sometimes border on the unconventional. This event represents an atypical panel that conforms to the concept of a game show that is focused on questions and answers related to OOPSLA themes.

Jeff Gray; Douglas C. Schmidt

2009-01-01

334

Diarrheal Disease in Show Swine  

E-print Network

or short-term diarrhea followed by systemic or blood stream infection. E-439 3-07 *Visiting Professor, Swine Practice, College of Veterinary Medicine and Biomedical Sciences, The Texas A&M University System. Diarrheal Disease in Show Swine Bruce Lawhorn...

Lawhorn, D. Bruce

2007-02-27

335

Browse the archive Show summaries  

E-print Network

for consumers? www.fightthepowergrab.o Slide Shows for Physics MathType for science and math presentations that a "fast ignition" laser facility could make a significant contribution to fusion research, as well than magnets to confine the plasma, will be investigated by the National Ignition Facility (NIF

336

Determination of left ventricular volume, ejection fraction, and myocardial mass by real-time three-dimensional echocardiography  

NASA Technical Reports Server (NTRS)

Reconstructed three-dimensional (3-D) echocardiography is an accurate and reproducible method of assessing left ventricular (LV) functions. However, it has limitations for clinical study due to the requirement of complex computer and echocardiographic analysis systems, electrocardiographic/respiratory gating, and prolonged imaging times. Real-time 3-D echocardiography has a major advantage of conveniently visualizing the entire cardiac anatomy in three dimensions and of potentially accurately quantifying LV volumes, ejection fractions, and myocardial mass in patients even in the presence of an LV aneurysm. Although the image quality of the current real-time 3-D echocardiographic methods is not optimal, its widespread clinical application is possible because of the convenient and fast image acquisition. We review real-time 3-D echocardiographic image acquisition and quantitative analysis for the evaluation of LV function and LV mass.

Qin, J. X.; Shiota, T.; Thomas, J. D.

2000-01-01

337

Use of a mouth gag instrument to facilitate bite block insertion and prevent finger and probe bites during transesophageal echocardiography.  

PubMed

Transesophageal echocardiography greatly enhances the examination of patients difficult to image transthoracically. While of low patient risk, a potential for harm from human bites to the echocardiography staff and to the transesophageal probe remains, particularly when dealing with uncooperative patients. This risk potential prompted implementation of additional anti-bite protection in our universal precautions policy beyond use of a standard mouth guard. A mouth gag instrument was modified by placing latex rubber tubing over the instrument blades. This instrument was inserted into the mouth and set in an open position giving the operator safe access for probe and mouth bite guard insertion. This technique improved access to the patient's mouth and visualization of probe insertion without the mouth bite guard. The mouth gag instrument provided an insertion of the transesophageal probe in impaired or otherwise uncooperative patients, which was safer for the patient, laboratory staff, and the probe itself. PMID:10147789

Lighty, G W; Hare, C L; Kaplan, D S

1992-09-01

338

Usefulness of low-dose dobutamine stress echocardiography for evaluating reversibility of brain death–induced myocardial dysfunction  

Microsoft Academic Search

Many of the myocardial wall motion abnormalities in heart donors are reversible after transplantation, indicating that the presence of wall motion abnormalities should not automatically lead to the exclusion of donor hearts. The present study observes the natural course of brain death–induced myocardial dysfunction, and investigates whether low-dose dobutamine stress echocardiography could identify reversible myocardial dysfunction in brain-dead patients. We

Tatsuji Kono; Takuya Nishina; Hiroshi Morita; Yuzo Hirota; Keishiro Kawamura; Akira Fujiwara

1999-01-01

339

Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation  

Microsoft Academic Search

Aims Two-dimensional (2D)-strain derived from speckle-tracking is an alternative to tissue velocity imaging (TVI)-based strain. We compared their feasibility and accuracy in 150 patients undergoing dobu- tamine stress echocardiography (DSE) and coronary angiography. Methods and results 2D- and TVI-strain were obtained in three apical views at rest and peak stress. Peak systolic strain rate (SR), endsystolic strain (1end-sys), and peak

Lizelle Hanekom; Goo-Yeong Cho; Rodel Leano; Leanne Jeffriess; Thomas H. Marwick

2007-01-01

340

Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure  

Microsoft Academic Search

B-type natriuretic peptide (BNP) and early diastolic transmitral velocity\\/tissue Doppler mitral annular velocity (E\\/Ea) both estimate left ventricular filling pressure, but have not been compared in the diagnosis of congestive heart failure (CHF). One hundred twenty-two hospital inpatients with suspected CHF underwent simultaneous clinical examination, BNP measurement, and comprehensive echo-Doppler examination. The accuracy of BNP and echocardiography was compared with

Hisham Dokainish; William A Zoghbi; Nasser M Lakkis; Miguel A Quinones; Sherif F Nagueh

2004-01-01

341

Simulation-based teaching versus point-of-care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study.  

PubMed

In recent years, the use of transoesophageal echocardiography has increased in anaesthesia and intensive care. We explored the impact of two different teaching methods on the ability of echocardiography-naïve subjects to identify cardiac anatomy associated with the 20 standard transoesophageal echocardiography imaging planes, and assessed trainees' satisfaction with these methods of training. Fifty-two subjects were randomly assigned to one of two groups: a simulation-based and a theatre-based teaching group. Subjects undertook video-based tests comprised of 20 multiple choice questions on echocardiography views before and after receiving echocardiography teaching. Subjects in simulation- and theatre-based teaching groups scored 40% (30-40 [20-50])% and 35% (30-40 [15-55])% in the pre-test, respectively (p = 0.52). Following echocardiography teaching, subjects within both groups improved upon their pre-test knowledge (p < 0.001). Subjects in the simulation-based teaching group significantly outperformed their theatre-based group counterparts in the post-intervention test (p = 0.0002). PMID:25308195

Ogilvie, E; Vlachou, A; Edsell, M; Fletcher, S N; Valencia, O; Meineri, M; Sharma, V

2015-03-01

342

[Evaluation of the size of the left-right shunt using pulse Doppler echocardiography in children--personal experience].  

PubMed

The purpose of the present study was to verify the value of a two-dimensional pulsed Doppler echocardiographic method for measurement of pulmonary (QP) and systemic blood flow (QS) in comparison with the radiocardiography in patients with ventricular and atrial septal defects. We reviewed 42 children with ventricular septal defect and 23 children with atrial septal defect. Two-dimensional echocardiography was employed to measure the diameter of the aorta and pulmonary artery and pulsed Doppler for measurement of pulmonary and systemic blood flow velocity in the pulmonary artery and left ventricular outflow tract. By comparing pulmonary and systemic blood flow ratios by pulsed Doppler echocardiography and radiocardiography, the correlation coefficient for children with atrial septal defect and those with ventricular septal defect respectively amounted to r = 0.71 and r = 0.81. The authors conclude that two-dimensional pulsed Doppler echocardiography, although a semiquantitative technique, appears to be a reliable non-invasive method for measuring pulmonary and systemic blood flow in patients with left-to-right sgunt. PMID:8170279

Kokos, Z; Fabeci?-Sabadi, V; Lukanovi?, T; Marki?evi?-Ruzici?, K

1993-01-01

343

Automatic computation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reduction.  

PubMed

Curve of left ventricular (LV) volume changes throughout the cardiac cycle is a fundamental parameter for clinical evaluation of various cardiovascular diseases. Currently, this evaluation is often performed manually which is tedious and time consuming and suffers from significant interobserver and intraobserver variability. This paper introduces a new automatic method, based on nonlinear dimensionality reduction (NLDR) for extracting the curve of the LV volume changes over a cardiac cycle from two-dimensional (2-D) echocardiography images. Isometric feature mapping (Isomap) is one of the most popular NLDR algorithms. In this study, a modified version of Isomap algorithm, where image to image distance metric is computed using nonrigid registration, is applied on 2-D echocardiography images of one cycle of heart. Using this approach, the nonlinear information of these images is embedded in a 2-D manifold and each image is characterized by a symbol on the constructed manifold. This new representation visualizes the relationship between these images based on LV volume changes and allows extracting the curve of the LV volume changes automatically. Our method in comparison to the traditional segmentation algorithms does not need any LV myocardial segmentation and tracking, particularly difficult in the echocardiography images. Moreover, a large data set under various diseases for training is not required. The results obtained by our method are quantitatively evaluated to those obtained manually by the highly experienced echocardiographer on ten healthy volunteers and six patients which depict the usefulness of the presented method. PMID:25059548

Alizadeh Sani, Zahra; Shalbaf, Ahmad; Behnam, Hamid; Shalbaf, Reza

2015-02-01

344

Clonidine changes lidocaine free concentrations in rat myocardium without affecting heart function measured by echocardiography.  

PubMed

Lidocaine is a local anaesthetic widely used in regional and epidural anaesthesia. Clonidine a alpha2-adrenergic agonist is an antihypertensive agent, regulating the production of catecholamines (epinephrine and norepinephrine) and added to local anesthetic infusions in order to improve postoperative analgesia. The aim of the study was to investigate the influence of clonidine co-administration on the binding of 14C lidocaine to rat serum and heart tissue protein as well as its pharmacodynamic effects in the heart. Four groups of Wistar rats (n=7) were used; Groups I and II received 4 mg/kg lidocaine i.m. Groups III and IV received lidocaine and 1 microg/kg clonidine i.m. In group I and III fifteen minutes and in groups II and IV thirty minutes after the initial treatment, ultrasound examination of heart function (heart rate, diameter of left ventricle in systole and diastole, ejection fraction) was performed. The animals were then sacrificed in all groups. Lidocaine free fraction in serum and heart was evaluated via ultrafiltration. The kinetics of lidocaine was altered by clonidine co-administration probably by mechanisms related to protein binding alterations. However, the pharmacokinetic interactions were not accompanied by changes of pharmacodynamic parameters including those of heart function as measured by echocardiography. PMID:20166443

Tigka, E; Kotsiou, A; Saranteas, T; Mourouzis, J; Kostopanagiotou, G; Tesseromatis, C

2009-01-01

345

Abnormal echocardiography 7 days after stem cell transplantation may be an early indicator of thrombotic microangiopathy.  

