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Sample records for 2-dimensional echocardiography 2de

  1. Echocardiography.

    PubMed Central

    Chambers, J. B.; Monaghan, M. J.; Jackson, G.

    1988-01-01

    Imaging echocardiography is an important extension of the clinical examination and will answer most questions in an emergency-for example, whether an enlarged cardiac shadow on the chest radiograph represents ventricular dilatation or an effusion. Doppler ultrasonography is essential for hospitals with an interest in cardiology because it provides direct haemodynamic data that are complementary to imaging. It requires more skill than imaging and may also be time consuming. Colour flow Doppler mapping is speedy and simple to use and aids the interpretation of continuous wave Doppler. It is therefore a natural companion to conventional Doppler, but there would have to be a high clinical load to justify its purchase. Images FIG 3 FIG 4 FIG 4 FIG 5 FIG 6 PMID:3143434

  2. Stress echocardiography

    MedlinePlus

    Echocardiography stress test; Stress test - echocardiography; CAD - stress echocardiography; Coronary artery disease - stress Echocardiography; Chest pain - stress echocardiography; Angina - stress echocardiography; ...

  3. Impact of surgical correction of tetralogy of fallot on short-term right and left ventricular function as determined by 2-dimensional speckle tracking echocardiography

    PubMed Central

    Li, Yuman; Wang, Xinfang; Lv, Qing; Wang, Jing; Yang, YaLi; He, Lin; Yuan, Li; Zhang, Li; Xie, Mingxing

    2016-01-01

    Abstract Right ventricular (RV) and left ventricular (LV) dysfunction is an important determinant of poor clinical status in repaired patients with tetralogy of Fallot (TOF). The purpose of our study is to assess the impact of surgical repair on short-term RV and LV function by 2-dimensional speckle tracking echocardiography (STE). Sixty-seven patients (median age 12 months) with TOF before and 6 months after repair and 35 healthy subjects were studied. The patients were divided into the younger (age at surgery ≤12 months) and older (age at surgery >12 months) subgroups. RV and LV global longitudinal systolic strain and strain rate (SR), and LV global circumferential and radial systolic strain and SR were measured by STE. After repair, RV longitudinal strain and SR increased in the younger patients, whereas RV longitudinal SR was decreased in the older patients. LV deformation parameters were unchanged in all patients. In the multivariate analysis, patients with better RV and LV deformation parameters preoperatively were identified to have better RV and LV strain and SR postoperatively (P < 0.05 for all). The surgical approach of the pulmonary valve ring was predictive of RV and LV systolic function postoperatively (P < 0.05 for all). After TOF repair, short-term RV function improvement is identified in the younger but not in the older patients, whereas LV function is unchanged in all patients. The preoperative RV and LV deformational indices are the determinant of postoperative biventricular function improvement. STE appears to be a valuable tool for assessment of biventricular function after congenital heart disease surgery. PMID:27495064

  4. Impact of Severe Obesity and Weight Loss on Systolic Left Ventricular Function and Morphology: Assessment by 2-Dimensional Speckle-Tracking Echocardiography

    PubMed Central

    Karimian, Sevda; Stein, Jürgen; Bauer, Boris; Teupe, Claudius

    2016-01-01

    Obesity is associated with an increased risk of heart failure. Little is known about the impact of dietary changes on the cardiac sequelae in obese patients. Twenty-one obese subjects underwent a 12-week low calorie fasting phase of a formula diet. Transthoracic two-dimensional speckle-tracking echocardiography was performed to obtain systolic left ventricular strain before and after weight loss. Body mass index decreased significantly from 38.6 ± 6.2 to 31.5 ± 5.3 kg/m2, and the total percentage fat loss was 19%. Weight reduction was associated with a reduction in blood pressure and heart rate. Left ventricular longitudinal global peak systolic strain was in the lower normal range (−18.7 ± 3.2%) before weight loss and was unchanged (−18.8 ± 2.4%) after 12 weeks on diet with substantial weight loss. Also, no significant change in global radial strain after weight loss was noted (41.1 ± 22.0 versus 43.9 ± 23.3, p = 0.09). Left atrial and ventricular dimensions were in normal range before fasting and remained unchanged after weight loss. In our study obesity was associated with normal systolic left ventricular function. A 12-week low calorie diet with successful weight loss can reduce blood pressure and heart rate. Systolic left ventricular function and morphology were not affected by rapid weight reduction. PMID:27006823

  5. Predicting Left Ventricular Dysfunction after Surgery in Patients with Chronic Mitral Regurgitation: Assessment of Myocardial Deformation by 2-Dimensional Multilayer Speckle Tracking Echocardiography

    PubMed Central

    Cho, Eun Jeong; Yun, Hye Rim; Jeong, Dong Seop; Lee, Sang-Chol; Park, Seung Woo; Park, Pyo Won

    2016-01-01

    Background and Objectives The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral valve regurgitation (MR) and portends a poor prognosis. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. The aim of the present study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional multilayer speckle-tracking echocardiography (2D MSTE) analysis in patients with chronic severe MR with preserved LV systolic function. Subjects and Methods Forty-three consecutive patients with chronic severe MR with preserved LV systolic function scheduled for mitral valve replacement (MVR) or MV repair were prospectively enrolled. Serial echocardiographic studies were performed before surgery, at 7 days follow-up, and at least 3 months follow-up postoperatively. The conventional echocardiographic parameters were analyzed. Global longitudinal strain (GLS) was obtained quantitatively by 2D MSTE. Results The mean age of patients was 51.7±14.3 years and 25 (58.1%) were male. In receiver-operating characteristic curve analysis, the most useful cutoff value for discriminating postoperative LV remodeling in severe MR with normal LV systolic function was -20.5% of 2D mid-layer GLS. Patients were divided into two groups by the baseline GLS -20.5%. Preoperative GLS values strongly predicted postoperative LV remodeling or LV dysfunction. The postoperative degree of decrease in LV end-diastolic dimension might be an additive predictive factor. Conclusion STE can be used to predict a decrease in LV function after MVR in patients with chronic severe MR. This promising method could be of use in the clinic when trying to decide upon the optimum time to schedule surgery for such patients. PMID:27014352

  6. The Origin of Echocardiography

    PubMed Central

    Singh, Siddharth; Goyal, Abha

    2007-01-01

    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

  7. Doppler echocardiography

    SciTech Connect

    Labovitz, A.J.; Williams, G.A.

    1988-01-01

    The authors are successful in presenting a basic book on clinical quantitative Doppler echocardiography. It is not intended to be a comprehensive text, but it does cover clinical applications in a succinct fashion. Only the more common diseases in the adult are considered. The subjects are presented logically and are easy to comprehend. The illustrations are good, and the book is paperbound. The basic principles of Doppler echocardiography are presented briefly. The book ends with chapters on left ventricular function (stroke volume and cardiac output), congenital heart disease, and color Doppler echo-cardiography. There are numerous references and a good glossary and index.

  8. Fetal echocardiography

    MedlinePlus

    ... Fetal echocardiography is a test that uses sound waves ( ultrasound ) to evaluate the baby's heart for problems ... over the area. The probe sends out sound waves, which bounce off the baby's heart and create ...

  9. Stress echocardiography

    MedlinePlus

    ... Philadelphia, PA: Elsevier Saunders; 2016:chap 71. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, et al. ... www.ncbi.nlm.nih.gov/pubmed/20538671 . Solomon SD, Wu J, Gillam L, Bulwer B. Echocardiography. In: ...

  10. Utility of 3-dimensional echocardiography, global longitudinal strain, and exercise stress echocardiography to detect cardiac dysfunction in breast cancer patients treated with doxorubicin-containing adjuvant therapy

    PubMed Central

    Khouri, Michel G.; Hornsby, Whitney E.; Risum, Niels; Velazquez, Eric J.; Thomas, Samantha; Lane, Amy; Scott, Jessica M.; Koelwyn, Graeme J.; Herndon, James E.; Mackey, John R.; Douglas, Pamela S.

    2015-01-01

    Conventional resting left ventricular ejection fraction (LVEF) assessments have limitations for detecting doxorubicin (DOX)-related cardiac dysfunction. Novel resting echocardiographic parameters, including 3-dimen-sional echocardiography (3DE) and global longitudinal strain (GLS), have potential for early identification of chemotherapy-related myocardial injury. Exercise “stress” is an established method to uncover impairments in cardiac function but has received limited attention in the adult oncology setting. We evaluated the utility of an integrated approach using 3DE, GLS, and exercise stress echocardiography for detecting subclinical cardiac dysfunction in early breast cancer patients treated with DOX-containing chemotherapy. Fifty-seven asymptomatic women with early breast cancer (mean 26 ± 22 months post-chemotherapy) and 20 sex-matched controls were studied. Resting left ventricular (LV) function was assessed by LVEF using 2-dimensional echocardiography (2DE) and 3DE and by GLS using 2-dimensional speckle-tracking echocardiography (2D-STE). After resting assessments, subjects completed cardiopulmonary exercise testing with stress 2DE. Resting LVEF was lower in patients than controls by 3DE (55 ± 4 vs. 59 ± 5 %; p = 0.005) but not 2DE (56 ± 4 vs. 58 ± 3 %; p = 0.169). 10 of 51 (20 %) patients had GLS greater than or equal to −17 %, which was below the calculated lower limit of normal (control mean 2SD); this patient subgroup had a mean 20 % impairment in GLS (−16.1 ± 0.9 vs. −20.1 ± 1.5 %; p < 0.001), despite similar LVEF by 2DE and 3DE compared to controls (p > 0.05). Cardiopulmonary function (VO2peak) was 20 % lower in patients than controls (p < 0.001). Exercise stress 2DE assessments of stroke volume (61 ± 11 vs. 69 ± 15 ml; p = 0.018) and cardiac index (2.3 ± 0.9 vs. 3.1 ± 0.8 1 min−1 m−2 mean increase; p = 0.003) were lower in patients than controls. Post-exercise increase in cardiac index predicted VO2peak (r = 0.429, p = 0

  11. Echocardiography in shock management.

    PubMed

    McLean, Anthony S

    2016-01-01

    Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. A more comprehensive diagnosis can be achieved with advanced levels of competency, for which practice guidelines are also now available. Hemodynamic evaluation and ongoing monitoring are possible with advanced levels of competency, which includes the use of colour Doppler, spectral Doppler, and tissue Doppler imaging and occasionally the use of more recent technological advances such as 3D or speckled tracking.The four core types of shock-cardiogenic, hypovolemic, obstructive, and vasoplegic-can readily be identified by echocardiography. Even within each of the main headings contained in the shock classification, a variety of pathologies may be the cause and echocardiography will differentiate which of these is responsible. Increasingly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock or hypovolemia and ventricular outflow obstruction.The diagnostic benefit of echocardiography in the shocked patient is obvious. The increasing prevalence of critical care physicians experienced in advanced techniques means echocardiography often supplants the need for more invasive hemodynamic assessment and monitoring in shock. PMID:27543137

  12. Assessment of Left Ventricular Volume and Function Using Real-Time 3D Echocardiography versus Angiocardiography in Children with Tetralogy of Fallot

    PubMed Central

    Abdel Aziz, Faten M; Abdel Dayem, Soha M; Ismail, Reem I; Hassan, Hebah

    2016-01-01

    Background Evaluation of left ventricular (LV) size and function is one of the important reasons for performing echocardiography. Real time three dimensional echocardiography (RT3DE) is now available for a precise non-invasive ventricular volumetry. Aim of work was to validate RT3DE as a non-invasive cardiac imaging method for measurement of LV volumes using cardiac angiography as the reference technique. Methods Prospective study on 40 consecutive patients with tetralogy of Fallot (TOF) referred for cardiac catheterization for preoperative assessment. Biplane cineangiography, conventional 2 dimensional echocardiography (2DE) and RT3DE were performed for the patients. A control group of 18 age and sex matched children was included and 2DE and RT3DE were performed for them. Results The mean LV end diastolic volume (LVEDV) and LVEDV index (LVEDVI) measured by RT3DE of patients were lower than controls (p value = 0.004, 0.01, respectively). There was strong correlation between the mean value of the LVEDV and the LVEDVI measured by RT3DE and angiography (r = 0.97, p < 0.001). The mean value of LV ejection fraction measured by RT3DE was lower than that assessed by 2DE (50 ± 6.2%, 65 ± 4.6%, respectively, p value < 0.001) in the studied TOF cases. There was good intra- and inter-observer reliability for all measurements. Conclusion RT3DE is a noninvasive and feasible tool for measurement of LV volumes that strongly correlates with LV volumetry done by angiography in very young infants and children, and further studies needed. PMID:27358704

  13. Normal Variants in Echocardiography.

    PubMed

    Sanchez, Daniel R; Bryg, Robert J

    2016-11-01

    Echocardiography is a powerful and convenient tool used routinely in the cardiac evaluation of many patients. Improved resolution and visualization of cardiac anatomy has led to the discovery of many normal variant structures that have no known pathologic consequence. Importantly, these findings may masquerade as pathology prompting unnecessary further evaluation at the expense of anxiety, cost, or potential harm. This review provides an updated and comprehensive collection of normal anatomic variants on both transthoracic and transesophageal imaging. PMID:27612473

  14. Training in critical care echocardiography

    PubMed Central

    2011-01-01

    Echocardiography is useful for the diagnosis and management of hemodynamic failure in the intensive care unit so that competence in some elements of echocardiography is a core skill of the critical care specialist. An important issue is how to provide training to intensivists so that they are competent in the field. This article will review issues related to training in critical care echocardiography. PMID:21906268

  15. [Echocardiography in infirmary].

    PubMed

    Heredia Guerrero, Ericka Nancy

    2007-01-01

    Cardiovascular diseases are the 1st death cause worldwide in the beginning of the third millennium. Due to its high incidence and fatal complications the study of ischaemic cardiopathy had great importance. Echocardiography is an image diagnostic technique, based on the use of ultrasound, applied in the evaluation and recognition of cardiovascular diseases. It is non invasive, harmless, accessible, easy to made and quick to interpret, safe and cheaper than others imaging techniques, its continuous development has allow its use in all cardiology fields. An area where the nursing staff begin their participation in the National Institute of Cardiology "Ignacio Chavez" is the Echocardiography Department where the nurse professional profile must embrace knowledge in different areas, with an active participation in the echocardiographic studies and protocols, optimizing the patient's quality of attention with the use of Nursing Attention Process based in the theory of Dorothea Orem with the aim of standardize and improve the patient's quality of attention along with the interdisciplinary team. PMID:18938734

  16. The Evolutionary Development of Echocardiography

    PubMed Central

    Maleki, Majid; Esmaeilzadeh, Maryam

    2012-01-01

    Echocardiography is a non-invasive diagnostic technique which provides information on cardiac morphology, function, and hemodynamics. It is the most frequently used cardiovascular diagnostic test only after electrocardiography. In less than five decades, the evolution in this technique has made it the basic part of cardiovascular medicine. Herein, the evolution of various forms of echocardiography is briefly described. PMID:23390327

  17. Clinical echocardiography - an overview.

    PubMed Central

    Lalani, A. V.; Lee, S. J.

    1976-01-01

    Echocardiography is a new diagnostic technique for noninvasive assessment of the size, structure and function of the heart, using pulsed ultrasound. The physical principles underlying the generation of the ultrasonic signal for diagnostic use and the three modes (A, B and M) of displaying the reflected "echo" signal are briefly discussed. A full echographic study of the heart includes evaluation of the dimensions and patterns of movement of its various structures and chambers. The normal anatomic relations and echographic appearances of these structures and the changes they undergo in some of the more commonly recognized clinical conditions are described. Assessment of output and contractile behaviour of the left ventricle and recognition of various congenital heart defects are two of the more recent applications of this technique. Two-dimensional sector and multiscanning devices permit several areas of the heart to be visualized simultaneously in "real time". Images FIG. 4 FIG. 5 FIG. 6 FIG. 7 FIG. 8 FIG. 9 FIG. 10 PMID:130201

  18. Contrast echocardiography 1996. A review.

    PubMed Central

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

    1996-01-01

    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

  19. Echocardiography: frontier imaging in cardiology

    PubMed Central

    Steeds, R P

    2011-01-01

    This article reviews the recent developments in echocardiography that have maintained this technology at the forefront of day-to-day imaging in clinical cardiology. The primary reason for most requests for imaging in cardiovascular medicine is to assess left ventricular structure and function. As our understanding of left ventricular mechanics has become more intricate, tissue Doppler and speckle tracking modalities have been developed that deliver greater insights into diagnosis of cardiomyopathy and earlier warning of ventricular dysfunction. Increased accuracy has been achieved with the dissemination of real-time three-dimensional echocardiography, which has also acquired a central role in the pre-operative assessment of patients prior to reparative valvular surgery. The use of contrast has broadened the indications for transthoracic echocardiography and has increased the accuracy of stress echocardiography, while reducing the number of patients who cannot be scanned because of a limited acoustic window. Finally, echocardiography will be seen in the future not only as a diagnostic tool in those affected by cardiovascular disease but also as a method for prediction of risk and perhaps activation of targeted treatment. PMID:22723531

  20. Echocardiography in Pregnancy: Part 2.

    PubMed

    Narayanan, Meena; Elkayam, Uri; Naqvi, Tasneem Z

    2016-09-01

    The prevalence of pregnant women with cardiovascular heart disease is increasing. Transthoracic echocardiography is safe during pregnancy, and it is an important diagnostic tool in pregnant women with established heart disease in order to monitor ventricular and valvular anatomy and function. In addition, it can be used to delineate cardiac anatomy in complex congenital heart disease and help stratify maternal risk during pregnancy. This review will focus on the use of echocardiography in the diagnosis and management of pregnant women with common congenital lesions and with prosthetic valves. PMID:27457084

  1. Echocardiography in Pregnancy: Part 1.

    PubMed

    Liu, Shuang; Elkayam, Uri; Naqvi, Tasneem Z

    2016-09-01

    Cardiovascular disease (CVD) remains the leading cause of maternal mortality, and clinical diagnosis of CVD in women during pregnancy is challenging. Pregnant women with known heart disease require careful multidisciplinary management by obstetric and medical teams to assess for maternal and fetal risk. Echocardiography is a safe and effective diagnostic tool indicated in pregnant women with cardiac symptoms or women with known cardiac disease for appropriate selection of women who require close monitoring of cardiac condition and valvular function. Echocardiography is the single most important clinical tool to diagnose and manage heart disease during pregnancy. Echocardiography is able to characterize cardiac structural abnormalities and corresponding hemodynamic changes, identifies heart diseases that are poorly tolerated in pregnancy, and helps select patients who may require a cesarean delivery because of hemodynamic instability. An understanding of the physiologic alterations including increased heart rate, blood volume, and cardiac output as well as the decreased vascular resistance is important for early recognition and monitoring of the consequences of cardiac disease in pregnancy. This review will focus on common acquired cardiac lesions encountered during pregnancy and the role of echocardiography in the diagnosis and management of these diseases. PMID:27491768

  2. Echocardiography in the flight program

    NASA Technical Reports Server (NTRS)

    Charles, John B.; Bungo, Michael W.; Mulvagh, Sharon L.

    1991-01-01

    Observations on American and Soviet astronauts have documented the association of changes in cardiovascular function during orthostasis with space flight. A basic understanding of the cardiovascular changes occurring in astronauts requires the determination of cardiac output and total peripheral vascular resistance as a minimum. In 1982, we selected ultrasound echocardiography as our means of acquiring this information. Ultrasound offers a quick, non-invasive and accurate means of determining stroke volume which, when combined with the blood pressure and heart rate measurements of the stand test, allows calculation of changes in peripheral vascular resistance, the body's major response to orthostatic stress. The history of echocardiography in the Space Shuttle Program is discussed and the results are briefly presented.

  3. Functional Neonatal Echocardiography: Indian Experience

    PubMed Central

    Suryawanshi, Pradeep B.; Maheshwari, Rajesh; Patnaik, Suprabha; Malshe, Nandini; Kalrao, Vijay; Lalwani, Sanjay; Surwade, Jitendra

    2015-01-01

    Introduction Functional echocardiography, as opposed to echocardiography as performed by the cardiologist, is the bedside utilization of cardiac ultrasound to take after functional and haemodynamic changes longitudinally. Information reflecting cardiovascular capacity and systemic and pulmonary blood flow in sick preterm and term neonates can be observed utilizing this strategy. Information is lacking on its use in neonatal units in India. Aim To characterize the impact of Functional neonatal echocardiography (FnECHO) programme on decision making in a tertiary care centre in India by evaluating its frequency of use, patient characteristics, and indications. Materials and Methods Prospective observational study of neonates in a tertiary Neonatal Intensive Care Unit (NICU) in Pune (India) from February 2014 to January 2015. All the neonates undergoing FnECHO during this 12 month period based on clinical findings were included in the study. Data extracted from the review of the clinical notes included gestational age, birth-weight, mode of delivery, Apgar scores, details of respiratory and cardiovascular support, timing of FnECHO and any other clinical diagnosis. The findings of echocardiography were recorded and correlated with the clinical and other laboratory or X-ray findings. If these findings indicated a change in management, it was instituted. Results A total of 348 echocardiographic studies were performed in 187 neonates (mean 1.86; SD 2.02). The most frequent indication was Patent Ductus Arteriosus (PDA) assessment (n= 174, 50%), followed by haemodynamic instability (n=43, 12.36%). The results of FnECHO modified treatment in 148 cases (42.50%) in the form of addition and/or change in the treatment or avoidance of unnecessary intervention. Conclusion FnECHO is frequently used in the NICU setting and may be a useful tool to guide treatment. PDA assessment and haemodynamic instability are the most frequent indications. To validate its usefulness, well co

  4. Emerging Concepts in Transesophageal Echocardiography

    PubMed Central

    Maxwell, Cory; Konoske, Ryan; Mark, Jonathan

    2016-01-01

    Introduced in 1977, transesophageal echocardiography (TEE) offered imaging through a new acoustic window sitting directly behind the heart, allowing improved evaluation of many cardiac conditions. Shortly thereafter, TEE was applied to the intraoperative environment, as investigators quickly recognized that continuous cardiac evaluation and monitoring during surgery, particularly cardiac operations, were now possible. Among the many applications for perioperative TEE, this review will focus on four recent advances: three-dimensional TEE imaging, continuous TEE monitoring in the intensive care unit, strain imaging, and assessment of diastolic ventricular function. PMID:26998250

  5. [Real time 3D echocardiography].

    PubMed

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

    2001-07-01

    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. PMID:11494630

  6. [Real time 3D echocardiography

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

    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.

  7. Heart size estimated by echocardiography correlates with maximal oxygen uptake.

    PubMed

    Young, L E; Marlin, D J; Deaton, C; Brown-Feltner, H; Roberts, C A; Wood, J L N

    2002-09-01

    Maximum oxygen uptake also appears to correlate to athletic performance in horses. In the Thoroughbred industry, there has long been an empirical theory that heart size is related to athletic performance, despite a lack of scientific evidence supporting this assertion. To investigate the relationship between peak oxygen consumption (VO2max) and cardiac size measured by echocardiography, guided M-mode and 2-dimensional echocardiography were performed in 17 conditioned Thoroughbreds with a range of VO2max from 126 to 217 ml/min/kg STPD (mean +/- s.d. 158 +/- 28 m/min/kg). Horses were age 2-10 years and weighed 430-510 kg. Echocardiography was performed using a Vingmed System V echocardiograph with a 2.25 MHz phased array ultrasound transducer. All images were obtained from the right hemithorax using a short axis view of the left ventricle (LV) at the level of the chordae tendinae. All horses were free from significant regurgitation at the aortic or mitral valves. Maximal oxygen uptake was measured during a standardised incremental treadmill exercise test to fatigue. Maximal oxygen uptake was correlated significantly with LVIDd (r = 0.71; P = 0.001), MWT (r = 0.72; P = 0.001), LV mass (r = 0.78; P = 0.0002) and LV short-axis area (r = 0.69; P = 0.003). When indices of heart size were indexed to bodyweight, the correlation between VO2max and indices of heart size were LVIDd (r = 0.57; P = 0.01), MWT (r = 0.44; P = 0.07), LV mass (r = 0.78; P = 0.0002) and LV short-axis area (r = 0.69; P = 0.003). The current study suggests there is a strong relationship between VO2max and measurements of left ventricular size in Thoroughbred horses when individuals with a range of VO2max are compared. PMID:12405735

  8. Echocardiography in pericardial diseases: new developments.

    PubMed

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

    2013-05-01

    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

  9. Transesophageal echocardiography in NeoChord procedure

    PubMed Central

    Demetrio, Pittarello; Andrea, Colli; Gianclaudio, Falasco; Antonio, Marcassa; Gino, Gerosa; Carlo, Ori

    2015-01-01

    Background: Transapical off-pump mitral valve intervention with neochord implantation for degenerative mitral valve disease have been recently introduced in the surgical practice. The procedure is performed under 2D-3D transesophageal echocardiography guidance. Methods: The use of 3D real-time transesophageal echocardiography provides more accurate information than 2D echocardiography only in all the steps of the procedure. In particular 3D echocardiography is mandatory for preoperative assessment of the morphology of the valve, for correct positioning of the neochord on the diseased segment, for the final tensioning of the chordae and for the final evaluation of the surgical result. Result and Conclusion: This article is to outline the technical aspects of the transesophageal echocardiography guidance of the NeoChord procedure showing that the procedure can be performed only with a close and continuous interaction between the anesthesiologist and the cardiac surgeon. PMID:25849688

  10. Non-Invasive Evaluation of Heart Function with Four-Dimensional Echocardiography

    PubMed Central

    Chen, Ran; Zhu, Meihua; Sahn, David J.; Ashraf, Muhammad

    2016-01-01

    Background The aim of this study is to assess the accuracy and feasibility of left ventricular systolic function determined by four-dimensional echocardiography (4DE). Methods Latex balloons were sewn into the left ventricle (LV) of 20 freshly harvested pig hearts which were then passively driven by a pulsatile pump apparatus. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and left ventricular ejection fraction (LVEF) derived from 4DEand two-dimensional echocardiography (2DE)-derived LVEF were quantified at different stroke volumes (SV) 30–70 ml and correlated with sonomicrometry data. Results In all comparisons, GLS, GCS, GAS, 2DE-LVEF, and 4DE-LVEF demonstrated strong correlations with sonomicrometry data (r = 0.77, r = 0.89, r = 0.79, r = 0.93, r = 0.96, all P <0.001). Bland-Altman analyses showed slight overestimations of echo-derived GLS, GCS, 2DE-LVEF and 3DE-LVEF over sonomicrometry values (bias = 2.88, bias = 3.99, bias = 3.37, bias = 2.78, respectively). Furthermore, there is better agreement between GCS, 4D LVEF and sonomicrometry values compared with GLS and 2D LVEF. Conclusion Four-dimensional echocardiography accurately assesses LV function. GCS derived by 4DE is a potential alternative parameter to quantify LV systolic function. PMID:27144844

  11. Utility of echocardiography in hypotension in the intensive care unit.

    PubMed

    Verma, Sumit; Kumar, Sumit; Gossage, James R; Shah, Vipul B

    2009-12-01

    A prospective study was performed on the utility of echocardiography in diagnosing hypotension in critically ill patients. In our study, we found that transthoracic echocardiography can help physicians determine the etiology of hypotension in a significant number of patients. Transesophageal echocardiography is useful when results obtained from transthoracic echocardiography are suboptimal. Left ventricular function assessed by echocardiography can be used to predict 30-day mortality. PMID:20877173

  12. Dynamic Three-Dimensional Echocardiography

    NASA Astrophysics Data System (ADS)

    Matsusaka, Katsuhiko; Doi, Motonori; Oshiro, Osamu; Chihara, Kunihiro

    2000-08-01

    Conventional three-dimensional (3D) ultrasound imaging equipment for diagnosis requires much time to reconstruct 3D images or fix the view point for observing the 3D image. Thus, it is inconvenient for cardiac diagnosis. In this paper, we propose a new dynamic 3D echocardiography system. The system produces 3D images in real-time and permits changes in view point. This system consists of ultrasound diagnostic equipment, a digitizer and a computer. B-mode images are projected to a virtual 3D space by referring to the position of the probe of the ultrasound diagnosis equipment. The position is obtained by the digitizer to which the ultrasound probe is attached. The 3D cardiac image is constructed from B-mode images obtained simultaneously in the cardiac cycle. To obtain the same moment of heartbeat in the cardiac cycle, this system uses the electrocardiography derived from the diagnosis equipment. The 3D images, which show various scenes of the stage of heartbeat action, are displayed sequentially. The doctor can observe 3D images cut in any plane by pushing a button of the digitizer and zooming with the keyboard. We evaluated our prototype system by observation of a mitral valve in motion.

  13. Transoesophageal echocardiography during liver transplantation

    PubMed Central

    De Pietri, Lesley; Mocchegiani, Federico; Leuzzi, Chiara; Montalti, Roberto; Vivarelli, Marco; Agnoletti, Vanni

    2015-01-01

    Liver transplantation (LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver transplant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the procedures as a result of both the disease process and the surgery. Transoesophageal echocardiography (TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. Moreover, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure. PMID:26483865

  14. Diagnostic Capability of Comprehensive Handheld vs Transthoracic Echocardiography

    PubMed Central

    Cullen, Michael W.; Blauwet, Lori A.; Vatury, Ori M.; Mulvagh, Sharon L.; Behrenbeck, Thomas R.; Scott, Christopher G.; Pellikka, Patricia A.

    2014-01-01

    Objective To assess the diagnostic capability of handheld echocardiography (HHE) compared with transthoracic echocardiography (TTE) performed and evaluated by experienced sonographers and expert echocardiographers. Patients and Methods We conducted a prospective study of adult outpatients undergoing comprehensive TTE from July 9, 2012, through April 3, 2013. Experienced sonographers performed a detailed, standardized examination with a handheld ultrasound device (Vscan; GE Healthcare) that included 2-dimensional and color Doppler images from standard imaging windows. TTE and HHE images were independently interpreted by expert echocardiographers to whom the other study was masked. Agreement between the standard TTE and the HHE reports was analyzed. Results The study group contained 190 patients (mean [SD] age, 62 [17] years; 49% male). κ Values were 0.52 for left ventricular (LV) enlargement, 0.52 for right ventricular enlargement, 0.62 for regional wall motion abnormalities, 0.73 for aortic stenosis, and 0.61 for mitral regurgitation. Lin concordance correlation coefficients ranged from 0.89 for LV end-systolic diameter to 0.78 for LV end-diastolic diameter. In 51 patients (27%), echocardiographic findings were discordant between HHE and standard TTE. The most common discordant finding was the presence vs absence of any regional wall motion abnormalities. In discordant cases, HHE tended to underestimate, rather than overestimate, the severity of abnormal findings. Conclusion HHE in experienced hands shows moderate correlation with standard TTE, but discordant findings were present in 27% of patients. HHE, even when performed and interpreted by experienced operators, should not be used as a surrogate for standard TTE. PMID:24684783

  15. [Two-dimensional echocardiography in ventricular septal rupture after acute myocardial infarction].

    PubMed

    Tanimoto, M; Iwasaki, T; Yamamoto, T; Makihata, S; Konisiike, A; Mihata, S; Matsumori, Y; Yasutomi, N; Koide, T; Kawai, Y

    1985-09-01

    We studied the echocardiographic findings of 11 patients with proven ventricular septal defect following acute myocardial infarction. There were seven men and four women whose ages ranged from 48 to 77 years, with an average of 66 years. Nine patients had acute anterior and two acute inferior myocardial infarctions. Two-dimensional echocardiography (2DE) was performed for eight patients and M-mode echocardiography for all 11 patients. In all eight patients with apical four-chamber view, in whom four had additional apical short-axis view, the septal defect was directly visualized, but it was not detected by M-mode echocardiography. The defect was visualized in the apical region of the septum in all eight patients by the apical four-chamber view. The anteroapical region of the septum was the site in three with anterior infarction and the inferoapical region in one with inferior infarction by the apical short-axis view. In five of the eight patients who underwent 2DE, surgical or autopsy confirmation of the defects was obtained, with a complete agreement with the echocardiographic findings. In two patients with echocardiographic findings of septal defects, the perforations were confirmed at surgery. Two cases with aneurysmal bulges of thin septum into the right ventricle had the thin necrotic muscle in the anteroapical regions. One patient with a cystic bulge into the septum showed an irregular tear in the inferoapical region of the septum at surgery. In eight patients, the left ventricular wall motion was assessed by 2DE. Six patients revealed hyperkinetic motion in the non-infarcted areas of the basal septum or posterior wall, and these cases had good prognosis. We concluded that 2DE is a sensitive, prompt and safe technique for diagnosing and observing the risk of complicating septal defects in acute myocardial infarction. In this respect, both the apical four-chamber and short-axis views should be utilized for the topographic diagnosis of the defect. PMID:3837058

  16. Layer-specific analysis of dobutamine stress echocardiography for the evaluation of coronary artery disease

    PubMed Central

    Park, Jae Hun; Woo, Jong Shin; Ju, Shin; Jung, Su Woong; Lee, Insoo; Kim, Jin Bae; Kim, Soo Joong; Kim, Weon; Kim, Woo-Shik; Kim, Kwon Sam

    2016-01-01

    Abstract Although dobutamine stress echocardiography (DSE) is a well-defined tool for the diagnosis of coronary artery disease (CAD), false-negative and false-positive results still occur. This study investigated the diagnostic role of layer-specific analysis using 2-dimensional speckle-tracking echocardiography (STE) during DSE. A total of 121 patients who underwent DSE and showed normal wall motion and ejection fraction during baseline echocardiography were enrolled. All patients underwent coronary angiography after DSE within 2 weeks. The patients were divided into the following 4 groups according to DSE results and CAD status: negative DSE with no significant CAD (n = 73), positive DSE with significant CAD (n = 16), negative DSE with significant CAD (n = 17), and positive DSE with no significant CAD (n = 15). Layer-specific global longitudinal strain (GLS) was assessed in the endocardium, mid-myocardium, and epicardium by STE techniques. Patients with significant CAD were older, more male and showed higher glucose level compared to patients without CAD. But coronary risk factors and previous medications were not different between patients with and without CAD. There were no significant differences in whole myocardium or layer-specific GLS found in the baseline echocardiography. During recovery echocardiography, endocardial GLS was significantly different between patients with and without CAD, regardless of the DSE results. A receiver-operating characteristic curve analysis showed that endocardial GLS (>−16%) was superior for identifying significant CAD during the DSE recovery stage. Diagnostic accuracy was improved by applying the results of endocardial GLS compared with visual estimation of DSE. The assessment of layer-specific strain by STE during DSE was feasible, and the evaluation of poststress endocardial function is a more sensitive tool for the detection of CAD. PMID:27512879

  17. (1+2)-dimensional strongly nonlocal solitons

    SciTech Connect

    Ouyang Shigen; Guo Qi

    2007-11-15

    Approximate solutions of (1+2)-dimensional strongly nonlocal solitons (SNSs) are presented. It is shown that the power of a SNS in a nematic liquid crystal is in direct proportion to the second power of the degree of nonlocality, the power of a SNS in a nonlocal medium with a logarithmic nonlocal response is in inverse proportion to the second power of its beamwidth, and the power of a SNS in a nonlocal medium with an sth-power decay nonlocal response is in direct proportion to the (s+2)th power of the degree of nonlocality.

  18. Echocardiography in the evaluation of athletes

    PubMed Central

    Montserrat, Silvia; Vidal, Bàrbara; Sitges, Marta

    2015-01-01

    Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes,  echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas. PMID:26236468

  19. [Echocardiography in superacute phase of myocardial infarction: an experimental study].