PubMed

Cardiac complications after hematopoietic stem cell transplantation (HSCT) can lead to significant morbidity and mortality. Cardiac evaluation during the first 100 days after HSCT is usually performed only if clinically indicated, and no studies have examined whether routine screening is beneficial in this patient population at high risk for tissue injury. We conducted a single-center prospective clinical study to screen for cardiac complications in pediatric and young adult patients. One hundred consecutive HSCT patients underwent scheduled echocardiographic screening on day +7 after transplantation, independent of their clinical condition. At least 1 abnormality was identified in 30% of cases. Seventeen children had a pericardial effusion, 13 elevated right ventricular pressure, and 3 reduced left ventricular function. Survival was reduced in children with any echocardiographic abnormality at day 7 (67% versus 80% in those with and without, respectively, abnormality, P = .073). Moreover, raised right ventricular pressure at day +7 was significantly associated with transplant-associated thrombotic microangiopathy (TA-TMA; P = .004) and may indicate early vascular injury in the lungs. These data suggest that echocardiography 7 days after HSCT can detect early cardiac complications of HSCT and may identify early vascular injury associated with TA-TMA. PMID:25300868

Dandoy, Christopher E; Davies, Stella M; Hirsch, Russel; Chima, Ranjit S; Paff, Zachary; Cash, Michelle; Ryan, Thomas D; Lane, Adam; El-Bietar, Javier; Myers, Kasiani C; Jodele, Sonata

2015-01-01

346

Feasibility of radial and circumferential strain analysis using 2D speckle tracking echocardiography in cats.  

PubMed

The purpose of the present study is to investigate the feasibility of strain analysis using speckle tracking echocardiography (STE) in cats and to evaluate STE variables in cats with hypertrophic cardiomyopathy (HCM). Sixteen clinically healthy cats and 17 cats with HCM were used. Radial and circumferential strain and strain rate variables in healthy cats were measured using STE to assess the feasibility. Comparisons of global strain and strain variables between healthy cats and cats with HCM were performed. Segmental assessments of left ventricle (LV) wall for strain and strain rate variables in cats with HCM were also performed. As a result, technically adequate images were obtained in 97.6% of the segments for STE analysis. Sedation using buprenorphine and acepromazine did not affect any global strain nor strain rate variable. In LV segments of cats with HCM, reduced segmental radial strain and strain rate variables had significantly related with segmental LV hypertrophy. It is concluded that STE analysis using short axis images of LV appeared to be clinically feasible in cats, having the possibility to be useful for detecting myocardial dysfunctions in cats with diseased heart. PMID:25373881

Takano, Hiroshi; Isogai, Tomomi; Aoki, Takuma; Wakao, Yoshito; Fujii, Yoko

2014-11-01

347

Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography  

NASA Technical Reports Server (NTRS)

Identification of thrombus-related mechanical prosthetic valve dysfunction (MPVD) has important therapeutic implications. We sought to develop an algorithm, combining clinical and echocardiographic parameters, for prediction of thrombus-related MPVD in a series of 53 patients (24 men, age 52 +/- 16 years) who had intraoperative diagnosis of thrombus or pannus from 1992 to 1997. Clinical and echocardiographic parameters were analyzed to identify predictors of thrombus and pannus. Prevalence of thrombus and diagnostic yields relative to the number of predictors were determined. There were 22 patients with thrombus, 19 patients with pannus, and 12 patients with both. Forty-two of 53 masses were visualized using transesophageal echocardiography (TEE), including 29 of 34 thrombi or both thrombi and panni and 13 of 19 isolated panni. Predictors of thrombus or mixed presentation include mobile mass (p = 0.009), attachment to occluder (p = 0.02), elevated gradients (p = 0.04), and an international normalized ratio of < or = 2.5 (p = 0.03). All 34 patients with thrombus or mixed presentation had > or = 1 predictor. The prevalence of thrombus in the presence of < or = 1, 2, and > or = 3 predictors is 14%, 69%, and 91%, respectively. Thus, TEE is sensitive in the identification of abnormal mass in the setting of MPVD. An algorithm based on clinical and transesophageal echocardiographic predictors may be useful to estimate the likelihood of thrombus in the setting of MPVD. In the presence of > or = 3 predictors, the probability of thrombus is high.

Lin, S. S.; Tiong, I. Y.; Asher, C. R.; Murphy, M. T.; Thomas, J. D.; Griffin, B. P.

2000-01-01

348

The use of laryngeal mask airway during transesophageal echocardiography in pediatric patients  

PubMed Central

Background: Transesophageal echocardiography (TEE) in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation (ET). This study was performed to investigate the safety and efficacy of using the laryngeal mask airway (LMA) as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE. Materials and Methods: A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA (LMA group) or ET (ET group). Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups. Results: There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group (P < 0.01). The mean recovery time was also significantly shorter in the LMA than in the ET group (44 ± 8 min and 59 ± 11 min, respectively; P < 0.001). Conclusion: The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE. PMID:25422606

Shafi Ahmed, Mohammed A.; Al-Ghamdi, Abdulmohsin A.; Mowafi, Hany A.; Al-Metwalli, Roshdy R.; Mousa, Wesam F.; Lardhi, Amer A.

2014-01-01

349

Two-dimensional echocardiography using a subcostal approach in patients with COPD.  

PubMed

The aim of this study was to examine whether two-dimensional echocardiography (2-DE) using a subcostal window can provide reliable parameters for the assessment of pulmonary artery hypertension (PAH) in patients with chronic obstructive pulmonary disease (COPD). Fifteen patients with steady state COPD (mean age 58.8 +/- 7.7) and PAH (MPAP 37.2 +/- 15.2 mm Hg) were compared with 15 healthy control subjects, (mean age 30.5 +/- 4.6). The 2-DE examination was performed with a sectorscanner from the subcostal approach. Measurements were made of the inner and maximal end-diastolic dimensions of the tricuspid annulus (TA), the short axis of the right ventricle (RV), and the free right ventricular anterior wall (AW). The TA X RV + AW/body surface area (mm/m2, 2D-index) was 378.3 +/- 47.6 in control subjects vs 871.2 +/- 314.5 in patients provided the closest correlation with MPAP (r 0.9055, p less than 0.001). We conclude that these 2-DE parameters can quantify the morphologic changes of the right heart in COPD with PAH and are useful in the assessment of PAH. PMID:4053714

Zenker, G; Forche, G; Harnoncourt, K

1985-11-01

350

[Risk classification of patients with acute myocardial infarct using two-dimensional echocardiography].  

PubMed

30 patients with acute myocardial infarction were examined by means of two-dimensional echocardiography, clinically classified according to Killip and the requisite CK peak level was determined. An echocardiographic score system was used to quantify the wall movement disturbances. The patients were subdivided into 3 groups according to clinical course during hospitalization (average 4 weeks) and these data correlated to Killip classification, CK peak level and echocardiographic score system determined on admission: Group 1 (9 patients with uncomplicated myocardial infarction), group 2 (11 patients with complicated posterior wall infarction), group 3 (10 patients with complicated anterior wall infarction). Cardiogenic shock, left ventricular pump failure, life-threatening arrhythmias and death were defined as complications. Mean value difference of the scores between group 1 and group 2 were significant (alpha less than 1%) and between group 1 and group 3 very significant (alpha less than 0.1%). With respect to CK, a significant difference existed between group 1 and group 2 and also between group 1 and group 3 (alpha less than 5%). Killip classification was specific, but very insensitive (64%). The echocardiographic score system is suitable for the prediction of in hospital course after myocardial infarction, and is superior to CK peak level determination. PMID:6666156

Zenker, G; Kandlhofer, B; Forche, G; Harnoncourt, K

1983-10-14

351

[The importance of fetal echocardiography in the detection and management of congenital cardiac malformations].  

PubMed

Using present-day high-resolution ultrasound scanners, it is possible to visualize and study the heart during the different stages of fetal growth in patients at risk of some forms of congenital heart disease. Detailed anatomical knowledge of cardiac structures combined with the accurate interpretation of echocardiographic images made during fetal development enable early diagnosis of particular forms of congenital disease that have serious pathophysiologic consequences. In addition, it also becomes possible to select the most appropriate nature and timing of delivery, and to organize early treatment for the newborn. Any decision taken on how to treat a fetus in which a congenital cardiac abnormality has been identified must be taken by a multidisciplinary team. This will help in coordinating the measures that must be taken after delivery and, in the near future, in implementing intrauterine surgery. Fetal echocardiography is establishing itself as a valuable tool in the management of the various types of congenital malformation, which together comprise the main cause of death among the newborn. In addition, the technique can be used to confirm and broaden our knowledge of the natural history of cardiac malformations, which are the most common congenital malformations. There is no doubt that the application and understanding of this imaging technology will increase the survival rate of newborns with specific congenital cardiac abnormalities, and will have a significant impact on long-term clinical outcome and quality of life in these patients. PMID:17178061

Finch, Ana D

2006-11-01

352

Integration of trans-esophageal echocardiography with magnetic tracking technology for cardiac interventions  

NASA Astrophysics Data System (ADS)

Trans-esophageal echocardiography (TEE) is a standard component of patient monitoring during most cardiac surgeries. In recent years magnetic tracking systems (MTS) have become sufficiently robust to function effectively in appropriately structured operating room environments. The ability to track a conventional multiplanar 2D TEE transducer in 3D space offers incredible potential by greatly expanding the cumulative field of view of cardiac anatomy beyond the limited field of view provided by 2D and 3D TEE technology. However, there is currently no TEE probe manufactured with MTS technology embedded in the transducer, which means sensors must be attached to the outer surface of the TEE. This leads to potential safety issues for patients, as well as potential damage to the sensor during procedures. This paper presents a standard 2D TEE probe fully integrated with MTS technology. The system is evaluated in an environment free of magnetic and electromagnetic disturbances, as well as a clinical operating room in the presence of a da Vinci robotic system. Our first integrated TEE device is currently being used in animal studies for virtual reality-enhanced ultrasound guidance of intracardiac surgeries, while the "second generation" TEE is in use in a clinical operating room as part of a project to measure perioperative heart shift and optimal port placement for robotic cardiac surgery. We demonstrate excellent system accuracy for both applications.

Moore, John T.; Wiles, Andrew D.; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Trejos, Ana Luisa; Patel, Rajni; Peters, Terry M.

2010-02-01

353

Noninvasive assessment of aortocoronary bypass graft patency using pulsed Doppler echocardiography.  