    PubMed

    Komasa, N; Tanimoto, M; Kimura, S; Yasutomi, N; Saito, Y; Yamamoto, T; Ikeoka, K; Makihata, S; Kawai, Y; Iwasaki, T

    1982-12-01

    The significance and usefulness of two-dimensional echocardiography (2DE) in the evaluation of superacute phase of myocardial infarction were studied in 13 dogs with coronary occlusion, and 2DE findings were compared with the hemodynamic indices. Myocardial infarction was produced by the occlusion of anterior descending branch of the left coronary artery in 13 anesthetized adult mongrel dogs. In 6 dogs, the end-diastolic area and percent fractional shortening (%FS) in each short-axis view of the left ventricle at the level of the mitral valve, chordae tendineae, papillary muscles, low papillary muscles and apex were measured during 60 minutes, and end-diastolic wall thickness of infarct area situated in the transitional zone between the septum and the anterior wall were compared with that of non-infarct area immediately and subsequent 60 minutes after occlusion. Positive dP/dt/P, time constant T and cardiac output were measured simultaneously with an echocardiographic study. Severe enlargement and expansion of the left ventricular cavity (ballooning) and a decrease of %FS and thinning of the left ventricular wall perfused by the occluded artery occurred immediately after occlusion and persisted during subsequent 60 minutes. Time constant T was significantly prolonged, while positive dP/dt/P and cardiac output were decreased immediately and continued up to 60 minutes after occlusion. 2DE findings corresponded well with the changes of cardiac function and hemodynamics determined simultaneously. We concluded that the detection of the left ventricular ballooning is important in the diagnosis of superacute phase of myocardial infarction in dogs. PMID:7186011

  20. Anisotropic 2-dimensional Robin Hood model

    NASA Astrophysics Data System (ADS)

    Buldyrev, Sergey; Cwilich, Gabriel; Zypman, Fredy

    2009-03-01

    We have considered the Robin Hood model introduced by Zaitsev[1] to discuss flux creep and depinning of interfaces in a two dimensional system. Although the model has been studied extensively analytically in 1-d [2], its scaling laws have been verified numerically only in that case. Recent work suggest that its properties might be important to understand surface friction[3], where its 2-dimensional properties are important. We show that in the 2-dimensional case scaling laws can be found provided one considers carefully the anisotropy of the model, and different ways of introducing that anisotropy lead to different exponents and scaling laws, in analogy with directed percolation, with which this model is closely related[4]. We show that breaking the rotational symmetry between the x and y axes does not change the scaling properties of the model, but the introduction of a preferential direction of accretion (``robbing'' in the language of the model) leads to new scaling exponents. [1] S.I.Zaitsev, Physica A189, 411 (1992) [2] M. Pacuzki, S. Maslov and P.Bak, Phys Rev. E53, 414 (1996) [3] S. Buldyrev, J. Ferrante and F. Zypman Phys. Rev E64, 066110 (2006) [4] G. Odor, Rev. Mod. Phys. 76, 663 (2004) .

  1. 2-Dimensional Strain Analysis of Regional Change in Right Ventricular Function after Treadmill Exercise

    PubMed Central

    Yoon, Se-Jung; Park, Sujung; Chung, Wook-Jin

    2016-01-01

    Background Function of right ventricle (RV) influences on symptoms and prognosis in various diseases. However the regional RV function analyzed with 2-dimensional (2D) strain echocardiography before and just after treadmill test has not been evaluated. The aim of this study was to show the change of regional RV function just after treadmill exercise with strain analysis. Methods A total of thirty eight patients who visited hospital for hypertension, chest pain or dyspnea between January 2007 and December 2010 were retrospectively analyzed (men, 47.4%; mean age, 54.9 ± 7.2 years). Treadmill exercise test and pre and post echocardiography were performed. 2D strain echocardiography was analyzed off line in RV free wall and septum. Results Mean exercise duration was 737 ± 132 sec. Tissue velocity in lateral tricuspid annulus is significantly increased in post exercise (initial, 10.5 ± 2.4 cm/sec vs. post exercise, 12.2 ± 1.8 cm/sec, p = 0.006). Systolic strain of RV free wall apex and mid portion were significantly changed in post exercise stage (free wall apex, -18.2 ± 7.6% vs. -22.3 ± 5.8%, p = 0.010; free wall mid, -14.1 ± 6.7% vs. -22.6 ± 6.8%, p = 0.022). Conclusion 2D strain imaging provides a precise tool to quantify regional RV function and reveals a characteristic regional pattern of RV after treadmill exercise. PMID:27081442

  2. Computing Myocardial Motion in 4D Echocardiography

    PubMed Central

    Mukherjee, Ryan; Sprouse, Chad; Pinheiro, Aurélio; Abraham, Theodore; Burlina, Philippe

    2012-01-01

    4D (3D spatial+time) echocardiography is gaining widespread acceptance at clinical institutions for its high temporal resolution and relatively low cost. We describe a novel method for computing dense 3D myocardial motion with high accuracy. The method is based on a classical variational optical flow technique, but exploits modern developments in optical flow research to utilize the full capabilities of 4D echocardiography. Using a variety of metrics, we present an in-depth performance evaluation of the method on synthetic, phantom, and intraoperative 4D Transesophageal Echocardiographic (TEE) data. When compared with state-of-the-art optical flow and speckle tracking techniques currently found in 4D echocardiography, the method we present shows notable improvements in error. We believe the performance improvements shown can have a positive impact when the method is used as input for various applications, such as strain computation, biomechanical modeling, or automated diagnostics. PMID:22677256

  3. Stress echocardiography: methods, indications and results

    PubMed Central

    Baur, L.H.B.

    2002-01-01

    Stress echocardiography has become an important clinical tool to detect cardiac ischaemia and viability in addition to single photon emission tomography. Stress echocardiography has a high positive and negative predictive value, is less expensive than the nuclear methods and has no radiation exposure. It can easily be used in an emergency room and coronary care unit. Because of its feasibility, low cost and high diagnostic accuracy, it will become a very important technique in every hospital and will soon be a real alternative to the more time-consuming and expensive nuclear techniques. The current article gives a review of the methods of stress echocardiography. ImagesFigure 2Figure 3Figure 4 PMID:25696080

  4. Digital echocardiography 2002: now is the time

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

    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.

  5. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC).

    PubMed

    Sicari, Rosa; Nihoyannopoulos, Petros; Evangelista, Arturo; Kasprzak, Jaroslav; Lancellotti, Patrizio; Poldermans, Don; Voigt, Jen-Uwe; Zamorano, Jose Luis

    2008-07-01

    Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. Among different stresses of comparable diagnostic and prognostic accuracy, semisupine exercise is the most used, dobutamine the best test for viability, and dipyridamole the safest and simplest pharmacological stress and the most suitable for combined wall motion coronary flow reserve assessment. The additional clinical benefit of myocardial perfusion contrast echocardiography and myocardial velocity imaging has been inconsistent to date, whereas the potential of adding - coronary flow reserve evaluation of left anterior descending coronary artery by transthoracic Doppler echocardiography adds another potentially important dimension to stress echocardiography. New emerging fields of application taking advantage from the versatility of the technique are Doppler stress echo in valvular heart disease and in dilated cardiomyopathy. In spite of its dependence upon operator's training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease. PMID:18579481

  6. Simulation for transthoracic echocardiography of aortic valve

    PubMed Central

    Nanda, Navin C.; Kapur, K. K.; Kapoor, Poonam Malhotra

    2016-01-01

    Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve. PMID:27397455

  7. Pocket ultrasound devices for focused echocardiography

    PubMed Central

    2012-01-01

    Pocket ultrasound devices have recently been developed and may be particularly useful for emergency assessment. These devices can be stored in a pocket but share only some technical features with conventional echocardiographic machines. Two-dimensional imaging and color flow mode are available, with possible adjustments of global gain and depth, but Doppler features are lacking. These devices are particularly fitted for focused echocardiography. In this issue, a trial compares a pocket ultrasound device with a conventional echocardiographic machine for focused echocardiography in patients admitted to the emergency department. This commentary will put these findings into perspective. PMID:22748159

  8. Coronary Artery Imaging with Transthoracic Doppler Echocardiography.

    PubMed

    Takeuchi, Masaaki; Nakazono, Akemi

    2016-07-01

    Coronary artery imaging with transthoracic Doppler echocardiography is a simple and useful technique to diagnose significant coronary artery stenosis. The visualization of mosaic flow in the proximal left coronary artery provides a direct indication of the presence of significant stenosis at the corresponding site during routine echocardiography. Coronary flow velocity reserve (CFVR) has a high diagnostic accuracy and feasibility in detecting the presence of functionally significant coronary stenosis in the left anterior descending coronary artery (LAD) and in the right coronary artery. The measurement of CFVR in the LAD also provides prognostic information in patients with intermediate coronary stenosis. This review summarizes the utility of transthoracic coronary artery imaging. PMID:27216843

  9. Simulation for transthoracic echocardiography of aortic valve.

    PubMed

    Nanda, Navin C; Kapur, K K; Kapoor, Poonam Malhotra

    2016-01-01

    Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve. PMID:27397455

  10. Left ventricular volumes by echocardiography in chronic aortic and mitral regurgitations.

    PubMed

    Bech-Hanssen, Odd; Polte, Christian Lars; Lagerstrand, Kerstin M; Johnsson, Åse A; Fadel, Bahaa M; Gao, Sinsia A

    2016-06-01

    Objectives Cut-off values for left ventricular (LV) dimensions indicating severe valve regurgitation have not been defined. The aim of this study was to establish echocardiographic cut-off values for LV dimensions indicating severe chronic aortic (AR) or mitral (MR) regurgitation. Design The hemodynamic significance was confirmed by documented reduction of end-diastolic volume (EDV) and symptom relief after surgery. Eighty-three patients with moderate or severe regurgitation (AR, n = 41; MR, n = 42) without other cardiac conditions underwent prospectively two-dimensional (2DE), real-time three-dimensional (RT3DE) echocardiography and cardiovascular magnetic resonance (CMR) exams within 4 h. Results The relationship between EDVCMR and EDV2DE and EDVRT3DE were strong (R 0.95 and 0.91). EDV index cut-offs for 2DE/RT3DE >87/104 ml/m(2) identified AR patients with severe regurgitation with a positive likelihood ratio (PLR) of 5.0/5.0. The corresponding in patients with MR EDV index cut-offs were >69/87 ml/m(2) with a PLR of 14.9/5.5. LV linear dimensions could not identify patients with severe regurgitation. Conclusions LV volumes by echocardiography can support the diagnosis of severe chronic regurgitation. Importantly, other causes for LV enlargement have to be considered. PMID:26822698

  11. Recent advances in echocardiography for valvular heart disease

    PubMed Central

    Hahn, Rebecca

    2015-01-01

    Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population. PMID:26594349

  12. Transesophageal echocardiography assessment of severe ostial left main coronary stenosis

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

    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.

  13. Real‐time three‐dimensional dobutamine stress echocardiography for coronary artery disease diagnosis: validation with coronary angiography

    PubMed Central

    Aggeli, Constadina; Giannopoulos, Georgios; Misovoulos, Platon; Roussakis, George; Christoforatou, Euaggelia; Kokkinakis, Christos; Brili, Stela; Stefanadis, Christodoulos

    2007-01-01

    Objective To compare real‐time three‐dimensional echocardiography (RT3DE) with two‐dimensional dobutamine stress echocardiography (2DE) for the detection of myocardial ischaemia, with angiographic validation of the results. Methods 56 patients (mean (SD) age 64.5 (6.2) years, 38 males), referred for coronary angiography, were examined by 2DE and RT3DE during the same dobutamine stress protocol. Results All 56 patients completed the stress protocol uneventfully. The mean (SD) acquisition time for the necessary views to evaluate all segments was 26.3 (2.5) s for RT3DE and 58.8 (3.7) s for 2DE (p<0.001). At peak stress, RT3DE had a higher wall‐motion score index (1.25 (0.24) by 2DE, 1.30 (0.27) by RT3DE; p = 0.014). The regional wall‐motion score for the four apical segments at peak stress was compared; it was 1.35 (0.55) by 2DE and 1.52 (0.69) by RT3DE (p = 0.003). The diagnostic parameters of 2DE versus RT3DE were: sensitivity 73% vs 78%, specificity 93% vs 89% and overall accuracy 86% vs 85%, respectively. In the left anterior descending artery territory, in particular, where RT3DE had higher regional wall‐motion scores, it showed a tendency towards higher sensitivity (85% vs 78%), although this difference did not achieve statistical significance. Conclusion RT3DE identifies wall‐motion abnormalities more readily in the apical region than 2DE, which may explain the tendency towards higher sensitivity in the left anterior descending artery territory. RT3DE results were validated using angiography as reference and findings indicate diagnostic equivalence to 2DE, with the advantage of considerable shorter acquisition times. PMID:17085530

  14. [M-mode and two-dimensional echocardiography in the evaluation of right atrial masses].

    PubMed

    Makihata, S; Mihata, S; Nakagawa, Y; Konishiike, A; Tanimoto, M; Yamamoto, T; Kawai, Y; Iwasaki, T; Miyamoto, T

    1983-09-01

    Five cases of miscellaneous right atrial mass were described to illustrate the very valuable diagnostic contribution of two-dimensional echocardiography (2DE). Two patients had a large myxoma in the right atrium, and other two had an extension of hepatoma into the right atrium through the inferior vena cava. The fifth patient with a past history of myocardial infarction had a floating right atrial thrombus. The myxoma in the right atrium appeared as a mottled, ovoid, and sharply demarcated mobile mass attached to the interatrial septum. The diagnosis of these two patients was confirmed at operation. The right atrial myxoma in the first case weighed 310 g and filled almost the entire right atrium and right ventricle. To our knowledge, this was the largest myxoma among previously reported cases. The hepatoma extended into the right atrium resembled myxoma, but was obscurely demarcated. The 2DE was useful to localize a large immobile mass extending into the right atrium. All these right atrial tumors were adequately demonstrated in the right lateral decubitus position with the transducer over the right parasternal position. In the fifth case, bedside real-time 2DE was performed after the attack of pulmonary thromboembolism, and an irregular echogenic mass was seen to float freely, suggesting a thrombus. Following the immediate anticoagulant therapy with heparin, the thrombus echo was no longer visible by 2DE. It was concluded that 2DE should be extensively applied to diagnose right atrial tumors or thrombi. PMID:6086775

  15. Initial clinical experience of real-time three-dimensional echocardiography in patients with ischemic and idiopathic dilated cardiomyopathy

    NASA Technical Reports Server (NTRS)

    Shiota, T.; McCarthy, P. M.; White, R. D.; Qin, J. X.; Greenberg, N. L.; Flamm, S. D.; Wong, J.; Thomas, J. D.

    1999-01-01

    The geometry of the left ventricle in patients with cardiomyopathy is often sub-optimal for 2-dimensional ultrasound when assessing left ventricular (LV) function and localized abnormalities such as a ventricular aneurysm. The aim of this study was to report the initial experience of real-time 3-D echocardiography for evaluating patients with cardiomyopathy. A total of 34 patients were evaluated with the real-time 3D method in the operating room (n = 15) and in the echocardiographic laboratory (n = 19). Thirteen of 28 patients with cardiomyopathy and 6 other subjects with normal LV function were evaluated by both real-time 3-D echocardiography and magnetic resonance imaging (MRI) for obtaining LV volumes and ejection fractions for comparison. There were close relations and agreements for LV volumes (r = 0.98, p <0.0001, mean difference = -15 +/- 81 ml) and ejection fractions (r = 0.97, p <0.0001, mean difference = 0.001 +/- 0.04) between the real-time 3D method and MRI when 3 cardiomyopathy cases with marked LV dilatation (LV end-diastolic volume >450 ml by MRI) were excluded. In these 3 patients, 3D echocardiography significantly underestimated the LV volumes due to difficulties with imaging the entire LV in a 60 degrees x 60 degrees pyramidal volume. The new real-time 3D echocardiography is feasible in patients with cardiomyopathy and may provide a faster and lower cost alternative to MRI for evaluating cardiac function in patients.

  16. Three dimensional echocardiography in congenital heart defects

    PubMed Central

    Shirali, Girish S.

    2008-01-01

    Three dimensional echocardiography (3DE) is a new, rapidly evolving modality for cardiac imaging. Important technological advances have heralded an era where practical 3DE scanning is becoming a mainstream modality. We review the modes of 3DE that can be used. The literature has been reviewed for articles that examine the applicability of 3DE to congenital heart defects to visualize anatomy in a spectrum of defects ranging from atrioventricular septal defects to mitral valve abnormalities and Ebstein's anomaly. The use of 3DE color flow to obtain echocardiographic angiograms is illustrated. The state of the science in quantitating right and left ventricular volumetrics is reviewed. Examples of novel applications including 3DE transesophageal echocardiography and image-guided interventions are provided. We also list the limitations of the technique, and discuss potential future developments in the field. PMID:20300232

  17. Quantification of systemic right ventricle by echocardiography.

    PubMed

    Iriart, Xavier; Roubertie, François; Jalal, Zakaria; Thambo, Jean-Benoit

    2016-02-01

    Improvements in cardiac imaging have recently focused a great interest on the right ventricle (RV). In patients with congenital heart disease, the right ventricle (RV) may support the systemic circulation (systemic RV). There are 2 different anatomic conditions providing such physiology: the congenitally corrected transposition of the great arteries (ccTGA) and the TGA surgically corrected by atrial switch. During the last decades, evidence is accumulating that progressive systemic RV failure develops leading to considerable morbidity and mortality. Various imaging modalities have been used to evaluate the systemic RV, but echocardiography is still predominantly used in clinical practice, allowing an anatomic and functional approach of the systemic RV function and the potential associated anomalies. The goal of this review is to offer a clinical perspective of the non-invasive evaluation of the systemic RV by echocardiography. PMID:26850171

  18. Role of echocardiography in patients with stroke.

    PubMed

    Nakanishi, Koki; Homma, Shunichi

    2016-08-01

    Investigation of potential embolic source is an important diagnostic step in treating patients with ischemic stroke and transient ischemic attack. Cardiogenic embolism has been estimated to be the causative factor in 15-30% of all cases of ischemic stroke. Cardioembolic strokes are generally severe and recurrence and mortality rate high. Various cardiac disorders including atrial fibrillation, ventricular thrombus, valvular heart disease, cardiac tumors, and structural heart defects can cause cardioembolic stroke. Although the aortic arch is not a cardiac structure, it is usually considered under source of cardiac embolism (cardioaortic source) and is reviewed in this article. Echocardiography (both transthoracic and transesophageal) is a widely used and versatile technique that can provide comprehensive information of thromboembolic risk in patients with stroke. This article reviews potential cardiac sources of stroke and discusses the role of echocardiography in clinical practice. PMID:27256218

  19. Echocardiography in a Patient on Mechanical Ventilation.

    PubMed

    Sachdeva, Ankush

    2015-07-01

    Cardiopulmonary interactions or effects of spontaneous and mechanical ventilation (MV) were first documented in the year 1733. Stephen Hales showed that the blood pressure of healthy individual fell during spontaneous inspiration and he later went on to discover the ventilator. A year later Kussmaul described pulsus paradoxus (inspiratory absence of radial pulse) in patients with tubercular pericarditis. Echocardiography can help to diagnose a wide variety of cardiovascular diseases and can guide therapeutic decisions in patients on mechanical ventilation. PMID:26731826

  20. [Hand-held echocardiography in clinical practice].

    PubMed

    Mondillo, Sergio; Galderisi, Maurizio

    2005-05-01

    In the last years the industry has created echocardiographic portable machines of reduced size, available for a growing number of operators. After the first experiences of the '70s, hand-held echocardiography (HHE) is earned interesting commercial positions. The transportability of these machines allows to perform examinations outside the echo-lab and provides diagnostic information in heterogeneous locations such as intensive care unit, emergency room and outpatient structures, at the bedside and even in ambulance. HHE can be useful for detection of several pathologies including aortic aneurysms and left ventricular hypertrophy, regional wall motion abnormalities, pericardial and pleural effusion. To date, four main kinds of HHE can be distinguished: a first, high-cost variety, including miniaturized machines, equipped with instrumentations of standard echocardiography and even new softwares for tissue Doppler and myocardial contrast echocardiography; a second kind of machines of high level but not miniaturized; a third (intermediate level and low cost), and a fourth one (basic level and very low cost), including "cardioscopes" corresponding to the ultrasound stethoscope, able to complete efficaciously the clinical examination. The introduction of HHE opens controversy about its diagnostic accuracy, the opportunity to establish the clinical scenario where it should be utilized and the identification of the potential users and the needed competence level. Preliminary experiences show the possibility of improving and anticipating the diagnosis of several cardiac diseases but also the need to plan specific ultrasound training to avoid inappropriate use of HHE. PMID:15934422

  1. Generalized elastica on 2-dimensional de Sitter space S12

    NASA Astrophysics Data System (ADS)

    Huang, Rongpei; Yu, Junyan

    2016-02-01

    In this paper, the extremals of curvature energy actions on non-null regular curves in 2-dimensional de Sitter space are studied. We completely solve the Euler-Lagrange equation by quadratures. By using the Killing field, we construct three special coordinate systems and express the generalized elastica in 2-dimensional de Sitter space S12 by integral explicitly.

  2. Utility of transesophageal echocardiography in infective endocarditis. A review.

    PubMed Central

    Jessurun, C; Mesa, A; Wilansky, S

    1996-01-01

    Despite recent diagnostic and therapeutic advances, infective endocarditis continues to be a very serious illness, with high patient morbidity and mortality rates. The diagnosis of infective endocarditis has been based primarily on clinical signs and positive blood cultures. Echocardiography is currently recognized as the technique of choice for the detection of valvular vegetations, which are the hallmark of endocarditis. We briefly review the use of echocardiography in the diagnosis of suspected infective endocarditis, with emphasis on transesophageal echocardiography. High-resolution imaging of the cardiac valves with transesophageal echocardiography has proved to be invaluable in the management of infective endocarditis. Images PMID:8792540

  3. Predicting and measuring fluid responsiveness with echocardiography

    PubMed Central

    Mandeville, Justin

    2016-01-01

    Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart–lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately. PMID:27249550

  4. Predicting and measuring fluid responsiveness with echocardiography.

    PubMed

    Miller, Ashley; Mandeville, Justin

    2016-06-01

    Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart-lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately. PMID:27249550

  5. Display of cardiac activation pathways with echocardiography

    NASA Astrophysics Data System (ADS)

    Olstad, Bjoern; Brodin, Lars A.; Berg, Sevald

    1997-05-01

    The study of cardiac activation dynamics is an important factor in the characterization of the cardiac function. One such example is the localization of WPW-pathways inside the myocardium. Accurate localization of these pathways can be used to determine if the patient should be treated with catheter techniques or surgical techniques. This paper analyzes the temporal information in tissue velocity imaging with both qualitative and quantitative methods. The clinical experiments indicate that echocardiography can become an alternative technique for non-invasive electrophysiology in these kinds of applications.

  6. Measurement of Thrombus Flux Using Transesophageal Echocardiography

    NASA Astrophysics Data System (ADS)

    Yamaguchi, Tadashi; Hirai, Kazuki; Aoki, Masami; Miyagi, Jin; Suzuki, Masahiko; Moriya, Hideshige; Hachiya, Hiroyuki

    2006-05-01

    Deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) are serious problem of total knee replacement (TKR). These diseases may be caused by a thrombus formed during the TKR operation. Therefore, understanding the flow volume of thrombus is important for curing and preventing PTE. In this paper, we tried to understanding the situation of the flow of thrombus by using transesophageal echocardiography movies. We applied the signal processing technique the FSET to extract the anomalous information from ultrasonic echo image. As a result of processing, the time change of the flow volume of thrombus was confirmed.

  7. Contrast stress echocardiography in hypertensive heart disease

    PubMed Central

    2011-01-01

    Hypertension is associated with atherosclerosis and cardiac and vascular structural and functional changes. Myocardial ischemia may arise in hypertension independent of coronary artery disease through an interaction between several pathophysiological mechanisms, including left ventricular hypertrophy, increased arterial stiffness and reduced coronary flow reserve associated with microvascular disease and endothelial dysfunction. The present case report demonstrates how contrast stress echocardiography can be used to diagnose myocardial ischemia in a hypertensive patient with angina pectoris but without significant obstructive coronary artery disease. The myocardial ischemia was due to severe resistant hypertension complicated with concentric left ventricular hypertrophy and increased arterial stiffness. PMID:22093163

  8. Myocardial perfusion echocardiography and coronary microvascular dysfunction

    PubMed Central

    Barletta, Giuseppe; Del Bene, Maria Riccarda

    2015-01-01

    Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking. PMID:26730291

  9. Myocardial perfusion echocardiography and coronary microvascular dysfunction.

    PubMed

    Barletta, Giuseppe; Del Bene, Maria Riccarda

    2015-12-26

    Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking. PMID:26730291

  10. Simulation-based transthoracic echocardiography: “An anesthesiologist's perspective”

    PubMed Central

    Magoon, Rohan; Sharma, Amita; Ladha, Suruchi; Kapoor, Poonam Malhotra; Hasija, Suruchi

    2016-01-01

    With the growing requirement of echocardiography in the perioperative management, the anesthesiologists need to be well trained in transthoracic echocardiography (TTE). Lack of formal, structured teaching program precludes the same. The present article reviews the expanding domain of TTE, simulation-based TTE training, the advancements, current limitations, and the importance of simulation-based training for the anesthesiologists. PMID:27397457

  11. Effect of Cardiac Resynchronization Therapy on Left Atrial Size and Function as Expressed by Speckle Tracking 2-Dimensional Strain.

    PubMed

    Valzania, Cinzia; Gadler, Fredrik; Boriani, Giuseppe; Rapezzi, Claudio; Eriksson, Maria J

    2016-07-15

    Changes in left atrial (LA) strain in patients treated with cardiac resynchronization therapy (CRT) remain not entirely explored. We prospectively evaluated long-term changes in LA size and function and their relation with left ventricular (LV) reverse remodeling and noninvasive hemodynamic variables in patients treated with CRT by 2-dimensional speckle tracking echocardiography. Thirty patients (62 ± 11 years, 63% men) underwent 2-dimensional speckle tracking echocardiography before implant and after 12 months. LA area, global and regional LA strains, LV ejection fraction (LVEF) and longitudinal strain, mitral regurgitation (MR), and diastolic variables were evaluated. At 12 months, CRT responders (60%) exhibited an increase in LA strain (11.4 ± 6.5% vs 16.5 ± 7.9%, p <0.001) and a reduction in LA area (p = 0.002), which were associated with an improvement in MR, E/E' ratio, LVEF, and LV longitudinal strain. In nonresponders, a worsening in LA strain (11.4 ± 6.8% vs 8.7 ± 4.6%, p = 0.017) and LA area (p = 0.002) occurred in parallel with an increase in E/E', whereas LVEF and LV longitudinal strain were unchanged. In conclusion, over long-term follow-up, LA size and strain improved in CRT responders, while worsening in nonresponders. Changes in LV function, filling pressures, and MR seem to be related to LA reverse remodeling, giving a feedback loop. PMID:27241837

  12. Echocardiography as an indication of continuous-time cardiac quiescence.

    PubMed

    Wick, C A; Auffermann, W F; Shah, A J; Inan, O T; Bhatti, P T; Tridandapani, S

    2016-07-21

    Cardiac computed tomography (CT) angiography using prospective gating requires that data be acquired during intervals of minimal cardiac motion to obtain diagnostic images of the coronary vessels free of motion artifacts. This work is intended to assess B-mode echocardiography as a continuous-time indication of these quiescent periods to determine if echocardiography can be used as a cost-efficient, non-ionizing modality to develop new prospective gating techniques for cardiac CT. These new prospective gating approaches will not be based on echocardiography itself but on CT-compatible modalities derived from the mechanics of the heart (e.g. seismocardiography and impedance cardiography), unlike the current standard electrocardiogram. To this end, echocardiography and retrospectively-gated CT data were obtained from ten patients with varied cardiac conditions. CT reconstructions were made throughout the cardiac cycle. Motion of the interventricular septum (IVS) was calculated from both echocardiography and CT reconstructions using correlation-based, deviation techniques. The IVS was chosen because it (1) is visible in echocardiography images, whereas the coronary vessels generally are not, and (2) has been shown to be a suitable indicator of cardiac quiescence. Quiescent phases were calculated as the minima of IVS motion and CT volumes were reconstructed for these phases. The diagnostic quality of the CT reconstructions from phases calculated from echocardiography and CT data was graded on a four-point Likert scale by a board-certified radiologist fellowship-trained in cardiothoracic radiology. Using a Wilcoxon signed-rank test, no significant difference in the diagnostic quality of the coronary vessels was found between CT volumes reconstructed from echocardiography- and CT-selected phases. Additionally, there was a correlation of 0.956 between the echocardiography- and CT-selected phases. This initial work suggests that B-mode echocardiography can be used as a

  13. Echocardiography as an indication of continuous-time cardiac quiescence

    NASA Astrophysics Data System (ADS)

    Wick, C. A.; Auffermann, W. F.; Shah, A. J.; Inan, O. T.; Bhatti, P. T.; Tridandapani, S.

    2016-07-01

    Cardiac computed tomography (CT) angiography using prospective gating requires that data be acquired during intervals of minimal cardiac motion to obtain diagnostic images of the coronary vessels free of motion artifacts. This work is intended to assess B-mode echocardiography as a continuous-time indication of these quiescent periods to determine if echocardiography can be used as a cost-efficient, non-ionizing modality to develop new prospective gating techniques for cardiac CT. These new prospective gating approaches will not be based on echocardiography itself but on CT-compatible modalities derived from the mechanics of the heart (e.g. seismocardiography and impedance cardiography), unlike the current standard electrocardiogram. To this end, echocardiography and retrospectively-gated CT data were obtained from ten patients with varied cardiac conditions. CT reconstructions were made throughout the cardiac cycle. Motion of the interventricular septum (IVS) was calculated from both echocardiography and CT reconstructions using correlation-based, deviation techniques. The IVS was chosen because it (1) is visible in echocardiography images, whereas the coronary vessels generally are not, and (2) has been shown to be a suitable indicator of cardiac quiescence. Quiescent phases were calculated as the minima of IVS motion and CT volumes were reconstructed for these phases. The diagnostic quality of the CT reconstructions from phases calculated from echocardiography and CT data was graded on a four-point Likert scale by a board-certified radiologist fellowship-trained in cardiothoracic radiology. Using a Wilcoxon signed-rank test, no significant difference in the diagnostic quality of the coronary vessels was found between CT volumes reconstructed from echocardiography- and CT-selected phases. Additionally, there was a correlation of 0.956 between the echocardiography- and CT-selected phases. This initial work suggests that B-mode echocardiography can be used as a

  14. Stress echocardiography in patients with morbid obesity

    PubMed Central

    Senior, Roxy

    2016-01-01

    The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE. PMID:27249552

  15. Oesophageal perforation following perioperative transoesophageal echocardiography.

    PubMed

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

    2000-05-01

    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

  16. Stress echocardiography in patients with morbid obesity.

    PubMed

    Shah, Benoy N; Senior, Roxy

    2016-06-01

    The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE. PMID:27249552

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

    PubMed Central

    Badano, Luigi P.

    2014-01-01

    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

  18. Adult perioperative echocardiography: anatomy, mechanisms and effective communication.

    PubMed

    Michelena, Hector I; Suri, Rakesh M; Malouf, Joseph; Enriquez-Sarano, Maurice; Mankad, Sunil V

    2014-01-01

    Intra-operative transesophageal echocardiography (TEE) is a mature imaging technique which represents the premier surgical quality control instrument in the contemporary operating room. In adult cardiac surgery, management of valvular heart disease and related structural cardiac abnormalities derive the most benefit from perioperative echocardiography which includes pre-operative transthoracic echocardiography, intra-operative TEE and post-surgical echocardiographic surveillance. This review discusses the theoretical background upon which these imaging techniques are built-on, and offers a practical state-of-the-art guide on their application, emphasizing the importance of anatomic relationships, mechanisms of dysfunction and effective communication with our surgeons. PMID:25081403

  19. Echocardiography as a Research and Clinical Tool in Veterinary Medicine

    PubMed Central

    Allen, D. G.

    1982-01-01

    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

  20. Pocket-Sized Echocardiography Devices: One Stop Shop Service?

    PubMed Central

    Seraphim, Andreas; Paschou, Stavroula A; Nihoyannopoulos, Petros

    2016-01-01

    The introduction of portable, pocket-sized echocardiography devices in various healthcare systems has raised new questions with regards to their realistic use in clinical practice. Several studies have already attempted to provide information regarding their safety and diagnostic potential, the training required to operate them, as well as their direct comparison with standard echocardiography machines. This manuscript is a review of the literature of the documents or position papers which employ the use of pocket or handheld devices. Following review of the literature, we suggest that these miniaturized devices can provide a valuable diagnostic tool that can complement and improve the diagnostic yield of clinical examination. When operated by appropriately trained professionals, they can provide a limited but very reliable echocardiographic assessment. Pocket-sized echocardiography is a part of physical examination and should not be considered a complete echocardiographic scan. Optimal training is required for the smooth operation of handheld echocardiography. PMID:27081437

  1. Teaching focused echocardiography for rheumatic heart disease screening.

    PubMed

    Engelman, Daniel; Kado, Joseph H; Reményi, Bo; Colquhoun, Samantha M; Watson, Caroline; Rayasidamu, Sera C; Steer, Andrew C

    2015-01-01

    Screening for rheumatic heart disease (RHD) requires workers skilled in echocardiography, which typically involves prolonged, specialized training. Task shifting echocardiographic screening to nonexpert health workers may be a solution in settings with limited human resources. An 8-week training program was designed to train health workers without any prior experience in focused echocardiography for RHD screening. Seven health workers participated. At the completion of training, the health workers performed unsupervised echocardiography on 16 volunteer children with known RHD status. A pediatric cardiologist assessed image quality. Participants provided qualitative feedback. The quality of echocardiograms were high at completion of training (55 of 56 were adequate for diagnosis) and all cases of RHD were identified. Feedback was strongly positive. Training health workers to perform focused echocardiography for RHD screening is feasible. After systematic testing for accuracy, this training program could be adapted in other settings seeking to expand echocardiographic capabilities. PMID:26085762

  2. [Improved reproducibility of contrast echocardiography by SH U 454. Experimental studies using digital subtraction echocardiography].

    PubMed

    Grube, E; Fritzsch, T

    1986-06-01

    The right heart chambers of 10 animals were contrasted by conventional (NaCl, CO2, H2O2, indocyanine green (ICG), haemaccel) and a newly developed echo-contrast medium (SH U 454) and studied by 2-D echocardiography. By means of digital subtraction echocardiography (DSE) endocardial borders were defined automatically and the results were compared with the manual input of endocardial borders of original and contrast echocardiograms. The area enclosed by these borders served as basis for the calculation of reproducibility (in %) and correlations. The following correlation coefficients (r) and SEE were calculated between the areas defined by the different contrast media and DSE and manually derived borders: r = 0.85, 3.98 cm2 (ICG), and 0.89, 1.00 cm2 (haemaccel). The best calculations were found using SH U 454 in concentrations between 100 and 300 mg/ml. The correlation coefficients were in the range of r = 0.95 and 0.98 with an SEE of 0.21 to 0.56 cm2 between manually and automatically derived contours. Comparing the reproducibility of data between the different evaluation methods we found the following results: manual input of endocardial borders in original echocardiograms 12.3%-16.9%; manual definition of endocardial borders in contrast echocardiograms 2.0% (SH U 454) - 15.7% (CO2); automatic contour finding in original echocardiograms 8.6%-28.9% (mean 21.6%); automatic definition of endocardium by DSE in contrast echocardiograms 7.6% (ICG) - 0.9% (SH U 454, 300 mg/ml). Our results demonstrate that digital subtraction echocardiography is a simple an safe procedure to define endocardial contours if echo contrast media lead to a uniform and homogeneous opacification of the left and right cardiac cavities.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3529670

  3. Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass indexes in infective endocarditis

    PubMed Central

    Sogomonian, Robert; Alkhawam, Hassan; Vyas, Neil; Jolly, JoshPaul; Nguyen, James; Haftevani, Emma A. Moradoghli; Al-khazraji, Ahmed; Ashraf, Amar

    2016-01-01

    Background Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE) with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) in patients with a body mass index (BMI) greater than or equal to 25 kg/m2 and less than 25 kg/m2. Methods A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Results Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65%) were discovered to have native valve vegetations on TEE and 58 (35%) with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m2 and the subsequent group with a BMI <25 kg/m2. Patients with a BMI ≥25 kg/m2 who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m2 had a TTE sensitivity and specificity of 78 and 95%, respectively. Conclusions Patients with a BMI <25 kg/m2 and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m2 may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE. PMID:27124167

  4. Dynamic 3D echocardiography in virtual reality

    PubMed Central

    van den Bosch, Annemien E; Koning, Anton HJ; Meijboom, Folkert J; McGhie, Jackie S; Simoons, Maarten L; van der Spek, Peter J; Bogers, Ad JJC

    2005-01-01

    Background This pilot study was performed to evaluate whether virtual reality is applicable for three-dimensional echocardiography and if three-dimensional echocardiographic 'holograms' have the potential to become a clinically useful tool. Methods Three-dimensional echocardiographic data sets from 2 normal subjects and from 4 patients with a mitral valve pathological condition were included in the study. The three-dimensional data sets were acquired with the Philips Sonos 7500 echo-system and transferred to the BARCO (Barco N.V., Kortrijk, Belgium) I-space. Ten independent observers assessed the 6 three-dimensional data sets with and without mitral valve pathology. After 10 minutes' instruction in the I-Space, all of the observers could use the virtual pointer that is necessary to create cut planes in the hologram. Results The 10 independent observers correctly assessed the normal and pathological mitral valve in the holograms (analysis time approximately 10 minutes). Conclusion this report shows that dynamic holographic imaging of three-dimensional echocardiographic data is feasible. However, the applicability and use-fullness of this technology in clinical practice is still limited. PMID:16375768

  5. 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)

    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

    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.

  6. Echocardiography and cardiac resynchronisation therapy, friends or foes?

    PubMed

    van Everdingen, W M; Schipper, J C; van 't Sant, J; Ramdat Misier, K; Meine, M; Cramer, M J

    2016-01-01

    Echocardiography is used in cardiac resynchronisation therapy (CRT) to assess cardiac function, and in particular left ventricular (LV) volumetric status, and prediction of response. Despite its widespread applicability, LV volumes determined by echocardiography have inherent measurement errors, interobserver and intraobserver variability, and discrepancies with the gold standard magnetic resonance imaging. Echocardiographic predictors of CRT response are based on mechanical dyssynchrony. However, parameters are mainly tested in single-centre studies or lack feasibility. Speckle tracking echocardiography can guide LV lead placement, improving volumetric response and clinical outcome by guiding lead positioning towards the latest contracting segment. Results on optimisation of CRT device settings using echocardiographic indices have so far been rather disappointing, as results suffer from noise. Defining response by echocardiography seems valid, although re-assessment after 6 months is advisable, as patients can show both continuous improvement as well as deterioration after the initial response. Three-dimensional echocardiography is interesting for future implications, as it can determine volume, dyssynchrony and viability in a single recording, although image quality needs to be adequate. Deformation patterns from the septum and the derived parameters are promising, although validation in a multicentre trial is required. We conclude that echocardiography has a pivotal role in CRT, although clinicians should know its shortcomings. PMID:26645707

  7. The ARM Best Estimate 2-dimensional Gridded Surface

    SciTech Connect

    Xie,Shaocheng; Qi, Tang

    2015-06-15

    The ARM Best Estimate 2-dimensional Gridded Surface (ARMBE2DGRID) data set merges together key surface measurements at the Southern Great Plains (SGP) sites and interpolates the data to a regular 2D grid to facilitate data application. Data from the original site locations can be found in the ARM Best Estimate Station-based Surface (ARMBESTNS) data set.

  8. Determination of left ventricular ejection fraction by visual estimation during real-time two-dimensional echocardiography

    SciTech Connect

    Rich, S.; Sheikh, A.; Gallastegui, J.; Kondos, G.T.; Mason, T.; Lam, W.

    1982-09-01

    It has been shown that the measured reduction in the cross-sectional area of the left ventricle (LV), as viewed in the short axis, closely approximates its ejection fraction (EF). We assessed the reliability of using two-dimensional echocardiography (2DE) to visually estimate the EF during real-time viewing, without the need of digitizers, planimetry, or calculations. Twenty-five adult hospitalized patients with either suspected or known cardiac disease were evaluated prospectively. Each patient also had gated nuclear angiography during the same admission, and 14 had cardiac catheterization with left ventriculography. The EF was determined by 2DE using a visual estimate of the percent area reduction of the LV cavity in the short-axis view at the level of the papillary muscles. All 2 DE studies were read by two or more blinded reviewers, with a value for the EF to the nearest 2.5% determined by consensus. These values correlated closely to the values determined in all 25 patients with gated nuclear angiography (r . 0.927) and the 14 patients who had left ventriculography (r . 0.935). We believe that this method of visually estimating the LVEF will enable echocardiographers to easily use 2 DE for a reliable and instantaneous assessment of ventricular function, without the need of sophisticated analytical equipment.

  9. Tuber borchii fruit body: 2-dimensional profile and protein identification.

    PubMed

    Pierleoni, Raffaella; Buffalini, Michele; Vallorani, Luciana; Guidi, Chiara; Zeppa, Sabrina; Sacconi, Cinzia; Pucci, Piero; Amoresano, Angela; Casbarra, Annarita; Stocchi, Vilberto

    2004-04-01

    The formation of the fruit body represents the final phase of the ectomycorrhizal fungus T. borchii life cycle. Very little is known concerning the molecular and biochemical processes involved in the fructification phase. 2-DE maps of unripe and ripe ascocarps revealed different protein expression levels and the comparison of the electropherograms led to the identification of specific proteins for each developmental phase. Associating micropreparative 2-DE to microchemical approaches, such as N-terminal sequencing and 2-D gel-electrophoresis mass-spectrometry, proteins playing pivotal roles in truffle physiology were identified. PMID:15081280

  10. Integration of 2-Dimensional Materials for Thermoelectric Power Generation

    NASA Astrophysics Data System (ADS)

    Alsaffar, Fadhel; Al Hussain, Abdulrahman; Amer, Moh. R.; Center of Exclence for Green Nanotechnologies Collaboration; Department of Electrical Engineering (UCLA) Collaboration

    Recent developments in nanomaterial research have significantly progressed the performance of thermoelectric devices. Theoretical investigations of the thermoelectic properties of 2-Dimentional monolayers demonstrate a high figure of merit (ZT) .. Here, we investigate the integration of these 2-Dimensional materials for power generation applications using solar heat. We show that using black phosphorus monolayer (phosphorene) as the p-type material, and Molybdenum disulfide (MoS2) monolayers as the n-type material, we get an effective figure of merit (ZT) at least (1.5) with a conversion efficiency of 13% at 280oC. Our results suggest that the integration of various 2-Dimensional materials is a promising approach for commercial thermoelectric power generation applications.

  11. Detection of left ventricular aneurysm on two dimensional echocardiography.

    PubMed

    Baur, H R; Daniel, J A; Nelson, R R

    1982-07-01

    The differentiation of left ventricular aneurysm from diffuse left ventricular dilation and hypokinesia may have important therapeutic consequences. Thus the diagnostic accuracy of wide angle two dimensional echocardiography for the detection of left ventricular aneurysm was evaluated in a prospective study of 26 consecutive patients with the clinical suspicion of left ventricular aneurysm referred over a 10 month period. Every patients was examined with two dimensional echocardiography and left ventricular cineangiography, and findings were interpreted by two independent observers. A dilated hypokinetic left ventricle without aneurysm formation on cineangiography in nine patients was identified in all with two dimensional echocardiography. A left ventricular aneurysm on cineangiography in 17 patients was correctly identified in 14 with the two dimensional study, as were the site and extent of the lesion (apical in 12, anterior in 1 and inferior in 1). One apical aneurysm was interpreted on the two dimensional study as apical dyskinesia; one anterior and one posterobasal aneurysm were missed with this technique. Mural thrombi were correctly identified with two dimensional echocardiography in seven of seven patients. It is concluded that two dimensional echocardiography is an accurate noninvasive method that allows differentiation of left ventricular aneurysm from diffuse left ventricular dilation in the majority of patients. It provides information regarding the resectability of the aneurysm and may obviate cineangiography in many cases. PMID:7091001

  12. Speckle Tracking Echocardiography of the Right Atrium: The Neglected Chamber.

    PubMed

    Rai, Aitzaz Bin Sultan; Lima, Eduardo; Munir, Farrukh; Faisal Khan, Anum; Waqas, Ahmed; Bughio, Sara; ul Haq, Ehtesham; Attique, Hassan Bin; Rahman, Zia Ur

    2015-11-01

    The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function make it distinct from ventricles. Various invasive and noninvasive techniques have been used to elucidate RA structure and function. Of these modalities, echocardiography has distinct advantages over others. Several conventional measures of RA function through echocardiography have been described in the literature, but they are load dependent. A relatively new technique is speckle tracking-derived strain, which is relatively less dependent on loading conditions. Speckle tracking echocardiography tracks acoustic scatters (speckles) of myocardium frame-by-frame to calculate strain or deformation of the myocardium. Speckle tracking echocardiography has been used extensively for strain assessment of the right and left ventricle to detect subtle disease pathology, to gain mechanistic insight, as a marker of ischemic metabolic memory, as an endpoint in clinical trials, and as a functional assessment tool. The RA is a relatively neglected chamber, as it is mostly studied for assessment of atrial mass lesions, for electrophysiological studies, and in animal models for physiological assessment. However, its role in the systolic and diastolic function of the right heart, pulmonary vascular pathology, congenital heart diseases, and combined electromechanical activation phenomena has been less explored or unexplored. Speckle tracking echocardiography is an ideal tool for the assessment of the RA because of its regional and global functional characterization, angle independence, and high temporal resolution. PMID:26418622

  13. Standard transthoracic echocardiography and transesophageal echocardiography views of mitral pathology that every surgeon should know

    PubMed Central

    Tan, Timothy C.

    2015-01-01

    The mitral valve is the most commonly diseased heart valve and the prevalence of mitral valve disease increases proportionally with age. Echocardiography is the primary diagnostic imaging modality used in the assessment of patients with mitral valve disease. It is a noninvasive method which provides accurate anatomic and functional information regarding the mitral valve and can identify the mechanism of mitral valve pathology. This is especially useful as it may guide surgical repair. This is increasingly relevant given the growing trend of patients undergoing mitral valve repair. Collaboration between cardiac surgeons and echocardiographers is critical in the evaluation of mitral valve disease and for identification of complex valvular lesions that require advanced surgical skill to repair. This article will provide an overview of transthoracic and transesophageal assessment of common mitral valve pathology that aims to aid surgical decision making. PMID:26539350

  14. Clinical use of echocardiography in structural heart disease.

    PubMed

    Shibayama, Kentaro; Watanabe, Hiroyuki

    2016-07-01

    Recently, a development of devices for transcatheter interventions, such as transcatheter aortic valve implantation for aortic stenosis, percutaneous mitral valve repair for mitral regurgitation, and percutaneous closure of atrial septal defect, has led to a greatly expanded armamentarium of catheter-based approaches for patients with structural heart disease (SHD). Comorbidity and anatomical limitations specific to each procedure are known to influence outcomes during and after the intervention. Therefore, risk stratification of the intervention including anatomical and functional assessments is critically important. Furthermore, echocardiography reveals both physiological and anatomical abnormalities of SHD in real-time even in the operation theater. Consequently, echocardiography plays an essential role in providing not only preoperative assessment of SHD but also intra-procedural monitoring and postoperative follow-up. This document is intended as a reference for cardiac surgeons using echocardiography clinically for patients with SHD, particularly those with valvular heart disease and atrial septal defect. PMID:27138937

  15. Evaluation of Arterial Stiffness by Echocardiography: Methodological Aspects

    PubMed Central

    Cho, Jae Yeong

    2016-01-01

    As humans age, degenerative changes in the arterial structure gradually progress and result in the stiffening of the arteries, which is called arteriosclerosis. Arterial stiffness is now an established risk factor of cardiovascular disease (CVD). This stiffening has adverse effects for both the general population as well as for patients with CVD. Measurements of pulse wave velocity and pulse wave analysis are the two most commonly used methods in the evaluation of arterial stiffness, but these methods just allow indirect measures of arterial stiffness. Echocardiography is the most widely used imaging modality in the evaluation of cardiac structure and function and with recent technical advances, it has become possible to evaluate the structure, function and blood flow hemodynamics of the arteries using echocardiography. In the present review, we will discuss the current status of echocardiography in the evaluation of arterial stiffness, especially focusing on the methodological aspects. PMID:27231673

  16. Role of Echocardiography Before Transcatheter Aortic Valve Implantation (TAVI).

    PubMed

    Badiani, Sveeta; Bhattacharyya, Sanjeev; Lloyd, Guy

    2016-04-01

    Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence; transcatheter aortic valve implantation (TAVI) has become an accepted alternative to surgical aortic valve replacement (AVR) in the high risk or inoperable patient. Appropriate selection of patients for TAVI is crucial and requires a multidisciplinary approach including cardiothoracic surgeons, interventional cardiologists, anaesthetists, imaging experts and specialist nurses. Multimodality imaging including echocardiography, CT and MRI plays a pivotal role in the selection and planning process; however, echocardiography remains the primary imaging modality used for patient selection, intra-procedural guidance, post-procedural assessment and long-term follow-up. The contribution that contemporary transthoracic and transoesophageal echocardiography make to the selection and planning of TAVI is described in this article. PMID:26960423

  17. Technology update: intracardiac echocardiography – a review of the literature

    PubMed Central

    Vitulano, Nicola; Pazzano, Vincenzo; Pelargonio, Gemma; Narducci, Maria Lucia

    2015-01-01

    The development of new imaging tools helps in better investigation of cardiac structures and function by showing detailed images during interventional procedures. Intracardiac echocardiography plays a pivotal role as an intraoperative real-time imaging tool during invasive cardiac procedures. Initially, this echocardiographic technique was particularly useful when transthoracic image quality was insufficient and to avoid general anesthesia for transesophageal imaging. Nowadays, intracardiac echocardiography is routinely used in several cardiac invasive laboratories to support several types of procedures, such as extraction and implantation of cardiac devices, electrophysiological mapping, ablation, and endomyocardial biopsies. This review gives an overview of the basic principles of intracardiac echocardiography and examines its applications in the different settings of invasive cardiology. PMID:26060415

  18. Evaluation and management of left atrial lymphoma guided by transesophageal echocardiography.

    PubMed

    Willens, Howard J; Ahn, Yeon S; Gallagher, Anthony J

    2003-08-01

    A highly mobile left atrial mass was detected by transesophageal echocardiography in a patient with mediastinal lymphoma. Transesophageal echocardiography also demonstrated resolution of the mass following chemotherapy. PMID:12859371

  19. Comparison of aortic annulus size by transesophageal echocardiography and computed tomography angiography with direct surgical measurement.

    PubMed

    Wang, Hanghang; Hanna, Jennifer M; Ganapathi, Asvin; Keenan, Jeffrey E; Hurwitz, Lynne M; Vavalle, John P; Kiefer, Todd L; Wang, Andrew; Harrison, J Kevin; Hughes, G Chad

    2015-06-01

    This study sought to compare the accuracy of 2-dimensional transesophageal echocardiography (TEE) and computed tomography angiography (CTA) for noninvasive aortic annular sizing as required for transcatheter aortic valve implantation (TAVI). Direct intraoperative (OR) sizing is the gold standard for aortic annular measurement in surgical aortic valve replacement. Unlike surgical aortic valve replacement, TAVI requires noninvasive assessment of aortic annular dimensions for determining the size of prosthesis to be implanted and controversy exists regarding the best imaging technique for TAVI sizing. Preoperative CTA and OR TEE images of the aortic annulus in 227 patients who underwent proximal aortic surgery with OR annular sizing at the Duke University Medical Center were reviewed. Both imaging techniques were compared with direct OR measurements of aortic annulus diameter using metric sizers as the gold standard. CTA overestimated aortic annulus diameter in 72.2% of cases, with 46.3% >1 TAVI valve-size (>3 mm) overestimations, whereas TEE underestimated aortic annulus diameter in 51.1% of cases, with 16.7% >1 valve-size underestimations. Combining both techniques improved the estimation of aortic annular size. In conclusion, there are limitations to current imaging techniques for noninvasive determination of aortic annular dimensions compared with direct OR sizing. Undersizing by TEE and oversizing by CTA are common and may be related to differences in methods for sizing an elliptical structure. Combining measurements from both techniques would decrease the false exclusion rate for TAVI eligibility because of size mismatch. PMID:25846765

  20. [Real time 3D echocardiography in congenital heart disease].

    PubMed

    Acar, P; Dulac, Y; Taktak, A; Villacèque, M

    2004-05-01

    The introduction of the 3D mode in echocardiography has led to its use in everyday clinical practice. One hundred and fifty real time 3D echocardiographic examinations were performed in 20 foetus, 110 children and 20 adults with various congenital heart lesions (shunts, valvular lesions, aortic diseases). The 4x matricial probe enables the instantaneous acquisition of transthoracic volumes. Four modes of 3D imaging were used: real time, total volume, colour Doppler and biplane. Quantitative measurements were performed at an outlying station. The feasibility of the method in the foetus, the child and the adult was respectively 90%, 99% and 85%. Real time 3D echocardiography did not affect the diagnoses made by standard echocardiography. The 3D imaging gave a more accurate description of atrial septal defects and congenital valvular lesions. Biplane imaging was decisive in the quantitative approach to aortic dilatation of Marfan's syndrome and in segmental analysis of the foetal heart. 3D colour Doppler imaging has been disappointing but the possibilities of volumic quantification of blood flow are very promising. The present limitations of the method are the inadequate resolution in the small child and the absence of quantitative measurement on the echograph. The facility of utilisation of the matricial probe should lead to routine usage of 3D echocardiography as with 2D and the Doppler modes. Its value should be decisive in many congenital cardiac lesions requiring surgery or interventional catheterisation. PMID:15214550

  1. Transesophageal echocardiography: first-line imaging for aortic diseases

    NASA Technical Reports Server (NTRS)

    Yalcin, F.; Thomas, J. D.; Homa, D.; Flachskampf, F. A.

    2000-01-01

    Transesophageal echocardiography (TEE) is now commonly used to evaluate the thoracic aorta, because it is widely available and provides high-resolution images and flow information by Doppler. This article reviews the essential features on TEE of acute and chronic aortic diseases, such as aortic dissection, aneurysm, and atherosclerosis, and discusses its strengths, weaknesses, and indications.

  2. Intraobserver reproducibility of parameters of standard and 2D speckle tracking echocardiography, dynamics of global longitudinal strain I in patients with acute primary anterior STEMI

    NASA Astrophysics Data System (ADS)

    Kercheva, M.; Ryabova, T.; Ryabov, V.; Karpov, R.

    2015-11-01

    The aim of this study was to assess the intraobserver reproducibility of parameters of standard and 2 dimensional speckle tracking echocardiography, dynamics of global longitudinal strain in patients with acute primary anterior STEMI. The study included 24 patients, mean age 58.46±10.2. Echocardiography with 2D speckle tracking imaging was performed on the 1st (T1), 7th (T2), 14th days (T3) after STEMI («Vivid E9»). Analysis of echocardiographic images was performed offline at the different periods by the two independent observers (EchoPac) - experienced and inexperienced. In order to assess the agreement between standard and 2D speckle tracking echocardiography, a correlation analysis (Pearson correlation, Spearman's rank correlation coefficient) and Bland-Altman analysis were undertaken. The 23 patients had urgent reperfusion therapy, 6 patients underwent primary PCI, 16 patients - PCI after successful fibrinolysis (68%). GLS and WMSI had the best intraobsever reproducibility. Dynamics of EDV LV, ESV LV, EF LV was without significant differences. Nevertheless, it was found positive dynamic of GLS: - 12.65±3.53 (T1), -13.61±3.81 (T2), -14.27±4.1 (T3), p<0.05. GLS reduced 11.35% (p=0.0048) from T1 to T3. The best intraobserver reproducibility of parameters of 2 D speckle-tracking and standard echocardiography was revealed in GLS and WMSI. The modern management of STEMI patients limits adverse postinfarction remodeling and preserves of global left ventricular contractility detected by the EF LV. However, GLS had the positive dynamics and improved to the 14th day.

  3. Finite temperature holographic duals of 2-dimensional BCFTs

    NASA Astrophysics Data System (ADS)

    Estes, J.

    2015-07-01

    We consider holographic duals of 2-dimensional conformal field theories in the presence of a boundary, interface, defect and/or junction, referred to collectively as BCFTs. In general, the presence of a boundary reduces the SO(2, 2) conformal symmetry to SO(2, 1) and the dual geometry is realized as a warped product of the form , where is not compact. In particular, it will contain points where the warp factor of the AdS 2 space diverges, leading to asymptotically AdS 3 regions. We show that the AdS 2 space-time may always be replaced with an AdS 2-"black-hole" space-time. We argue the resulting geometry describes the BCFT at finite temperature. To motivate this claim, we compute the entanglement entropy holographically for a segment centered around the defect or ending on the boundary and find agreement with a known universal formula.

  4. Quantitative Assessment of Left Ventricular Function and Myocardial Mass: A Comparison of Coronary CT Angiography with Cardiac MRI and Echocardiography

    PubMed Central

    Kara, Bedia; Nayman, Alaaddin; Guler, Ibrahim; Gul, Enes Elvin; Koplay, Mustafa; Paksoy, Yahya

    2016-01-01

    Summary Background The purpose of this study was to compare the left ventricular parameters obtained from multi-detector row computed tomography (MDCT) studies with two-dimensional echocardiography (2DE), and magnetic resonance imaging (MRI), which is accepted as the gold standard in the evaluation of left ventricular functions. The study also aimed to evaluate whether or not there is a relationship between the MR-Argus and CMR tools software programs which are used in post-process calculations of data obtained by MRI. Material/Methods Forty patients with an average age of 51.4±14.9 years who had been scanned with cardiac MDCT were evaluated with cardiac MRI and 2DE. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), and myocardial mass values calculated by MDCT, MRI, and 2DE were compared with each other. Two different MR software programs were used to compare left ventricular functions. The CMR tools LV tutorials method is accepted as the gold standard because it can be used in three-dimensional functional evaluation. The Pearson Correlation and Bland-Altman analysis were performed to compare the results from the two MR methods (MR-Argus and CMR tools) and the results from both the MDCT and the 2DE with the CMR tools results. Results Strong positive correlations for EF values were found between the MDCT and CMR tools (r=0.702 p<0.001), and between the MR-Argus and CMR tools (r=0.746 p<0.001). The correlation between the 2DE and CMR tools (r=0.449 p<0.004), however, was only moderate. Similar results were obtained for the other parameters. The strongest correlation for ESV, EDV, and EF was between the two MR software programs. The correlation coefficient between the MDCT and CMR tools is close to the correlation coefficient between the two software programs. While the correlation between 2DE and CMR tools was satisfactory for ESV, EDV, and CO values, it was at a moderate level for the other

  5. How best to assess right ventricular function by echocardiography*

    PubMed Central

    DiLorenzo, Michael P.; Bhatt, Shivani M.; Mercer-Rosa, Laura

    2016-01-01

    Right ventricular function is a crucial determinant of long-term outcomes of children with heart disease. Quantification of right ventricular systolic and diastolic performance by echocardiography is of paramount importance, given the prevalence of children with heart disease, particularly those with involvement of the right heart, such as single or systemic right ventricles, tetralogy of Fallot, and pulmonary arterial hypertension. Identification of poor right ventricular performance can provide an opportunity to intervene. In this review, we will go through the different systolic and diastolic indices, as well as their application in practice. Quantification of right ventricular function is possible and should be routinely performed using a combination of different measures, taking into account each disease state. Quantification is extremely useful for individual patient follow-up. Laboratories should continue to strive to optimise reproducibility through quality improvement and quality assurance efforts in addition to investing in technology and training for new, promising techniques, such as three-dimensional echocardiography. PMID:26675593

  6. Entropy-based straight kernel filter for echocardiography image denoising.

    PubMed

    Rajalaxmi, S; Nirmala, S

    2014-10-01

    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

  7. On-Orbit Prospective Echocardiography on International Space Station

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

    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.

  8. Influence of psoriasis on circulatory system function assessed in echocardiography.

    PubMed

    Milaniuk, Sylwia; Pietrzak, Aldona; Mosiewicz, Barbara; Mosiewicz, Jerzy; Reich, Kristian

    2015-12-01

    Psoriasis vulgaris is a chronic disease with a multifactorial pathogenesis. It affects about 2-4 % of the population all over the world. In course of psoriatic arthritis, joints' damages are observed. In patients with psoriasis vulgaris and psoriatic arthritis, there is increased morbidity and mortality caused by cardiovascular diseases observed. The aim of the study is to analyze the echocardiography of patients with psoriasis vulgaris and psoriatic arthritis on the basis of the literature available in PubMed database. Abnormalities found in echocardiography of patients with psoriasis include valvular defects (40.7 % of the patients), left ventricle diastolic dysfunction (27.8 %), and left ventricle hypertrophy (11.1 %). Left ventricle's systolic disorders, increased aorta stiffness index and increased pulmonary artery blood pressure were also observed in this group of patients. PMID:26121943

  9. Use of adenosine echocardiography for diagnosis of coronary artery disease

    SciTech Connect

    Zoghbi, W.A. )

    1991-07-01

    Two-dimensional echocardiography combined with exercise is sensitive and specific in the detection of coronary artery disease (CAD) by demonstrating transient abnormalities in wall motion. Frequently, however, patients cannot achieve maximal exercise because of various factors. Pharmacologic stress testing with intravenous adenosine was evaluated as a means of detecting CAD in a noninvasive manner. Patients with suspected CAD underwent echocardiographic imaging and simultaneous thallium 201 single-photon emission computed tomography during the intravenous administration of 140 micrograms/kg/min of adenosine. An increase in heart rate, decrease in blood pressure, and increase in double product were observed during adenosine administration. Initial observations revealed that wall motion abnormalities were induced by adenosine in areas of perfusion defects. The adenosine infusion was well tolerated, and symptoms disappeared within 1 to 2 minutes after termination of the infusion. Therefore preliminary observations suggest that adenosine echocardiography appears to be useful in the assessment of CAD.

  10. Transesophageal echocardiography probe shutdown in a patient with hyperthermia

    PubMed Central

    Saluja, Vandana; Singh, Gaganpal; Pandey, Chandrakant

    2016-01-01

    The use of transesophageal echocardiography (TEE) has been increasing over the past few years. It is considered a semi-invasive monitor and a safe diagnostic device. Though complications are rare, they must be known to operators who frequently perform TEE. TEE probes are known to cause tissue heating and damage on prolonged use. In this case report, we describe shutdown of the transesophageal probe in our patient with high-grade fever. PMID:26952152

  11. Open access echocardiography is feasible in the Netherlands

    PubMed Central

    Baur, L.H.B.; Veenstra, L.; Lenderink, T.; der Bolt, C.L.B. Lodewijks-van; Winkens, R.A.G.; Soomers, F.L.M.; Stoffers, H.E.J.H.

    2006-01-01

    Objectives In an urban region in the Netherlands, general practitioners (GPs) were offered an open access echocardiographic service. We report the outcomes of the first two years of this project. Methods GPs were given a course on the indications and restrictions for diagnostic referral as well as the interpretation of echocardiographic results. Indications were restricted to `dyspnoea', `cardiac murmur' and `peripheral oedema'. A uniform request form was developed, using ticking boxes for quick completion. The echocardiogram was performed within one week after the request. Results were interpreted by the cardiologist according to the criteria of the Dutch, European and American Societies of Echocardiography. Results Sixty GPs from 43 general practices participated, covering a practice population of 130,000 persons. During a period of 24 months, 198 patients were referred. Only 1.5% of the workload of the echocardiography department was due to requests from GPs. The GPs kept well to the agreements on indications for echocardiography (91% approved reasons). An abnormal echocardiographic outcome was found in 53% of all patients. For `cardiac murmur' this was 52%, for `dyspnoea' 63%, and for `peripheral oedema' 58%. Left ventricular dysfunction was present in 49 patients (25%); diastolic dysfunction was present in most of them (39 patients, 19%). Systolic dysfunction (LVEF < 40%) was found in 19 patients (10%). Twenty patients (10%) appeared to have relevant aortic or mitral valve disease. Conclusion GPs did not overuse the open access echocardiographic service; they possibly used it conservatively. To prevent underdiagnosis of left ventricular dysfunction, diagnostic strategies in which electrocardiogram, NT-pro-BNP and echocardiography are combined, should be developed. PMID:25696570

  12. Real-time transesophageal echocardiography facilitates antegrade balloon aortic valvuloplasty

    PubMed Central

    Ito, Kazato; Yano, Kentaro; Tanaka, Chiharu; Nakashoji, Tomohiro; Tonomura, Daisuke; Takehara, Kosuke; Kino, Naoto; Yoshida, Masataka; Kurotobi, Toshiya; Tsuchida, Takao; Fukumoto, Hitoshi

    2016-01-01

    We report two cases of severe aortic stenosis (AS) where antegrade balloon aortic valvuloplasty (BAV) was performed under real-time transesophageal echocardiography (TEE) guidance. Real-time TEE can provide useful information for evaluating the aortic valve response to valvuloplasty during the procedure. It was led with the intentional wire-bias technique in order to compress the severely calcified leaflet, and consequently allowed the balloon to reach the largest possible size and achieve full expansion of the aortic annulus. PMID:27054107

  13. Current Clinical Applications of Transthoracic Three-Dimensional Echocardiography

    PubMed Central

    Boccalini, Francesca; Muraru, Denisa; Bianco, Lucia Dal; Peluso, Diletta; Bellu, Roberto; Zoppellaro, Giacomo; Iliceto, Sabino

    2012-01-01

    The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography. PMID:22509433

  14. Estimating pulmonary artery pressures by echocardiography in patients with emphysema.

    PubMed

    Fisher, M R; Criner, G J; Fishman, A P; Hassoun, P M; Minai, O A; Scharf, S M; Fessler, H E

    2007-11-01

    In patients with emphysema being evaluated for lung volume reduction surgery, Doppler echocardiography has been used to screen for pulmonary hypertension as an indicator of increased peri-operative risk. To determine the accuracy of this test, the present authors compared the results of right heart catheterisations and Doppler echocardiograms in 163 patients participating in the cardiovascular substudy of the National Emphysema Treatment Trial. Substudy patients had both catheterisation and Doppler echocardiography performed before and after randomisation. In 74 paired catheterisations and echocardiograms carried out on 63 patients, the mean values of invasively measured pulmonary artery systolic pressures and the estimated right ventricular systolic pressures were similar. However, using the World Health Organization's definitions of pulmonary hypertension, echocardiography had a sensitivity of 60%, specificity of 74%, positive predictive value of 68% and a negative predictive value of 67% compared with the invasive measurement. Bland-Altman analysis revealed a bias of 0.37 kPa with 95% limits of agreement from -2.5-3.2 kPa. In patients with severe emphysema, echocardiographic estimates of pulmonary artery pressures correlate very weakly with right heart catheterisations, and the test characteristics (e.g. sensitivity, specificity, etc.) of echocardiographic assessments are poor. PMID:17652313

  15. Assessment of right ventricular systolic function by tissue Doppler echocardiography.

    PubMed

    Kjærgaard, Jesper

    2012-03-01

    This thesis summarizes a series of studies performed in order to assess the clinical usefulness of a novel echocardiographic technology that allows non-invasive assessment of regional right ventricular myocardial velocities and deformation: tissue Doppler echocardiography. While the technology is a promising tool for improving our understanding of right ventricular hemodynamics, several aspects of the technology must be evaluated. The accuracy and reproducibility of the technology is evaluated in vitro, and normal values, impact of changes in loading of the right ventricle, response to exercise and pharmacological pulmonary vasodilatation is established in normal subjects. The diagnostic and prognostic importance of adding tissue Doppler echocardiography to conventional echocardiographic and clinical parameters was evaluated in studies on patients with diseases associated with different modes of impact on right ventricular hemodynamics: pulmonary embolism, Arrhythmogenic right ventricular cardiomyopathy and pulmonary regurgitation, the latter in an animal model. The conclusions of the thesis are: Color tissue Doppler echocardiography accurately measures velocities, SR and strain in vitro. No systematic bias between ultrasound systems can be found, and accuracy of the measurements is good. However, the reproducibility of measurements in a test-retest design can limit the usefulness of the technology in daily clinical use, as 25% to 80% of change would be needed for the technology to identify a change in individual patients [I]. Normal values of tissue Doppler based measurements of RV regional velocities, SR and strain exist, and apply to both sexes and in all age groups with the exception of slightly decreasing values in strain with increasing age. Increasing preload and afterload changes regional myocardial velocities, but no changes in SR, strain or isovolumic acceleration could be observed [II and III]. Tissue Doppler echocardiography of the RV free wall in non

  16. How Rescue Echocardiography Changed the Intraoperative Management of an Obese Patient with Refractory Hypotension?

    PubMed

    Wang, Connie; Shelton, Kenneth; Ortiz, Vilma E

    2016-06-15

    The value of perioperative echocardiography as a rescue tool to complement the clinical assessment of patients who develop hemodynamic instability during noncardiac surgery is becoming increasingly recognized. Several studies have demonstrated the utility of echocardiography in establishing a diagnosis during clinical emergencies. We present the case of an obese patient with refractory hypotension during laparoscopic gynecologic surgery in which rescue transesophageal echocardiography was pivotal in elucidating a diagnosis and changing the course of management. PMID:27301054

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

    PubMed

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

    2015-02-01

    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

  18. Registration of multi-view apical 3D echocardiography images

    NASA Astrophysics Data System (ADS)

    Mulder, H. W.; van Stralen, M.; van der Zwaan, H. B.; Leung, K. Y. E.; Bosch, J. G.; Pluim, J. P. W.

    2011-03-01

    Real-time three-dimensional echocardiography (RT3DE) is a non-invasive method to visualize the heart. Disadvantageously, it suffers from non-uniform image quality and a limited field of view. Image quality can be improved by fusion of multiple echocardiography images. Successful registration of the images is essential for prosperous fusion. Therefore, this study examines the performance of different methods for intrasubject registration of multi-view apical RT3DE images. A total of 14 data sets was annotated by two observers who indicated the position of the apex and four points on the mitral valve ring. These annotations were used to evaluate registration. Multi-view end-diastolic (ED) as well as end-systolic (ES) images were rigidly registered in a multi-resolution strategy. The performance of single-frame and multi-frame registration was examined. Multi-frame registration optimizes the metric for several time frames simultaneously. Furthermore, the suitability of mutual information (MI) as similarity measure was compared to normalized cross-correlation (NCC). For initialization of the registration, a transformation that describes the probe movement was obtained by manually registering five representative data sets. It was found that multi-frame registration can improve registration results with respect to single-frame registration. Additionally, NCC outperformed MI as similarity measure. If NCC was optimized in a multi-frame registration strategy including ED and ES time frames, the performance of the automatic method was comparable to that of manual registration. In conclusion, automatic registration of RT3DE images performs as good as manual registration. As registration precedes image fusion, this method can contribute to improved quality of echocardiography images.