PubMed

To evaluate noninvasively aortocoronary bypass graft patency, pulsed Doppler echocardiography was performed at the time of postoperative coronary angiography in 120 consecutive patients. Ultrasonic examination of 163 vein grafts was possible. One hundred twenty-seven patent and 14 occluded grafts were correctly identified. Eleven patent grafts could not be recorded, and 11 occluded grafts were falsely diagnosed as patent. The method had an overall sensitivity of 92% and a specificity of 56%. This high sensitivity level may be increased to almost 100% by enhanced technical skill and experience. The low specificity level, although the method must be tested in a larger number of bypass grafts, stresses the importance of correctly identifying other sources of diastolic blood flow. Diastolic flows from the superior vena cava, internal mammary veins, tricuspid valve, mitral valve and right ventricle may be eliminated by careful adjustment of the depth, site and size of the pulsed Doppler electronic sampling gate. Standard echocardiographic landmarks for avoiding confusion with the coronary arteries are also described. PMID:310240

Diebold, B; Theroux, P; Bourassa, M G; Peronneau, P; Guermonprez, J L

1979-01-01

354

Psoriasis Severity: Mild, Moderate or Severe  

MedlinePLUS

... Symptoms and Diagnosis Types of Psoriasis Plaque Guttate Inverse Pustular Erythrodermic Specific Locations Plaque Guttate Inverse Pustular Erythrodermic Severity Triggers Plaque Guttate Inverse Pustular ...

355

[Noninvasive detection by Doppler and M-mode echocardiography of acute rejection reaction after heart transplantation: preliminary results of a prospective study].  

PubMed

Diagnosis of acute cardiac allograft rejection is still based on the results of endomyocardial biopsy. The objective of this study was to evaluate changes of left ventricular (LV) diastolic function associated with rejection using Doppler and M-mode echocardiography. The study patients, consisting of 29 cardiac allograft recipients (12 female, 17 male) aged 27 to 58 (mean 41) years, were classified into two groups on the basis of histopathologic findings: 13 patients without rejection (mean age 40 years) and 16 patients with moderate to severe allograft rejection (mean age 42 years) at myocardial biopsy. All patients underwent serial echocardiographic examination 4-10 weeks after transplantation and 8 +/- 2 days later on the day of myocardial biopsy. Twenty-five healthy volunteers (11 female, 14 male; mean age 39 years) served for assessing normal values. Echocardiographic assessment included peak velocity (PEV), pressure half-time (PHT), velocity-time integral (VTI-E) of early mitral flow (E-wave), and isovolumic relaxation period (IVRP). In transplant recipients, significantly higher values as compared to normals were found for PEV (72 vs 55 cm/s; p less than 0.01), PHT (51 vs 42 ms; p less than 0.001), VTI-E (71 vs 56 mm; p less than 0.001), and IVRP (91 vs 73 ms; p less than 0.001). During rejection, heart rate increased significantly from 78 to 93 beats/min (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2278168

Störk, T; Walkowiak, T; Siniawski, H; Danne, O; Müller, R; Möckel, M; Eichstädt, H; Hetzer, R; Hochrein, H

1990-11-01

356

Real-time transmission of full-motion echocardiography over a high-speed data network: impact of data rate and network quality of service  

NASA Technical Reports Server (NTRS)

With high-resolution network transmission required for telemedicine, education, and guided-image acquisition, the impact of errors and transmission rates on image quality needs evaluation. METHODS: We transmitted clinical echocardiograms from 2 National Aeronautics and Space Administration (NASA) research centers with the use of Motion Picture Expert Group-2 (MPEG-2) encoding and asynchronous transmission mode (ATM) network protocol over the NASA Research and Education Network. Data rates and network quality (cell losses [CLR], errors [CER], and delay variability [CVD]) were altered and image quality was judged. RESULTS: At speeds of 3 to 5 megabits per second (Mbps), digital images were superior to those on videotape; at 2 Mbps, images were equivalent. Increasing CLR caused occasional, brief pauses. Extreme CER and CDV increases still yielded high-quality images. CONCLUSIONS: Real-time echocardiographic acquisition, guidance, and transmission is feasible with the use of MPEG-2 and ATM with broadcast quality seen above 3 Mbps, even with severe network quality degradation. These techniques can be applied to telemedicine and used for planned echocardiography aboard the International Space Station.

Main, M. L.; Foltz, D.; Firstenberg, M. S.; Bobinsky, E.; Bailey, D.; Frantz, B.; Pleva, D.; Baldizzi, M.; Meyers, D. P.; Jones, K.; Spence, M. C.; Freeman, K.; Morehead, A.; Thomas, J. D.

2000-01-01

357

Acute Effects of an Energy Drink on Myocardial Function Assessed by Conventional Echo-Doppler Analysis and by Speckle Tracking Echocardiography on Young Healthy Subjects  

PubMed Central

Purpose. Previous studies have underlined the effects of the energy drinks containing caffeine end taurine on the cardiovascular system. The aim of this study was to determine acute changes on echocardiographic parameters assessed by conventional echo-Doppler analysis and by speckle tracking echocardiography after the consumption of an energy drink in a young healthy population. Methods. measurement of blood pressure, electrocardiographic, and echocardiographic examination were performed on 35 healthy subjects (mean age 25 ± 2 years, 16 men), at baseline and one hour after the consumption of a body surface area indexed amount of an energy drink (168?mL/m2) containing caffeine (0.03%) and taurine (0.4%). Results. The analysis of left ventricular function showed a significant increase of mean relative values of MAPSE (+11%; P < 0.001), global longitudinal strain (+10%, P = 0.004), and left ventricular twisting (+22%, P < 0.0001) in respect to baseline. Also, right ventricular function parameters appeared significantly increased after energy drink consumption, as TAPSE (+15%, P < 0.0001), global, and free wall right ventricular longitudinal strain (+8%, P = 0.001; +5%, P = 0.1, resp.). Conclusion. In conclusion, the consumption of the ED in our population showed a significant increase of right and left ventricular myocardial function, suggesting a possible positive inotropic effect related to the substances contained therein. PMID:24319592

Menci, Daniele; Righini, Francesca Maria; Cameli, Matteo; Lisi, Matteo; Benincasa, Susanna; Focardi, Marta; Mondillo, Sergio

2013-01-01

358

Using volume-time curves with real-time three-dimensional echocardiography to analyze right ventricular function in patients with pneumoconiosis.  

PubMed

We evaluated right ventricular function in patients with pneumoconiosis using real-time three-dimensional echocardiography (RT3DE). A total of 80 consecutive patients were prospectively recruited, 44 of whom were diagnosed with pneumoconiosis, and the remaining 36 age- and gender-matched healthy volunteers served as the control group. All patients underwent both 2D and 3DE. The tricuspid regurgitation pressure (TRPG), right ventricular anterior wall thickness and range of motion, right ventricular posterior wall thickness and range of motion, right ventricular end-diastolic volume, right ventricular end-systolic volume, and right ventricular ejection fraction (RVEF) were measured. The RVEF of healthy volunteers ranged from 50 to 78%, while the RVEF of pneumoconiosis patients ranged from 29 to 73%. TRPG influenced RVEF by 77.3% (P = 0.006) and showed a negative correlation (r = -0.643, P < 0.01). Volume-time curves (VTC) of patients with pneumoconiosis showed more troughs (low stroke volumes) than the VTCs of normal subjects. Evaluation of right ventricular function in patients with pneumoconiosis using RT3DE can provide additional clinical information. PMID:25501178

Wei, D M; Ding, Y; He, W

2014-01-01

359

Mimas Showing False Colors #1  

NASA Technical Reports Server (NTRS)

False color images of Saturn's moon, Mimas, reveal variation in either the composition or texture across its surface.

During its approach to Mimas on Aug. 2, 2005, the Cassini spacecraft narrow-angle camera obtained multi-spectral views of the moon from a range of 228,000 kilometers (142,500 miles).

The image at the left is a narrow angle clear-filter image, which was separately processed to enhance the contrast in brightness and sharpness of visible features. The image at the right is a color composite of narrow-angle ultraviolet, green, infrared and clear filter images, which have been specially processed to accentuate subtle changes in the spectral properties of Mimas' surface materials. To create this view, three color images (ultraviolet, green and infrared) were combined into a single black and white picture that isolates and maps regional color differences. This 'color map' was then superimposed over the clear-filter image at the left.

The combination of color map and brightness image shows how the color differences across the Mimas surface materials are tied to geological features. Shades of blue and violet in the image at the right are used to identify surface materials that are bluer in color and have a weaker infrared brightness than average Mimas materials, which are represented by green.

Herschel crater, a 140-kilometer-wide (88-mile) impact feature with a prominent central peak, is visible in the upper right of each image. The unusual bluer materials are seen to broadly surround Herschel crater. However, the bluer material is not uniformly distributed in and around the crater. Instead, it appears to be concentrated on the outside of the crater and more to the west than to the north or south. The origin of the color differences is not yet understood. It may represent ejecta material that was excavated from inside Mimas when the Herschel impact occurred. The bluer color of these materials may be caused by subtle differences in the surface composition or the sizes of grains making up the icy soil.

The images were obtained when the Cassini spacecraft was above 25 degrees south, 134 degrees west latitude and longitude. The Sun-Mimas-spacecraft angle was 45 degrees and north is at the top.

The Cassini-Huygens mission is a cooperative project of NASA, the European Space Agency and the Italian Space Agency. The Jet Propulsion Laboratory, a division of the California Institute of Technology in Pasadena, manages the mission for NASA's Science Mission Directorate, Washington, D.C. The Cassini orbiter and its two onboard cameras were designed, developed and assembled at JPL. The imaging operations center is based at the Space Science Institute in Boulder, Colo.

For more information about the Cassini-Huygens mission visit http://saturn.jpl.nasa.gov . The Cassini imaging team homepage is at http://ciclops.org .

2005-01-01

360

Human neural stem cell intracerebral grafts show spontaneous early neuronal differentiation after several weeks.  

PubMed

Human neural stem cells (hNSCs) hold great promise for the treatment of neurological diseases. Considerable progress has been made to induce neural differentiation in the cell culture in vitro and upon transplantation in vivo [2] in order to explore restoration of damaged neuronal circuits. However, in vivo conventional strategies are limited to post mortem analysis. Here, we apply our developed first fate mapping platform to monitor neuronal differentiation in vivo by magnetic resonance imaging, bioluminescence imaging, and fluorescence imaging. Ferritin, Luciferase and GFP under neuronal-specific promoters for immature and mature neurons, respectively, were used to generate transgenic hNSCs. Differentiation-linked imaging reporter expression was validated in vitro. The time profile of spontaneous neuronal maturation after transplantation into mouse brain cortex demonstrated early neuronal differentiation within 6 weeks. Fully mature neurons expressing synaptogenesis were observed only after three months or longer. Our trimodal fate mapping strategy represents a unique non-invasive tool to monitor the time course of neuronal differentiation of transplanted stem cells in vivo. PMID:25617134

Tennstaedt, Annette; Aswendt, Markus; Adamczak, Joanna; Collienne, Ursel; Selt, Marion; Schneider, Gabriele; Henn, Nadine; Schaefer, Cordula; Lagouge, Marie; Wiedermann, Dirk; Kloppenburg, Peter; Hoehn, Mathias

2015-03-01

361

Smokers Beware: Study Shows Increased Cadmium Levels in the Brain May Cause Severe Neurological Disorders  

ERIC Educational Resources Information Center

Tobacco is one crop that accumulates cadmium, making smokers susceptible to higher levels of the metal in their bodies. The findings suggest that even a low-level exposure to a heavy metal like cadmium is likely to cause a change in the functions of neurons in the brain and the behavioral response to drugs of abuse.