  19. Hand-held echocardiography: its use and usefulness.

    PubMed

    Mondillo, Sergio; Giannotti, Giovanna; Innelli, Pasquale; Ballo, Pier Carlo; Galderisi, Maurizio

    2006-07-28

    In recent years, several echocardiographic hand-held devices have been developed and are now available for a growing number of cardiologists. After the first clinical use 25 years ago, hand-held echocardiography (HHE) is now earning important commercial positions. Their transportability permits echo performance out the echo-labs and offers the possibility to make diagnosis in intensive care unit, emergency room, outpatient clinic, at the bedside, and even in ambulance. Experiences in the clinical setting have demonstrated the ability of HHE to detect multiple diseases including abdominal aortic aneurysms, left ventricular hypertrophy, regional wall motion abnormalities, pericardial and pleural effusions. At the present time, four varieties of HHE have to be recognized: the first includes high-cost, miniaturized machines, similar to the most advanced instrumentations, provided by new tools and imaging transfer systems; a second intermediate, middle-cost variety encompasses devices corresponding to standard echocardiography, but not miniaturized; according to the definition of the American Society of Echocardiography, a third and a fourth category comprise machines of weight lower than 2.7 kg, battery supplied and appropriately defined as "portable cardioschopes", which can be utilized as a technical refinement of physical examination. The use of HHE opens main controversy concerning their diagnostic accuracy, the opportunity to establish in which clinical settings they should be used and the identification of both potential users and required competence level. Preliminary experiences show the possibility to improve and anticipate diagnosis of several cardiovascular diseases but also the need to plan specific ultrasound training to avoid incorrect use of HHE. PMID:16087257

  20. Live/real time three-dimensional transesophageal echocardiography.

    PubMed

    Sudhakar, Selvin; Khairnar, Prakash; Nanda, Navin C

    2012-01-01

    Since the advent of matrix array transducer, three-dimensional transesophageal echocardiography has come to frequent clinical use. It has significantly enhanced the communication between the operators and cardiac imagers in the operating room as well as in the cardiac interventional labs. This article reviews the history, technological aspects, and the protocol for acquisition and processing of the data sets. It also discusses its advantages in various clinical scenarios, both in diagnostic and therapeutic situations. It highlights its limitations in the current form and prospects of future development. PMID:23186294

  1. Echocardiography for the Assessment of Congenital Heart Defects in Calves.

    PubMed

    Mitchell, Katharyn Jean; Schwarzwald, Colin Claudio

    2016-03-01

    Congenital heart disease should be considered when evaluating calves with chronic respiratory signs, failure to thrive, poor growth, or if a murmur is heard on physical examination. Echocardiography is currently the gold standard for diagnosing congenital heart defects. A wide variety of defects, either alone or in combination with a ventricular septal defect, are possible. A standardized approach using sequential segmental analysis is required to fully appreciate the nature and severity of more complex malformations. The prognosis for survival varies from guarded to poor and depends on the hemodynamic relevance of the defects and the degree of cardiac compensation. PMID:26922111

  2. Intracardiac echocardiography to diagnose pannus formation after aortic valve replacement.

    PubMed

    Yamamoto, Yoshiya; Ohara, Takahiro; Funada, Akira; Takahama, Hiroyuki; Amaki, Makoto; Hasegawa, Takuya; Sugano, Yasuo; Kanzaki, Hideaki; Anzai, Toshihisa

    2016-03-01

    A 66-year-old female, under regular follow-up for 20 years after aortic valve replacement (19-mm Carbomedics), presented dyspnea on effort and hypotension during hemodialysis. A transthoracic echocardiogram showed elevation of transvalvular velocity up to 4 m/s, but the structure around the aortic prosthesis was difficult to observe due to artifacts. Fluoroscopy revealed normal motion of the leaflets of the mechanical valve. Intracardiac echocardiography (ICE) revealed a pannus-like structure in the left ventricular outflow tract. Transesophageal echocardiogram also revealed this structure. ICE can visualize structural abnormalities around a prosthetic valve after cardiac surgery even in patients in whom conventional imaging modalities failed. PMID:26732266

  3. Mycotic aneurysm of the descending aorta diagnosed by echocardiography.

    PubMed

    Ozkutlu, S; Ozbarlas, N; Bilgiç, A; Paşaoğlu, I

    1992-10-01

    We present a 3-yr-old girl with coarctation of aorta and patent ductus arteriosus in whom mycotic aneurysm and bacterial endarteritis developed postoperatively and was diagnosed by two-dimensional and Doppler echocardiography. Five weeks after the operation of ligation of ductus and resection of coarctated segment, the patient was readmitted with complaints of vomiting, fever and coughing. Bacterial endarteritis, empyema and septic arthritis were diagnosed. Suprasternal echocardiographic examination demonstrated an aneurysmatic appearance 60 x 65 mm in size at the location of coarctation. The patient died, most probably due to aortic rupture, before surgical treatment could be undertaken. Autopsy study confirmed our diagnosis. PMID:1428279

  4. Echocardiography in the Assessment of Patients with Rheumatologic Diseases.

    PubMed

    Al-Mohaissen, Maha A; Chan, Kwan-Leung

    2016-08-01

    Cardiovascular disease is an important extra-articular manifestation of rheumatologic diseases leading to considerable mortality and morbidity. Echocardiography emerges as a useful non-invasive technique for the screening and evaluation of cardiac involvement in these patients. With the technological advancement in echocardiographic techniques, we have gained a greater appreciation of the prevalence and nature of the cardiac involvement in these patients, as detection of subclinical disease is increasingly feasible. This review discusses cardiac involvement in patients with rheumatoid arthritis, systemic lupus erythematosus, anti-phospholipid antibody syndrome, systemic sclerosis and ankylosing spondylitis, and the role of different echocardiographic modalities in their evaluation. PMID:27306356

  5. Recent advances in echocardiography: strain and strain rate imaging

    PubMed Central

    Mirea, Oana; Duchenne, Jurgen; Voigt, Jens-Uwe

    2016-01-01

    Deformation imaging by echocardiography is a well-established research tool which has been gaining interest from clinical cardiologists since the introduction of speckle tracking. Post-processing of echo images to analyze deformation has become readily available at the fingertips of the user. New parameters such as global longitudinal strain have been shown to provide added diagnostic value, and ongoing efforts of the imaging societies and industry aimed at harmonizing methods will improve the technique further. This review focuses on recent advances in the field of echocardiographic strain and strain rate imaging, and provides an overview on its current and potential future clinical applications. PMID:27158476

  6. Hydrometeor classification from a 2 dimensional video disdrometer

    NASA Astrophysics Data System (ADS)

    Grazioli, Jacopo; Tuia, Devis; Berne, Alexis

    2014-05-01

    Hydrometeor classification techniques aim at identifying the dominant hydrometeor type in a given observation volume or at a given time step, during precipitation. Such techniques are employed to interpret measurements from polarimetric weather radars, cloud lidars, and airborne particle imagers and their output is applied to risk assessment, air traffic control, and parametrization of numerical weather models. In the present work we develop a hydrometeor classification approach designed for data collected by a ground instrument: the 2 dimensional video disdrometer (2DVD). The 2DVD provides fall velocity and 2D views of each particle falling in its sampling area, by means of two orthogonally oriented line scanning cameras. We summarize this large amount of information over time steps of 60 seconds by characterizing the statistical behavior of a set of shape, size and velocity descriptors calculated for each falling hydrometeor. This summarized information is the input for the classification algorithm, that therefore provides the dominant hydrometeor type during a given time step of precipitation. 8 dominant hydrometeor classes have been identified by visual inspection of data collected in different climatologies (Switzerland, France and Canada), namely: small particles, dendrites, columns, graupel, rimed particles, aggregates, melting snow and rain. 400 representative time steps have been manually selected and classified in one of these classes in order to build a training set for the classification algorithm. The employed classifier is a support vector machine (SVM), a supervised linear classification method trained and evaluated on subsets of the 400 time steps. The algorithm achieves accurate performances, with overall accuracy higher than 90% in global terms and higher than 84% in median for each of the 8 hydrometeor classes available. This is confirmed by the Cohen's Kappa score (or HSS), that takes into account the prediction by chance and is higher than 0

  7. Materials Science and Device Physics of 2-Dimensional Semiconductors

    NASA Astrophysics Data System (ADS)

    Fang, Hui

    Materials and device innovations are the keys to future technology revolution. For MOSFET scaling in particular, semiconductors with ultra-thin thickness on insulator platform is currently of great interest, due to the potential of integrating excellent channel materials with the industrially mature Si processing. Meanwhile, ultra-thin thickness also induces strong quantum confinement which in turn affect most of the material properties of these 2-dimensional (2-D) semiconductors, providing unprecedented opportunities for emerging technologies. In this thesis, multiple novel 2-D material systems are explored. Chapter one introduces the present challenges faced by MOSFET scaling. Chapter two covers the integration of ultrathin III V membranes with Si. Free standing ultrathin III-V is studied to enable high performance III-V on Si MOSFETs with strain engineering and alloying. Chapter three studies the light absorption in 2-D membranes. Experimental results and theoretical analysis reveal that light absorption in the 2-D quantum membranes is quantized into a fundamental physical constant, where we call it the quantum unit of light absorption, irrelevant of most of the material dependent parameters. Chapter four starts to focus on another 2-D system, atomic thin layered chalcogenides. Single and few layered chalcogenides are first explored as channel materials, with focuses in engineering the contacts for high performance MOSFETs. Contact treatment by molecular doping methods reveals that many layered chalcogenides other than MoS2 exhibit good transport properties at single layer limit. Finally, Chapter five investigated 2-D van der Waals heterostructures built from different single layer chalcogenides. The investigation in a WSe2/MoS2 hetero-bilayer shows a large Stokes like shift between photoluminescence peak and lowest absorption peak, as well as strong photoluminescence intensity, consistent with spatially indirect transition in a type II band alignment in this

  8. Role of echocardiography in detecting portopulmonary hypertension in liver transplant candidates.

    PubMed

    Cotton, Cynthia L; Gandhi, Sanjay; Vaitkus, Paul T; Massad, Malek G; Benedetti, Enrico; Mrtek, Robert G; Wiley, Thelma E

    2002-11-01

    Portopulmonary hypertension (PPHTN) is a recognized complication of end-stage liver disease that adversely affects the outcome of orthotopic liver transplantation (OLT). There are limited data on the role of Doppler echocardiography in assessing pulmonary artery systolic pressure (PASP) in this population. The purpose of our study was to examine the accuracy of Doppler echocardiography in evaluating pulmonary artery pressures in liver transplant candidates. Clinical and demographic data were gathered retrospectively for 78 liver transplant candidates (48 men and 30 women, mean age 51 +/- 9.6 yr) who had PASP determined both by right heart catheterization (RHC) and echocardiography. Paired sample t-test was used to compare mean PASP by echocardiography and RHC. Correlation of PASP between echocardiography and RHC was determined using Pearson's linear correlation. Positive and negative predictive values for echocardiography for PASP > 50 mmHg are reported as compared with RHC. The mean PASP by echocardiography (43.2 +/- 12.3 mm Hg) was significantly higher than mean PASP by RHC (33.7 +/- 15.5 mm Hg; P <.001). Regarding PASP, there was a significant but weak correlation between echocardiography and RHC (r = 0.46, P =.01). The positive and negative predictive values of echocardiography for identifying clinically significant pulmonary hypertension (PASP > 50 mm Hg) were 37.5% and 91.9%, respectively. Echocardiography is a useful tool in estimating PASP in liver transplant candidates. Patients with apparently elevated PASP by echocardiography should undergo invasive assessment by RHC before being excluded from liver transplant. PMID:12424719

  9. Supporting the early use of echocardiography in blunt chest trauma

    PubMed Central

    2012-01-01

    This case reports a very unusual mechanism of cardiac rupture following an episode of multiple blunt chest trauma. The patient, a professional jockey, was trampled by horses, and although shocked on hospital admission, he did not present with signs and symptoms that were consistent with cardiogenic shock. This case highlights the difficult and subjective nature of clinical examination in emergency situations when dealing with cases of acute cardiac tamponade. It further emphasises the lack of sensitivity of traditional trauma imaging and investigative approaches such as the standard anteroposterior chest X-ray and electrocardiogram. The diagnosis of acute cardiac tamponade was not made until tertiary-care-centre arrival, when ultrasound technology in the form of bedside echocardiography was used, facilitating emergency surgery to repair a ruptured left ventricle. It is hoped that the sharing of this case will alert fellow clinicians to this uncommon but possible mechanism of cardiac rupture and subsequent tamponade, encourage the early use of echocardiography at the bedside in hypotensive blunt chest trauma cases and reinforce the principles of the Advanced Trauma Life Support course in treating trauma victims. PMID:22870886

  10. 6DoF catheter detection, application to intracardiac echocardiography.

    PubMed

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

    2014-01-01

    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

  11. Temporal enhancement of two-dimensional color doppler echocardiography

    NASA Astrophysics Data System (ADS)

    Terentjev, Alexey B.; Settlemier, Scott H.; Perrin, Douglas P.; del Nido, Pedro J.; Shturts, Igor V.; Vasilyev, Nikolay V.

    2016-03-01

    Two-dimensional color Doppler echocardiography is widely used for assessing blood flow inside the heart and blood vessels. Currently, frame acquisition time for this method varies from tens to hundreds of milliseconds, depending on Doppler sector parameters. This leads to low frame rates of resulting video sequences equal to tens of Hz, which is insufficient for some diagnostic purposes, especially in pediatrics. In this paper, we present a new approach for reconstruction of 2D color Doppler cardiac images, which results in the frame rate being increased to hundreds of Hz. This approach relies on a modified method of frame reordering originally applied to real-time 3D echocardiography. There are no previous publications describing application of this method to 2D Color Doppler data. The approach has been tested on several in-vivo cardiac 2D color Doppler datasets with approximate duration of 30 sec and native frame rate of 15 Hz. The resulting image sequences had equivalent frame rates to 500Hz.

  12. A safety checklist for transoesophageal echocardiography from the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists

    PubMed Central

    Alderton, Susan; Steeds, Richard; Bradlow, Will; Chenzbraun, Adrian; Oxborough, David; Mathew, Thomas; Jones, Richard; Wheeler, Richard; Sandoval, Julie; Lloyd, Guy; O'Gallagher, Kevin; Knight, Daniel; Ring, Liam; Collins, Katherine; O'Keeffe, Niall; Fletcher, Nick; Harkness, Allan; Rana, Bushra

    2015-01-01

    The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduction of this checklist resulted in a significant reduction in the incidence of complications and death in patients undergoing surgery. Consequently, the WHO Surgical Safety checklist is recommended for use by the National Patient Safety Agency for all patients undergoing surgery. However, many invasive or interventional procedures occur outside the theatre setting and there are increasing requirements for a safety checklist to be used prior to such procedures. Transoesophageal echocardiography (TOE) is an invasive procedure and although generally considered to be safe, it carries the risk of serious and potentially life-threatening complications. Strict adherence to a safety checklist may reduce the rate of significant complications during TOE. However, the standard WHO Surgical Safety Checklist is not designed for procedures outside the theatre environment and therefore this document is designed to be a procedure-specific safety checklist for TOE. It has been endorsed for use by the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists. PMID:26798486

  13. The diagnostic ability of echocardiography for infective endocarditis and its associated complications.

    PubMed

    Vilacosta, Isidre; Olmos, Carmen; de Agustín, Alberto; López, Javier; Islas, Fabián; Sarriá, Cristina; Ferrera, Carlos; Ortiz-Bautista, Carlos; Sánchez-Enrique, Cristina; Vivas, David; San Román, Alberto

    2015-11-01

    Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations. PMID:26471429

  14. Imaging Aortic Regurgitation: The Incremental Benefit of Speckle Tracking Echocardiography

    PubMed Central

    Garg, Pankaj; Yassin, Firas; Leischik, Roman

    2015-01-01

    Aortic regurgitation (AR) affects global left ventricular mechanics. However, limited literature is available on how it may affect regional longitudinal strain. We present a case where severe AR jet is thrashing the anterior-septal wall and reducing its overall longitudinal performance most likely secondary to increased wall shear stress in diastole. This new insight into patho-physiological process using deformation study may have supplementary impact in decision making for surgical intervention. Transthoracic echocardiography is the primary imaging modality for the assessment of AR as it offers evaluation of severity of AR, aetiology of AR, left ventricular (LV) dilatation, LV systolic function, left ventricular mass, diastolic function and global strain. This case highlights the regional disturbances in longitudinal strain in eccentric AR. PMID:27006711

  15. Noninvasive estimation of left atrial pressure with transesophageal echocardiography

    PubMed Central

    Cowie, Brian; Kluger, Roman; Rex, Steffen; Missant, Carlo

    2015-01-01

    Background: The pulmonary artery catheter (PAC) has historically been used to measure cardiac filling pressures of which pulmonary capillary wedge pressure (PCWP) has been used as a surrogate of left atrial pressure (LAP) and left ventricular end-diastolic pressure. Increasingly, the use of the PAC has been questioned in the perioperative period with multiple large studies unable to clearly demonstrate benefit in any group of patients, resulting in a declining use in the perioperative period. Alternative methods for the noninvasive estimation of left-sided filling pressures are required. Echocardiography has been used to provide noninvasive estimation of PCWP and LAP, based on evaluating mitral inflow velocity with the E and A waves and looking at movement of the mitral annulus with tissue Doppler (e’). Aim: The aim of our study was to assess the relationship between PCWP and E/e’ in cardiac surgical patients with transesophageal echocardiography (TOE). Design: A prospective observational study. Setting: Cardiac surgical patients in a single quaternary referral university teaching hospital. Methods: The ratio of mitral inflow velocity (E wave) to mitral annular tissue velocity (e’) (the E/e’ ratio) and PCWP of 91 patients undergoing general anesthesia and cardiac surgery were simultaneously recorded, with the use of TOE and a PAC. Results: The correlation between E/e’ and PCWP was modest with a Spearman rank correlation coefficient of 0.29 (P = 0.005). The area under the receiver operating characteristic curve for using E/e’ to predict elevated PCWP (≥18 mmHg) was 0.6825 (95% confidence interval: 0.57–0.80), indicating some predictive utility. The optimum threshold value of E/e’ was 10 which had 71% sensitivity and 60% specificity to predict a PCWP ≥18 mmHg. Conclusions: Noninvasive measurements of E/e’ in general cardiac surgical patients have only a modest correlation and does not reliably estimate PCWP. PMID:26139734

  16. Pulmonary hypertension: prevalence and mortality in the Armadale echocardiography cohort

    PubMed Central

    Strange, Geoff; Stewart, Simon; Deague, Jenny A; Nelson, Helen; Kent, Aaron; Gabbay, Eli

    2012-01-01

    Background Pulmonary hypertension (PHT) lacks community prevalence and outcome data. Objective To characterise minimum ‘indicative’ prevalences and mortality data for all forms of PHT in a selected population with an elevated estimated pulmonary artery systolic pressure (ePASP) on echocardiography. Design Observational cohort study. Setting Residents of Armadale and the surrounding region in Western Australia (population 165 450) referred to our unit for transthoracic echocardiography between January 2003 and December 2009. Results Overall, 10 314 individuals (6.2% of the surrounding population) had 15 633 echo studies performed. Of these, 3320 patients (32%) had insufficient TR to ePASP and 936 individuals (9.1%, 95% CI 8.6% to 9.7%) had PHT, defined as, ePASP>40 mm Hg. The minimum ‘indicative’ prevalence for all forms of PHT is 326 cases/100 000 inhabitants of the local population, with left heart disease-associated PHT being the commonest cause (250 cases/100 000). 15 cases of pulmonary arterial hypertension/100 000 inhabitants were identified and an additional 144 individuals (15%) with no identified cause for their PHT. The mean time to death for those with ePASP >40 mm Hg, calculated from the first recorded ePASP, was 4.1 years (95% CI 3.9 to 4.3). PHT increased mortality whatever the underlying cause, but patients with PHT from left heart disease had the worst prognosis and those with idiopathic pulmonary arterial hypertension receiving disease-specific treatment the best prognosis. Risk of death increased with PHT severity: severe pulmonary hypertension shortened the lifespan by an average of 1.1 years compared with mild pulmonary hypertension. Conclusions In this cohort, PHT was common and deadly. Left heart disease was the most common cause and had the worst prognosis and treated pulmonary arterial hypertension had the best prognosis. PMID:22760869

  17. On-Orbit Prospective Echocardiography on International Space Station Crew

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

    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.

  18. Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-flight Echocardiography Aboard the International Space Station

    NASA Technical Reports Server (NTRS)

    Martin, David; Borowski, Allan; Bungo, Michael W.; Dulchavsky, Scott; Gladding, Patrick; Greenberg, Neil; Hamilton, Doug; Levine, Benjamin D.; Norwoord, Kelly; Platts, Steven H.; Poston, Sue; Roper, Matthew; Sandoz, Gwenn; Thomas, James D.

    2011-01-01

    Echocardiography is ideally suited for cardiovascular imaging in remote environments, but the expertise to perform it is often lacking. In 2001, an ATL HDI5000 was delivered to the International Space Station (ISS). The instrument is currently being used in a study to investigate the impact of long-term microgravity on cardiovascular function. The purpose of this report is to describe the methodology for remote guidance of echocardiography in space. Methods: In the year before launch of an ISS mission, potential astronaut echocardiographic operators participate in 5 sessions to train for echo acquisitions that occur roughly monthly during the mission, including one exercise echocardiogram. The focus of training is familiarity with the study protocol and remote guidance procedures. On-orbit, real-time guidance of in-flight acquisitions is provided by a sonographer in the Telescience Center of Mission Control. Physician investigators with remote access are able to relay comments on image optimization to the sonographer. Live video feed is relayed from the ISS to the ground via the Tracking and Data Relay Satellite System with a 2 second transmission delay. The expert sonographer uses these images along with two-way audio to provide instructions and feedback. Images are stored in non-compressed DICOM format for asynchronous relay to the ground for subsequent off-line analysis. Results: Since June, 2009, a total of 19 resting echocardiograms and 4 exercise studies have been performed in-flight. Average acquisition time has been 45 minutes, reflecting 26,000 km of ISS travel per study. Image quality has been adequate in all studies, but remote guidance has proven imperative for fine-tuning imaging and prioritizing views when communication outages limit the study duration. Typical resting studies have included 12 video loops and 21 still-frame images requiring 750 MB of storage. Conclusions: Despite limited crew training, remote guidance allows research

  19. History of echocardiography in the Netherlands: 30 years of education and clinical applications

    PubMed Central

    Kamp, O.

    2008-01-01

    The development of ultrasound has created great opportunities for diagnostic cardiac imaging. For more than 30 years, echocardiography has been the most important and cost-effective diagnostic imaging modality in clinical cardiology. Many developments originated in the Netherlands, including the very first practical real-time crosssectional imaging of the moving heart with a linear array. Milestones include the first portable echo apparatus, early versions of echo catheters and transoesophageal echocardiography probes as well as many clinical ‘firsts’ with reference to the more than 100 Dutch dissertations related to echocardiography. The future of echocardiography promises to be as productive and exciting as it has been in the previous three decades, including threedimensional echocardiography, myocardial perfusion echocardiography, tissue Doppler imaging and speckle tracking. New potential therapeutic applications are upcoming. In this article, the advances of echocardiography in the Netherlands are described, in the past and during 30 years of education, as was recently presented by three Dutch pioneers during the ‘Echomiddagen 2006-2007’ organised by the CVOI. (Neth Heart J 2008;16:16-20.18317539) PMID:18317539

  20. Doppler tissue energy and stress echocardiography in the diagnosis of myocardial contusion in canines.

    PubMed

    Wenhua, Du; Xiuqin, Xiong; Weimin, Zhang

    2012-03-01

    We sought to evaluate the significance of Doppler tissue energy (DTE) and stressed echocardiography for diagnosing myocardial contusion (MC) in canines. Ten adult healthy dogs were anesthetized (3% pentobarbital sodium/i.v.) and impacted by BIM-II biological impact machine to induce MC. Conventional and stressed echocardiographies were used for segmental abnormal ventricular wall motions; DTE was also used to detect the abnormal ventricular wall motions and areas of injured myocardial fibers after MC, and the results were compared with those of triphenyl tetrazolium chloride (TTC) staining. The data show that both conventional and stressed echocardiographies identified ventricular wall segmental abnormal motions or even aneurysms. These segments were mainly distributed over the front and middle interventricular walls and anterolateral ventricular wall. The ventricular wall motion scoring and wall motion segment index (WMSI) increased remarkably after MC induction. Compared with TTC staining, the conventional echocardiography showed 100% sensitivity and 66.67% specificity, whereas the stressed echocardiography displayed 100% sensitivity and 88.89% specificity. DTE showed both the sensitivity and specificity of 100% for MC diagnosis. Thus, DTE has higher specificity than conventional and stressed echocardiographies. In conclusion, both DTE and stress echocardiography have higher clinical value for MC diagnosis in canines. PMID:22065256

  1. Saline contrast echocardiography for the detection of patent foramen ovale in hypoxia: a validation study using intracardiac echocardiography.

    PubMed

    Fenster, Brett E; Curran-Everett, Douglas; Freeman, Andrew M; Weinberger, Howard D; Kern Buckner, J; Carroll, John D

    2014-04-01

    Although the "3 beat rule" is widely utiized to discriminate patent foramen ovale (PFO)-mediated right-to-left shunt (RTLS) from intrapulmonary RTLS using saline contrast transthoracic echocardiography (SCE), SCE diagnostic performance has yet to be validated using an invasive intracardiac standard. Percutaneous PFO occluder placement was recently shown to ameliorate hypoxia in patients with suspected PFO-mediated RTLS. We evaluated the ability of SCE to predict PFO presence and size using intracardiac echocardiography (ICE) as a gold standard in a hypoxic cohort. Sixty-three hypoxic patients with suspected PFO-mediated RTLS who underwent SCE at rest, with Valsalva maneuver, and with cough prior to ICE were evaluated retrospectively. PFO RTLS was defined by ICE findings including PFO anatomy, RTLS by saline contrast and color Doppler, and probe patency. SCE shunt severity and timing of left heart saline target appearance were compared to the presence of ICE-defined PFO RTLS. Forty-seven patients (75%) met criteria for PFO-mediated RTLS. A 4 beat cutoff for resting SCE provided optimal diagnostic performance for detection of PFO-mediated RTLS with a 71% sensitivity, 94% specificity, and 97% positive predictive value (PPV). Valsalva and cough maneuvers improved sensitivity compared to rest SCE (89% and 80%, respectively). Valsalva SCE shunt severity more accurately predicted PFO size than resting SCE. In contrast to the widely accepted "3 beat rule," resting SCE for the detection of PFO RTLS in a hypoxic population performs optimally using a 4-cycle cutoff with both excellent specificity and PPV. PMID:24138568

  2. Comparison of Transesophageal and Transthoracic Contrast Echocardiography for Detection of a Patent Foramen Ovale

    NASA Technical Reports Server (NTRS)

    Siostrzonek, Peter; Zangeneh, Massoud; Gossinger, Heinz; Lang, Wilfried; Rosenmayr, Georg; Heinz, Gottfried; Stumpflen, Andreas; Zeiler, Karl; Schwarz, Martin; Mosslacher, Herbert

    1991-01-01

    Presence of a patent foramen ovale may indicate paradoxic embolism in patients with otherwise unexplained embolic disease. Transthoracic contrast echocardiography has been used as a simple technique for detecting patent foramen ovale. However, particularly in patients with poor transthoracic image quality, presence of a patent foramen ovale might be missed. Transesophageal contrast echocardiography provides superior visualization of the atrial septum and therefore is believed to improve diagnostic accuracy. The present study investigates the influence of image quality on the detection of a patent foramen ovale by both transthoracic and transesophageal contrast echocardiography.

  3. Comprehensive imaging including three-dimensional echocardiography of an infected, ruptured sinus of valsalva aneurysm.

    PubMed

    Medina, Hector M; Vazquez, Jacobo; Pritchett, Allison; Lakkis, Nasser; Dokainish, Hisham

    2007-11-01

    A 30-year-old man presented with fevers and fatigue. Blood cultures grew Streptococcus mitis in 4/4 bottles. Transthoracic three-dimensional echocardiography revealed an anterior coronary sinus of Valsalva (SOV) aneurysm with fistula formation into the right ventricle with vegetation on the fistulous tract, and a bicuspid aortic valve without vegetation. Transesophageal echocardiography confirmed these findings. After parenteral antibiotic treatment, the patient went for successful repair of the fistula, with the imaging findings confirmed at surgery. This case represents a rare complication of a ruptured SOV aneurysm, with excellent delineation of cardiac anatomy using transthoracic three-dimensional echocardiography. PMID:18001366

  4. Assessment of coronary flow reserve by transesophageal echocardiography in cardiac transplant recipients.

    PubMed

    Unger, P; Preumont, N; Vachiéry, J L; Bougard, M; Damhaut, P; Goldman, S; Berkenboom, G

    1998-06-01

    This study investigated the feasibility of dipyridamole Doppler transesophageal echocardiography to assess coronary flow reserve in 26 patients with orthotopic heart transplantation and compared it with positron emission tomography. We found an 85% success rate in obtaining Doppler flow signals in the proximal left anterior descending coronary artery. Our data also showed that the correlation between transesophageal echocardiography and dipyridamole N-13 ammonia positron emission tomography increases when respective resting rate-pressure products are taken into account. However, comparison between the two methods should be made with caution because coronary flow reserve derived from transesophageal echocardiography tends to be higher than that obtained with positron emission tomography. PMID:9657400

  5. Transthoracic and transoesophageal echocardiography: a systematic review of feasibility and impact on diagnosis, management and outcome after cardiac surgery.

    PubMed

    Heiberg, J; El-Ansary, D; Royse, C F; Royse, A G; Alsaddique, A A; Canty, D J

    2016-10-01

    Transthoracic and transoesophageal echocardiography are increasingly used as tools to improve clinical assessment following cardiac surgery. However, most physicians are not trained in echocardiography, and there is no widespread agreement on the feasibility, indications or effect on outcome of transthoracic or transoesophageal echocardiography for patients after cardiac surgery. We performed a systematic review of electronic databases for focused transthoracic and transoesophageal echocardiography after cardiac surgery which revealed 15 full-text articles. They consistently reported that echocardiography is feasible, whether performed by a novice or expert, and frequently resulted in important changes in diagnosis of cardiac abnormalities and their management. However, most were observational studies and there were no well-designed trials investigating the impact of echocardiography on outcome. We conclude that both transthoracic and transoesophageal echocardiography are useful following cardiac surgery. PMID:27341788

  6. Left Ventricular Diastolic Dysfunction Assessed by Conventional Echocardiography and Spectral Tissue Doppler Imaging in Adolescents With Arterial Hypertension.

    PubMed

    Morka, Aleksandra; Szydlowski, Leslaw; Moric-Janiszewska, Ewa; Mazurek, Boguslaw; Markiewicz-Loskot, Grazyna; Stec, Sebastian

    2016-02-01

    Compared to conventional echocardiography, spectral tissue Doppler imaging (s-TDI) allows more precise evaluation of diastolic cardiac function. The purpose of this study was to conduct s-TDI to analyze the slow movement of the left ventricular (LV) myocardium in adolescents with systemic arterial hypertension (HT) and to determine whether patients with HT suffer from LV diastolic dysfunction. The study group comprised 69 consecutive patients (48 boys and 21 girls aged 14-17 years [mean, 15.5 ± 1.1 years]) with primary HT, and the control group comprised 48 healthy participants (24 boys and 24 girls aged 14-17 years [mean, 15.8 ± 1.3 years]). Physical examinations, 24-hour arterial blood pressure monitoring, conventional 2-dimensional and Doppler echocardiography, and s-TDIs were performed. Analysis revealed that study group participants were significantly heavier and had greater LV mass indices than controls (P < 0.001). There were no differences between the velocities of E waves (peak early filling of mitral inflow), but the deceleration times of the mitral E waves were significantly shorter whereas the A waves survived longer in the study group than in the control group. The velocities of A waves (peak late filling of mitral inflow) were elevated (P = 0.041), and the E/A wave pattern (E/A = 1.8 ± 0.4) was normal. These results suggest pseudonormalization, a type of LV diastolic dysfunction in adolescents with HT.In the study group, when the sample volume was positioned at the septal or lateral insertion site of the mitral leaflet, the e' wave velocity was significantly depressed whereas the a' wave velocity was elevated, compared to those of the control group (P < 0.001).The e'/a' ratios from the septal and lateral insertion sites were lower, whereas the E/e' ratio from the septal insertion site was significantly higher in the study group, similar to that seen in atrial reversal velocity (P < 0.001).These findings indicate that

  7. Left Ventricular Diastolic Dysfunction Assessed by Conventional Echocardiography and Spectral Tissue Doppler Imaging in Adolescents With Arterial Hypertension

    PubMed Central

    Morka, Aleksandra; Szydlowski, Leslaw; Moric-Janiszewska, Ewa; Mazurek, Boguslaw; Markiewicz-Loskot, Grazyna; Stec, Sebastian

    2016-01-01

    Abstract Compared to conventional echocardiography, spectral tissue Doppler imaging (s-TDI) allows more precise evaluation of diastolic cardiac function. The purpose of this study was to conduct s-TDI to analyze the slow movement of the left ventricular (LV) myocardium in adolescents with systemic arterial hypertension (HT) and to determine whether patients with HT suffer from LV diastolic dysfunction. The study group comprised 69 consecutive patients (48 boys and 21 girls aged 14–17 years [mean, 15.5 ± 1.1 years]) with primary HT, and the control group comprised 48 healthy participants (24 boys and 24 girls aged 14–17 years [mean, 15.8 ± 1.3 years]). Physical examinations, 24-hour arterial blood pressure monitoring, conventional 2-dimensional and Doppler echocardiography, and s-TDIs were performed. Analysis revealed that study group participants were significantly heavier and had greater LV mass indices than controls (P < 0.001). There were no differences between the velocities of E waves (peak early filling of mitral inflow), but the deceleration times of the mitral E waves were significantly shorter whereas the A waves survived longer in the study group than in the control group. The velocities of A waves (peak late filling of mitral inflow) were elevated (P = 0.041), and the E/A wave pattern (E/A = 1.8 ± 0.4) was normal. These results suggest pseudonormalization, a type of LV diastolic dysfunction in adolescents with HT. In the study group, when the sample volume was positioned at the septal or lateral insertion site of the mitral leaflet, the e′ wave velocity was significantly depressed whereas the a′ wave velocity was elevated, compared to those of the control group (P < 0.001). The e′/a′ ratios from the septal and lateral insertion sites were lower, whereas the E/e′ ratio from the septal insertion site was significantly higher in the study group, similar to that seen in atrial reversal velocity (P < 0

  8. Anatomically corrected malposed great arteries misdiagnosed as transposition of great arteries: Diagnosis on fetal echocardiography

    PubMed Central

    Kumar, Vivek; Shah, Sejal

    2016-01-01

    We present a diagnosis of isolated anatomically corrected malposed great arteries on fetal echocardiography at 31 weeks of gestation period. The patient was referred to our institute with a diagnosis of suspected transposition of great arteries.

  9. Anatomically corrected malposed great arteries misdiagnosed as transposition of great arteries: Diagnosis on fetal echocardiography.

    PubMed

    Kumar, Vivek; Shah, Sejal

    2016-01-01

    We present a diagnosis of isolated anatomically corrected malposed great arteries on fetal echocardiography at 31 weeks of gestation period. The patient was referred to our institute with a diagnosis of suspected transposition of great arteries. PMID:27625528

  10. The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

    PubMed Central

    Esmaeilzadeh, Maryam; Parsaee, Mozhgan; Maleki, Majid

    2013-01-01

    Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction. PMID:23646042

  11. Evaluation of fetal echocardiography as a routine antenatal screening tool for detection of congenital heart disease

    PubMed Central

    Nayak, Krishnananda; Shetty, Ranjan; Narayan, Pratap Kumar

    2016-01-01

    Background Fetal echocardiography plays a pivotal role in identifying the congenital heart defects (CHDs) in utero. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool still needs to be defined. Performing foetal echocardiography based on only these indications can lead to a significant numbers of CHD cases going undetected who will be deprived of further management leading to increased early neonatal mortalities. The aim of this study is to assess the incidence of CHDs by fetal echocardiography in an unselected population of pregnant women in comparison with pregnant women with conventional high risk factors for CHD. Methods This study enrolled consecutive pregnant women who attended antenatal clinic between 2008 and 2012 in a tertiary care hospital. These pregnant women were categorized into two groups: high risk group included pregnant women with traditional risk factors for CHD as laid down by Pediatric Council of the American Society of Echocardiography and low risk group. Detailed fetal 2 D echocardiography was done. Results A total of 1,280 pregnant women were included in study. The 118 women were categorized as the high risk group while remaining 1,162 were included in the low risk group. Twenty six cases of CHDs were detected based on abnormal foetal echocardiography (20.3 per 1,000). Two of the 26 cases of CHD occurred in high risk group whereas the remaining 24 occurred in low risk pregnancy. The difference in the incidence of CHDs between the two groups was not significant statistically (P=0.76). Conclusions Our study shows no difference in incidence of CHDs between pregnancies associated with high risk factors compared to low risk pregnancies. So we advocate foetal echocardiography should be included as a part of routine antenatal screening and all pregnant women irrespective of risk factors for CHDs. PMID:26885491

  12. Results of a Prospective Echocardiography Trial in International Space Station Crew

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

    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.

  13. Retrieval of a Dislodged Catheter Using Combined Fluoroscopy and Intracardiac Echocardiography

    PubMed Central

    Mitsopoulos, Gus; Hanna, Robert F.; Brejt, Sidney Z.; Goldstein, Greg E.; Sheynzon, Vladimir; Weintraub, Joshua L.; Gray, William A.

    2015-01-01

    This report details a method of percutaneous, transluminal retrieval of an intracardiac foreign body using fluoroscopy in combination with intracardiac echocardiography. During retrieval, intracardiac echocardiography (ICE) provided real-time anatomic localization of a constantly moving, almost radiolucent micropuncture coaxial dilator fragment with respect to the tricuspid and pulmonary valves. This method may serve as a crucial aid in retrieval of intracardiac foreign bodies that are difficult to see with fluoroscopy and which may be adjacent to cardiac valves. PMID:26075131

  14. Aspergillus niger aortitis after aortic valve replacement diagnosed by transesophageal echocardiography.

    PubMed

    Duygu, Hamza; Nalbantgil, Sanem; Ozerkan, Filiz; Kirilmaz, Bahadir; Yagdi, Tahir

    2006-05-01

    Aspergillus aortitis following cardiac surgery has an important role among the cardiac infections as almost all affected cases result in death. Survival of the patient with Aspergillus aortitis is dependent on early initiation of aggressive medical and surgical treatment. Transesophageal echocardiography proved very useful in the diagnosis of this uncommon case of aortitis. In this paper, we present a patient with aortitis caused by Aspergillus niger that hasn't been reported previously diagnosed by transesophageal echocardiography following cardiac surgery. PMID:16686625

  15. The potential role and limitations of echocardiography in acute respiratory distress syndrome.

    PubMed

    Lazzeri, Chiara; Cianchi, Giovanni; Bonizzoli, Manuela; Batacchi, Stefano; Peris, Adriano; Gensini, Gian Franco

    2016-04-01

    Bedside use of Doppler echocardiography is being featured as a promising, clinically useful tool in assessing the pulmonary circulation in patients with acute respiratory distress syndrome (ARDS). The present review is aimed at summarizing the available evidence obtained with echocardiography on right ventricle (RV) function and pulmonary circulation in ARDS and to highlight the potential of this technique in clinical practice (only articles in English language were considered). According to the available evidence on echocardiographic findings, the following conclusions can be drawn: (a) echocardiography (transthoracic and transesophageal) has a growing role in the management ARDS patients mainly because of the strict interactions between the lung (and ventilation) and the RV and pulmonary circulation; (b) there may be a continuum of alterations in RV size and function and pulmonary circulation which may end in the development of acute cor pulmonale, probably paralleling ARDS disease severity; and (c) the detection of acute cor pulmonale should prompt intensivists to tailor their ventilatory strategy to the individual patient depending on the echocardiography findings. Bearing in mind the clinical role and growing importance of echocardiography in ARDS and the available evidence on this topic, we present a flow chart including the parameters to be measured and the timing of echo exams in ARDS patients. Despite the important progress that echocardiography has gained in the evaluation of patients with ARDS, several open questions remain and echocardiography still appears to be underused in these patients. A more systematic use of echocardiography (mainly through shared protocols) in ARDS could help intensivists to tailor the optimal treatment in individual patients as well as highlighting the limits and potential of this methodology in patients with ALI. PMID:26660667

  16. Anesthetic Management Guided by Transthoracic Echocardiography During Cesarean Delivery Complicated by Hypertrophic Cardiomyopathy.

    PubMed

    DesRoches, Jaclyn M; McKeen, Dolores Madeline; Warren, Andrew; Allen, Victoria M; George, Ronald B; Kells, Catherine; Shukla, Romesh

    2016-03-15

    We describe the management of a parturient woman with hypertrophic cardiomyopathy who developed a symptomatic accelerated idioventricular rhythm who required an urgent cesarean delivery at 32 weeks. Transthoracic echocardiography helped guide anesthetic management, including epidural dosing, fluid management, and phenylephrine infusion rates. This case demonstrates the application of transthoracic echocardiography to guide anesthetic management in a parturient woman at risk for cardiovascular compromise. PMID:26720049

  17. Three-dimensional echocardiography: the benefits of the additional dimension.

    PubMed

    Lang, Roberto M; Mor-Avi, Victor; Sugeng, Lissa; Nieman, Petra S; Sahn, David J

    2006-11-21

    Over the past 3 decades, echocardiography has become a major diagnostic tool in the arsenal of clinical cardiology for real-time imaging of cardiac dynamics. More and more, cardiologists' decisions are based on images created from ultrasound wave reflections. From the time ultrasound imaging technology provided the first insight into the human heart, our diagnostic capabilities have increased exponentially as a result of our growing knowledge and developing technology. One of the most significant developments of the last decades was the introduction of 3-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging. While continuing its meteoric rise instigated by constant technological refinements and continuing increase in computing power, this tool is guaranteed to be integrated in routine clinical practice. The major proven advantage of this technique is the improvement in the accuracy of the echocardiographic evaluation of cardiac chamber volumes, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic and unique comprehensive views of cardiac valves and congenital abnormalities. In addition, 3D imaging is extremely useful in the intraoperative and postoperative settings because it allows immediate feedback on the effectiveness of surgical interventions. In this article, we review the published reports that have provided the scientific basis for the clinical use of 3D ultrasound imaging of the heart and discuss its potential future applications. PMID:17112995

  18. Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis.

    PubMed

    Yang, Hyun Suk; Hur, Mina; Kim, Hanah; Magrini, Laura; Marino, Rossella; Di Somma, Salvatore

    2016-11-01

    Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis. PMID:27578513

  19. Perioperative transoesophageal echocardiography: current status and future directions.

    PubMed

    Mahmood, Feroze; Shernan, Stanton Keith

    2016-08-01

    Transoesophageal echocardiography (TOE) is used in the perioperative arena to monitor patients during life-threatening emergencies, cardiac and high-risk non-cardiac surgeries. It provides qualitative and quantitative information on valvular and ventricular functions, and dynamic cardiac anatomy can be displayed with a physiological perspective. This technology has evolved from two-dimensional (2D) to the ready availability of real-time three-dimensional (RT-3D) imaging in the operating rooms. Enhanced spatial and temporal resolutions with 3D imaging have most significantly impacted the quality of intraoperative surgical valve repair and replacement decisions. Additionally, 3D imaging has facilitated the advent of minimally invasive and percutaneous interventions for structural heart disease. Information derived from TEE is routinely used to evaluate a patient's suitability for an intervention, provide guidance during the intervention and eventually comment on the quality and success of the procedure. Expertise in perioperative TEE is an integral component of a cardiac anaesthesiologist's skill sets. With structural heart disease interventions becoming more minimally invasive, the intraoperative guidance provided by TEE will continue to be a critical component of these procedures. With improving computational and processing power, the expectations from TEE will continue to be incremental in the perioperative arena. PMID:27048769

  20. Canine fetal echocardiography: correlations for the analysis of cardiac dimensions.

    PubMed

    Giannico, Amália Turner; Gil, Elaine Mayumi Ueno; Garcia, Daniela Aparecida Ayres; Sousa, Marlos Gonçalves; Froes, Tilde Rodrigues

    2016-03-01

    The aim of this study was to develop regression models for correlation of canine fetal heart development with body size to characterize normal development or suggest cardiac anomalies. Twenty clinically healthy pregnant bitches, either brachycephalic and non-brachycephalic, were examined ultrasonographically. Transabdominal fetal echocardiography was conducted every 4 days from the beginning of cardiac chambers differentiation until parturition. Ten cardiac parameters were measured: length, width and diameter of the heart; heart area; left and right ventricular dimensions; left and right atrial dimensions; and aortic and pulmonary artery diameter. Femoral length, biparietal diameter and abdominal cross-sectional area were also recorded. Regression equations were developed for each parameter of fetal body size, and linear and logarithmic models were compared. The model with the highest correlation coefficient was chosen to produce equations to calculate relative dimensions based on the correlations. Only the left-ventricular chamber differed between the two racial groups. Biparietal diameter was the independent parameter that produced the highest correlation coefficient for the most fetal cardiac dimensions, although good correlations were also observed using femoral length and abdominal cross-sectional area. Heart width and heart diameter were used as surrogates of cardiac development, as these measurements showed the best statistical correlation. Quantitative evaluation of fetal cardiac structures can be used to monitor normal and abnormal cardiac development. PMID:26689920

  1. Elevational spatial compounding for enhancing image quality in echocardiography

    PubMed Central

    McDicken, Norman; MacGillivray, Tom; Anderson, Tom

    2016-01-01

    Introduction Echocardiography is commonly used in clinical practice for the real-time assessment of cardiac morphology and function. Nevertheless, due to the nature of the data acquisition, cardiac ultrasound images are often corrupted by a range of acoustic artefacts, including acoustic noise, speckle and shadowing. Spatial compounding techniques have long been recognised for their ability to suppress common ultrasound artefacts, enhancing the imaged cardiac structures. However, they require extended acquisition times as well as accurate spatio-temporal alignment of the compounded data. Elevational spatial compounding acquires and compounds adjacent partially decorrelated planes of the same cardiac structure. Methods This paper employs an anthropomorphic left ventricle phantom to examine the effect of acquisition parameters, such as inter-slice angular displacement and 3D sector angular range, on the elevational spatial compounding of cardiac ultrasound data. Results and conclusion Elevational spatial compounding can produce substantial noise and speckle suppression as well as visual enhancement of tissue structures even for small acquisition sector widths (2.5° to 6.5°). In addition, elevational spatial compounding eliminates the need for extended acquisition times as well as the need for temporal alignment of the compounded datasets. However, moderate spatial registration may still be required to reduce any tissue/chamber blurring side effects that may be introduced. PMID:27274757

  2. Statistical analysis on 1-dimensional and 2-dimensional thermal dissipation for nickel metal hydride battery system

    NASA Astrophysics Data System (ADS)

    Hashim, Mohammad Firdaus Abu; Ramakrishnan, Sivakumar; Mohamad, Ahmad Azmin

    2014-06-01

    Due to low environmental impact and rechargeable capability, the Nickel Metal Hydride battery has been considered to be one of the most promising candidate battery for electrical vehicle nowadays. The energy delivered by the Nickel Metal Hydride battery depends heavily on its discharge profile and generally it is intangible to tract the trend of the energydissipation that is stored in the battery for informative analysis. The thermal models were developed in 1-dimensional and 2-dimensional using Matlab and these models are capable of predicting the temperature distributions inside a cell. The simulated results were validated and verified with referred exact sources of experimental data using Minitab software. The result for 1-Dimensional showed that the correlations between experimental and predicted results for the time intervals 60 minutes, 90 minutes, and 114 minutes frompositive to negative electrode thermal dissipationdirection are34%, 83%, and 94% accordingly while for the 2-Dimensional the correlational results for the same above time intervals are44%, 93% and 95%. These correlationalresults between experimental and predicted clearly indicating the thermal behavior under natural convention can be well fitted after around 90 minutes durational time and 2-Dimensional model can predict the results more accurately compared to 1-Dimensional model. Based on the results obtained from simulations, it can be concluded that both 1-Dimensional and 2-Dimensional models can predict nearly similar thermal behavior under natural convention while 2-Dimensional model was used to predict thermal behavior under forced convention for better accuracy.

  3. Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care.

    PubMed

    Heiberg, J; El-Ansary, D; Canty, D J; Royse, A G; Royse, C F

    2016-09-01

    Focused echocardiography is becoming a widely used tool to aid clinical assessment by anaesthetists and critical care physicians. At the present time, most physicians are not yet trained in focused echocardiography or believe that it may result in adverse outcomes by delaying, or otherwise interfering with, time-critical patient management. We performed a systematic review of electronic databases on the topic of focused echocardiography in anaesthesia and critical care. We found 18 full text articles, which consistently reported that focused echocardiography may be used to identify or exclude previously unrecognised or suspected cardiac abnormalities, resulting in frequent important changes to patient management. However, most of the articles were observational studies with inherent design flaws. Thirteen prospective studies, including two that measured patient outcome, were supportive of focused echocardiography, whereas five retrospective cohort studies, including three outcome studies, did not support focused echocardiography. There is an urgent requirement for randomised controlled trials. PMID:27346556

  4. Dobutamine stress--Doppler echocardiography before and after coronary angioplasty.

    PubMed

    el-Said, E S; Fioretti, P M; Roelandt, J R; McNeill, A J; Rijsterborgh, H; Forster, T; Di Mario, C; Linker, D T

    1993-08-01

    To determine if dobutamine-induced myocardial ischaemia causes abnormalities in Doppler parameters of left ventricular ejection and filling and to assess early effects of successful coronary angioplasty (PTCA) on these parameters, dobutamine stress echocardiography and Doppler studies were performed once in 11 normal volunteers and twice in 17 patients (within 1 day pre- and post-PTCA). Dobutamine induced wall motion abnormalities, ST changes and angina in 11, five and five patients, respectively, before and three, two and one patients, respectively, after PTCA. Doppler indices of both systolic and diastolic function were comparable at rest, before and after PTCA. Dobutamine induced similar increases in peak aortic velocity and average acceleration in healthy individuals (39% and 53%) and in patients with one-vessel disease both before (38% and 39%) and after PTCA (39% and 40%). In the three patients with multivessel disease, peak aortic velocity showed a blunted response (-0.3%) before PTCA but increased by 17% after PTCA, while acceleration decreased both before (12%) and after PTCA (14%). There were significant differences (P < 0.0001) between healthy individuals and pre-PTCA patients in the effect of dobutamine on peak early (E) filling velocity (+34% vs -19%), E-acceleration (+35% vs -26%), peak early to atrial filling velocity ratio (E/A) (-0.7% vs -37%) and diastolic time velocity integral (TVI) (+34% vs -22%). After PTCA, the response of Doppler diastolic indices improved during dobutamine, as shown by the increase in E and E-acceleration (+8%, +24%), respectively) and by the decline in the reduction of E/A and TVI (-17% and -10%, respectively). Thus, the response of Doppler diastolic parameters to dobutamine stress is a sensitive indicator of significant coronary disease and is superior to changes in ejection indices. Successful PTCA resulted in an improved diastolic filling response to dobutamine stress. PMID:8404930

  5. Intracardiac Echocardiography Evaluation in Secundum Atrial Septal Defect Transcatheter Closure

    SciTech Connect

    Zanchetta, Mario; Pedon, Luigi; Rigatelli, Gianluca; Carrozza, Antonio; Zennaro, Marco; Di Martino, Roberta; Onorato, Eustaquio; Maiolino, Pietro

    2003-02-15

    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.

  6. Hypertension and ischemic heart disease. Role of dipyridamole echocardiography test.

    PubMed

    Gulizia, M M; Lo Giudice, P; Doria, G; Valenti, R; Circo, A G

    1994-11-01

    The aim of this study is to try to evaluate the relationship between arterial hypertension and ischemic heart disease (IHD) in the light of the physiopathologic response pattern to the dipyridamole echocardiography test (DET) in hypertensive patients, in pharmacologic washout, without any electrocardiographic ST segment depression during exercise tests or at rest. Sixty patients affected by mild to moderate asymptomatic essential arterial hypertension were studied: the subjects had a sitting diastolic blood pressure > or = 95 < or = 114 mmHg; there were 38 men and 22 women with a mean age of 49.8 +/- 7.6 years (range twenty-nine to sixty-eight). All patients had undergone high-dose DET (0.84 mg/kg in ten minutes). No patients developed side effects or asynergy in cardiac contractility during the test. In the absence of any significant coronary artery obstruction assessed angiographically, 18 patients (30%) showed ST segment depression > 1.0 mV during DET, sometimes with the presence of ventricular and/or supraventricular extrasystoles. In this group of patients the left ventricular mass index (LVMI) and duration of hypertension (in months) were higher as compared with those of the other 42 patients (respectively: 160.2 +/- 5.1 vs 129.2 +/- 9.2 g/m2, P < 0.02; and 30 +/- 4.8 vs 9 +/- 5.4 months, P < 0.007). In conclusion it is reasonable to speculate from these data that the ischemic-like" dipyridamole-induced ST segment depression, like that shown by patients affected by Syndrome X, might involve a worse prognosis in hypertensive patients. This may be because of increased coronary resistance due to structural modification or anatomic background. PMID:7978508

  7. Student tutors for hands-on training in focused emergency echocardiography – a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Focused emergency echocardiography performed by non-cardiologists has been shown to be feasible and effective in emergency situations. During resuscitation a short focused emergency echocardiography has been shown to narrow down potential differential diagnoses and to improve patient survival. Quite a large proportion of physicians are eligible to learn focused emergency echocardiography. Training in focused emergency echocardiography usually comprises a lecture, hands-on trainings in very small groups, and a practice phase. There is a shortage of experienced echocardiographers who can supervise the second step, the hands-on training. We thus investigated whether student tutors can perform the hands-on training for focused emergency echocardiography. Methods A total of 30 volunteer 4th and 5th year students were randomly assigned to a twelve-hour basic echocardiography course comprising a lecture followed by a hands-on training in small groups taught either by an expert cardiographer (EC) or by a student tutor (ST). Using a pre-post-design, the students were evaluated by an OSCE. The students had to generate two still frames with the apical five-chamber view and the parasternal long axis in five minutes and to correctly mark twelve anatomical cardiac structures. Two blinded expert cardiographers rated the students’ performance using a standardized checklist. Students could achieve a maximum of 25 points. Results Both groups showed significant improvement after the training (p < .0001). In the group taught by EC the average increased from 2.3±3.4 to 17.1±3.0 points, and in the group taught by ST from 2.7±3.0 to 13.9±2.7 points. The difference in improvement between the groups was also significant (p = .03). Conclusions Hands-on training by student tutors led to a significant gain in echocardiography skills, although inferior to teaching by an expert cardiographer. PMID:23107588

  8. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

    PubMed Central

    de Araujo, Ana Carla Pereira; Santos, Bruno F. de Oliveira; Calasans, Flavia Ricci; Pinto, Ibraim M. Francisco; de Oliveira, Daniel Pio; Melo, Luiza Dantas; Andrade, Stephanie Macedo; Tavares, Irlaneide da Silva; Sousa, Antonio Carlos Sobral; Oliveira, Joselina Luzia Menezes

    2014-01-01

    Background Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1) or positive (G2) for myocardial ischemia. The endpoints analyzed were all‑cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results G2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 – 6.01; p = 0.016). The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 – 6.53; p = 0.022) and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively). Conclusion Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia. PMID:25352460

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

    PubMed Central

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

    2001-01-01

    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% (κ = 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

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

    PubMed Central

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

    2008-01-01

    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

  11. Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-Flight Echocardiography Aboard the International Space Station

    NASA Technical Reports Server (NTRS)

    Martin, David S.; Borowski, Allan; Bungo, Michael W.; Gladding, Patrick; Greenberg, Neil; Hamilton, Doug; Levine, Benjamin D.; Lee, Stuart M.; Norwood, Kelly; Platts, Steven H.; Matz, Timothy; Roper, Matthew; Sandoz, Gwenn; Thomas, James D.

    2012-01-01

    Methods: In the year before launch of an ISS mission, potential astronaut echocardiographic operators participate in 5 sessions to train for echo acquisitions that occur roughly monthly during the mission, including one exercise echocardiogram. The focus of training is familiarity with the study protocol and remote guidance procedures. On-orbit, real-time guidance of in-flight acquisitions is provided by a sonographer in the Telescience Center of Mission Control. Physician investigators with remote access are able to relay comments on image quality to the sonographer. Live video feed is relayed from the ISS to the ground via the Tracking and Data Relay Satellite System with a 2- second transmission delay. The expert sonographer uses these images, along with twoway audio, to provide instructions and feedback. Images are stored in non-compressed DICOM format for asynchronous relay to the ground for subsequent off-line analysis. Results: Since June, 2009, a total of 27 resting echocardiograms and 5 exercise studies have been performed during flight. Average acquisition time has been 45 minutes, reflecting 26,000 km of ISS travel per study. Image quality has been adequate in all studies, and remote guidance has proven imperative for fine-tuning imaging and prioritizing views when communication outages limit the study duration. Typical resting studies have included 27 video loops and 30 still-frame images requiring 750 MB of storage. Conclusions: Despite limited crew training, remote guidance allows research-quality echocardiography to be performed by non-experts aboard the ISS. Analysis is underway and additional subjects are being recruited to define the impact of microgravity on cardiac structure and systolic and diastolic function.

  12. Patent Ductus Arteriosus in Extreme Prematurity: Role of Echocar-diography and Other Imaging Techniques.

    PubMed

    Yap, Norah; Bharucha, Tara

    2016-01-01

    Clinical signs alone are unreliable in the diagnosis of patent ductus arteriosus (PDA) in preterm infants, and therefore echocardiography remains the mainstay of diagnosis of this common condition. Echocardiography also facilitates understanding of the hemodynamic effects of a PDA, and thus aids in management decisions. Several echocardiographic parameters, including duct size, maximum ductal velocity, left atrial: aorta ratio, mitral inflow E:A ratio, and isovolumic relaxation time, have been utilized in the assessment of PDA, but no single measurement can be used in isolation to inform clinical judgement. Therefore, it is important that echocardiographers on the neonatal unit have a comprehensive understanding of available methods and their limitations. Newer echocardiographic techniques, such as 3 Dimensional echocardiography, tissue Doppler imaging and strain imaging, are now providing insights into myocardial function in the adaptation of preterm infants to extra-uterine life, and into the effects of a PDA causing systemic-to-pulmonary artery shunting. Magnetic resonance imaging delivers excellent diagnostic information and accurate hemodynamic evaluation; however this modality is not easily accessible for most preterm infants, in comparison to echocardiography, which is readily available at the cotside in most neonatal units. Further developments in echocardiography may further refine the contribution it makes to individualized clinical decisionmaking in the management of premature infants with PDA. PMID:27197955

  13. [A new approach to the tricuspid valve in Ebstein's anomaly by real time 3D echocardiography].

    PubMed

    Taktak, A; Acar, P; Dulac, Y; Abadir, S; Chilon, T; Roux, D; Glock, Y; Fournial, G

    2005-05-01

    Ebstein's anomaly affects the tricuspid valve with a large range of anatomical forms. Successful tricuspid valvuloplasty depends mainly on the ability to mobilise the leaflets. Evaluation of the leaflet surface is difficult with 2D echocardiography whereas 3D echocardiography provides intracardiac views of the valve. The authors used this method in 10 patients with 3 modes of imaging: biplane, real time and total volume. The study population (age: 1 day to 30 years) included: 1 prenatal diagnosis, 1 neonate with refractory cyanosis, 5 patients with mild tricuspid regurgitation, 3 patients with severe tricuspid regurgitation, 2 of whom underwent valvuloplasty. 3D echocardiography was disappointing in the foetus and neonate because of poor spatial resolution. The ventricular view of the tricuspid valve in older children and adults allowed analysis of tricuspid leaflet coaptation and of the mechanism of regurgitation. The commissures and leaflet surfaces were assessed. The results of surgical valvuloplasty could be evaluated by 3D echocardiography. 3D echocardiography is now transthoracic and a real time investigation. Technical advances are required before it comes into routine usage: a more manoeuvrable matricial probe (integrating pulsed and continuous wave Doppler) and larger volume real time 3D imaging with better resolution. Its role in the assessment of Ebstein's anomaly should be evaluated in a larger series of patients. PMID:15966604

  14. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism.

    PubMed

    Saric, Muhamed; Armour, Alicia C; Arnaout, M Samir; Chaudhry, Farooq A; Grimm, Richard A; Kronzon, Itzhak; Landeck, Bruce F; Maganti, Kameswari; Michelena, Hector I; Tolstrup, Kirsten

    2016-01-01

    Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations. PMID:26765302

  15. Darboux transformations for (1+2)-dimensional Fokker-Planck equations with constant diffusion matrix

    SciTech Connect

    Schulze-Halberg, Axel

    2012-10-15

    We construct a Darboux transformation for (1+2)-dimensional Fokker-Planck equations with constant diffusion matrix. Our transformation is based on the two-dimensional supersymmetry formalism for the Schroedinger equation. The transformed Fokker-Planck equation and its solutions are obtained in explicit form.

  16. Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

    PubMed Central

    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

    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 β-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). β-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. β-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

  17. Open-access echocardiography to general practitioners for suspected heart failure.

    PubMed Central

    Murphy, J J; Frain, J P; Ramesh, P; Siddiqui, R N; Bossingham, C M

    1996-01-01

    Echocardiography is now considered to be the key investigation when heart failure is suspected, and should improve clinical management. An open-access echocardiography service was piloted to 24 general practitioners and the service was audited after 250 cases. The impact on clinical management was assessed by reviewing general practice notes 2 months after the echocardiogram. Significant impairment of left ventricular function was found in 49 patients (20%). Out of these subjects, 38 had been started on an ACE inhibitor. Twenty patients were considered to have a significant valve lesion by echocritiera, of whom 14 had been referred for a cardiological opinion. The provision of an open-access echocardiography service was popular with general practitioners and the information resulted in appropriate management decisions being made. PMID:8949328

  18. Two-dimensional echocardiography in the diagnosis of left atrial myxoma.

    PubMed Central

    Perry, L S; King, J F; Zeft, H J; Manley, J C; Gross, C M; Wann, L S

    1981-01-01

    We performed M-mode echocardiograms on 11 patients who later had left atrial myxomas removed at operations. Seven of these 11 patients were also examined with two-dimensional echocardiography. M-mode echocardiography showed the characteristic pattern of a left atrial mass entering the mitral orifice during diastole in nine of the 11 patients. M-mode echocardiographic findings were equivocal in two patients because a short tumour stalk prevented significant motion of the tumour. Cross-sectional echocardiography clearly showed a left atrial mass attached by a stalk to the interatrial septum in all seven patients examined, including one patient in whom the tumour was immobile. Three-dimensional measurements of tumour size made from orthogonal cross-sectional echocardiographic planes were within 6 mm of similar measurements made on the excised tumours. PMID:7259916

  19. [Acute post-traumatic aortic insufficiency: transesophageal echocardiography in the diagnosis and therapy of the lesions].

    PubMed

    Brandstätt, P; Carlioz, R; Fontaine, B; Hémery, Y; Pats, B; Chapuis, O; Lang-Lazdunsky, L; Jancovici, R; Burlaton, J P; Hvass, U

    1998-10-01

    A 58-year-old car driver suffered a road accident responsible for severe blunt thoraco-abdominal trauma. Transoephageal echocardiography, performed following the secondary development of a diastolic murmur, confirmed the presence of aortic incompetence due to commissural avulsion and guided the surgical treatment, which consisted of commissural suspension under cardiopulmonary bypass via a mini transverse trans-sternal incision. The rarity of acute aortic valve incompetence following non-penetrating thoracic trauma is illustrated by the data of the literature. This lesion is due to either avulsion of a sigmoid cusp or commissure, or laceration of the valvular tissue. Transthoracic echocardiography confirms the reality of aortic incompetence suggested clinically by appearance of a diastolic murmur, but confirmation of the mechanism of the lesions is based on transoesophageal echocardiography which allows perfectly safe and rapid visualization of the mechanism of the valvular lesion, investigation of associated lesions and guidance of therapeutic management. PMID:9809140

  20. Acute Bilateral Internal Carotid Occlusion from Embolization of Left Atrial Thrombus During Transesophageal Echocardiography: Case Report

    PubMed Central

    Mahmood, Syed Saad; Manjila, Sunil; Singh, Gagandeep; Xavier, Andrew R

    2016-01-01

    Background and purpose: Transesophageal echocardiography (TEE) is a relatively safe imaging modality used to visualize intracardiac thrombus. Summary of case: We report on a unique, fatal complication during TEE of embolization of a pre-existing “smoking” left atrial thrombus causing acute bilateral internal carotid occlusion, confirmed on angiogram. Conclusions: Patients with history of lung pathology, such as COPD, who experience retching and cough during transesophageal echocardiography may be more susceptible to embolization of pre-existing thrombi. A need exists to risk stratify such patients. PMID:27403219

  1. A case of giant mediastinal cyst initially detected and diagnosed by echocardiography.

    PubMed

    Li, XiaoDong; Wang, XiaoCong; Duan, XiuMei; Xu, Hui

    2015-07-01

    Mediastinal cysts are a group of benign mediastinal lesions, and their diagnoses are primarily depended on x-ray and computed tomography. The development of ultrasound instruments and inspection techniques in recent years has led to the ability to use transthoracic echocardiography to clearly display structures surrounding the heart according to the dark fluid space (blood) of the atrium, ventricles, and large vessels as an acoustic window. This technique offers improved detection rates of mediastinal lesions. We report a case of a mediastinal cyst that was first detected and diagnosed on thoracic echocardiography examination and then confirmed by thoracoscopic surgery and pathological analysis. PMID:25640147

  2. The Heart of the Matter: Increasing Quality and Charge Capture from Intraoperative Transesophageal Echocardiography.

    PubMed

    Sanford, Joseph A; Kadry, Bassam; Oakes, Daryl; Macario, Alex; Schmiesing, Cliff

    2016-04-15

    Although transesophageal echocardiography is routinely performed at our institution, there is no easy way to document the procedure in the electronic medical record and generate a bill compliant with reimbursement requirements. We present the results of a quality improvement project that used agile development methodology to incorporate intraoperative transesophageal echocardiography into the electronic medical record. We discuss improvements in the quality of clinical documentation, technical workflow challenges overcome, and cost and time to return on investment. Billing was increased from an average of 36% to 84.6% when compared with the same time period in the previous year. The expected recoupment of investment for this project is just 18 weeks. PMID:27082233

  3. Stress echocardiography: what is new and how does it compare with myocardial perfusion imaging and other modalities?

    PubMed

    Tweet, Marysia S; Arruda-Olson, Adelaide M; Anavekar, Nandan S; Pellikka, Patricia A

    2015-06-01

    Cardiovascular disease is a leading cause of morbidity and mortality, and noninvasive strategies to diagnose and risk stratify patients remain paramount in the evaluative process. Stress echocardiography is a well-established, versatile, real-time imaging modality with advantages including lack of radiation exposure, portability, and affordability. Innovative techniques in stress echocardiography include myocardial contrast echocardiography, deformation imaging, three-dimensional (3D) echocardiography, and assessment of coronary flow reserve. Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) are imaging alternatives, and stress cardiac magnetic resonance imaging and coronary computed tomography (CT) angiography, including CT perfusion imaging, are emerging as newer approaches. This review will discuss recent and upcoming developments in the field of stress testing, with an emphasis on stress echocardiography while highlighting comparisons with other modalities. PMID:25911442

  4. Gravitational Fields with 2-Dimensional Killing Leaves and the Gravitational Interaction of Light

    NASA Astrophysics Data System (ADS)

    Vilasi, Gaetano

    Gravitational fields invariant for a non Abelian Lie algebra generating a 2-dimensional distribution, are explicitly described. When the orthogonal distribution is integrable and the metric is not degenerate along the orbits, these solutions are parameterized either by solutions of a transcendental equation (the tortoise equation), or by solutions of Darboux equation. Metrics, corresponding to solutions of the tortoise equation, are characterized as those that admit a 3-dimensional Lie algebra of Killing fields with 2-dimensional leaves. It is shown that the remaining metrics represent nonlinear gravitational waves obeying to two nonlinearsuperposition laws. The energy and the polarization of this family of waves are explicitly evaluated; it is shown that they have spin-1 and their possible sources are also described. Old results by Tolman, Ehrenfest, Podolsky and Wheeler on the gravitational interaction of photons are naturally reinterpreted.

  5. New echocardiography-based classification of mitral valve pathology: relevance to surgical valve repair.

    PubMed

    Shah, Pravin M; Raney, Aidan A

    2012-01-01

    A new echocardiography-based classification of mitral valve pathology is proposed, the adoption of which may provide a uniform approach to the assessment of individual cases by the cardiologist, cardiac anesthesiologist, and surgeon. This type of approach may facilitate the planning and execution of valve repair techniques, with higher rates of success than are currently reported. PMID:22474740

  6. Automatic assessment of mitral regurgitation severity based on extensive textural features on 2D echocardiography videos.

    PubMed

    Moghaddasi, Hanie; Nourian, Saeed

    2016-06-01

    Heart disease is the major cause of death as well as a leading cause of disability in the developed countries. Mitral Regurgitation (MR) is a common heart disease which does not cause symptoms until its end stage. Therefore, early diagnosis of the disease is of crucial importance in the treatment process. Echocardiography is a common method of diagnosis in the severity of MR. Hence, a method which is based on echocardiography videos, image processing techniques and artificial intelligence could be helpful for clinicians, especially in borderline cases. In this paper, we introduce novel features to detect micro-patterns of echocardiography images in order to determine the severity of MR. Extensive Local Binary Pattern (ELBP) and Extensive Volume Local Binary Pattern (EVLBP) are presented as image descriptors which include details from different viewpoints of the heart in feature vectors. Support Vector Machine (SVM), Linear Discriminant Analysis (LDA) and Template Matching techniques are used as classifiers to determine the severity of MR based on textural descriptors. The SVM classifier with Extensive Uniform Local Binary Pattern (ELBPU) and Extensive Volume Local Binary Pattern (EVLBP) have the best accuracy with 99.52%, 99.38%, 99.31% and 99.59%, respectively, for the detection of Normal, Mild MR, Moderate MR and Severe MR subjects among echocardiography videos. The proposed method achieves 99.38% sensitivity and 99.63% specificity for the detection of the severity of MR and normal subjects. PMID:27082766

  7. Gated cardiac NMR imaging and 2D echocardiography in the detection of intracardial neoplasm

    SciTech Connect

    Go, R.T.; O'Donnell, J.K.; Salcedo, E.E.; Feiglin, D.H.; Underwood, D.A.; MacIntyre, W.J.; Meaney, T.F.

    1985-05-01

    Noninvasive 2D echocardiography has replaced contrast angiography as the procedure of choice in the diagnosis of intracardiac neoplasm. The purpose of this study was to determine whether intracardiac neoplasm can be detected as well by gated cardiac NMR. Four patients with known intracardiac neoplasm previously diagnosed by 2D echocardiography had gated cardiac NMR imaging using a superconductive 0.6 Tesla magnet. All patients were performed using a Tl weighted spin echo pulse sequence with a TE of 30 msec and TR of one R-R interval. Two-dimensional planar single or multiple slice techniques were used. In one patient, imaging at different times along the R-R interval were performed for cine display. The results of the present study show detection of the intracardiac neoplasm in all four cases by gated cardiac NMR imaging and the results were comparable to 2D echocardiography. The former imaging technique showed superior spatial resolution. Despite its early stage of development, gated cardiac NMR imaging appears at least equal to 2D echocardiography in the detection of intracardiac neoplasm. The availability of multislice coupled with multiframe acquisition techniques now being developed will provide a cinematic display that will be more effective in the display of the tumor in motion within the cardiac chamber involved and facilitate visualization of the relationship of the tumor to adjacent cardiac structures.

  8. Exercise Echocardiography in Asymptomatic Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction

    PubMed Central

    Henri, Christine

    2014-01-01

    The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exercise echocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patients who may benefit most from early surgery. In "truly" asymptomatic patients, an increase in mean aortic gradient ≥ 18-20 mmHg, a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adverse cardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients to radiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction. PMID:24753801

  9. Usefulness of contrast perfusion echocardiography for differential diagnosis of cardiac masses.

    PubMed

    Tang, Qiao-Ying; Guo, Ling-Dan; Wang, Wen-Xuan; Zhou, Wei; Liu, Ya-Ni; Liu, Hong-Yun; Li, Li; Deng, You-Bin

    2015-09-01

    The aim of this study was to assess the usefulness of contrast perfusion echocardiography in the differential diagnosis of different types of cardiac masses. Conventional echocardiography and contrast perfusion echocardiography were performed in 72 patients with cardiac masses. The degree of contrast enhancement of the mass and an adjacent section of myocardium after injection of contrast agent was determined by visual inspection and quantitative time-signal intensity curve analysis. The difference in maximal steady-state pixel intensity between the mass and the adjacent myocardium (ΔAmass-myocardium) was calculated. All masses had a pathologic diagnosis or resolved after anticoagulation. All 16 cardiac masses without enhancement on visual inspection were confirmed to be cardiac thrombi. Twenty-four masses with incomplete enhancement on visual inspection were recognized as benign tumors with validation methods. Of the 32 cardiac masses with complete enhancement, 30 were confirmed as malignant tumors and two as benign tumors with validation methods. The sensitivity and specificity of ΔAmass-myocardium in differentiating thrombi from tumors were 93% and 100%, respectively, and 100% and 97% in differentiating malignant tumors from benign tumors and thrombi. Both visual and quantitative assessment of degree of enhancement of cardiac masses in relation to the adjacent myocardium during contrast perfusion echocardiography had high diagnostic accuracy for differentiation of a thrombus from a tumor or a benign tumor from a malignant tumor. PMID:26087885

  10. "Hyper-response" evaluated by 3D echocardiography after cardiac resynchronization therapy.