King, Angela G.

2005-01-01

362

Diagnostic Value of Electrocardiography Compared with Echocardiography in Measuring Left Ventricular Mass Index in Major Thalassemia Patients Over 10 Years of Age  

PubMed Central

Background: Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treated well, would be at risk of heart dysfunction. This study was performed to determine the diagnostic value of electrocardiography versus echocardiography in measuring the left ventricular mass index in these patients. Methods Between July 2010 and June 2011, 82 asymptomatic patients over 10 years of age with major thalassemia (42 men with a mean age of 17.65 ± 3.39 years and 40 women with a mean age of 16.9 ± 3.38 years) were enrolled in this study. For all the patients, standard electrocardiography (to measure R in aVL and S in V3 and calculate left ventricular mass index by electrocardiography) and echocardiography (to measure interventricular septum diameter in diastole, left ventricular posterior wall diameter in diastole, and left ventricular diameter in diastole in order to calculate left ventricular mass index by echocardiography) were performed, at least one week after transfusion. The calculated left ventricular mass indices were thereafter compared between the two methods (electrocardiography and echocardiography). Results: Sensitivity, specificity, positive predictive value, and negative predictive value in the two techniques in determining the left ventricular mass index were 67%, 25%, 89%, and 7% in the females, 65%, 33%, 92%, and 6% in the males, and 67%, 14%, 89%, and 3% in the total population, respectively. Furthermore, this study demonstrated that the average left ventricular mass index by echocardiography and electrocardiography was 104.86 ± 21.65 gr/m2 and 91.69 ± 12.03 gr/m2, respectively. Echocardiography was much more accurate than electrocardiography in determining the left ventricular mass index (p value = 0.0001). Conclusion: The findings of this study demonstrated that echocardiography was more accurate and more reliable than electrocardiography in determining the left ventricular mass index in major thalassemia patients. PMID:24396360

Noori, Noormohammad; Mahjoubifard, Maziar; Alavi, Seyed Mostafa; Hosseini, Saeid; Sanati, Hamidreza; Mirmesdagh, Yalda

2013-01-01

363

Development of Left Ventricular Longitudinal Speckle Tracking Echocardiography in Very Low Birth Weight Infants with and without Bronchopulmonary Dysplasia during the Neonatal Period  

PubMed Central

Objectives In preterm infants, postnatal myocardial adaptation may be complicated by bronchopulmonary dysplasia (BPD). We aimed to describe the development of left ventricular function by serial 2D, Doppler, and speckle tracking echocardiography (2D-STE) in infants with and without BPD during the neonatal period and compare these to anthropometric and conventional hemodynamic parameters. Study Design Prospective echocardiography on day of life (DOL) 1, 7, 14, and 28 in 119 preterm infants <1500 g birth weight of whom 36 developed BPD (need for oxygen supplementation at 36 weeks gestational age). Non-BPD and BPD infants differed significantly in median (IQR) gestational age (25.5(24–26.5) weeks vs. 29(27–30) weeks, p<0.001) and birth weight (661(552–871) g vs. 1100(890–1290) g, p<0.001). Results The intra- and inter-observer variability of the 2D-STE parameters measured did not depend on time of measurement, although there were significant differences in the reproducibility of the parameters. Low intra- and inter-observer variability was seen for longitudinal systolic strain and strain rate mid septum with a median CV (coefficient of variation) of <4.6%. Much higher CVs (>10%) were seen for the apical segment. While anthropometric parameters show rapid development during the first 4 weeks of life, the speckle tracking parameters did not differ statistically significantly during the neonatal period. Infants with and without BPD differed significantly (p<0.001) in the development of anthropometric parameters, conventional hemodynamic parameters except for heart rate, and 2D-STE parameters: global longitudinal systolic strain rate (GLSSR) and longitudinal systolic strain for the mid left wall (LSSR). The largest differences were seen at DOL 1 and 7 in GLSSR (p<0.001) and in LSSR (p<0.01). Conclusions Reproducible 2D-STE measurements are possible in preterm infants <1500 g. Cardiac deformation reveals early (DOL 1 and 7) ventricular changes (GLSSR and LSSR) in very low birth weight infants who develop BPD. PMID:25184634

Czernik, Christoph; Rhode, Stefanie; Helfer, Sven; Schmalisch, Gerd; Bührer, Christoph; Schmitz, Lothar

2014-01-01

364

[Quantitative evaluation and color display of echo intensity by two-dimensional echocardiography].  

PubMed

To assess myocardial tissue changes by two-dimensional echocardiography, quantitative evaluation and color display of the echo intensity were attempted using computerized image processing. The materials consisted of 11 patients with old anteroseptal myocardial infarction one year or more after the onset (OMI), and 12 normal subjects. Two-dimensional echocardiograms in the parasternal long-axis view were obtained using a commercially-available phased-array sector scanner. Scanner receiver settings including sensitivity-time control were maintained constant in all subjects. Images were recorded on the U-matic tape using a video tape recorder, then stop-frame end-diastolic images were converted to digital images. To measure echo intensity, regions of interest (ROI) were placed in the interventricular septum (IVS), the left ventricular posterior wall (LVPW), the left ventricular cavity, and the pericardium. The mean value of the echo intensities was determined for each ROI. Then, the relative echo intensity of the IVS or LVPW was calculated using the mean value of the pericardium as the maximum echo intensity, and the mean value of the left ventricular cavity as the minimum echo intensity. In normal subjects, the relative echo intensity of the IVS was 0.40 +/- 0.05 (mean +/- SE) and that of the LVPW was 0.31 +/- 0.02. By contrast, in patients with OMI, there was a significant increase (p less than 0.001) in the relative echo intensity of the IVS (0.71 +/- 0.06). The relative echo intensity of the LVPW was less than normal, but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3841900

Sakabe, Y; Hishida, H; Kawamura, K; Murashima, Y; Hagiwara, K; Sakai, Y; Miyagi, Y; Nomura, M; Mizuno, Y

1985-12-01

365

Estimation of shunt fraction by transesophageal echocardiography during one-lung ventilation.  

PubMed

As the blood flow volume in non-dependent lung composed the primary part of the intrapulmonary shunt during one-lung ventilation (OLV), the shunt fraction (SF) during OLV can be represented by the ratio of blood flow volume in non-dependent lung to the bilateral lung. The purpose of this study is to estimate the shunt in non-dependent lung by transesophageal echocardiography (TEE). Fifteen adult patients requiring OLV for thoracic surgery were enrolled in the study. The upper pulmonary venous flow pattern in bilateral lung and main pulmonary artery flow pattern were acquired respectively by TEE for their velocity time integral (VTI) measurements in following time intervals: before OLV (T0), 30 min after OLV (T30) and 60 min after OLV (T60). Simultaneously the arterial blood was sampled for gas analysis. SF was calculated by VTI of bilateral upper pulmonary veins, and percentage change of blood flow (BFP) was the ratio of upper pulmonary venous VTI between in OLV period and before OLV in non-dependent lung. There was significant decrease in PaO2 and increase in cardiac output after OLV. The pulmonary blood flow in non-dependent lung decreased significantly compared with T0, and SF was 37.1 ± 8.3 and 35.2 ± 7.2 % respectively at T30 and T60. There was significant liner correlation between SF and PaO2 (r = 0.717), and between BFP and PaO2 (r = 0.593). It is feasible to estimate intrapulmonary shunt by TEE in anesthetized patients undergoing OLV. SF measured by TEE has significant correlation with PaO2, and it would expected to be used to predict hypoxemia during OLV. PMID:25155453

Wang, Miao; Gong, Quan; Wei, Wei

2014-08-26

366

Impact of Transesophageal Echocardiography on Management in Patients With Suspected Cardioembolic Stroke.  

PubMed

Transesophageal echocardiography (TEE) is frequently performed in patients with acute ischemic cerebrovascular events to exclude a cardioembolic source. We aimed to determine the clinical impact of TEE on management. This is a retrospective single-center study of 1,458 consecutive patients hospitalized with acute ischemic stroke or transient ischemic attack who underwent TEE for evaluation of a suspected cardioembolic cause. Significant TEE findings were determined for each patient as recorded on the TEE report. The medical record was reviewed for baseline, clinical, and demographic variables and to determine whether significant management changes occurred as a result of the TEE findings. Potential significant changes in management included initiation of anticoagulation, placement of a patent foramen ovale (PFO) closure device, initiation of antibiotic therapy for endocarditis, surgical PFO closure, other cardiac surgery, and coil embolization of a pulmonary arteriovenous malformation. A significant change in management occurred in 243 patients (16.7%); 173 (71%) underwent treatment for PFO with a percutaneous PFO closure device (n = 100), initiation of chronic systemic anticoagulation (n = 68), or surgical PFO closure (n = 5). Additional findings leading to a change in management included endocarditis (n = 20), aortic arch atheroma (n = 14), intracardiac thrombus (n = 13), pulmonary arteriovenous malformation (n = 2), aortic valve fibroelastoma (n = 2), other valve masses (n = 4), and miscellaneous causes (n = 15). In conclusion, in patients with suspected cardioembolic stroke, TEE findings led to a change in management in 16.7% of patients. Of these, most (71%) were directed at prevention of subsequent paradoxical emboli in patients with PFO. PMID:25438921

Khariton, Yevgeniy; House, John A; Comer, Lynn; Coggins, Tina R; Magalski, Anthony; Skolnick, David G; Good, Thomas H; Main, Michael L

2014-12-15

367

Characteristics of Patent Foramen Ovale Associated with Cryptogenic Stroke: A Biplane Transesophageal Echocardiography Study  

NASA Technical Reports Server (NTRS)

Patent foramen ovale is associated with ischemic stroke in patients without a clearly identifiable etiology for stroke (cryptogenic stroke). Paradoxical embolization is thought to be a potential mechanism. However, patent foramen ovale is also found in patients with known cause of stroke. Therefore, using contrast transesophageal echocardiography, we characterized the patent foramen ovale in cryptogenic stroke patients to assess morphological factors that may contribute to paradoxical embolization. Methods: Contrast transesophageal echocardiographic studies of 74 consecutive patients referred for ischemic stroke were reviewed. Twenty-three patients with patent foramen ovale were identified. These patients were classified as having strokes of determined origin or cryptogenic strokes according to criteria developed for the Stroke Data Bank of the National Institute of Neurological Disorders and Stroke. Separation of septum primum from secundum and the number of microbubbles appearing in left atrium were then quantitated. These parameters were compared between patients with cryptogenic stroke and those with known cause of stroke. Results: The patent foramen ovale dimension was significantly larger in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (2.1+/-1.7 mm versus 057+/-0.78 mm [mean+/-SD]; P<.01). The number of microbubbles was also greater in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (13.9+/-10.7 versus 1.62+/-0.8 [mean+/-SD]; P<.0005). Conclusions: Patients with cryptogenic stroke have larger patent foramen ovale with more extensive right-to-left inter-atrial shunting than patients with stroke of determined cause. Transesophageal echocardiographically identifiable characteristics of patent foramen ovale may be important in defining the clinical significance of individual patent foramina.