    PubMed

    Hotta, Viviane Tiemi; Vieira, Marcelo Luiz Campos; Rassi, Daniela do Carmo; Nishioka, Silvana Angelina D'orio; Martinelli Filho, Martino; Mathias, Wilson

    2011-06-01

    Cardiac resynchronization therapy consists of a promising treatment for patients with severe heart failure, but about 30% of patients do not exhibit clinical improvement with this procedure. However, approximately 10% of patients undergoing this therapy may have hyperresponsiveness, and three-dimensional echocardiography can provide an interesting option for the selection and evaluation of such patients. PMID:21789343

  11. Echocardiography and pulmonary embolism severity index have independent prognostic roles in pulmonary embolism.

    PubMed

    Sanchez, Olivier; Trinquart, Ludovic; Planquette, Benjamin; Couturaud, Francis; Verschuren, Franck; Caille, Vincent; Meneveau, Nicolas; Pacouret, Gérard; Roy, Pierre-Marie; Righini, Marc; Perrier, Arnaud; Bertoletti, Laurent; Parent, Florence; Lorut, Christine; Meyer, Guy

    2013-09-01

    We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock. 529 patients were included, 25 (4.7%, 95% CI 3.2-6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (p<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular dilatation. In multivariate analysis, the PESI (class III-IV versus I-II, OR 3.1, 95% CI 1.2-8.3; class V versus I-II, OR 5.5, 95% CI 1.5-25.5 and echocardiography (right ventricular/left ventricular ratio, OR (for an increase of 0.1) 1.3, 95% CI 1.1-1.5) were independent predictors of an adverse outcome. In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI. PMID:23258789

  12. A Natural Language Processing Tool for Large-Scale Data Extraction from Echocardiography Reports.

    PubMed

    Nath, Chinmoy; Albaghdadi, Mazen S; Jonnalagadda, Siddhartha R

    2016-01-01

    Large volumes of data are continuously generated from clinical notes and diagnostic studies catalogued in electronic health records (EHRs). Echocardiography is one of the most commonly ordered diagnostic tests in cardiology. This study sought to explore the feasibility and reliability of using natural language processing (NLP) for large-scale and targeted extraction of multiple data elements from echocardiography reports. An NLP tool, EchoInfer, was developed to automatically extract data pertaining to cardiovascular structure and function from heterogeneously formatted echocardiographic data sources. EchoInfer was applied to echocardiography reports (2004 to 2013) available from 3 different on-going clinical research projects. EchoInfer analyzed 15,116 echocardiography reports from 1684 patients, and extracted 59 quantitative and 21 qualitative data elements per report. EchoInfer achieved a precision of 94.06%, a recall of 92.21%, and an F1-score of 93.12% across all 80 data elements in 50 reports. Physician review of 400 reports demonstrated that EchoInfer achieved a recall of 92-99.9% and a precision of >97% in four data elements, including three quantitative and one qualitative data element. Failure of EchoInfer to correctly identify or reject reported parameters was primarily related to non-standardized reporting of echocardiography data. EchoInfer provides a powerful and reliable NLP-based approach for the large-scale, targeted extraction of information from heterogeneous data sources. The use of EchoInfer may have implications for the clinical management and research analysis of patients undergoing echocardiographic evaluation. PMID:27124000

  13. Outcome prediction in sepsis: Speckle tracking echocardiography based assessment of myocardial function

    PubMed Central

    2014-01-01

    Introduction Speckle tracking echocardiography (STE) is a relatively novel and sensitive method for assessing ventricular function and may unmask myocardial dysfunction not appreciated with conventional echocardiography. The association of ventricular dysfunction and prognosis in sepsis is unclear. We sought to evaluate frequency and prognostic value of biventricular function, assessed by STE in patients with severe sepsis or septic shock. Methods Over an eighteen-month period, sixty patients were prospectively imaged by transthoracic echocardiography within 24 hours of meeting severe sepsis criteria. Myocardial function assessment included conventional measures and STE. Association with mortality was assessed over 12 months. Results Mortality was 33% at 30 days (n = 20) and 48% at 6 months (n = 29). 32% of patients had right ventricle (RV) dysfunction based on conventional assessment compared to 72% assessed with STE. 33% of patients had left ventricle (LV) dysfunction based on ejection fraction compared to 69% assessed with STE. RV free wall longitudinal strain was moderately associated with six-month mortality (OR 1.1, 95% confidence interval, CI, 1.02-1.26, p = 0.02, area under the curve, AUC, 0.68). No other conventional echocardiography or STE method was associated with survival. After adjustment (for example, for mechanical ventilation) severe RV free wall longitudinal strain impairment remained associated with six-month mortality. Conclusion STE may unmask systolic dysfunction not seen with conventional echocardiography. RV dysfunction unmasked by STE, especially when severe, was associated with high mortality in patients with severe sepsis or septic shock. LV dysfunction was not associated with survival outcomes. PMID:25015102

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

    NASA Technical Reports Server (NTRS)

    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

    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

  15. Spectrum of congenital heart disease in a tropical environment: an echocardiography study.

    PubMed Central

    Sani, Mahmoud U.; Mukhtar-Yola, Mariya; Karaye, Kamilu M.

    2007-01-01

    Echocardiography is a major mode of cardiovascular imaging with versatile applications. Modern two-dimensional echocordiographic techniques provide a comprehensive means for evaluating virtually all forms of congenital heart disease (CHD) found in both adults and children. CHD is an abnormality in cardiocirculatory structure or function that is present at birth, even if it is discovered much later. We set out to describe the spectrum of CHD using echocardiography in two centers in Kano, northern Nigeria. In this retrospective study, transthoracic echocardiography (TTE) data collected from two echocardiography laboratories in Kano over a period of 48 months (June 2002 to May 2006) were reviewed. Patients with diagnosis of congenital heart disease were selected. Information obtained from the records included the age, gender, clinical diagnosis and echocardiographic findings. One-hundred-twenty-two patients had CHD, making 9.3% of the 1312 patients with abnormal echocardiograms. There were 73 males and 49 females (ratio 1.5:1); and their ages ranged from nine days to 35 years. Forty-one (33.6%) children presented for echocardiography before the age of one year, and 69% presented before the age of five years. Thirteen (10.6%) were > or =18 years. Ventricular septal defect (VSD) was the most common echocardiographic diagnosis present in 56 patients (45.9%). Thirty-two (26.2%) had tetralogy of Fallot, and 15 (12.3%) had atrial septal defect (ASD). Ten (8.2%) had endocardial cushion defect, and nine (7.4%) had other congenital heart abnormalities. Coarctation of the aorta and aortic stenosis were rare. CHD is a common cardiovascular problem in our setting, and a number of patients were diagnosed in adulthood. With increasing availability of echocardiographic facilities, more cases of CHD are likely to be identified early. PMID:17595936

  16. A Natural Language Processing Tool for Large-Scale Data Extraction from Echocardiography Reports

    PubMed Central

    Jonnalagadda, Siddhartha R.

    2016-01-01

    Large volumes of data are continuously generated from clinical notes and diagnostic studies catalogued in electronic health records (EHRs). Echocardiography is one of the most commonly ordered diagnostic tests in cardiology. This study sought to explore the feasibility and reliability of using natural language processing (NLP) for large-scale and targeted extraction of multiple data elements from echocardiography reports. An NLP tool, EchoInfer, was developed to automatically extract data pertaining to cardiovascular structure and function from heterogeneously formatted echocardiographic data sources. EchoInfer was applied to echocardiography reports (2004 to 2013) available from 3 different on-going clinical research projects. EchoInfer analyzed 15,116 echocardiography reports from 1684 patients, and extracted 59 quantitative and 21 qualitative data elements per report. EchoInfer achieved a precision of 94.06%, a recall of 92.21%, and an F1-score of 93.12% across all 80 data elements in 50 reports. Physician review of 400 reports demonstrated that EchoInfer achieved a recall of 92–99.9% and a precision of >97% in four data elements, including three quantitative and one qualitative data element. Failure of EchoInfer to correctly identify or reject reported parameters was primarily related to non-standardized reporting of echocardiography data. EchoInfer provides a powerful and reliable NLP-based approach for the large-scale, targeted extraction of information from heterogeneous data sources. The use of EchoInfer may have implications for the clinical management and research analysis of patients undergoing echocardiographic evaluation. PMID:27124000

  17. 2-DE using hemi-fluorinated surfactants.

    PubMed

    Starita-Geribaldi, Mireille; Thebault, Pascal; Taffin de Givenchy, Elisabeth; Guittard, Frederic; Geribaldi, Serge

    2007-07-01

    The synthesis of hemi-fluorinated zwitterionic surfactants was realized and assessed for 2-DE, a powerful separation method for proteomic analysis. These new fluorinated amidosulfobetaine (FASB-p,m) were compared to their hydrocarbon counterparts amidosulfobetaine (ASB-n) characterized by a hydrophilic polar head, a hydrophobic and lipophilic tail, and an amido group as connector. The tail of these FASB surfactants was in part fluorinated resulting in the modulation of its lipophilicity (or oleophobicity). Their effect on the red blood cell (RBC) membrane showed a specific solubilization depending on the length of the hydrophobic part. A large number of polypeptide spots appeared in the 2-DE patterns by using FASB-p,m. The oleophobic character of these surfactants was confirmed by the fact that Band 3, a highly hydrophobic transmembrane protein, was not solubilized by these fluorinated structures. The corresponding pellet was very rich in Band 3 and could then be solubilized by using a strong detergent such as amidosulfobetaine with an alkyl tail containing 14 carbon atoms (ASB-14). Thus, these hemi-fluorinated surfactants appeared as powerful tools when used at the first step of a two-step solubilization strategy using a hydrocarbon homologous surfactant in the second step. PMID:17577887

  18. Damage spreading in 2-dimensional isotropic and anisotropic Bak-Sneppen models

    NASA Astrophysics Data System (ADS)

    Bakar, B.; Tirnakli, U.

    2008-03-01

    We implement the damage spreading technique on 2-dimensional isotropic and anisotropic Bak-Sneppen models. Our extensive numerical simulations show that there exists a power-law sensitivity to the initial conditions at the statistically stationary state (self-organized critical state). Corresponding growth exponent α for the Hamming distance and the dynamical exponent z are calculated. These values allow us to observe a clear data collapse of the finite size scaling for both versions of the Bak-Sneppen model. Moreover, it is shown that the growth exponent of the distance in the isotropic and anisotropic Bak-Sneppen models is strongly affected by the choice of the transient time.

  19. Dynamical analysis and simulation of a 2-dimensional disease model with convex incidence

    NASA Astrophysics Data System (ADS)

    Yu, Pei; Zhang, Wenjing; Wahl, Lindi M.

    2016-08-01

    In this paper, a previously developed 2-dimensional disease model is studied, which can be used for both epidemiologic modeling and in-host disease modeling. The main attention of this paper is focused on various dynamical behaviors of the system, including Hopf and generalized Hopf bifurcations which yield bistability and tristability, Bogdanov-Takens bifurcation, and homoclinic bifurcation. It is shown that the Bogdanov-Takens bifurcation and homoclinic bifurcation provide a new mechanism for generating disease recurrence, that is, cycles of remission and relapse such as the viral blips observed in HIV infection.

  20. A Finger-Shaped Tactile Sensor for Fabric Surfaces Evaluation by 2-Dimensional Active Sliding Touch

    PubMed Central

    Hu, Haihua; Han, Yezhen; Song, Aiguo; Chen, Shanguang; Wang, Chunhui; Wang, Zheng

    2014-01-01

    Sliding tactile perception is a basic function for human beings to determine the mechanical properties of object surfaces and recognize materials. Imitating this process, this paper proposes a novel finger-shaped tactile sensor based on a thin piezoelectric polyvinylidene fluoride (PVDF) film for surface texture measurement. A parallelogram mechanism is designed to ensure that the sensor applies a constant contact force perpendicular to the object surface, and a 2-dimensional movable mechanical structure is utilized to generate the relative motion at a certain speed between the sensor and the object surface. By controlling the 2-dimensional motion of the finger-shaped sensor along the object surface, small height/depth variation of surface texture changes the output charge of PVDF film then surface texture can be measured. In this paper, the finger-shaped tactile sensor is used to evaluate and classify five different kinds of linen. Fast Fourier Transformation (FFT) is utilized to get original attribute data of surface in the frequency domain, and principal component analysis (PCA) is used to compress the attribute data and extract feature information. Finally, low dimensional features are classified by Support Vector Machine (SVM). The experimental results show that this finger-shaped tactile sensor is effective and high accurate for discriminating the five textures. PMID:24618775

  1. Determining the Best Sensing Coverage for 2-Dimensional Acoustic Target Tracking

    PubMed Central

    Pashazadeh, Saeid; Sharifi, Mohsen

    2009-01-01

    Distributed acoustic target tracking is an important application area of wireless sensor networks. In this paper we use algebraic geometry to formally model 2-dimensional acoustic target tracking and then prove its best degree of required sensing coverage. We present the necessary conditions for three sensing coverage to accurately compute the spatio-temporal information of a target object. Simulations show that 3-coverage accurately locates a target object only in 53% of cases. Using 4-coverage, we present two different methods that yield correct answers in almost all cases and have time and memory usage complexity of Θ(1). Analytic 4-coverage tracking is our first proposed method that solves a simultaneous equation system using the sensing information of four sensor nodes. Redundant answer fusion is our second proposed method that solves at least two sets of simultaneous equations of target tracking using the sensing information of two different sets of three sensor nodes, and fusing the results using a new customized formal majority voter. We prove that 4-coverage guarantees accurate 2-dimensional acoustic target tracking under ideal conditions. PMID:22412319

  2. A finger-shaped tactile sensor for fabric surfaces evaluation by 2-dimensional active sliding touch.

    PubMed

    Hu, Haihua; Han, Yezhen; Song, Aiguo; Chen, Shanguang; Wang, Chunhui; Wang, Zheng

    2014-01-01

    Sliding tactile perception is a basic function for human beings to determine the mechanical properties of object surfaces and recognize materials. Imitating this process, this paper proposes a novel finger-shaped tactile sensor based on a thin piezoelectric polyvinylidene fluoride (PVDF) film for surface texture measurement. A parallelogram mechanism is designed to ensure that the sensor applies a constant contact force perpendicular to the object surface, and a 2-dimensional movable mechanical structure is utilized to generate the relative motion at a certain speed between the sensor and the object surface. By controlling the 2-dimensional motion of the finger-shaped sensor along the object surface, small height/depth variation of surface texture changes the output charge of PVDF film then surface texture can be measured. In this paper, the finger-shaped tactile sensor is used to evaluate and classify five different kinds of linen. Fast Fourier Transformation (FFT) is utilized to get original attribute data of surface in the frequency domain, and principal component analysis (PCA) is used to compress the attribute data and extract feature information. Finally, low dimensional features are classified by Support Vector Machine (SVM). The experimental results show that this finger-shaped tactile sensor is effective and high accurate for discriminating the five textures. PMID:24618775

  3. Comparison of indium-111 platelet scintigraphy and two-dimensional echocardiography in the diagnosis of left ventricular thrombi

    SciTech Connect

    Ezekowitz, M.D.; Wilson, D.A.; Smith, E.O.; Burow, R.D.; Harrison, L.H. Jr.; Parker, D.E.; Elkins, R.C.; Peyton, M.; Taylor, F.B.

    1982-06-24

    In a study comparing indium-111 platelet scintigraphy and two-dimensional echocardiography as methods of identifying left ventricular thrombi, the results obtained with both techniques were verified at surgery or autopsy in 53 patients-34 with left ventricular aneurysms, and 19 with mitral-valve disease. Left ventricular thrombi were found at surgery or autopsy in 14 of the patients with aneurysms and in none of those with mitral-valve disease. Thirteen of 53 echocardiograms (25%) were technically inadequate and excluded from the analysis. In the group with aneurysms, the sensitivity of scintigraphy in detecting thrombi was 71%, and that of echocardiography was 77%. The specificity of scintigraphy was 100%, and that of echocardiography was 93%. We conclude that indium-111 platelet scintigraphy and two-dimensional echocardiography have useful and complementary roles in the detection of left ventricular thrombi. Both these noninvasive techniques can be used to monitor therapy.

  4. Imaging Tuberous Sclerosis: The Incremental Benefit of Three-Dimensional and Speckle Tracking Echocardiography.

    PubMed

    Garg, Pankaj; Musa, Tarique A; Ripley, David P

    2015-09-01

    Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome and multisystem disorder with autosomal dominant inheritance and variable penetrance. Cardiac rhabdomyomas have been reported in 50-64% of patients with TSC and transthoracic echocardiography is established as the primary imaging modality for their detection. The precise functional assessment of the left ventricle in these patients requires clarification. We report a case of a 19-year-old male with known TSC who was referred for outpatient transthoracic echocardiography (TTE) to investigate for the presence of cardiac rhabdomyomas. TTE demonstrated multiple rhabdomyomas with a normal ejection fraction but altered global and regional deformation on speckle tracking. The regional longitudinal strain was notably reduced in the anterior septum (-11%) and inferior septum (-15%). The global circumferential strain (GCS) was significantly reduced at -15.6%. The distribution of regional circumferential strain reduction for the mid-ventricular segment correlated with the location of cardiac rhabdomyomas. PMID:25736174

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

    PubMed

    Maini, Brijeshwar

    2015-01-01

    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

  6. Automatic computation of 2D cardiac measurements from B-mode echocardiography

    NASA Astrophysics Data System (ADS)

    Park, JinHyeong; Feng, Shaolei; Zhou, S. Kevin

    2012-03-01

    We propose a robust and fully automatic algorithm which computes the 2D echocardiography measurements recommended by America Society of Echocardiography. The algorithm employs knowledge-based imaging technologies which can learn the expert's knowledge from the training images and expert's annotation. Based on the models constructed from the learning stage, the algorithm searches initial location of the landmark points for the measurements by utilizing heart structure of left ventricle including mitral valve aortic valve. It employs the pseudo anatomic M-mode image generated by accumulating the line images in 2D parasternal long axis view along the time to refine the measurement landmark points. The experiment results with large volume of data show that the algorithm runs fast and is robust comparable to expert.

  7. Intraoperative transesophageal two-dimensional echocardiography: a basic vertical plane patient examination sequence.

    PubMed Central

    Rafferty, T. D.; Tousignant, G.

    1995-01-01

    We have previously reported a standardized stepwise transesophageal echocardiography transverse plane (monoplane) patient examination sequence suitable for intraoperative use. Biplane transesophageal echocardiography furnishes images of the heart and great vessels in both transverse and vertical planes. This report describes a seven-step vertical plane examination, the completion component of a comprehensive intraoperative biplane evaluation. Each step is illustrated by presentation of a two-dimensional echocardiographic image, a matching diagram and a schematic representation of the corresponding axis of interrogation. Examples of clinical presentations complete the report. Images Figure 2 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14a Figure 14b Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21a Figure 21b Figure 21c PMID:8792603

  8. Speckle reduction in echocardiography by temporal compounding and anisotropic diffusion filtering

    NASA Astrophysics Data System (ADS)

    Giraldo-Guzmán, Jader; Porto-Solano, Oscar; Cadena-Bonfanti, Alberto; Contreras-Ortiz, Sonia H.

    2015-01-01

    Echocardiography is a medical imaging technique based on ultrasound signals that is used to evaluate heart anatomy and physiology. Echocardiographic images are affected by speckle, a type of multiplicative noise that obscures details of the structures, and reduces the overall image quality. This paper shows an approach to enhance echocardiography using two processing techniques: temporal compounding and anisotropic diffusion filtering. We used twenty echocardiographic videos that include one or three cardiac cycles to test the algorithms. Two images from each cycle were aligned in space and averaged to obtain the compound images. These images were then processed using anisotropic diffusion filters to further improve their quality. Resultant images were evaluated using quality metrics and visual assessment by two medical doctors. The average total improvement on signal-to-noise ratio was up to 100.29% for videos with three cycles, and up to 32.57% for videos with one cycle.

  9. Extracorporeal cardiopulmonary resuscitation in bedside echocardiography-diagnosed massive pulmonary embolism.

    PubMed

    Jeong, Won Joon; Lee, Jun Wan; Yoo, Youn Ho; Ryu, Seung; Cho, Sung Wook; Song, Kyoung Hyuk; Park, Sang Il

    2015-10-01

    Acute pulmonary embolism (PE) is one of the major causes of inhospital cardiac arrest as well as out-of-hospital cardiac arrest. Bedside diagnosis of acute PE in the emergency department (ED) can be challenging, especially in a cardiac arrest setting. Even if the early diagnosis of an acute massive PE had been made, hemodynamic instability may be worsened unless obstructive shock gets resolved. We present a case of a 46-year-old woman who developed pulseless electrical activity (PEA) after complaining of weakness and dyspnea in an ambulance, presumptively diagnosed as acute PE by bedside focused echocardiography. She received thrombolytic therapy and was rescued by extracorporeal cardiopulmonary resuscitation for recurrent PEA arrest in the ED. Focused bedside echocardiography provides a rapid diagnostic adjunct, and extracorporeal cardiopulmonary resuscitation can be a valuable rescue therapy for PEA arrest from massive PE. PMID:26275631

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

    PubMed Central

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

    1990-01-01

    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 techniques agreed closely with thermodilution in most patients. None the less, three results with each method disagreed with thermodilution by more than 1 1/min. Both non-invasive techniques were reproducible and accurate in most patients with acute myocardial infarction. Doppler echocardiography was time consuming and technically demanding. Electrical bioimpedance was simple to use and had the additional advantage of allowing continuous monitoring of the cardiac output. PMID:2317415

  11. Complete Neurological Recovery After Transesophageal Echocardiography-Guided Diagnosis and Management of Prolonged Cardiopulmonary Resuscitation.

    PubMed

    Ramarapu, Srikiran

    2015-12-01

    A 70-year-old man was scheduled for open reduction and internal fixation of his right knee fracture. When the tourniquet was deflated after 150 minutes, his arterial blood pressure and heart rate decreased precipitously. The patient was deemed to exhibit pulseless electrical activity. Cardiopulmonary resuscitation was initiated. The bispectral index reading improved to 25 to 30, but his end-tidal carbon dioxide was still very low (5 mm Hg). Transesophageal echocardiography showed a pulmonary embolism. Feedback from echo imaging improved the quality of chest compressions and motivated the resuscitation team to maintain the diastolic blood pressure>25 mm Hg. Although capnographic guidance was ineffective by itself, echocardiography monitoring was very helpful for showing the intracardiac events. PMID:26588031

  12. The role of echocardiography in the management of the sources of embolism.

    PubMed

    Esposito, Roberta; Raia, Rosa; De Palma, Daniela; Santoro, Ciro; Galderisi, Maurizio

    2012-01-01

    The echocardiographic diagnosis of cardiac thrombi, vegetations and tumors as well as the identification of predisposing conditions such as patent foramen ovale, aortic atherosclerosis and other minor causes (e.g., mitral valve prolapse, mitral and aortic valve calcification) have crucial clinical relevance, affecting the choice of surgery and/or of pharmaceutical therapy in the setting of patients presenting embolism. The echocardiographic assessment helps not only for the retrospective diagnosis of sources of embolism but also for the prevention of events in asymptomatic patients. Echocardiography can also distinguish normal variants and artifacts from cardiac masses and tumors. Echocardiographic characterization/typology of cardiac sources of embolism is currently below par when compared with cardiac MRI, the current gold standard. Nevertheless, echocardiography remains the 'first-line' imaging tool, because of its low cost and the possibility to add easily available, functional and structural information at the patient's bedside. PMID:22185449

  13. Three-dimensional speckle-tracking echocardiography: methodological aspects and clinical potential.

    PubMed

    Urbano-Moral, Jose A; Patel, Ayan R; Maron, Martin S; Arias-Godinez, Jose A; Pandian, Natesa G

    2012-09-01

    Speckle-tracking echocardiography (STE) is an advanced echocardiographic technique that allows a novel approach to the assessment of cardiac physiology through the study of myocardial mechanics. In its three-dimensional (3D) modality, it overcomes the drawbacks inherent to other echocardiographic techniques, namely two-dimensional echocardiography and tissue Doppler imaging. Several research studies and software improvements have led 3D-STE to become a promising tool for accurate evaluation of global and regional cardiac function. This article addresses the image acquisition, analytical methods, and parameters of myocardial mechanics that could be derived from 3D-STE. This systematic guidance may help to establish its usefulness in the global and regional evaluation of cardiac function, and to facilitate its clinical application. PMID:22783969

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

    PubMed Central

    2013-01-01

    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

  15. Methodological Gaps in Left Atrial Function Assessment by 2D Speckle Tracking Echocardiography

    PubMed Central

    Rimbaş, Roxana Cristina; Dulgheru, Raluca Elena; Vinereanu, Dragoş

    2015-01-01

    The assessment of left atrial (LA) function is used in various cardiovascular diseases. LA plays a complementary role in cardiac performance by modulating left ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and Doppler echocardiography can measure LA function non-invasively. However, evaluation of LA deformation derived from 2D speckle tracking echocardiography (STE) is a new feasible and promising approach for assessment of LA mechanics. These parameters are able to detect subclinical LA dysfunction in different pathological condition. Normal ranges for LA deformation and cut-off values to diagnose LA dysfunction with different diseases have been reported, but data are still conflicting, probably because of some methodological and technical issues. This review highlights the importance of an unique standardized technique to assess the LA phasic functions by STE, and discusses recent studies on the most important clinical applications of this technique. PMID:26761370

  16. Three-dimensional mapping and intracardiac echocardiography in the treatment of sinoatrial nodal tachycardias.

    PubMed

    Nagarakanti, Ranghadham; Saksena, Sanjeev

    2016-06-01

    Three-dimensional mapping and intracardiac echocardiography are important tools for the study of the site of origin of an arrhythmia and its substrate. This review examines the application of these techniques in the diagnosis and treatment of sinoatrial tachycardias with a special focus on the syndrome of inappropriate sinus tachycardia. The use of these techniques in electrophysiologic mapping and interventions such as catheter ablation is discussed. Three-dimensional mapping provides unique insights into the generation of normal and abnormal sinus impulses in man and their propagation in the atrium. It permits precise placement of ablation lesions and assessment of real-time electrophysiologic impact of these interventions. Intracardiac echocardiography provides delineation of important anatomic structures in the vicinity of the sinoatrial node complex and monitors the safety of interventions such as catheter ablation. PMID:26607480

  17. Usefulness of three-dimensional echocardiography for evaluation of pathological mass in the right atrium.

    PubMed

    Michalski, Błażej; Kasprzak, Jarosław D; Lipiec, Piotr

    2011-04-01

    The authors present a case of 51-year-old male patient with symptoms of congestive heart failure. Two-dimensional transthoracic echocardiography (2D TTE) at the time of admission revealed a spherical, highly mobile structure in the right atrium (4.5 cm in diameter). Despite using multiple views it was impossible to distinguish if this structure had a stalk or was free-floating. The real time three-dimensional transthoracic echocardiography (3D TTE) revealed the presence of thin stalk attached to the roof of the right atrium. Guidance of 2D TTE by 3D TTE findings finally allowed the recognition of the stalk in modified subcostal view. PMID:21349104

  18. Clinical Use of Doppler Echocardiography in Organic Mitral Regurgitation: From Diagnosis to Patients' Management

    PubMed Central

    Russo, Antonio; Pasquale, Ferdinando; Biagini, Elena; Barberini, Francesco; Ferlito, Marinella; Leone, Ornella; Rapezzi, Claudio

    2015-01-01

    Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR. PMID:26448820

  19. [Clinical practice guidelines of the Spanish Society of Cardiology on echocardiography].

    PubMed

    Evangelista Masip, A; María Alonso Gómez, A; Martín Durán, R; Moreno Yagüela, M; María Oliver Ruiz, J; Rodríguez Padial, L; Tobaruela, A

    2000-05-01

    Doppler echocardiography has become the technique of choice for the diagnosis and follow-up of most heart diseases its main advantages are that it is non-invasive, easy to use, readily available, rapid and has a high cost-benefict ratio. Multiple studies have demonstrated the accuracy of the technique in the diagnosis and severity quantification of the severity of different diseases. Nevertheless, its main limitation lies in the fact that results are operator dependent, and therefore correct training of the echocardiographer is mandatory. In addition, adequate infrastructure and appropriate equipment are a required guarantee quality of the study. Finally, the technique should be used for the indications, in which beneficial information can be yielded. The aim of the present article was to define and update these considerations to enhance the usefulness of echocardiography in clinical practice. PMID:10816174

  20. Assessment and impact of diastolic function by echocardiography in elderly patients

    PubMed Central

    Dugo, Clementina; Rigolli, Marzia; Rossi, Andrea; Whalley, Gillian A

    2016-01-01

    Doppler echocardiography is the gold standard for assessment of diastolic dysfunction, which is increasingly recognised as a cause of heart failure, especially in the elderly. Using a combination of Doppler echocardiography techniques, it is possible to identify grades of diastolic dysfunction, estimate left ventricular filling pressures and establish the chronicity of diastolic dysfunction. These physiologically-derived measures have been widely validated against invasive measurements of left heart pressures and have been shown to be prognostically valuable in a wide range of clinical settings. This review explores the mechanisms, and approaches to the assessment of diastolic dysfunction in the elderly. The challenge for clinicians is to identify pathophysiological changes from those associated with normal ageing. When used in combination, and taking age into account, Doppler echocardiographic parameters are helpful in the assessment of dyspnoea in older patients and provide prognostic insights. PMID:27103921

  1. Detection of Quiescent Phases in Echocardiography Data using Non-Linear Filtering and Boundary Detection

    PubMed Central

    Ravichandran, Lakshminarayan; Wick, Carson A.; Tridandapani, Srini

    2013-01-01

    In order to detect the quasi-stationary states of the heart within a cardiac cycle from echocardiography data, we present an algorithm that uses non-linear filtering and boundary detection. The non-linear filtering algorithm involves anisotropic diffusion to remove the speckle noise from the data and to smoothen the homogeneous regions while preserving the edges. Following this, we perform binary thresholding and boundary detection, and observe the positional changes in the region of interest. From a series of echocardiography images, we derived the regions of cardiac quiescence, which we then plotted on the electrocardiograph (ECG) R–R interval. It is observed that the quiescence occurs in the diastolic region of the ECG signal, but the position and length of quiescence varies across multiple cardiac cycles for the same individual. PMID:23366202

  2. Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting--a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society.

    PubMed

    Gorcsan, John; Abraham, Theodore; Agler, Deborah A; Bax, Jeroen J; Derumeaux, Genevieve; Grimm, Richard A; Martin, Randy; Steinberg, Jonathan S; Sutton, Martin St John; Yu, Cheuk-Man

    2008-03-01

    Echocardiography plays an evolving and important role in the care of heart failure patients treated with biventricular pacing, or cardiac resynchronization therapy (CRT). Numerous recent published reports have utilized echocardiographic techniques to potentially aide in patient selection for CRT prior to implantation and to optimized device settings afterwards. However, no ideal approach has yet been found. This consensus report evaluates the contemporary applications of echocardiography for CRT including relative strengths and technical limitations of several techniques and proposes guidelines regarding current and possible future clinical applications. Principal methods advised to qualify abnormalities in regional ventricular activation, known as dyssynchrony, include longitudinal velocities by color-coded tissue Doppler and the difference in left ventricular to right ventricular ejection using routine pulsed Doppler, or interventricular mechanical delay. Supplemental measures of radial dynamics which may be of additive value include septal-to-posterior wall delay using M-mode in patients with non-ischemic disease with technically high quality data, or using speckle tracking radial strain. A simplified post-CRT screening for atrioventricular optimization using Doppler mitral inflow velocities is also proposed. Since this is rapidly changing field with new information being added frequently, future modification and refinements in approach are anticipated to continue. PMID:18314047

  3. LV motion tracking from 3D echocardiography using textural and structural information.

    PubMed

    Myronenko, Andriy; Song, Xubo; Sahn, David J

    2007-01-01

    Automated motion reconstruction of the left ventricle (LV) from 3D echocardiography provides insight into myocardium architecture and function. Low image quality and artifacts make 3D ultrasound image processing a challenging problem. We introduce a LV tracking method, which combines textural and structural information to overcome the image quality limitations. Our method automatically reconstructs the motion of the LV contour (endocardium and epicardium) from a sequence of 3D ultrasound images. PMID:18044597

  4. Strain Imaging: The Emergence of Speckle Tracking Echocardiography into Clinical Pediatric Cardiology.

    PubMed

    Colquitt, John L; Pignatelli, Ricardo H

    2016-01-01

    Speckle tracking echocardiography measures myocardial strain and allows for the quantification of regional and global left and right ventricular function. A growing body of literature is supporting its transition from research into clinical practice. This article aims to provide a practical review of strain imaging as it applies to congenital and pediatric heart disease, with the goals of increasing literacy and advocating for greater clinical integration. PMID:26879728

  5. Surgeon-Performed Hemodynamic Transesophageal Echocardiography in the Burn Intensive Care Unit.

    PubMed

    Held, Jenny M; Litt, Jeffrey; Kennedy, Jason D; McGrane, Stuart; Gunter, Oliver L; Rae, Lisa; Kahn, Steven A

    2016-01-01

    The use of transesophageal echocardiography (TEE) for resuscitation after burn injury has been reported in small case studies. Conventional TEE is invasive and often requires a subspecialist with a high level of training. The authors report a series of surgeon-performed hemodynamic TEE with an indwelling, less bulky, user-friendly probe. Records of patients treated in a regional burn center who underwent hemodynamic TEE between October 1, 2012 and May 30, 2014 were reviewed. The clinical course of each patient was recorded. All bedside interpretations were retrospectively reviewed for accuracy by a cardiac anesthesiologist. Eleven patients were included in the study. Median age was 68.5 years (interquartile range, 49.5-79.5). Median burn size was 37% TBSA (interquartile range: 16.3-53%). Seven patients were male, and four suffered inhalation injury. The operator's interpretation matched that of the echocardiography technician and cardiac anesthesiologist in all instances. No complications occurred from probe placement. Four patients underwent hemodynamic TEE to determine volume status during resuscitation. Changes in volume status on echocardiography preceded the eventual changes in urine output and vital signs for one patient. Hemodynamic TEE diagnosed cardiogenic shock and was used to titrate inotropes and vasopressors in seven elderly patients. Hemodynamic TEE is a useful adjunct to manage the burn patient who deviates off the expected course, especially if there is a question of cardiac function or volume status. It is less invasive and can be accurately performed by surgical intensivists when transthoracic echo windows are limited. The role of echocardiography in optimizing routine burn resuscitations needs to be further studied. PMID:26594864

  6. Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult.

    PubMed

    Jung, Jae Wook; Cheol Go, Gwang; Jeon, Sang Yoon; Bang, Sira; Lee, Ki Hwa; Kim, Yong Han; Kim, Dong-Kie

    2013-11-01

    Atrial septal defect (ASD) is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography (TEE) is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine (DEX), which is a highly selective α2-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation. PMID:24550975

  7. [Role of echocardiography in the tailored follow-up of outpatients with chronic heart failure].

    PubMed

    Temporelli, Pier Luigi; Cioffi, Giovanni; Dini, Frank L; Ghio, Stefano; Rossi, Andrea

    2010-05-01

    Although a huge number of papers have been published on echocardiography in heart failure, there is no expert consensus on how the ultrasound evaluation can really improve the management of heart failure patients. The only way to reach this goal is to have echocardiographers knowing which echo information are relevant for the clinicians who treat heart failure patients and to have clinicians becoming familiar with the interpretation of the echocardiographic examination. PMID:20873465

  8. The Evaluation of Left Ventricular Functions with Tissue Doppler Echocardiography in Adults with Celiac Disease

    PubMed Central

    Akin, Fatma E.; Sari, Cenk; Özer-Sari, Sevil; Demirezer-Bolat, Aylin; Durmaz, Tahir; Keles, Telat; Ersoy, Osman; Bozkurt, Engin

    2016-01-01

    Background/Aim: The aim of this study was to investigate the effects of celiac disease on cardiac functions using tissue Doppler echocardiography (TDE). Patients and Methods: The study included 30 patients with celiac disease (CD) and 30 healthy volunteers. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S'm), early diastolic myocardial peak velocity (E'm), late diastolic myocardial peak velocity (A'm), E'm/A'm ratio, myocardial precontraction time (PCT'm), myocardial contraction time (CT'm), and myocardial isovolumetric relaxation time (IVRT'm), E to E'm ratio were measured. Results: In pulsed wave Doppler echocardiography, mitral late diastolic flow (A) velocity and E to E'm ratio were significantly higher (P = 0.02 and P = 0,017), E/A ratio was significantly lower (P = 0.008) and IVRT was significantly prolonged (P = 0.014) in patients with CD. In TDE, S'm, E'm, and E'm/A'm ratio were significantly lower, IVRT'm was longer (P = 0.009) from septal mitral annulus and S'm, E'm, E'm/A'm ratio were significantly lower, PCT'm, PCT/ET ratio, IVRT'm were longer, and MPI was higher from lateral mitral annulus in celiac group than controls. Conclusion: Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDE. We recommend using TDE in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with CD. PMID:26997217

  9. Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass

    PubMed Central

    Jain, Pawan Kumar; Malik, Vishwas; Divya, Abha; Narula, Jitin; Hote, Milind

    2015-01-01

    Cystic echinococcosis (hydatid disease) arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS) solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope. PMID:26139754

  10. Diagnostic value of transoesophageal echocardiography in suspected haemodynamically significant pulmonary embolism

    PubMed Central

    Pruszczyk, P; Torbicki, A; Kuch-Wocial, A; Szulc, M; Pacho, R

    2001-01-01

    OBJECTIVE—To assess the value of transoesophageal echocardiography (TOE) for diagnosing suspected haemodynamically significant pulmonary embolism and signs of right ventricular overload at standard echocardiography.
METHODS—113 consecutive patients (58 male; 55 female), mean (SD) age 53.6 (13.3) years, in whom there was clinical suspicion of pulmonary embolism and right ventricular overload on transthoracic echocardiography, underwent TOE in addition to routine diagnostic procedures to identify pulmonary artery thrombi.
RESULTS—TOE revealed thrombi in 32 of 51 patients who had suspected acute pulmonary embolism and in 31 of 62 with suspected chronic pulmonary embolism. In one patient a pulmonary angiosarcoma rather than chronic pulmonary embolism was found at surgery. The diagnosis of pulmonary embolism was confirmed in 77 patients by scintigraphy, spiral computed tomography, angiography, or necropsy (reference methods). While TOE failed to provide a diagnosis of pulmonary embolism in 15 of these 77 patients, no false positive findings were reported (sensitivity 80.5%, specificity 97.2%). In 11 and 26 cases, respectively, the thrombi were confined to the left or right pulmonary artery. Bilateral thrombi were found in 25 patients. Mobile thrombi were observed only in acute pulmonary embolism (in 19 of 32 patients). No complications of TOE were noted.
CONCLUSIONS—TOE permits visualisation of pulmonary arterial thrombi, confirming the diagnosis in the majority of patients with pulmonary embolism and right ventricular overload. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy.


Keywords: pulmonary embolism; transoesophageal echocardiography PMID:11359740

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

    PubMed Central

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

    2012-01-01

    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

  12. Role of transesophageal echocardiography: A rare case of acute left atrial free wall dissection

    PubMed Central

    Kumar, G. Anil; Nandakumar, N. M.; Sudhir, B. V.; Pasarad, Ashwini Kumar

    2015-01-01

    Transesophageal echocardiography (TEE) has been used routinely in the diagnosis and follow-up of cardiac cases. Left atrial dissection (LAd), an exceedingly rare complication of cardiac surgery, is most commonly associated with mitral valve surgery. A case of LAd is presented, and the pathology was accurately defined and immediately diagnosed using intraoperative TEE. This case highlights the importance of prompt diagnosis of LAd using intraoperative TEE, and a second cardiac surgery was avoided. PMID:26440252

  13. Volume Measurements in Aortic Root Assessment Using Two-Dimensional Echocardiography

    PubMed Central

    Oyedeji, Adebayo T.; Egbewale, Bolaji E.; Akintunde, Adeseye A.; Ajayi, Ebenezer A.; Owojori, Olukolade O.; Balogun, Michael O.

    2016-01-01

    BACKGROUND Aortic dilatation is associated with the presence of aortic diseases. Current guidelines for assessing the aortic root (AoR) depend on linear measurements acquired by two-dimensional (2D) echocardiography. We considered that real-time three-dimensional echocardiography, which correlates better with AoR volume obtained by computed tomography, is widely unavailable, and therefore, there is a need to determine the AoR volume using 2D echocardiography. METHODS Fifty-one consecutive apparently healthy volunteers were recruited and subsequently divided into three age groups. Specified planes of acquisition and previously defined landmarks were identified, and phases of the cardiac cycle that allowed for measurement standardization were used. Volume was determined by the modified Simpson’s method. RESULTS Although the average diastolic and systolic volume measurements of the AoR dimensions were not significantly different across the three age groups in the study population, a highly significant difference was observed in the volume measurements between male and female normotensive persons, P < 0.01 in each case. AoR volume measurements were five times in the diseased compared with the normotensive individuals; however, linear measurements were only 1.5 times in size of the normal individuals. Both point and interval estimates of the volume measurements of AoR in adult normotensives in three age groups were presented as baseline information. CONCLUSIONS We hereby present a novel way to determine the AoR volume using 2D echocardiography and the normal reference range with respect to age and gender. We also established the relevance of our measurement by comparing the normal population with two isolated diseased aortas. PMID:27398033

  14. Unexpected refractory intra-operative hypotension during non-cardiac surgery: Diagnosis and management guided by trans-oesophageal echocardiography

    PubMed Central

    Reddy, Sundara; Ueda, Kenichi

    2014-01-01

    We present a case of severe refractory hypotension in a patient undergoing de-bulking liver resection for massive polycystic liver disease. Emergent trans-oesophageal echocardiography (TOE) revealed dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Notably, he had a structurally normal heart on pre-operative trans-thoracic echocardiography (TTE). Diagnosis of SAM by TOE, possible mechanisms and specific management of refractory hypotension in this context are discussed. PMID:24700900

  15. Multiview 3-D Echocardiography Fusion with Breath-Hold Position Tracking Using an Optical Tracking System.

    PubMed

    Punithakumar, Kumaradevan; Hareendranathan, Abhilash R; McNulty, Alexander; Biamonte, Marina; He, Allen; Noga, Michelle; Boulanger, Pierre; Becher, Harald

    2016-08-01

    Recent advances in echocardiography allow real-time 3-D dynamic image acquisition of the heart. However, one of the major limitations of 3-D echocardiography is the limited field of view, which results in an acquisition insufficient to cover the whole geometry of the heart. This study proposes the novel approach of fusing multiple 3-D echocardiography images using an optical tracking system that incorporates breath-hold position tracking to infer that the heart remains at the same position during different acquisitions. In six healthy male volunteers, 18 pairs of apical/parasternal 3-D ultrasound data sets were acquired during a single breath-hold as well as in subsequent breath-holds. The proposed method yielded a field of view improvement of 35.4 ± 12.5%. To improve the quality of the fused image, a wavelet-based fusion algorithm was developed that computes pixelwise likelihood values for overlapping voxels from multiple image views. The proposed wavelet-based fusion approach yielded significant improvement in contrast (66.46 ± 21.68%), contrast-to-noise ratio (49.92 ± 28.71%), signal-to-noise ratio (57.59 ± 47.85%) and feature count (13.06 ± 7.44%) in comparison to individual views. PMID:27166019

  16. Assessment of right ventricular systolic function by echocardiography after surgical repair of congenital heart defects.

    PubMed

    Khraiche, Diala; Ben Moussa, Nidhal

    2016-02-01

    Postoperative impairment of right ventricular (RV) systolic function can appear after surgical repair of complex congenital heart defects, such as tetralogy of Fallot; it is caused by chronic volume and/or pressure overload due to pulmonary regurgitation and/or stenosis. RV dysfunction is strongly associated with prognosis in these patients. Cardiac magnetic resonance imaging is the gold standard for quantification of RV volumes and ejection fraction in patients with congenital heart diseases; however, it is costly and is not widely available. Echocardiography is the imaging modality that is most available and most frequently used to assess RV systolic function. However, RV ejection fraction cannot be measured accurately by standard two-dimensional echocardiography because of its pyramidal shape. Surrogate parameters of RV systolic function are mostly used in routine practice. New techniques of two-dimensional strain and three-dimensional quantification of RV volumes and ejection fraction have been developed in recent years. The aim of this article is to show the pertinence of each variable of RV systolic function measured by echocardiography in patients with repaired congenital heart disease and residual chronic RV overload. PMID:26774976

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

    PubMed Central

    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

    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

  18. Role of Echocardiography in the Evaluation of Left Ventricular Assist Devices: the Importance of Emerging Technologies.

    PubMed

    Longobardo, Luca; Kramer, Christopher; Carerj, Scipione; Zito, Concetta; Jain, Renuka; Suma, Valentin; Thohan, Vinay; Sulemanjee, Nasir; Downey, Frank X; Khandheria, Bijoy K

    2016-07-01

    The role of left ventricular assist devices (LVAD) in patients with end-stage heart failure is well known, both as a temporary treatment before transplantation and as destination therapy, in a scenario of a relative shortage of donors to satisfy the increasing requests for transplantation. The increased population of LVAD patients needs careful imaging assessment before, during, and after LVAD implantation; echocardiography is the best tool for their evaluation and is considered the diagnostic technique of choice for the assessment before, during, and after device implantation. Although the conventional echocardiographic assessment is quite effective in evaluating the main critical issues, the role of new technologies like three-dimensional echocardiography and myocardial deformation measurements is still not properly clarified. In this review, we aim to provide an overview of the main elements that should be considered in the assessment of these patients, underlining the role that could be played by new techniques to improve the diagnostic and prognostic effectiveness of echocardiography in this setting. PMID:27216842

  19. Early dobutamine echocardiography for the assessment of coronary stenosis after first Q-wave myocardial infarction.

    PubMed

    De Felice, F; Gostoli, E; Russo, M; Recanzone, P; Moretti, C; Pinneri, F; Borello, G

    2001-08-01

    We assessed the accuracy of early dobutamine stress echocardiography to detect infarct-related coronary artery and multivessel disease in patients with first Q wave myocardial infarction after withdrawal of cardioactive drugs. Dobutamine-atropine echocardiography was performed in 91 consecutive patients (mean age 59+/-6 years) 7+/-4 days after myocardial infarction. Dobutamine was infused at incremental doses of 5, 10, 20, 30 to 40 microg/kg/min each one dose for 3 min. Peak heart rate was 134+/-17 bpm. All patients underwent coronary angiography before discharge. Sensitivity, specificity and accuracy of ischemic and biphasic response to detect residual stenosis of infarct-related coronary artery were 70, 92 and 73%, respectively. The sensitivity, specificity and accuracy of ischemic or biphasic response were similar in the vascular territories of left anterior descending (74, 86 and 75%, respectively), right (67, 100 and 70%, respectively) and circumflex coronary arteries (64, 100, and 69%, respectively). Sensitivity, specificity and accuracy of heterozonal wall motion abnormalities for multivessel coronary artery disease were 64, 82 and 76%, respectively. Dobutamine stress echocardiography is sensitive and specific in detecting residual coronary stenosis and multivessel disease in patients with first Q-wave myocardial infarction. The test is safe even without pharmacological protection. PMID:11532546

  20. Cardiac high-energy phosphate metabolism alters with age as studied in 196 healthy males with the help of 31-phosphorus 2-dimensional chemical shift imaging.

    PubMed

    Esterhammer, Regina; Klug, Gert; Wolf, Christian; Mayr, Agnes; Reinstadler, Sebastian; Feistritzer, Hans-Josef; Metzler, Bernhard; Schocke, Michael F H

    2014-01-01

    Recently published studies have elucidated alterations of mitochondrial oxidative metabolism during ageing. The intention of the present study was to evaluate the impact of ageing on cardiac high-energy phosphate metabolism and cardiac function in healthy humans. 31-phosphorus 2-dimensional chemical shift imaging (31P 2D CSI) and echocardiography were performed in 196 healthy male volunteers divided into groups of 20 to 40 years (I, n = 43), 40 to 60 years (II, n = 123) and >60 years (III, n = 27) of age. Left ventricular PCr/β-ATP ratio, myocardial mass (MM), ejection fraction and E/A ratio were assessed. Mean PCr/β-ATP ratios were significantly different among the three groups of volunteers (I, 2.10 ± 0.37; II, 1.77 ± 0.37; III, 1.45 ± 0.28; all p<0.001). PCr/β-ATP ratios were inversely related to age (r(2)  =  -0.25; p<0.001) with a decrease from 2.65 by 0.02 per year of ageing. PCr/β-ATP ratios further correlated with MM (r =  -0.371; p<0.001) and E/A ratios (r = 0.213; p<0.02). Moreover, E/A ratios (r =  -0.502, p<0.001), MM (r = 0.304, p<0.001), glucose-levels (r = 0.157, p<0.05) and systolic blood pressure (r = 0.224, p<0.005) showed significant correlations with age. The ejection fraction did not significantly differ between the groups. This study shows that cardiac PCr/β-ATP ratios decrease moderately with age indicating an impairment of mitochondrial oxidative metabolism due to age. Furthermore, MM increases, and E/A ratio decreases with age. Both correlate with left-ventricular PCr/β-ATP ratios. The findings of the present study confirm numerous experimental studies showing an impairment of cardiac mitochondrial function with age. PMID:24940736

  1. Determination of chemical concentration with a 2 dimensional CCD array in the Echelle grating spectrometer

    SciTech Connect

    Lewis, D.K.; Stevens, C.G.

    1994-11-15

    The Echelle grating spectrometer (EGS) uses a stepped Echelle grating, prisms and a folded light path to miniaturize an infrared spectrometer. Light enters the system through a slit and is spread out along Y by a prism. This light then strikes the grating and is diffracted out along X. This spreading results in a superposition of spectral orders since the grating has a high spectral range. These orders are then separated by again passing through a prism. The end result of a measurement is a 2 dimensional image which contains the folded spectrum of the region under investigation. The data lies in bands from top to bottom, for example, with wavenumber increments as small as 0.1 lying from left to right such that the right end of band N is the same as the left end of band N+1. This is the image which must be analyzed.

  2. Time-resolved spatial phase measurements with 2-dimensional spectral interferometry

    NASA Astrophysics Data System (ADS)

    Childress, Colby; Planchon, Thomas; Amir, Wafa; Squier, Jeff A.; Durfee, Charles G.

    2007-03-01

    We are using 2-dimensional spectral interferometry for sensitive measurements of spatial phase distortions. The reference pulse and the time-delayed probe pulse are coincident on an imaging spectrometer, yielding spectral and spatial phase information. This technique offers the potential of higher sensitivity than traditional spatial interferometry since there are many fringes of data for each spatial point. We illustrate this technique with measurements of the thermal lensing profile in a cryogenically cooled Ti:sapphire amplifier crystal that is pumped by tens of watts of power from four frequency-doubled Nd:YLF lasers running at 1 kHz. By adjusting the relative delay of the probe and reference pulses, we characterize the thermal transients during and after the pump pulses. We compare the measured transient thermal profiles with those calculated with a finite-element model.

  3. The structural identification of a methyl analog of methaqualone via 2-dimensional NMR techniques.

    PubMed

    Angelos, S A; Lankin, D C; Meyers, J A; Raney, J K

    1993-03-01

    A submission to the Drug Enforcement Administration North Central Laboratory of a substance believed to be a structural analog of methaqualone hydrochloride precipitated an interest in being able to obtain a rapid and positive identification of such compounds. Both mass spectrometry and proton NMR spectroscopy (1-dimensional) provided evidence to suggest that the structural analog possessed a second methyl group in the molecule, relative to methaqualone, and that the methyl group was attached to the existing methyl-substituted phenyl ring. By application of proton 2-dimensional (2-D) NMR techniques, specifically the homonuclear shift correlation spectroscopy (COSY) and 2-D NOE (NOESY), the precise location of the methyl group in this unknown methaqualone analog was established and shown to have the structure 2. PMID:8455002

  4. 2-dimensional simulations of electrically asymmetric capacitively coupled RF-discharges

    NASA Astrophysics Data System (ADS)

    Mohr, Sebastian; Schulze, Julian; Schuengel, Edmund; Czarnetzki, Uwe

    2011-10-01

    Capactively coupled RF-discharges are widely used for surface treatment like the deposition of thin films. For industrial applications, the independent control of the ion flux to and the mean energy of the electrons impinging on the surfaces is desired. Experiments and 1D3v-PIC/MCC-simulations have shown that this independent control is possible by applying a fundamental frequency and its second harmonic to the powered electrode. This way, even in geometrically symmetric discharges, as they are often used in industrial reactors, a discharge asymmetry can be induced electrically, hence the name Electrical Asymmetry Effect (EAE). We performed 2D-simulations of electrically asymmetric discharges using HPEM by the group of Mark Kushner, a simulation tool suitable for simulating industrial reactors. First results are presented and compared to previously obtained experimental and simulation data. The comparison shows that for the first time, we succeeded in simulating electrically asymmetric discharges with a 2-dimensional simulation. Capactively coupled RF-discharges are widely used for surface treatment like the deposition of thin films. For industrial applications, the independent control of the ion flux to and the mean energy of the electrons impinging on the surfaces is desired. Experiments and 1D3v-PIC/MCC-simulations have shown that this independent control is possible by applying a fundamental frequency and its second harmonic to the powered electrode. This way, even in geometrically symmetric discharges, as they are often used in industrial reactors, a discharge asymmetry can be induced electrically, hence the name Electrical Asymmetry Effect (EAE). We performed 2D-simulations of electrically asymmetric discharges using HPEM by the group of Mark Kushner, a simulation tool suitable for simulating industrial reactors. First results are presented and compared to previously obtained experimental and simulation data. The comparison shows that for the first time, we

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

    PubMed

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

    2014-12-01

    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

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

    PubMed Central

    Kapral, M K; Silver, F L

    1999-01-01

    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

  7. Intravenous myocardial contrast echocardiography predicts regional and global left ventricular remodelling after acute myocardial infarction: comparison with low dose dobutamine stress echocardiography

    PubMed Central

    Abe, Y; Muro, T; Sakanoue, Y; Komatsu, R; Otsuka, M; Naruko, T; Itoh, A; Yoshiyama, M; Haze, K; Yoshikawa, J

    2005-01-01

    Objective: To assess the role of intravenous myocardial contrast echocardiography (MCE) in predicting functional recovery and regional or global left ventricular (LV) remodelling after acute myocardial infarction (AMI) compared with low dose dobutamine stress echocardiography (LDSE). Methods: 21 patients with anterior AMI and successful primary angioplasty underwent MCE and LDSE during the subacute stage (2–4 weeks after AMI). Myocardial perfusion and contractile reserve were assessed in each segment (12 segment model) with MCE and LDSE. The 118 dyssynergic segments in the subacute stage were classified as recovered, unchanged, or remodelled according to wall motion at six months’ follow up. Percentage increase in LV end diastolic volume (%ΔEDV) was also calculated. Results: The presence of perfusion was less accurate than the presence of contractile reserve in predicting regional recovery (55% v 81%, p < 0.0001). However, the absence of perfusion was more accurate than the absence of contractile reserve in predicting regional remodelling (83% v 48%, p < 0.0001). The number of segments without perfusion was an independent predictor of %ΔEDV, whereas the number of segments without contractile reserve was not. The area under the receiver operating characteristic curve showed that the number of segments without perfusion predicted substantial LV dilatation (%ΔEDV > 20%) more accurately than did the number of segments without contractile reserve (0.88 v 0.72). Conclusion: In successfully revascularised patients with AMI, myocardial perfusion assessed by MCE is predictive of regional and global LV remodelling rather than of functional recovery, whereas contractile reserve assessed by LDSE is predictive of functional recovery rather than of LV remodelling. PMID:15797931

  8. Usefulness of transthoracic and transoesophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma.

    PubMed Central

    Chirillo, F.; Totis, O.; Cavarzerani, A.; Bruni, A.; Farnia, A.; Sarpellon, M.; Ius, P.; Valfrè, C.; Stritoni, P.

    1996-01-01

    OBJECTIVE: To assess the diagnostic potential of transthoracic and transoesophageal echocardiography for the detection of traumatic cardiovascular injuries in patients suffering from severe blunt chest trauma. DESIGN: Prospective study over a three year period. SETTING: A regional cardiothoracic centre. PATIENTS: 134 consecutive patients (94 M/40 F; mean age 38 (SD 14) years) suffering from severe blunt chest trauma (injury severity score 33.5 (18.2)). Most patients (89%) were victims of motor vehicle accidents. EVALUATION: All patients underwent transthoracic and transoesophageal echocardiography within 8 h of admission. Aortography was performed in the first 20 patients and in a further five equivocal cases. RESULTS: Transthoracic echocardiography provided suboptimal images in 83 patients, detecting three aortic ruptures, 28 pericardial effusions (one cardiac tamponade), 35 left pleural effusions, and 15 myocardial contusions. Transoesophageal echocardiography was feasible in 131 patients and detected 14 aortic ruptures (13 at the isthmus), 40 pericardial effusions, 51 left pleural effusions, 34 periaortic haematomas, 45 myocardial contusions, right atrial laceration in one patient with cardiac tamponade, one tricuspid valve rupture, and one severe mitral regurgitation caused by annular disruption. For the detection of aortic rupture transoesophageal echocardiography showed 93% sensitivity, 98% specificity, and 98% accuracy. Time to surgery was significantly shorter (30 (12) v 71 (21) min; P < 0.05) for patients operated on only on the basis of transoesophageal echocardiographic findings. CONCLUSIONS: Transthoracic echocardiography has low diagnostic yield in severe blunt chest trauma, while transoesophageal echocardiography provides accurate diagnosis in a short time at the bedside, is inexpensive, minimally invasive, and does not interfere with other diagnostic or therapeutic procedures. Images PMID:8800997

  9. Left ventricular mass and hypertrophy by echocardiography and cardiac magnetic resonance: The Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Armstrong, Anderson C.; Gjesdal, Ola; Almeida, André; Nacif, Marcelo; Wu, Colin; Bluemke, David A.; Brumback, Lyndia; Lima, João A. C.

    2013-01-01

    BACKGROUND Left ventricular mass (LVM) and hypertrophy (LVH) are important parameters, but their use is surrounded by controversies. We compare LVM by echocardiography and cardiac magnetic resonance (CMR), investigating reproducibility aspects and the effect of echocardiography image quality. We also compare indexing methods within and between imaging modalities for classification of LVH and cardiovascular risk. METHODS MESA enrolled 880 participants in Baltimore City; 146 had echocardiograms and CMR on the same day. LVM was then assessed using standard techniques. Echocardiography image quality was rated (good/limited) according to the parasternal view. LVH was defined after indexing LVM to body surface area, height1.7, height2.7, or by the predicted LVM from a reference group. Participants were classified for cardiovascular risk according to Framingham score. Pearson’s correlation, Bland-Altman plots, percent agreement, and kappa coefficient assessed agreement within and between modalities. RESULTS LVM by echocardiography (140 ± 40 g) and by CMR were correlated (r = 0.8, p < 0.001) regardless of the echocardiography image quality. The reproducibility profile had strong correlations and agreement for both modalities. Image quality groups had similar characteristics; those with good images compared to CMR slightly superiorly. The prevalence of LVH tended to be higher with higher cardiovascular risk. The agreement for LVH between imaging modalities ranged from 77% to 98% and the kappa coefficient from 0.10 to 0.76. CONCLUSIONS Echocardiography has a reliable performance for LVM assessment and classification of LVH, with limited influence of image quality. Echocardiography and CMR differ in the assessment of LVH, and additional differences rise from the indexing methods. PMID:23930739

  10. Incremental Value of Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in the Assessment of a Thrombus in Transit through a Patent Foramen Ovale.

    PubMed

    Thind, Munveer; Ahmed, Mustafa I; Gok, Gulay; Joson, Marisa; Elsayed, Mahmoud; Tuck, Benjamin C; Townsley, Matthew M; Klas, Berthold; McGiffin, David C; Nanda, Navin C

    2015-05-01

    We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three-dimensional transesophageal echocardiography provided considerable incremental value over two-dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three-dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden. PMID:25827179

  11. Evaluation of right ventricular function using single-beat three-dimensional echocardiography in neonate.

    PubMed

    Watanabe, Kazuhiro; Hashimoto, Ikuo; Ibuki, Keijiro; Okabe, Mako; Kaneda, Hisashi; Ichida, Fukiko

    2015-06-01

    Aim of our study was to evaluate right ventricular (RV) systolic function in neonate using newly developed single-beat three-dimensional echocardiography (sb3DE). We enrolled 15 healthy or premature neonates (0-53 days after birth). We scanned one beat full volume using Siemens ACUSON SC2000 (Siemens AG) echocardiography with 4Z1c full-volume transducer without ECG gating. RV end-diastolic volume (RVEDV) and RV end-systolic volume (RVESV) were computed with special software dedicated to analysis for RV volume. RV ejection fraction (RVEF) and RV stroke volume (3D-RVSV) were calculated. And RV stroke volume was also determined from the recordings of ejection blood flow velocity and diameter at the level of the pulmonary orifice in RV outflow tract (Doppler-RVSV). Tricuspid annular plane systolic excursion (TAPSE) was also measured by 2D echocardiography. RVEDV ranged from 5.1 to 10.7 ml (average 7.5 ml), RVESV ranged from 2.3 to 5.8 ml (average 3.9 ml). There was a good correlation between 3D-RVSV and Doppler-RVSV (r = 0.77). Bland-Altman plot revealed that 3D-RVSV became underestimation of an average of 1.78 ml compared to Doppler-RVSV. And TAPSE positively correlated with 3D-RVEF (r = 0.58, P = 0.038). Newly developed sb3DE enables us to perform three-dimensional acquisition of RV volume without ECG gating even in neonate. However, 3D-RVSV currently tends to be underestimated in neonatal measurement. PMID:25588573

  12. Echocardiography based cardiac evaluation in the patients suffering from chronic obstructive pulmonary disease.

    PubMed

    Shrestha, B; Dhungel, S; Chokhani, R

    2009-03-01

    Chronic obstructive pulmonary disease (COPD) is the most common medical problem in Nepal. Echocardiography based cardiac evaluation in COPD is rare in Nepal. The purpose of this study is to evaluate the echocardiography based cardiac function in consecutively admitted COPD patients (507) in medical wards of Nepal Medical College Teaching Hospital during 13th April 2007 to 12th April 2008. Male female ratio was 0.9:1. Age (mean +/- SD) was 66.1 +/- 10.9 yr. Brahman and Chhetri ethnic group comprised of more than half of total COPD patients followed by similar number of patients in Newar (22.1%) and Mongolian ethnic groups (21.5%). More than half of the COPD patients were in age group 60-75 years, followed by less number of patients (approximately 20.0%) in both 45-59 years and 75-89 years age groups. Of the total patients (507), 141 patients underwent echocardiographic evaluation. Among them significant number of patients had poor LVEF (29, 20.6%) with statistically significant difference in LVEF (36.0 +/- 10.5 vs. 64.3 +/- 8.5%, p value < 0.01). More than half of the total patients showed features of chronic cor pulmonale (56.3%), followed by valvular heart disease (49.3%), diastolic dysfunction (38.7%) and left ventricular hypertrophy (14.1%). Mild pulmonary artery hypertension (PAH) was detected in approximately half of patients (49.1%), followed by moderate PAH in 17.6% patients. Transthoracic echocardiography was found to be very useful to identify various concomitant cardiac abnormalities demanding special treatment consideration in managing clinically COPD like patients. PMID:19769230

  13. The role of speckle tracking echocardiography in assessment of lipopolysaccharide-induced myocardial dysfunction in mice

    PubMed Central

    Chu, Ming; Gao, Yao; Zhang, Yanjuan; Zhou, Bin; Wu, Bingruo

    2015-01-01

    Background Sepsis-induced myocardial dysfunction is a common and severe complication of septic shock. Conventional echocardiography often fails to reveal myocardial depression in severe sepsis due to hemodynamic changes; in contrast, decline of strain measurements by speckle tracking echocardiography (STE) may indicate impaired cardiac function. This study investigates the role of STE in detecting lipopolysaccharide (LPS)-induced cardiac dysfunction with mouse models. Methods We evaluated cardiac function in 20 mice at baseline, 6 h (n=10) and 20 h (n=10) after LPS injection to monitor the development of heart failure induced by severe sepsis using 2-D and M-mode echocardiography. Ejection fraction (EF) and fractional shortening (FS) were measured with standard M-mode tracings, whereas circumferential and radial strain was derived from STE. Serum biochemical and cardiac histopathological examinations were performed to determine sepsis-induced myocardial injury. Results Left ventricular (LV) myocardial function was significantly reduced at 6 h after LPS treatment assessed by circumferential strain (−14.65%±3.00% to −8.48%±1.72%, P=0.006), whereas there were no significant differences between 6 and 20 h group. Conversely, EF and FS were significantly increased at 20 h when comparing to 6 h (P<0.05) accompanied with marked decreases in EF and FS 6 h following LPS administration. Consistent with strain echocardiographic results, we showed that LPS injection leaded to elevated serum level of cardiac Troponin-T (cTnT), CK-MB and rising leucocytes infiltration into myocardium within 20 h. Conclusions Altogether, these results demonstrate that, circumferential strain by STE is a specific and reliable value for evaluating LPS-induced cardiac dysfunction in mice. PMID:26793347

  14. Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure

    PubMed Central

    Balzer, Jan; Eickholt, Christian; Petersen, Margot; Kehmeier, Eva; Veulemans, Verena; Kelm, Malte; Willems, Stephan; Meyer, Christian

    2015-01-01

    Aims To investigate whether percutaneous left atrial appendage (LAA) closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging results in decreased radiation exposure. Methods and Results In this open-label single-center study LAA closure (AmplatzerTM Cardiac Plug) was performed in 34 consecutive patients (8 women; 73.1±8.5 years) with (n = 17, EN+) or without (n = 17, EN-) integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator® [EN]; Philips Healthcare). There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01). Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035). These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96) or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53). During short-term follow-up of at least 3 months (mean: 8.1±5.9 months) no device-related events occurred. Conclusions Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure. Trial Registration ClinicalTrials.gov NCT01262508 PMID:26465747

  15. Low dose dobutamine stress echocardiography predicts the improvement of left ventricular systolic function in dilated cardiomyopathy

    PubMed Central

    Kitaoka, H; Takata, J; Yabe, T; Hitomi, N; Furuno, T; Doi, Y

    1999-01-01

    OBJECTIVE—To determine whether dobutamine stress echocardiography can predict the improvement of left ventricular systolic function in patients with dilated cardiomyopathy (DCM).
METHODS—Myocardial contractile reserve, as assessed by dobutamine stress echocardiography, was determined in 18 patients with DCM (mean (SD) age 53 (13) years, left ventricular ejection fraction (LVEF) 28 (10)%) and compared with changes in LVEF during a follow up period of 15 (8) months. The LVEF and regional left ventricular wall motion score (0, normal to 4, dyskinesis) of 12 segments in short axis and four chamber views were analysed before and after dobutamine infusion (5-20 µg/kg/min).
RESULTS—During a follow up period of 15 (8) months, a significant improvement in LVEF (> 20%) was found in seven patients but not in the remaining 11. Baseline haemodynamic findings were similar in both groups. Patients with an improvement in follow up LVEF showed a greater change in wall motion score from baseline during dobutamine infusion than patients with no improvement (at rest, 1.7 (0.4) v 1.9 (0.2), NS; dobutamine 10 µg/kg/min, 0.6 (0.4) v 1.2 (0.4), p < 0.05). The percentage change in LVEF during dobutamine infusion was also significantly greater in patients who showed improvement than in those who did not. The change in LVEF during the follow up period (follow up LVEF/baseline LVEF) correlated well with the change in LVEF during dobutamine stress (LVEF at rest/LVEF at dobutamine 10 µg/kg/min; r = 0.74, p < 0.001).
CONCLUSIONS—Changes in left ventricular systolic performance during low dose dobutamine stress echocardiography are a useful marker to predict the outcome of left ventricular systolic function in patients with DCM.


Keywords: dilated cardiomyopathy; dobutamine stress echocardiography; contractile reserve PMID:10212172

  16. Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report

    PubMed Central

    Nagaraja, P. S.; Singh, Naveen G.; Simha, Parimala Prasanna; Davan, K. R.; Manjunath, V.; Jagadeesh, A. M.

    2015-01-01

    Truncus arteriosus (TA) is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1-year is uncommon. Here, we report a unique case of 12-year-old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management. PMID:25849699

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

    PubMed

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

    2014-02-01

    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

  18. Esophageal Perforation: A Rare Complication of Transesophageal Echocardiography in a Patient with Asymptomatic Esophagitis

    PubMed Central

    Ahmed, Kabir; Lal, Yasir; Condron, Steven

    2012-01-01

    Transesophageal echocardiography (TEE) is a commonly used procedure in patients with suspected endocarditis. A rare but dreadful complication of this procedure is perforation of the esophagus. We report the case of an elderly female with multiple comorbidities, who presented with polyarticular septic arthritis. TEE was performed to rule out endocarditis. Though the standard procedure protocol was followed, she developed esophageal perforation. It was managed with esophageal stenting but she developed multiorgan failure and did not survive. This case highlights the potential of severe morbidity and mortality associated with TEE. Appropriate screening must be done and high-risk individuals must be identified before such procedures are attempted. PMID:23341798

  19. Three-Dimensional Echocardiography-based Prediction of Posterior Leaflet Resection

    PubMed Central

    Rim, Yonghoon; Choi, Ahnryul; Laing, Susan T.; McPherson, David D.; Kim, Hyunggun

    2014-01-01

    Clinical long-term outcomes have shown that partial leaflet resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of mitral valve (MV) leaflet prolapse. We report a 61-year-old male for three-dimensional transesophageal echocardiography (3D TEE)-based virtual posterior leaflet resection and ring annuloplasty. Severe mitral regurgitation was found and computational evaluation demonstrated substantial leaflet malcoaptation and high stress concentration. Following virtual resection and ring annuloplasty, posterior leaflet prolapse markedly decreased, sufficient leaflet coaptation was restored, and high stress concentration disappeared. Virtual MV repair strategies using 3D TEE have the potential to help optimize MV repair. PMID:25109487

  20. Nonlinear Exact Solutions of the 2-Dimensional Rotational Euler Equations for the Incompressible Fluid

    NASA Astrophysics Data System (ADS)

    An, Hong-Li; Yang, Jin-Jing; Yuen, Man-Wai

    2015-05-01

    In this paper, the Clarkson-Kruskal direct approach is employed to investigate the exact solutions of the 2-dimensional rotational Euler equations for the incompressible fluid. The application of the method leads to a system of completely solvable ordinary differential equations. Several special cases are discussed and novel nonlinear exact solutions with respect to variables x and y are obtained. It is of interest to notice that the pressure p is obtained by the second kind of curvilinear integral and the coefficients of the nonlinear solutions are solitary wave type functions like tanh(kt/2) and sech (kt/2) due to the rotational parameter k ≠ 0. Such phenomenon never appear in the classical Euler equations wherein the Coriolis force arising from the gravity and Earth's rotation is ignored. Finally, illustrative numerical figures are attached to show the behaviors that the exact solutions may exhibit. Supported by the National Natural Science Foundation of China under Grant No. 11301269, Jiangsu Provincial Natural Science Foundation of China under Grant No. BK20130665, the Fundamental Research Funds KJ2013036 for the Central Universities, Student Research Training under Grant No. 1423A02 of Nanjing Agricultural University, and the Research Grant RG21/2013-2014R from the Hong Kong Institute of Education

  1. Role of surface defects on the formation of the 2-dimensional electron gas at polar interfaces

    NASA Astrophysics Data System (ADS)

    Artacho, Emilio; Aguado-Puente, Pablo

    2014-03-01

    The discovery of a 2-dimensional electron gas (2DEG) at the interface between two insulators, LaAlO3 and SrTiO3, has fuelled a great research activity on this and similar systems in the last years. The electronic reconstruction model, typically invoked to explain the formation of the 2DEG, while being intuitive and successful on predicting fundamental aspects of this phenomenon like the critical thickness of LaAlO3, fails to explain many other experimental observations. Oxygen vacancies, on the other hand, are known to dramatically affect the physical behaviour of this system, but their role at the atomic level is far from well understood. Here we perform ab initio simulations in order to assess whether the formation of oxygen vacancies at the surface of the polar material can account for various recent experimental results that defy the current theoretical understanding of these interfaces. We simulate SrTiO3/LaAlO3 slabs with various concentrations of surface oxygen vacancies and analyze the role of the defects on the formation of the metallic interface, their electrostatic coupling with the 2DEG and the interplay with the different instabilities of the materials involved. Financial support from Spanish MINECO under grant FIS2012-37549-C05-01. Computational resources provided by the Red Espñola de Supercomputación and DIPC.