Homma, S.; DiTullio, M. R.; Sacco, R. L.; Mihalatos, D..; LiMandri, G.; Mohr, J. P.

1994-01-01

368

Left Atrial Function by Speckle-Tracking Echocardiography in Chronic Asymptomatic Alcoholic Patients.  

PubMed

Although the effects of chronic alcoholism on left ventricular (LV) systolic function are well established, diastolic impairment has been evaluated partially. In addition, there are scarce data available about the relation of LV diastolic function to either or both duration and quantity of drinking among alcoholics. The aim of the study was to evaluate the left atrial (LA) function in chronic asymptomatic alcoholic patients by using two-dimensional speckle-tracking echocardiography (2D-STE). We enrolled 30 healthy subjects (age 34.8 ± 5.8 years) and 75 asymptomatic male alcoholics (age 39.8 ± 6.5 years) divided into two groups, according to total lifetime dose of ethanol: group I, <15 kg/kg and group II, ?15 kg/kg. In the 2D-STE analysis of the LA, strain during ventricular systole (LA-Res), during late diastole (LA-Pump) and strain rate during ventricular contraction (LA-SRs), during passive ventricular filling (LA-SRe), during active atrial contraction (LA-SRa) were obtained. Deceleration time was longer, E/A and V p were smaller, and E/E m was higher in alcoholics. Although parameters of diastolic dysfunction were comparable in alcoholic groups, LA-Res and LA-Pump were found significantly different among the alcoholics. However, there were no differences in LA-SRs and LA-SRe between the controls and alcoholic groups. LA function is reduced in chronic alcohol abuse, and heavy alcohol consumption may play an important role in LA function impairment. PMID:25245871

Kocabay, Gonenc; Karabay, Can Yucel; Kalayc?, Arzu; Oduncu, Vecih; Akgun, Taylan; Guler, Ahmet; K?l?cgedik, Alev; Kalkan, Sedat; Izgi, Akin; K?rma, Cevat

2014-09-23

369

Three-dimensional transesophageal echocardiography for descending aortic atheroma: a preliminary study.  

PubMed

Transesophageal echocardiography (TEE) is an efficient method for characterization of aortic atherosclerotic plaques (AAP). The aim of our study was to evaluate the feasibility and the additional contribution of three-dimensional (3D) TEE in the evaluation of AAPs in descending thoracic aorta. We studied 82 patients referred for TEE regardless of the indication. All patients underwent two-dimensional (2D) conventional acquisitions. A 3D TEE study was performed for all AAPs localized in the descending thoracic aorta. Thickness, degree of calcification, the presence of ulceration or mobile debris were compared for 2D and 3D modes. From 3D data, three types of AAPs were defined according to their morphological characteristics (surface and contours). Among 192 AAPs found on 2D acquisition, 189 (98.4 %) were also identified by 3D TEE. For AAP characterization, agreement was good between 2D TEE and 2D extracted from 3D with the multiplanar reconstruction mode: 83.6 % (k = 0.69) for thickness and 82.5 % (k = 0.72) for degree of calcification. All AAPs ulcerations (n = 13) and mobile debris (n = 3) seen in 2D were identified in 3D. 2D characteristics of the 3D AAPs' morphological types were different: type I plaques were thin and rarely calcified; type III plaques were thicker and often calcified; and type II presented intermediate characteristics. There was overlap among groups and the 3D morphology could not be predicted from 2D data. 3D TEE is a feasible method for the analysis of AAPs. In addition to conventional characterization, 3D TEE provides a new morphological approach to AAPs. PMID:25056253

Hammoudi, Nadjib; Ihaddaden, Malek; Lang, Sylvie; Laveau, Florent; Ederhy, Stephane; Michel, Pierre-Louis; Alamowitch, Sonia; Cohen, Ariel

2014-12-01

370

Adaptation of heart to training: A comparative study using echocardiography & impedance cardiography in male & female athletes  

PubMed Central

Background & objectives: Intensive regular physical exercise training is associated with a physiological changes in left ventricular (LV) morphology and functions. This cardiac remodeling observed in the athletes is associated with the specific haemodynamic requirements of the exercise undertaken. The main objective of this study is to evaluate the effect of endurance training on cardiac morphology, systolic and diastolic LV functions and haemodynamic parameters both in male and female athletes. Methods: Seventy nine healthy athletes (age 20.0 ± 2.6 yr; 49% male) and 82 healthy sedentary adolescent (age 20.8 ± 2.2 yr, 49% male) volunteered to participate in this study. All subjects underwent transthoracic echocardiography and impedance cardiography. Results: Both female and male athletes had greater LV end-diastolic cavity sizes, LV mass and stroke volume (SV) values when compared with controls. Also, in male athletes, LV mass index was higher than in female athletes. While male athletes had lower resting heart rate compared to female athletes, they had higher mean arterial blood pressure. In male athletes, basal septal and mid septal strain values were higher compared to controls. There were no significant differences in strain and peak systolic strain rate values between female athletes and controls. In male athletes, there was a weak positive correlation between SV and LV mass, basal lateral and septal strain values. In female athletes, only a weak positive correlation was found between SV and basal septal strain values. Interpretation & conclusions: Endurance-trained male and female athletes had higher LV mass, LV cavity dimensions and SV compared to sedentary controls. Although there was no difference in diastolic cardiac functions between athletes and controls, local enhanced systolic function was found with increase of SV. Both morphologic and haemodynamic differences were more evident in male athletes. PMID:23852292

Yilmaz, Dilek Cicek; Buyukakilli, Belgin; Gurgul, Serkan; Rencuzogullari, Ibrahim

2013-01-01

371

Staphylococcus aureus bacteraemia: evaluation of the role of transoesophageal echocardiography in identifying clinically unsuspected endocarditis.  

PubMed

Staphylococcus aureus bacteraemia (SAB) is an important cause of community and nosocomial sepsis, with a significant mortality rate. Infective endocarditis (IE) is a serious complication, occurring in up to 25 % of cases. Transoesophageal echocardiography (TOE) significantly improves the sensitivity of diagnosis. We compared the sensitivity and specificity of clinical evaluation alone in diagnosing IE. We evaluated all adult patients with SAB at our centre from 1998 to 2006 in order to determine what proportion of clinically unsuspected cases were diagnosed with IE on TOE. IE was defined according to modified Duke criteria. The median age of the patients was 68 years, 77 % were male and the majority of cases did not have a known pre-existing condition. Twenty-one percent were methicillin-resistant Staphylococcus aureus (MRSA). Intravascular device was the most common cause of bacteraemia. TOE was performed in 144 (100 %) of the cases. IE was suspected clinically in 15 % of cases, and the overall prevalence of possible or definite IE on TOE-inclusive Duke criteria was 29 % (n?=?41). Following TOE, 22 (15 %) cases were reclassified as either possible or definite endocarditis. TOE detected a vegetation in 37 (90 %) of the 41 cases of IE. Nineteen (46 %) were not suspected clinically by Duke criteria. Sensitivity improved in the presence of pre-existing valve lesion or community acquisition. The overall in-hospital mortality was 10 %. There is a high incidence of endocarditis in SAB and a large percentage of cases are not evident on clinical grounds. TOE evaluation is indicated for all medically suitable adult patients with SAB in order to improve the detection of endocarditis. PMID:23417650

Incani, A; Hair, C; Purnell, P; O'Brien, D P; Cheng, A C; Appelbe, A; Athan, E

2013-08-01

372

Anesthetic management of a repeat cesarean section in a parturient with severe peripartum cardiomyopathy requiring ECMO in a previous pregnancy: a case report.  

PubMed

The number of pregnant women with cardiac disease is increasing with improvements in technology. In addition, more people are part of the national health insurance plan. However, there are few reports concerning the best method for anesthesia and mode of delivery in these high-risk patients. We report a 29-year-old woman scheduled for a planned caesarean section, who had a history of severe peripartum cardiomyopathy requiring extracorporeal membrane oxygenation in a previous pregnancy. The patient had regular prenatal care in our obstetric clinic. At 29 weeks' gestation, she developed severe dyspnea. A chest radiograph revealed bilateral pulmonary edema and 2-dimensional echocardiography showed a global hypokinesis and severe valve regurgitation with left ventricular ejection fraction of 41.2%. She had an emergency caesarean section and a cardiovascular surgeon was consulted to stand-by. Anesthesia was induced by ketamine 25 mg, midazolam 2.5 mg and rocuronium 50 mg for rapid intubation. The patient tolerated the procedure well and was extubated on postoperative day 1. She was discharged one week after surgery. Postoperatively, the patient was followed in the obstetric and cardiovascular surgery outpatient departments and at 5 months after surgery she was in good condition without any complaints. PMID:22490455

Chen, Hsiu-Pin; Sung, Wei-Che; Hui, Yu-Ling; Hui, Chung-Kun

2011-01-01

373

[A comparison between two investigator's difference of results of left ventricular parameters using echocardiography and cardio MR in hypertensive patients].  

PubMed

The aim of the study is estimation of compatibility between morphological and functional results obtained from two independent evaluations used nowadays in cardiology procedures: echocardiography and Cardio MR. 48 patients were examined (24 fema les and 24 males) from 37 to 75 years of age (mean age was 56 years) with diagnosed cardiac hypertrophy in the course of 2nd and 3rd degree primary hypertension. All patients from this gro up underwent echocardiography exami nation obtained from two independent evaluations, using 2.5 M Hz transducer. Also all the patients underwent Cardio MR examination using MR 1.5 T Signa Excite (GE) system, obtained from two independent evaluations. Dedicated software was used for post-processing (MASS). The same left ventricular mor phological and functional parameters. were assessed in both procedures. Analysis of differences between results obtainedfromtwo independent doctors of the same parameter for each method separately was performed. It was assu med, that the method there were less differences between results obtained from two examiners foreach parameter, was more objective. Statistically significant differences in measurements between different examiners in echocardiography was demonstrated of the following left ven tricular parameters: LV end-diastolic diameter (LVDd), LV end-systolic dia meter (LVSd), end-diastolic long axis (LD), end-systolic long axis (LS), end diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) and left ventricular mass (LVM). No statistically significant differences in measurements between both exami ners in Cardio MR for all measured LV parameters was demonstrated. Cardio MR examination is the procedure, where the result not depends on the operator. PMID:23944094

Brzozowska-Czarnek, Agata

2013-01-01

374

Echocardiography guided therapy for massive intra-operative pulmonary emboli during arterio-venous fistula/graft thrombectomy.  

PubMed

Various techniques' are currently employed for thrombectomies of the arterio-venous (AV) fistula/graft to restore flow. Sub massive or massive pulmonary emboli's have been reported following such procedures both intra-operatively and post-operatively. The hemodynamic responses depend not only on the size of the emboli's but also on the pre existing cardiac or pulmonary reserve of the patient. Rapid intra-operative echocardiography by anesthesiologist not only will help the clinicians with diagnosis but also can guide treatment plan as well as prognosis. PMID:24180172

Porhomayon, Jahan; Nader, Nader D

2013-06-01

375

Incremental value of transthoracic real time three-dimensional echocardiography in assessment of a right ventricular mass.  

PubMed

A 52-year-old male with a right ventricular mass that filled the entire right ventricle and assumed its shape was evaluated by two-dimensional and real time three-dimensional (3D) echocardiography. Contrast enhanced 3D imaging and quantitative assessments of the size of the mass were performed. The clinical correlation, the imaging characteristics of the mass, and the pattern of vascularity were consistent with metastatic hepatocellular carcinoma. The case illustrates the incremental role of 3D echo in defining the size, shape, spatial relationship, attachments, consistency, and vascularity of the right ventricular mass. PMID:23551136

Almomani, Ahmed; Morsy, Mohamed; Dimaano, Meneleo; Ahmad, Masood

2013-07-01

376

Identification of high-risk patients with acute coronary syndrome using point-of-care echocardiography in the ED.  

PubMed

Stratifying risk of patients with acute coronary syndrome (ACS) in the emergency department (ED) remains a frequent challenge. When ST-elevation criteria are absent, current recommendations rely upon insensitive and time-intensive methods such as the electrocardiogram and cardiac enzyme testing. Here, we report on a series of cases, where emergency physicians used a simplified model for identifying regional wall motion abnormalities by point-of-care echocardiography in patients presenting with chest pain to the ED. With the use of a simplified model described herein, high-risk patients with ACS were identified rapidly in a cohort usually difficult to risk stratify. PMID:24745875

Frenkel, Oron; Riguzzi, Christine; Nagdev, Arun

2014-06-01

377

The Physics of Equestrian Show Jumping  

NASA Astrophysics Data System (ADS)

This article discusses the kinematics and dynamics of equestrian show jumping. For some time I have attended a series of show jumping events at Spruce Meadows, an international equestrian center near Calgary, Alberta, often referred to as the "Wimbledon of equestrian jumping." I have always had a desire to write an article such as this one, but when I searched the Internet for information and looked at YouTube presentations, I could only find simplistic references to Newton's laws and the conservation of mechanical energy principle. Nowhere could I find detailed calculations. On the other hand, there were several biomechanical articles with empirical reports of the results of kinetic and dynamic investigations of show jumping using high-speed digital cameras and force plates. They summarize their results in tables that give information about the motion of a horse jumping over high fences (1.40 m) and the magnitudes of the forces encountered when landing. However, they do not describe the physics of these results.

Stinner, Art

2014-04-01

378

Severe cardiogenic shock due to acute onset of an aorto-to-right atrial shunt in a patient with aortic valve endocarditis?  

PubMed Central

INTRODUCTION Heart failure is the most common cause of death due to infective endocarditis. We report a case of a patient presenting with severe shock due to an infection-associated left-to-right cardiac shunt. PRESENTATION OF CASE A 62-year-old man, who underwent aortic valve replacement five years previously, was admitted to ICU due to acute hemodynamic deterioration. A few days earlier, he had a septic episode with blood cultures positive for Staphylococcus aureus and clinical features of infective endocarditis. In ICU, transthoracic echocardiography revealed shunting from the aortic root to the right atrium resulting in severe cardiogenic shock. DISCUSSION This case report describes a near fatal complication of infective endocarditis, detected by routine use of transthoracic echocardiography. CONCLUSION Our case outlines the relevance of early cardiac surgery strategies in patients with infective endocarditis and we briefly discuss the current literature. PMID:24463563

Siebers, Christian; Schramm, René; Friedmann, Anton; Weig, Thomas

2014-01-01

379

Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography  

Microsoft Academic Search

Background  Percutaneous edge-to-edge repair with the MitraClip device has been shown to allow effective treatment of mitral regurgitation.\\u000a It is mainly guided by transesophageal echocardiography while fluoroscopic guidance is of less importance. The impact of real-time\\u000a three-dimensional transesophageal echocardiography (RT 3-D TEE) for guidance of this complex interventional procedure has\\u000a not been evaluated.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In 28 high-surgical risk patients with moderate or

Ertunc Altiok; Michael Becker; Sandra Hamada; Sebastian Reith; Nikolaus Marx; Rainer Hoffmann

380

Intraoperative two-dimensional echocardiography and color flow Doppler imaging: a basic transesophageal single plane patient examination sequence.  

PubMed Central

Recent advances in technology have allowed application of transesophageal echocardiography to intraoperative care of critically ill patients. Early clinical application primarily involved evaluation of left ventricular regional wall motion. However, valid intraoperative use of transesophageal echocardiography should also encompass systematic assessment of the entire heart as well as the great vessels. This report describes a 10-step sequence of single plane, two-dimensional echocardiographic views which constitute a basic patient examination capable of being performed by a practitioner whose primary responsibility is the delivery of anesthesia care. A 5-step color flow Doppler examination sequence is also presented. These views complement the two-dimensional echocardiographic steps. Representations of methods for grading Doppler-defined valvular regurgitation complete the report. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Figure 24 Figure 25 Figure 26 PMID:7825339

Rafferty, T. D.; Lippmann, H.

1993-01-01

381

Noninvasive aortic bloodflow by Pulsed Doppler Echocardiography (PDE) compared to cardiac output by the direct Fick procedure  

NASA Technical Reports Server (NTRS)

Left ventricular stroke volume was estimated from the systolic velocity integral in the ascending aorta by pulsed Doppler Echocardiography (PDE) and the cross sectional area of the aorta estimated by M mode echocardiography on 15 patients with coronary disease undergoing right catheterization for diagnostic purposes. Cardiac output was calculated from stroke volume and heart volume using the PDE method as well as the Fick procedure for comparison. The mean value for the cardiac output via the PDE method (4.42 L/min) was only 6% lower than for the cardiac output obtained from the Fick procedure (4.69 L/min) and the correlation between the two methods was excellent (r=0.967, p less than .01). The good agreement between the two methods demonstrates that the PDE technique offers a reliable noninvasive alternative for estimating cardiac output, requiring no active cooperation by the subject. It was concluded that the Doppler method is superior to the Fick method in that it provides beat by beat information on cardiac performance.

1980-01-01

382

Data-driven shape parameterization for segmentation of the right ventricle from 3D+t echocardiography.  

PubMed

Model-based segmentation facilitates the accurate measurement of geometric properties of anatomy from ultrasound images. Regularization of the model surface is typically necessary due to the presence of noisy and incomplete boundaries. When simple regularizers are insufficient, linear basis shape models have been shown to be effective. However, for problems such as right ventricle (RV) segmentation from 3D+t echocardiography, where dense consistent landmarks and complete boundaries are absent, acquiring accurate training surfaces in dense correspondence is difficult. As a solution, this paper presents a framework which performs joint segmentation of multiple 3D+t sequences while simultaneously optimizing an underlying linear basis shape model. In particular, the RV is represented as an explicit continuous surface, and segmentation of all frames is formulated as a single continuous energy minimization problem. Shape information is automatically shared between frames, missing boundaries are implicitly handled, and only coarse surface initializations are necessary. The framework is demonstrated to successfully segment both multiple-view and multiple-subject collections of 3D+t echocardiography sequences, and the results confirm that the linear basis shape model is an effective model constraint. Furthermore, the framework is shown to achieve smaller segmentation errors than a state-of-art commercial semi-automatic RV segmentation package. PMID:25577559

Stebbing, Richard V; Namburete, Ana I L; Upton, Ross; Leeson, Paul; Noble, J Alison

2015-04-01

383

The incidence and severity of pulmonary hypertension in obstructive sleep apnea with hypothyroidism  

PubMed Central

Background Hypothyroidism and obstructive sleep apnea (OSA) are both common health problems and can be seen together. Each of these 2 diseases can cause pulmonary hypertension (PH). We aimed to determine whether hypothyroidism with OSA has a significant effect on the frequency and severity of PH. Material/Methods A total of 236 patients were included in the study. Patients were divided into 3 groups: Group I, Obstructive Sleep Apnea (n=149); Group II, Hypothyroidism (n=56); and Group III, Obstructive Sleep Apnea-Hypothyroidism (n=31). All patients underwent polysomnography and echocardiography and serum levels of thyroid-stimulating hormone (TSH) and free thyroxine 4 (FT4) were analyzed. Results There were 167 male and 69 female participants, and the mean age was 47.8±11.5 (Group I: 81.9% male, 18.1% female; Group II: 44.6% male, 55.4% female; Group III: 64.6% male, 35.4% female). Distribution of mean pulmonary arterial pressure on echocardiography was statistically different among the 3 groups (x2=14.99, p=0.006). When adjusted according to the apnea-hypopnea index (AHI), age, and body mass index (BMI), a significant relation with PH was determined (p=0.002). Conclusions The combination of hypothyroidism with OSA is associated with an increased frequency and severity of PH. When PH is found out of line with the severity of OSA, thyroid dysfunction should be investigated. PMID:24149072

Araz, Omer; Ucar, Elif Yilmazel; Yalcin, Asl?han; Pulur, Didem; Acemoglu, Hamit; Tas, Hakan; Saglam, Leyla; Akgun, Metin; Mirici, Arzu

2013-01-01

384

Comparison of two- and three-dimensional transthoracic echocardiography to cardiac magnetic resonance imaging for assessment of paravalvular regurgitation after transcatheter aortic valve implantation.  

PubMed

This study evaluated 2-dimensional (2D) transthoracic echocardiography (TTE) using Valve Academic Research Consortium-2 (VARC-2) criteria and 3-dimensional (3D) TTE for assessment of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) in comparison with cardiac magnetic resonance (CMR) imaging. In 71 patients, 2D TTE, 3D TTE, and CMR imaging were performed to assess AR severity after TAVI. Using 2D TTE, AR severity was graded according to VARC-2 criteria and regurgitant volume (RVol) was determined. Three-dimensional color Doppler TTE allowed direct planimetry of the vena contracta area of the paravalvular regurgitation jet and calculation of the RVol as product with the velocity-time integral. RVol by CMR imaging was measured by phase-contrast velocity mapping in the ascending aorta. After TAVI, mean RVol determined by CMR imaging was 9.2 ± 9.6 ml/beat and mean regurgitant fraction was 13.3 ± 10.3%. AR was assessed as none or mild in 58 patients (82%) by CMR imaging. Correlation of 3D TTE and CMR imaging on RVol was better than correlation of 2D TTE and CMR imaging (r = 0.895 vs 0.558, p <0.001). There was good agreement between RVol by CMR imaging and by 3D TTE (mean bias = 2.4 ml/beat). Kappa on grading of AR severity was 0.357 between VARC-2 and CMR imaging versus 0.446 between 3D TTE and CMR imaging. Intraobserver variability for analysis of RVol of AR after TAVI was 73.5 ± 52.2% by 2D TTE, 16.7 ± 21.9% by 3D TTE, and 2.2 ± 2.0% by CMR imaging. In conclusion, 2D TTE considering VARC-2 criteria has limitations in the grading of AR severity after TAVI when CMR imaging is used for comparison. Three-dimensional TTE allows quantification of AR with greater accuracy than 2D TTE. Observer variability on RVol after TAVI is considerable using 2D TTE, significantly less using 3D TTE, and very low using CMR imaging. PMID:24837265

Altiok, Ertunc; Frick, Michael; Meyer, Christian G; Al Ateah, Ghazi; Napp, Andreas; Kirschfink, Annemarie; Almalla, Mohammad; Lotfi, Shahran; Becker, Michael; Herich, Lena; Lehmacher, Walter; Hoffmann, Rainer

2014-06-01

385

Automatic measurement of aortic annulus diameter in 3-dimensional Transoesophageal echocardiography  

PubMed Central

Background Transcatheter aortic valve implantation involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis. In order to select a proper device, precise sizing of the aortic valve annulus must be completed. Methods In this paper, we describe a fully automatic segmentation method to measure the aortic annulus diameter in patients with aortic calcification, operating on 3-dimensional transesophageal echocardiographic images. The method is based on state estimation of a subdivision surface representation of the left ventricular outflow tract and aortic root. The state estimation is solved by an extended Kalman filter driven by edge detections normal to the subdivision surface. Results The method was validated on echocardiographic recordings of 16 patients. Comparison against two manual measurements showed agreements (mean ±SD) of -0.3±1.6 and -0.2±2.3 mm for perimeter-derived diameters, compared to an interobserver agreement of -0.1±2.1 mm. Conclusions With this study, we demonstrated the feasibility of an efficient and fully automatic measurement of the aortic annulus in patients with aortic disease. The algorithm robustly measured the aortic annulus diameter, providing measurements indistinguishable from those done by cardiologists. PMID:25200865

2014-01-01

386

Sources of variation in assessing left atrial functions by 2D speckle-tracking echocardiography.  

PubMed

Left atrial (LA) strain and strain rate, determined by speckle-tracking echocardiography (STE), are reproducible indices to assess LA function. Different normal ranges for LA phasic functions have been reported. We investigated the role of the reference point (P- and R-wave), gain, and region of interest (ROI), as the major sources of variation when assessing LA function. 52 subjects were evaluated for LA conventional and STE analysis. 45 of them (46 ± 14 years, 26 men) were feasible for concomitant LA deformation, and LA phasic volumes and ejection fractions (LAEF) evaluation. First, we compared the P- and R-wave methods, for the evaluation of the LA functions. We used diastolic mitral profile to clearly delineate the time intervals for each LA function. For the P-wave method, active function was assessed from negative global strain as a difference between the strain at pre-atrial contraction and strain just before mitral valve closure (GSA-), and late diastolic strain rate (GSRL); passive function from positive strain at MVO (GSA+), and from early negative diastolic strain rate (GSRE); reservoir function from the sum of GSA- and GSA+ (TGSA), and positive strain rate at the beginning of LV systole (GSR+). For the R-wave method we used the same SR parameters. The active function was evaluated by late positive global strain (GSAC), the reservoir by positive peak before the opening of the mitral valve (TGSA), and conduit function by the difference between TGSA and GSAC (GSA+). Then, by using P-wave method, we measured all previously described parameters for different gains-minimum (G0), medium (G12), and maximum (G24), and for different ROIs-minimum (ROI0), step 1 (ROI1), and 2 (ROI2). Feasibility of the LA strain measurements was 87 %. Active LA function was similar in the absolute value (GSAC and GSA-), whereas passive and reservoir functions were significantly higher (GSA+, TGSA) with the R-wave method. Active LAEF correlated with GSA- measured by the P-wave (r = -0.44, p = 0.002), but not with the GSAC measured by the R-wave method. Similar correlations were found for passive and reservoir LAEF with correspondent strain parameters, only with P-wave method. There were no differences between methods regarding SR indices and their correlations with correspondent LAEFs. Increase of gain from minimum to maximum overestimated all measured LA functions (all p < 0.05). Intermediary changes did not have a significant impact on the measurement of active and conduit function, but they do have on the measurement of the reservoir function. Increase of ROI from minimum to ROI2 was associated with an overestimation of all measurements of atrial functions (all p < 0.05). For all parameters, except GSR+, a decrease of atrial S and SR values from minimum ROI to step 1 was recorded. For GSA+, TGSA, GSRE a decrease of S and SR values with each ROI step was recorded. The two methods used to assess LA functions by STE do not provide similar results. The R-wave method essentially ignores negative peak, creating a positive strain for atrial contraction, and also provides higher values for the reservoir and conduit functions, by comparison with the P-wave method. Increase of gain overestimates, whereas increase of ROI underestimates all parameters of LA functions. Therefore, we suggest that P-wave as a reference point, a medium gain, and a minimum ROI should be used as the best choice for a correct assessment. PMID:25388354

Rimba?, Roxana Cristina; Mih?il?, Sorina; Vinereanu, Drago?

2014-11-12

387

Severe scoliosis in a patient with severe methylenetetrahydrofolate reductase deficiency.  

PubMed

Severe methylenetetrahydrofolate reductase (MTHFR) deficiency is a rare autosomal recessively inherited inborn error of folate metabolism. We report a new patient with severe MTHFR deficiency who presented at age 4months with early onset severe scoliosis associated with severe hypotonia. Markedly decreased MTHFR enzyme activity (0.3nmoles CHO/mg protein/h; reference range>9) and compound heterozygous mutations (c. 1304T>C; p.Phe435Ser and c.1539dup; p.Glu514Argfs?24) in the MTHFR gene confirmed the diagnosis. She was treated with vitamin B12, folic acid and betaine supplementation and showed improvements in her developmental milestones and hypotonia. To the best of our knowledge, this is the first patient with MTHFR deficiency reported with severe early onset scoliosis. Despite the late diagnosis and treatment initiation, she showed favorable short-term neurodevelopmental outcome. This case suggests that homocysteine measurement should be included in the investigations of patients with developmental delay, hypotonia and scoliosis within first year of life prior to organizing genetic investigations. PMID:24726568

Munoz, Tatiana; Patel, Jinesh; Badilla-Porras, Ramses; Kronick, Jonathan; Mercimek-Mahmutoglu, Saadet

2015-01-01

388

Several, few and many  

Microsoft Academic Search

The proper analysis of several, few, and many involves the hypothesis that each is a modifier of a usually unpronounced counterpart of the noun number. In the case of few and many, there is close link to overt phrases like a small number or a large number. Several is more complex and arguably involves a hidden comparative structure. The relation

Richard S. Kayne

2007-01-01

389

Severe Weather Perceptions.  

ERIC Educational Resources Information Center

Severe weather is an element of nature that cannot be controlled. Therefore, it is important that the general public be aware of severe weather and know how to react quickly and appropriately in a weather emergency. This study, done in the community surrounding the Southern Illinois University at Carbondale, was conducted to compile and analyze…

Abrams, Karol

390

Functional role of TASK-1 in the heart: studies in TASK-1-deficient mice show prolonged cardiac repolarization and reduced heart rate variability.  

PubMed

TASK-1, a member of the recently identified K2P channel family, is mainly expressed in the heart and the nervous system. TASK-1 is regulated by several physiological and pathological conditions and functions as a background potassium channel. However, there are limited data concerning the significance of TASK-1 in cardiac physiology. We studied the functional role of TASK-1 in the heart by cardiac phenotyping the TASK-1-deficient mouse (TASK-1(-/-)). TASK-1 was predominantly expressed in the ventricles of control animals. Real-time PCR and immunoblot demonstrated that the expression of seven other K2P channels was unchanged in TASK-1(-/-) mice. No structural or functional abnormalities were found by histology and echocardiography. Electrophysiological studies recording monophasic action potentials (MAPs) showed a significant prolongation of action potential duration in spontaneously beating and atrially paced hearts, respectively. Surface ECGs of TASK-1(-/-) mice revealed a significant prolongation of the rate corrected QT interval. Telemetric ECG recordings for 24 h, during physical and pharmacological stress testing and after ischemia/reperfusion injury did not result in a higher incidence of arrhythmias. Infarct size was comparable in both genotypes. However, TASK-1(-/-) mice had a higher mean heart rate and significantly reduced heart rate variability (HRV). Time and frequency domain measurements as well as baroreceptor reflex testing revealed a sympathovagal imbalance with a shift to an increase in sympathetic influence in TASK-1(-/-) mice. In conclusion, TASK-1 plays a functional role in the repolarization of the cardiac action potential in vivo and contributes to the maintenance of HRV. PMID:20978771

Donner, Birgit C; Schullenberg, Martina; Geduldig, Nora; Hüning, Anja; Mersmann, Jan; Zacharowski, Kai; Kovacevic, Alexander; Decking, Ulrich; Aller, Maria Isabel; Schmidt, Klaus G

2011-01-01

391

Predictive value of low dose dobutamine transesophageal echocardiography and fluorine-18 fluorodeoxyglucose positron emission tomography for recovery of regional left ventricular function after successful revascularization  

Microsoft Academic Search

Objectives. This study was designed to assess the predictive value of myocardial viability diagnosed by dobutamine transesophageal echocardiography and fluorine (F)-18 fluorodeoxyglucose positron emission tomography for left ventricular functional recovery after revascularization in patients with chronic left ventricular dysfunction.Background. The identification of akinetic but viable myocardium is of particular importance for the selection of patients with a compromised left ventricle

Frank M. Baer; Eberhard Voth; Hans J. Deutsch; Christian A. Schneider; Michael Horst; Ernst R. de Vivie; Harald Schicha; Erland Erdmann; Udo Sechtem

1996-01-01

392

Speckle-Tracking and Tissue-Doppler Stress Echocardiography in Arterial Hypertension: A Sensitive Tool for Detection of Subclinical LV Impairment  

PubMed Central

Early diagnosis of cardiac alterations in hypertensive heart disease is still challenging. Since such patients might have depressed global LV systolic strain or strain rate when EF is still normal, speckle-tracking echocardiography (STE) and tissue-Doppler imaging (TDI) combined with stress echocardiography might improve early diagnosis of cardiac alterations. In this prospective study standard 2D Doppler echocardiography, STE, and TDI were performed at rest and during bicycle exercise in 92 consecutive patients—46 hypertensive subjects with normal ejection fraction and 46 healthy controls. STE and TDI were used to measure global peak systolic LV circumferential strain (CS), longitudinal strain (LS), and longitudinal strain rate (SR). Mean arterial blood pressure was significantly higher in hypertensive patients at rest (100.8?mmHg SD 13.5?mmHg; P = 0.002) and during physical exercise testing (124.2?mmHg SD 13.4?mmHg; P = 0.003). Hypertensive patients had significantly reduced values of systolic CS (P = 0.001), LS (P = 0.014), and SR (P < 0.001) at rest as well as during physical exercise—CS (P < 0.001), LS (P < 0.001), and SR (P < 0.001). Using STE and TDI, reduced LV systolic strain and strain rate consistent with early cardiac alterations can be detected in patients with arterial hypertension. These findings were evident at rest and markedly pronounced during exercise echocardiography. PMID:25389528

Hensel, Kai O.; Leischik, Roman

2014-01-01

393

Perioperative tissue Doppler echocardiography and bypass graft flowmetry in patients undergoing coronary revascularization: predictive power for late recovery of regional myocardial function.  

PubMed

To assess if recovery of regional myocardial function can be predicted by perioperative Doppler tissue echocariography, 20 patients undergoing coronary artery bypass graft surgery (mean 4.1 grafts) had serial transthoracic and transesophageal echocardiography. Systolic velocities were lower in basal posterior and anterior segments, and higher in the midanterior septum, at intraoperative transesophageal echocardiography compared with preoperative transthoracic echocardiography (-45%, -30%, +18%, respectively), but comparable elsewhere. After bypass, velocities were increased in midposterior, basal lateral, basal anterior, and midanterior septal segments (+41%, 25%, 27%, 44%, respectively, P <.05). Increased velocities in circumflex segments at 6 weeks (midposterior, basal lateral, and midlateral +54%, 45%, 39%, respectively, P <.05) were not predicted by perioperative changes or related to graft flow (transit-time flowmetry; R -0.09, -0.14, and -0.32, respectively, not significant). Myocardial velocities measured by transthoracic and transesophageal echocardiography are not comparable in segments with different angles of insonation. Perioperative changes in resting myocardial systolic velocity are highly variable and do not predict late recovery. PMID:12411906

Williams, R Ian; Haaverstad, Rune; Sianos, Georgios; Vourvouri, Eleni; Fraser, Alan G

2002-10-01

394

Effects of antithrombotic drugs in patients with left ventricular thrombi: assessment with indium-111 platelet imaging and two-dimensional echocardiography  

SciTech Connect

Patients with left ventricular thrombi not caused by recent myocardial infarction were prospectively studied by indium-111 platelet imaging and two-dimensional echocardiography to determine the reproducibility of these techniques and the short-term effects of sulfinpyrazone (200 mg four times daily), aspirin (325 mg three times daily) plus dipyridamole (75 mg three times daily), and full-dose warfarin. At baseline, all patients underwent indium-111 platelet imaging and echocardiography, and the results were positive for thrombus. In six patients on no antithrombotic drug therapy, repeat platelet scans and echocardiographic studies at 6.0 +/- 3.3 weeks remained positive and were unchanged. In seven patients studied on sulfinpyrazone, three platelet scans became negative, two became equivocal, and two were unchanged; the presence and size of thrombus was constant by echocardiography in all seven patients. Of the six patients studied on aspirin plus dipyridamole, one platelet scan became negative, those of three became equivocal, and two were unchanged; all echocardiographic findings remained positive, but one patient had decreased thrombus size. Among four warfarin-treated patients, three had resolution of platelet deposition and one was unchanged; by echocardiography, thrombus resolved in one patient, was decreased in size in one, and was unchanged in two. We conclude that, in the absence of antithrombotic drug therapy, platelet imaging and echocardiographic findings are stable in patients with left ventricular thrombi not caused by recent myocardial infarction. Sulfinpyrazone, aspirin plus dipyridamole, and warfarin all interrupt platelet deposition in some patients with chronic left ventricular thrombi.

Stratton, J.R.; Ritchie, J.L.

1984-03-01

395

Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction  

Microsoft Academic Search

OBJECTIVESThe goal of this study was to determine, in patients with a recent myocardial infarction (MI) and residual wall motion abnormalities within the distribution of the infarct-related artery, whether normal perfusion by myocardial contrast echocardiography (MCE) would accurately predict recovery of segmental left ventricular (LV) function.BACKGROUNDLeft ventricular dysfunction after acute MI may be secondary to myocardial stunning or necrosis. Recent

Michael L. Main; Anthony Magalski; Nicholas K. Chee; Michael M. Coen; David G. Skolnick; Thomas H. Good

2001-01-01

396

Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures A Comparative Simultaneous Doppler-Catheterization Study  

Microsoft Academic Search

Background—Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether mitral annular velocities as assessed by tissue Doppler imaging are associated with invasive measures of diastolic LV performance and whether additional information is gained over traditional Doppler variables. Methods and Results—One hundred

S. R. Ommen; R. A. Nishimura; C. P. Appleton; F. A. Miller; J. K. Oh; M. M. Redfield; A. J. Tajik

397

Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction  

Microsoft Academic Search

Background Although echocardiography is an important tool for making the diagnosis of left ventricular (LV) dysfunction, the cost of this procedure limits its use as a routine screening tool for this purpose. Brain natriuretic peptide (BNP) accurately reflects ventricular pressure, and preliminary studies have found it to be highly sensitive and highly specific in diagnosing congestive heart failure in the

Alan S. Maisel; Jen Koon; Padma Krishnaswamy; Radmila Kazenegra; Paul Clopton; Nancy Gardetto; Robin Morrisey; Alex Garcia; Albert Chiu; Anthony De Maria

2001-01-01

398

Currency flaw severity. [Banknotes  

SciTech Connect

A survey of currency flaw severity was carried out using 300 banknotes and 37 judges. Each judge assigned each note to one of five flaw severity categories. These categories correspond to severity grades of 1 to 5 with 1 equivalent to ''always accepted'' and 5 ''never accepted.'' An average flaw severity grade for each note was obtained by taking the mean of the severity grades assigned to that note by the 37 judges. Thus, each note has a single numerical real-number flaw grade between 1 and 5. Mathematical modeling of the currency flaw survey results is continuing with some very promising initial results. Our present model handles common excess ink and missing ink flaw types quite well. We plan to extend the model to ink level, mash, setoff and blanket impression flaw types.

Johnson, C.; Burnett, M.; Goodman, C.; Sherrod, R.; Schmoyer, R.; Harrison, C.; Uppuluri, R.

1986-01-01

399

Cardiac function in Vietnamese patients with different dengue severity grades  

PubMed Central

Objective Dengue continues to cause significant global morbidity and mortality. Severe disease is characterized by cardiovascular compromise from capillary leakage. Cardiac involvement in dengue has also been reported, but has not been adequately studied. Setting Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam. Design Seventy-nine patients aged 8-46 years with different dengue severity grades were studied using echocardiography including tissue Doppler imaging. The patients were split into severity grades: dengue, dengue with warning signs and severe dengue. Changes in cardiac functional parameters and haemodynamic indices were monitored over the hospital stay. Measurements and Main Results Patients with severe dengue had worse cardiac function compared to dengue, in the form of left ventricular (LV) systolic dysfunction with increased Left myocardial performance index (LMPI) (0.58 (0.26-0.80) vs. 0.38 (0.22-0.70), P=0.006). Septal myocardial systolic velocities (S?) were reduced, (6.4 (4.8-10) vs. 8.1 (6-13) cm/s, P=0.01) as well as right ventricular (RV) systolic (11.4 (7.5-17) vs. 13.5 (10-17) cm/s, P=0.016), and diastolic (E?) velocities (13 (8-23) vs. 17 (12-25) cm/s, P=0.0026). In the severe group, these parameters improved from hospital admission to discharge; septal S? to 8.8 (7-11) cm/s (P=0.002), RV S? to 15.0 (11.8-23) cm/s, (P=0.003) and diastolic velocity E? to 21 (11-25) cm/s (P=0.002). Patients with cardiac impairment were more likely to have significant pleural effusions. Conclusions Patients with severe dengue have evidence of systolic and diastolic cardiac impairment, with septal and right ventricular wall being predominantly affected. PMID:21946658

Yacoub, Sophie; Griffiths, Anna; Chau, Tran Thi Hong; Simmons, Cameron P; Wills, Bridget; Hien, Tran Tinh; Henein, Michael; Farrar, Jeremy

2014-01-01

400

In Vitro Validation of Real-Time Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Proximal Isovelocity Surface Area in Mitral Regurgitation  

PubMed Central

The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional–PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flowmeter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional–PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r2 = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 ± 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r2 = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 ± 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions. PMID:17493476

Little, Stephen H.; Igo, Stephen R.; Pirat, Bahar; McCulloch, Marti; Hartley, Craig J.; Nosé, Yukihiko; Zoghbi, William A.

2012-01-01