  2. A 2-dimensional fully analytical model for design of high voltage junction barrier Schottky (JBS) diodes

    NASA Astrophysics Data System (ADS)

    Radhakrishnan, Rahul; Zhao, Jian H.

    2011-09-01

    A physics-based closed form analytical model for the reverse leakage current of a high voltage junction barrier Schottky (JBS) diode is developed and shown to agree with experimental results. Maximum electric field "seen" by the Schottky contact is calculated from first principles by a 2-dimensional method as a function of JBS diode design parameters and confirmed by numerical simulations. Considering thermionic emission under image force barrier lowering and quantum mechanical tunneling, electric field at the Schottky contact is then related to reverse current. In combination with previously reported forward current and resistance models, this gives a complete I- V relationship for the JBS diode. A layout of interdigitated stripes of P-N and Schottky contacts at the anode is compared theoretically with a honeycomb layout and the 2-D model is extended to the 3-D honeycomb structure. Although simulation and experimental results from 4H-Silicon Carbide (SiC) diodes are used to validate it, the model itself is applicable to all JBS diodes.

  3. A 2-dimensional MHD code & survey of the ``buckling'' phenomenon in cylindrical magnetic flux compression experiments

    NASA Astrophysics Data System (ADS)

    Xiao, Bo; Wang, Ganghua; Gu, Zhuowei; Computational Physics Team

    2015-11-01

    We made a 2-dimensional magneto-hydrodynamics Lagrangian code. The code handles two kinds of magnetic configuration, a (x-y) plane with z-direction magnetic field Bz and a (r-z) plane with θ-direction magnetic field Bθ. The solving of the MHD equations is split into a pure dynamical step (i.e., ideal MHD) and a diffusion step. In the diffusion step, the Joule heat is calculated with a numerical scheme based on an specific form of the Joule heat production equation, ∂eJ/∂t = ∇ . (η/μ0 º × (∇ × º)) -∂/∂t (1/2μ0 B2) , where the term ∂/∂t (1/2μ0 B2) is the magnetic field energy variation caused solely by diffusion. This scheme insures the equality of the total Joule heat produced and the total electromagnetic energy lost in the system. Material elastoplasticity is considered in the code. An external circuit is coupled to the magneto-hydrodynamics and a detonation module is also added to enhance the code's ability for simulating magnetically-driven compression experiments. As a first application, the code was utilized to simulate a cylindrical magnetic flux compression experiment. The origin of the ``buckling'' phenomenon observed in the experiment is explored.

  4. Electronic thermal conductivity of 2-dimensional circular-pore metallic nanoporous materials

    NASA Astrophysics Data System (ADS)

    Huang, Cong-Liang; Lin, Zi-Zhen; Luo, Dan-Chen; Huang, Zun

    2016-09-01

    The electronic thermal conductivity (ETC) of 2-dimensional circular-pore metallic nanoporous material (MNM) was studied here for its possible applications in thermal cloaks. A simulation method based on the free-electron-gas model was applied here without considering the quantum effects. For the MNM with circular nanopores, there is an appropriate nanopore size for thermal conductivity tuning, while a linear relationship exists for this size between the ETC and the porosity. The appropriate nanopore diameter size will be about one times that of the electron mean free path. The ETC difference along different directions would be less than 10%, which is valuable when estimating possible errors, because the nanoscale-material direction could not be controlled during its application. Like nanoparticles, the ETC increases with increasing pore size (diameter for nanoparticles) while the porosity was fixed, until the pore size reaches about four times that of electron mean free path, at which point the ETC plateaus. The specular coefficient on the surface will significantly impact the ETC, especially for a high-porosity MNM. The ETC can be decreased by 30% with a tuning specular coefficient.

  5. Data assimilation technique of 2-dimensional vertical temperature transport model (Case study: Tropical Pacific Ocean)

    NASA Astrophysics Data System (ADS)

    Nurfitri, Suliskania; Putri, Mutiara Rachmat

    2015-09-01

    Data assimilation technique was applied into 2-dimensional vertical temperature transport model to improve temperature results especially at thermocline layer that have large change toward depth. The simple case experiment only applies on baroclinic condition in Tropical Pacific Ocean (2°N and 137°E - 140°W). Model simulation was running for 2 years from January 1st 2011 to December 31st 2012 from surface to 500 m depth and verified to observation data from TAO (Tropical Atmosphere Ocean) at 3 locations, 147°E, 165°E, and 170°W. Data assimilation procedure which applied at 3 locations (156°E, 180°W, and 155°W) using Cressman analysis technique can reduce model's RMSE (Root Mean Square Error) toward depth until 55,7% and toward time until 64,5%. The largest error of model was found at 200 m depth, while the smallest found at the surface and 500 m depth.

  6. Identification and comparative proteomic study of quail and duck egg white protein using 2-dimensional gel electrophoresis and matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry analysis

    PubMed Central

    Hu, Shan; Qiu, Ning; Liu, Yaping; Zhao, Hongyan; Gao, Dan; Song, Rui; Ma, Meihu

    2016-01-01

    A proteomic study of egg white proteins from 2 major poultry species, namely quail (Coturnix coturnix) and duck (Anas platyrhynchos), was performed with comparison to those of chicken (Gallus gallus) through 2-dimensional polyacrylamide gel electrophoresis (2-DE) analysis. By using matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry (MALDI-TOF MS/MS), 29 protein spots representing 10 different kinds of proteins as well as 17 protein spots designating 9 proteins were successfully identified in quail and duck egg white, respectively. This report suggested a closer relationship between quail and chicken egg white proteome patterns, whereas the duck egg white protein distribution on the 2-DE map was more distinct. In duck egg white, some well-known major proteins, such as ovomucoid, clusterin, extracellular fatty acid-binding protein precursor (ex-FABP), and prostaglandin D2 synthase (PG D2 synthase), were not detected, while two major protein spots identified as “deleted in malignant brain tumors 1” protein (DMBT1) and vitellogenin-2 were found specific to duck in the corresponding range on the 2-DE gel map. These interspecies diversities may be associated with the egg white protein functions in cell defense or regulating/supporting the embryonic development to adapt to the inhabiting environment or reproduction demand during long-term evolution. The findings of this work will give insight into the advantages involved in the application on egg white proteins from various egg sources, which may present novel beneficial properties in the food industry or related to human health. PMID:26957635

  7. Identification and comparative proteomic study of quail and duck egg white protein using 2-dimensional gel electrophoresis and matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry analysis.

    PubMed

    Hu, S; Qiu, N; Liu, Y; Zhao, H; Gao, D; Song, R; Ma, M

    2016-05-01

    A proteomic study of egg white proteins from 2 major poultry species, namely quail (Coturnix coturnix) and duck (Anas platyrhynchos), was performed with comparison to those of chicken (Gallus gallus) through 2-dimensional polyacrylamide gel electrophoresis (2-DE) analysis. By using matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry (MALDI-TOF MS/MS), 29 protein spots representing 10 different kinds of proteins as well as 17 protein spots designating 9 proteins were successfully identified in quail and duck egg white, respectively. This report suggested a closer relationship between quail and chicken egg white proteome patterns, whereas the duck egg white protein distribution on the 2-DE map was more distinct. In duck egg white, some well-known major proteins, such as ovomucoid, clusterin, extracellular fatty acid-binding protein precursor (ex-FABP), and prostaglandin D2 synthase (PG D2 synthase), were not detected, while two major protein spots identified as "deleted in malignant brain tumors 1" protein (DMBT1) and vitellogenin-2 were found specific to duck in the corresponding range on the 2-DE gel map. These interspecies diversities may be associated with the egg white protein functions in cell defense or regulating/supporting the embryonic development to adapt to the inhabiting environment or reproduction demand during long-term evolution. The findings of this work will give insight into the advantages involved in the application on egg white proteins from various egg sources, which may present novel beneficial properties in the food industry or related to human health. PMID:26957635

  8. Cross-sectional echocardiography. I. Analysis of mathematic models for quantifying mass of the left ventricle in dogs.

    PubMed

    Wyatt, H L; Heng, M K; Meerbaum, S; Hestenes, J D; Cobo, J M; Davidson, R M; Corday, E

    1979-11-01

    Cross-sectional echocardiography was used to quantify left ventricular mass noninvasively in 21 dogs. Short- and long-axis cross-sectional images of the left ventricle were reproducibly traced at endocardial and epicardial borders during stop-motion video-tape replay. We used area, length and diameter measurements to calculate left ventricular mass by seven mathematic models, including the standard formulas used with M-mode echocardiography and cineangiography. Calculated mass was compared with excised weight of the left ventricle by regression and percent error analyses. Formulas using short-axis areas and long-axis length resulted in higher correlation coefficients (0.94--0.95) and lower mean errors (6--7%) than for standard formulas. Since short-axis areas account for regional left ventricular irregularities, noninvasive quantification of left ventricular mass by cross-sectional echocardiography in dogs is most accurate with formulas using short-axis areas. PMID:487544

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

    NASA Technical Reports Server (NTRS)

    Bobinsky, Eric A.

    1998-01-01

    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.

  10. Physical stress testing of bovine jugular veins using magnetic resonance imaging, echocardiography and electrical velocimetry.

    PubMed

    Boethig, Dietmar; Ernst, Franziska; Sarikouch, Samir; Norozi, Kambiz; Lotz, Joachim; Opherk, Jan Patrick; Meister, Maren; Breymann, Thomas

    2010-06-01

    Bovine jugular veins (BJVs) (Contegra) are valve-bearing pulmonary artery substitutes. Their valves have higher profiles than human pulmonary valves; this might result in less optimal performance. Therefore, we investigated the impact of stress and undersizing on conduit performance with ergometry, echocardiography and magnetic resonance imaging (MRI). Between April 2007 and June 2008, 20 BJV recipients (age 7.9-19.6 years) underwent spiroergometry and subsequent echocardiography; after due rest, ergometry was repeated and followed by MRI during recovery. A year later, exams were repeated. Data was evaluated as follows: comparison of stress related maximal individual valve performance changes (magnetic resonance: exercise induced average stroke volume changes by 61+/-49%; mean insufficiency increased by 2% in patients with <1% rest insufficiency and by 8% after rest insufficiency of >10%; the average rest gradient of 24+/-11 mmHg rose to 40+/-20 mmHg), and stratification of pooled observations by regurgitation fraction, insufficiency grades and z-values (insufficiency rose with increasing heart rate and decreasing stroke volume; undersizing increased gradients during recovery by 7+/-0.7 mmHg/z-value). Contegras high-profile valves tolerate stress without performance drop. Stress induced changes of insufficiency and gradient were clinically not significant, but sufficient to distort examination results; therefore, constant examination conditions are indispensable for a correct follow-up. PMID:20479070

  11. Exercise treadmill saline contrast echocardiography for the detection of patent foramen ovale in hypoxia.

    PubMed

    Fenster, Brett E; Freeman, Andrew M; Silveira, Lori; Buckner, J Kern; Curran-Everett, Douglas; Carroll, John D

    2015-12-01

    Percutaneous patent foramen ovale (PFO) occluder placement improves dyspnea and oxygen requirement in hypoxic patients with PFO-mediated right-to-left shunt (RTLS). Although saline contrast echocardiography (SCE) in the resting state can identify PFO RTLS, SCE performed with exercise stress testing may provide incremental diagnostic yield compared to rest SCE. We evaluated the ability of exercise SCE to predict PFO presence and size using intracardiac echocardiography (ICE) as a gold standard in a hypoxic cohort. Thirty-three hypoxic patients with suspected PFO RTLS who underwent rest, Valsalva, and exercise stress SCE prior to ICE were evaluated retrospectively. PFO RTLS was defined by ICE findings including PFO anatomy, RTLS by saline contrast and color Doppler, and probe patency. SCE shunt severity was compared to the presence of ICE-defined PFO RTLS and PFO size. Exercise SCE for the detection of PFO RTLS performed with an area under the curve of 0.77, sensitivity of 73%, and specificity of 86%. Among 26 patients with PFO RTLS, exercise SCE identified four additional patients with PFO that had negative rest SCE and two patients with negative Valsalva SCE. Exercise SCE had a stronger correlation with PFO size than resting or Valsalva SCE. Exercise SCE detects PFO RTLS and predicts PFO size in a hypoxic cohort. In addition, exercise SCE can identify PFO RTLS that is otherwise undetected with rest or Valsalva SCE. Exercise SCE may be appropriate when a clinical suspicion for PFO RTLS persists despite negative rest and Valsalva SCE. PMID:26231342

  12. Point-of-care echocardiography in simulation-based education and assessment

    PubMed Central

    Amini, Richard; Stolz, Lori A; Javedani, Parisa P; Gaskin, Kevin; Baker, Nicola; Ng, Vivienne; Adhikari, Srikar

    2016-01-01

    Background Emergency medicine milestones released by the Accreditation Council for Graduate Medical Education require residents to demonstrate competency in bedside ultrasound (US). The acquisition of these skills necessitates a combination of exposure to clinical pathology, hands-on US training, and feedback. Objectives We describe a novel simulation-based educational and assessment tool designed to evaluate emergency medicine residents’ competency in point-of-care echocardiography for evaluation of a hypotensive patient with chest pain using bedside US. Methods This was a cross-sectional study conducted at an academic medical center. A simulation-based module was developed to teach and assess the use of point-of-care echocardiography in the evaluation of the hypotensive patient. The focus of this module was sonographic imaging of cardiac pathology, and this focus was incorporated in all components of the session: asynchronous learning, didactic lecture, case-based learning, and hands-on stations. Results A total of 52 residents with varying US experience participated in this study. Questions focused on knowledge assessment demonstrated improvement across the postgraduate year (PGY) of training. Objective standardized clinical examination evaluation demonstrated improvement between PGY I and PGY III; however, it was noted that there was a small dip in hands-on scanning skills during the PGY II. Clinical diagnosis and management skills also demonstrated incremental improvement across the PGY of training. Conclusion The 1-day, simulation-based US workshop was an effective educational and assessment tool at our institution. PMID:27330339

  13. Assessment of diastolic function by tissue Doppler echocardiography: comparison with standard transmitral and pulmonary venous flow

    NASA Technical Reports Server (NTRS)

    Farias, C. A.; Rodriguez, L.; Garcia, M. J.; Sun, J. P.; Klein, A. L.; Thomas, J. D.

    1999-01-01

    The objective of this study was to determine the utility of Doppler tissue echocardiography in the evaluation of diastolic filling and in discriminating between normal subjects and those with various stages of diastolic dysfunction. We measured myocardial velocities in 51 patients with various stages of diastolic dysfunction and in 27 normal volunteers. The discriminating power of each of the standard Doppler indexes of left ventricular filling, pulmonary venous flow, and myocardial velocities was determined with the use of Spearman rank correlation and analysis of variance F statistics. Early diastolic myocardial velocity (E(m)) was higher in normal subjects (16.0 +/- 3.8 cm/s) than in patients with either delayed relaxation (n = 15, 7.5 +/- 2.2 cm/s), pseudonormal filling (n = 26, 7.6 +/- 2.3 cm/s), or restrictive filling (n = 10, 7.4 +/- 2.4 cm/s, P <.0001). E(m ) was the best single discriminator between control subjects and patients with diastolic dysfunction (P =.7, F = 64.5). Myocardial velocities assessed by Doppler tissue echocardiography are useful in differentiating patients with normal from those with abnormal diastolic function. Myocardial velocity remains reduced even in those stages of diastolic dysfunction characterized by increased preload compensation.

  14. How to use information from echocardiography and magnetic resonance for diagnosing myocardial viability.

    PubMed

    Sechtem, U

    1996-10-01

    The identification of viable myocardium in patients with coronary artery disease with or without a history of myocardial infarction and regions of akinesia is of great clinical importance. Viable myocardium which is underperfused due to severe atherosclerotic disease in the feeding vessel needs to be revascularized both to ameliorate symptoms and improved prognosis. In contrast, scarred myocardium should not be revascularized and medical therapy for heart failure should be instituted. Due to the complexity of the problem, which requires information about wall motion and coronary artery anatomy, viability tests are usually requested after the results of left heart catheterization with coronary angiography are known. Often cardiac catheterization itself already provides important clues to the presence of viable myocardium: the degree of wall motion abnormality, post-extrasystolic improvement of wall motion, the presence of angina in a patient with single-vessel disease and the presence of collaterals, are all associated with viability. Echocardiography has become a strong competitor to myocardial perfusion studies in assessing myocardial viability. Published figures for sensitivity and specificity parallel those of scintigraphic techniques and even positron emission tomography scans. However, there are insufficient data on the use of echocardiography in patients with severely depressed left ventricular function. A new and exciting technique to detect viable myocardium is magnetic resonance imaging, which has been shown to have similar diagnostic accuracy as FDG-PET. PMID:8950243

  15. Current diagnostic and treatment strategies for Lutembacher syndrome: the pivotal role of echocardiography

    PubMed Central

    Dzudie, Anastase; Takah, Noah Fongwen; Ngu, Kathleen Blackett; Sliwa, Karen; Kengne, Andre Pascal

    2015-01-01

    Lutembacher syndrome (LS) is a rare cardiac abnormality characterized by any combination of a congenital or iatrogenic atrial septal defect (ASD) and a congenital or acquired mitral stenosis (MS). Clinical features and hemodynamic effects of LS depend on the balance of effects of the MS and the ASD. Prognosis is influenced by several factors [pulmonary vascular resistance, right ventricle (RV) compliance, size of ASD and MS severity] but the occurrence of secondary pulmonary hypertension and congestive heart failure is commonly associated with poor outcome. Echocardiography remains the gold standard for diagnosis and evaluation of LS. Timely diagnosis is critical for modifying the natural course, by allowing patients to benefit from currently available percutaneous trans-catheter therapies with favorable effects on the outcomes. This article is a review of published literature on the current diagnostic and therapeutic modalities for LS, focusing on the pivotal role of echocardiography as the key diagnostic tool. Clinical suspicion of LS should prompt extensive investigation with non-invasive and where possible, invasive technics. Multicenter registers have a potential to assist the evaluation of long term outcomes of percutaneous trans-catheter therapies in patients with LS. PMID:25984452

  16. Speckle Tracking in Intracardiac Echocardiography for the Assessment of Myocardial Deformation

    PubMed Central

    Yue, Yong; Clark, John W.; Khoury, Dirar S.

    2009-01-01

    Intracardiac echocardiography has proven to be useful for online anatomical imaging during catheterization. Our objective was to develop a speckle tracking method for myocardial motion estimation from intracardiac echocardiographic image sequences in order to provide a mean for regional functional imaging. Our approach was to solve two problems in motion estimation from two-dimensional intracardiac echocardiographic image sequences: non-rigid myocardial deformation and speckle decorrelation. To achieve robust noise resistance, we employed maximum likelihood estimation while fully exploiting ultrasound speckle statistics, and treated the maximization of motion probability as the minimization of an energy function. Non-rigid myocardial deformation was estimated by optimizing this energy function within a framework of parametric elastic registration. Evaluation of the method was carried out using a computer model that synthesized echocardiographic image sequences, and subsequently an animal model that provided continuous intracardiac echocardiographic images as well as reference measurements using sonomicrometry crystals. In conclusion, accurate estimation of regional myocardial deformation from intracardiac echocardiography by novel speckle tracking is feasible. This approach may have important clinical implications for multimodal imaging during catheterization. PMID:19272903

  17. Assessment and analysis of territorial experiences in digital tele-echocardiography.

    PubMed

    Frumento, Enrico; Colombo, Cesare; Borghi, Gabriella; Masella, Cristina; Zanaboni, Paolo; Barbier, Paolo; Cavoretto, Dario

    2009-01-01

    Nowadays digital ultrasound-cardiovascular devices are able to send out directly digital images and films. Thanks to the large adoption of such devices, the echocardiographic world is facing new ways of exchanging images and collaborating. What we present in this paper is a review of the experimental projects carried in Lombardy, meant to support the work of specialists by means of second opinion and telemedicine services. On the medical point of view echocardiography is a widely used activity where operators are perfectly accustomed to do repetitive operations and steps. Tele-echocardiography (T-E) introduces new methods and technologies into stable and everyday medical practice, causing disruptions either on the side of the specialists' way of working or on the new opportunities and service. Introducing such a service means to properly model it in order to reduce the changes in the operators' way of working while maximizing the benefits. A proper method of modelling the operators' needs is then a key factor which must be correctly addressed. This paper will present some successful projects and the assessment procedure but it will also discuss a possible service modelling method, which has been adopted for the described experiences. PMID:20061656

  18. Atrial Myxoma Presenting as Myocardial Infarction Diagnosed by Echocardiography, Managed Endoscopically with Robot-Assisted Surgery.

    PubMed

    Chaudhuri, Aadel A; Simmons, Charles; Ellison, Douglas; Hemp, James; Chung, Kiyon

    2016-01-01

    Atrial myxomatous embolization into the coronary arteries is a rare event. Management of large myxomas is usually via surgical resection involving a median sternotomy. Echocardiography is not a routine part of non-ST-elevation myocardial infarction (NSTEMI) management. Here, we present the case of a 70-year-old Caucasian man with a history of hypertension and hyperlipidemia who presented to the emergency department with an NSTEMI. Transthoracic echocardiogram and transesophageal echocardiogram revealed a large and highly mobile atrial mass, traversing through the mitral valve orifice during diastole. Coronary angiography revealed a focal 60% lesion in the right coronary artery and no other significant obstructive coronary artery disease, suggesting that the cause of his presentation was tumor embolization into the coronary circulation. The patient underwent robot-assisted endoscopic resection of his atrial mass and was discharged in stable condition on postoperative day 2. Pathology revealed atrial myxoma. To our knowledge, this is the first reported case of an atrial myxoma presenting with an NSTEMI and managed with a robot-assisted endoscopic approach. This case also highlights the importance of routine early echocardiography in patients presenting with NSTEMI. PMID:27014518

  19. Atrial Myxoma Presenting as Myocardial Infarction Diagnosed by Echocardiography, Managed Endoscopically with Robot-Assisted Surgery

    PubMed Central

    Simmons, Charles, Jr.; Ellison, Douglas; Hemp, James; Chung, Kiyon

    2016-01-01

    Atrial myxomatous embolization into the coronary arteries is a rare event. Management of large myxomas is usually via surgical resection involving a median sternotomy. Echocardiography is not a routine part of non-ST-elevation myocardial infarction (NSTEMI) management. Here, we present the case of a 70-year-old Caucasian man with a history of hypertension and hyperlipidemia who presented to the emergency department with an NSTEMI. Transthoracic echocardiogram and transesophageal echocardiogram revealed a large and highly mobile atrial mass, traversing through the mitral valve orifice during diastole. Coronary angiography revealed a focal 60% lesion in the right coronary artery and no other significant obstructive coronary artery disease, suggesting that the cause of his presentation was tumor embolization into the coronary circulation. The patient underwent robot-assisted endoscopic resection of his atrial mass and was discharged in stable condition on postoperative day 2. Pathology revealed atrial myxoma. To our knowledge, this is the first reported case of an atrial myxoma presenting with an NSTEMI and managed with a robot-assisted endoscopic approach. This case also highlights the importance of routine early echocardiography in patients presenting with NSTEMI. PMID:27014518

  20. LVM Assessed by Echocardiography and Cardiac Magnetic Resonance, Cardiovascular Outcomes, and Medical Practice

    PubMed Central

    Armstrong, Anderson C.; Gidding, Samuel; Gjesdal, Ola; Wu, Colin; Bluemke, David A; Lima, João A.

    2012-01-01

    We investigate three important areas related to the clinical use of LVM (LVM): accuracy of assessments by echocardiography and cardiac magnetic resonance (CMR), the ability to predict cardiovascular outcomes, and the comparative value of different indexing methods. The recommended formula for echocardiographic estimation of LVM uses linear measurements and is based on the assumption of the left ventricle as a prolate ellipsoid of revolution. CMR permits a modeling of the left ventricle free of cardiac geometric assumptions or acoustic window dependency, showing better accuracy and reproducibility. However, echocardiography has lower cost, easier availability, and better tolerability. From the Medline database, 26 longitudinal echocardiographic studies and 5 CMR studies, investigating LVM or LV hypertrophy as predictors of death or major cardiovascular outcomes, were identified. LVM and LV hypertrophy were reliable cardiovascular risk predictors using both modalities. However, no study directly compared the methods for the ability to predict events, agreement in hypertrophy classification, or performance in cardiovascular risk reclassification. Indexing LVM to BSA was the earliest normalization process used, but it seems to underestimate the prevalence of hypertrophy in obese and overweight subjects. Dividing LVM by height to 1.7 or 2.7 as allometric powers are the most promising normalization methods in terms of practicality and usefulness from a clinical ans scientific standpoints for scaling myocardial mass to body size. The measurement of LVM, calculation of LVMi, and classification for LVH should be standardized by scientific societies across measurement techniques and adopted by clinicians in risk stratification and therapeutic decision. PMID:22897998

  1. Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: role of echocardiography.

    PubMed

    Zito, Concetta; Longobardo, Luca; Cadeddu, Christian; Monte, Ines; Novo, Giuseppina; Dell'Oglio, Sonia; Pepe, Alessia; Madonna, Rosalinda; Tocchetti, Carlo G; Mele, Donato

    2016-05-01

    The evaluation by cardiovascular imaging of chemotherapy patients became a central topic in the last several years. The use of drugs for the treatment of cancers increased, and new molecules and protocols were developed to improve outcomes in these patients. Although, these novel approaches also produced a progressive increase in side effects, particularly myocardial dysfunction. Imaging of the heart was highly accurate in the early diagnosis of cancer therapeutics related-cardiac dysfunction. Echocardiography is the first-line method to assess ventricular function alterations, and it is required to satisfy the need for an early, easy and accurate diagnosis to stratify the risk of heart failure and manage treatments. A careful monitoring of cardiac function during the course of therapy should prevent the onset of severe heart impairment. This review provides an overview of the most important findings of the role of echocardiography in the management of chemotherapy-treated patients to create a clear and complete description of the efficacy of conventional measurements, the importance of comprehensive heart evaluations, the additional role of new echocardiographic techniques, the utility of integrated studies using other imaging tools and the positions of the most important international societies on this topic. PMID:27183524

  2. Mode vibrations of a matrix transducer for three-dimensional second harmonic transesophageal echocardiography.

    PubMed

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

    2012-10-01

    Transesophageal echocardiography (TEE) uses the esophagus as an imaging window to the heart. This enables cardiac imaging without interference from the ribs or lungs and allows for higher frequency ultrasound to be used compared with transthoracic echocardiography (TTE). TEE facilitates the successful imaging of obese or elderly patients, where TTE may be unable to produce images of satisfactory quality. Recently, three-dimensional (3-D) TEE has been introduced, which greatly improves the image quality and diagnostic value of TEE by adding an extra dimension. Further improvement could be achieved by optimizing 3-D TEE for harmonic imaging. This article describes the optimal geometry and element configuration for a matrix probe for 3-D second harmonic TEE. The array concept features separated transmit and receive subarrays. The element geometry was studied using finite element modeling and a transmit subarray prototype was examined both acoustically and with laser interferometry. The transmit subarray is suitable for its role, with a 3 MHz resonance frequency, a 40%-50% -3 dB bandwidth and crosstalk levels <-27 dB. The proposed concept for the receive subarray has a 5.6 MHz center frequency and a 50% -3 dB bandwidth. PMID:22958515

  3. Changes in echocardiography and blood variables during and after development of Ballantyne syndrome.

    PubMed

    Umazume, Takeshi; Morikawa, Mamoru; Yamada, Takahiro; Minakami, Hisanori

    2016-01-01

    We report a pregnant woman who was monitored by echocardiography and determination of blood variables, including components of the renin-angiotensin-aldosterone system (RAAS), cardiac biomarkers and soluble fms-like tyrosine kinase-1 (sFlt-1), during and after the development of Ballantyne syndrome. Generalised maternal oedema with dyspnoea following fetal and placental hydrops necessitated a caesarean section at 33 weeks of gestation. Changes in blood variables and simultaneous echocardiography changes indicated acutely enhanced RAAS and hyperdynamic left ventricular function in response to excessive volume overload (as evidenced by brain-type natriuretic peptide level of 523 pg/mL) in the absence of increased systemic vascular resistance. Elevated sFlt-1 (15 600 pg/mL) and human chorionic gonadotrophin (404 000 IU/L) levels were also noted. The increased plasma aldosterone concentration (2070 pg/mL) may have been responsible for the increase in circulating plasma volume, and the increased sFlt-1 level was responsible for generalised maternal oedema. It remains unclear which factor(s) triggered RAAS activation. PMID:27329098

  4. Automated mutual exclusion rules discovery for structured observational codes in echocardiography reporting

    PubMed Central

    Forsberg, Thomas A.; Sevenster, Merlijn; Bieganski, Szymon; Bhagat, Puran; Kanasseril, Melvin; Jia, Yugang; Spencer, Kirk T.

    2015-01-01

    Structured reporting in medicine has been argued to support and enhance machine-assisted processing and communication of pertinent information. Retrospective studies showed that structured echocardiography reports, constructed through point-and-click selection of finding codes (FCs), contain pair-wise contradictory FCs (e.g., “No tricuspid regurgitation” and “Severe regurgitation”) downgrading report quality and reliability thereof. In a prospective study, contradictions were detected automatically using an extensive rule set that encodes mutual exclusion patterns between FCs. Rules creation is a labor and knowledge-intensive task that could benefit from automation. We propose a machine-learning approach to discover mutual exclusion rules in a corpus of 101,211 structured echocardiography reports through semantic and statistical analysis. Ground truth is derived from the extensive prospectively evaluated rule set. On the unseen test set, F-measure (0.439) and above-chance level AUC (0.885) show that our approach can potentially support the manual rules creation process. Our methods discovered previously unknown rules per expert review. PMID:26958191

  5. Advanced Echocardiography in Adult Zebrafish Reveals Delayed Recovery of Heart Function after Myocardial Cryoinjury

    PubMed Central

    Kossack, Mandy; Juergensen, Lonny; Fuchs, Dieter; Katus, Hugo A.; Hassel, David

    2015-01-01

    Translucent zebrafish larvae represent an established model to analyze genetics of cardiac development and human cardiac disease. More recently adult zebrafish are utilized to evaluate mechanisms of cardiac regeneration and by benefiting from recent genome editing technologies, including TALEN and CRISPR, adult zebrafish are emerging as a valuable in vivo model to evaluate novel disease genes and specifically validate disease causing mutations and their underlying pathomechanisms. However, methods to sensitively and non-invasively assess cardiac morphology and performance in adult zebrafish are still limited. We here present a standardized examination protocol to broadly assess cardiac performance in adult zebrafish by advancing conventional echocardiography with modern speckle-tracking analyses. This allows accurate detection of changes in cardiac performance and further enables highly sensitive assessment of regional myocardial motion and deformation in high spatio-temporal resolution. Combining conventional echocardiography measurements with radial and longitudinal velocity, displacement, strain, strain rate and myocardial wall delay rates after myocardial cryoinjury permitted to non-invasively determine injury dimensions and to longitudinally follow functional recovery during cardiac regeneration. We show that functional recovery of cryoinjured hearts occurs in three distinct phases. Importantly, the regeneration process after cryoinjury extends far beyond the proposed 45 days described for ventricular resection with reconstitution of myocardial performance up to 180 days post-injury (dpi). The imaging modalities evaluated here allow sensitive cardiac phenotyping and contribute to further establish adult zebrafish as valuable cardiac disease model beyond the larval developmental stage. PMID:25853735

  6. Phase transfer of 1- and 2-dimensional Cd-based nanocrystals

    NASA Astrophysics Data System (ADS)

    Kodanek, Torben; Banbela, Hadeel M.; Naskar, Suraj; Adel, Patrick; Bigall, Nadja C.; Dorfs, Dirk

    2015-11-01

    In this work, luminescent CdSe@CdS dot-in-rod nanocrystals, CdSe@CdS/ZnS nanorods as well as CdSe-CdS core-crown nanoplatelets were transferred into aqueous phase via ligand exchange reactions. For this purpose, bifunctional thiol-based ligands were employed, namely mercaptoacetic acid (MAA), 3-mercaptopropionic acid (MPA), 11-mercaptoundecanoic acid (MUA) as well as 2-(dimethylamino)ethanthiol (DMAET). Systematic investigations by means of photoluminescence quantum yield measurements as well as photoluminescence decay measurements have shown that the luminescence properties of the transferred nanostructures are affected by hole traps (induced by the thiol ligands themselves) as well as by spatial insulation and passivation against the environment. The influence of the tips of the nanorods on the luminescence is, however, insignificant. Accordingly, different ligands yield optimum results for different nanoparticle samples, mainly depending on the inorganic passivation of the respective samples. In case of CdSe@CdS nanorods, the highest emission intensities have been obtained by using short-chain ligands for the transfer preserving more than 50% of the pristine quantum yield of the hydrophobic nanorods. As opposed to this, the best possible quantum efficiency for the CdSe@CdS/ZnS nanorods has been achieved via MUA. The gained knowledge could be applied to transfer for the first time 2-dimensional CdSe-CdS core-crown nanoplatelets into water while preserving significant photoluminescence (up to 12% quantum efficiency).In this work, luminescent CdSe@CdS dot-in-rod nanocrystals, CdSe@CdS/ZnS nanorods as well as CdSe-CdS core-crown nanoplatelets were transferred into aqueous phase via ligand exchange reactions. For this purpose, bifunctional thiol-based ligands were employed, namely mercaptoacetic acid (MAA), 3-mercaptopropionic acid (MPA), 11-mercaptoundecanoic acid (MUA) as well as 2-(dimethylamino)ethanthiol (DMAET). Systematic investigations by means of

  7. Effective Hydraulic Conductivity Scaling in a 2-Dimensional Geometrical Multifractal Model for Aquifer Heterogeneity

    NASA Astrophysics Data System (ADS)

    Gentry, R. W.; Perfect, E.; Sukop, M. C.

    2005-12-01

    Recent analyses of field data suggest that the spatial variation of hydraulic conductivity, K, within an aquifer may be multifractal. We investigated the implications of this finding for the scaling of effective hydraulic conductivity, , by performing numerical simulations of flow in 2-dimensional geometrical multifractal K fields. A theoretical framework for generating such fields is presented based on the parameters of the truncated binomial distribution, TBD. This leads to an approximate analytical expression showing that increases with increasing length scale as a power law, whose exponent, α, is determined by the TBD parameters. Five geometrical multifractal K fields were generated with different minimum length scales. Each domain was discretized using a block center grid consisting of 59,049 uniformly-spaced nodes. A unit cube aquifer was used for the numerical simulations. The boundary conditions were implemented with constant head (unit gradient) parallel planes, and corresponding zero flux planes on the normal axes. A finite difference simulation model based on MODFLOW 2000 was used, and "zone budget" was employed to calculate the flow balance. The discharge into and out of the unit cube was then used to calculate based on Darcy's law. The numerical simulations produced similar increases in with increasing length scale to those predicted by the analytical model. Nonlinear regression analyses yielded estimates of α from the numerical simulations that were within 10% of the analytical value for these fields. These simulations provide a theoretical explanation for effective hydraulic conductivity scaling in terms of multifractals. The advantage of such an approach is that the α-parameter, which controls the degree of scaling, is physically-based and can potentially be estimated from independent measurements.

  8. Cardiac Magnetic Resonance Imaging Might Complement Two-Dimensional Echocardiography in the Detection of a Reversible Nonischemic Cardiomyopathy

    PubMed Central

    Madanieh, Raef; Mathew, Shawn; Shah, Pratik; Vatti, Satya K.; Madanieh, Abed; Kosmas, Constantine E.; Vittorio, Timothy J.

    2015-01-01

    We report a case of reversible nonischemic dilated cardiomyopathy in a male in his 60s who presented with an acute heart failure syndrome. Both conventional two-dimensional echocardiography and cardiac magnetic resonance imaging (cMRI) demonstrated severe left ventricular systolic dysfunction; however, both modalities were devoid of significant valvular heart disease as well as the presence of fibrosis, infiltration, inflammation, and scar. After six months of aggressive neurohumoral modulation, there was complete reverse remodeling and normalization of left ventricular function, which highlights the role of cMRI as an adjunct to two-dimensional echocardiography in the detection of a potentially reversible nonischemic cardiomyopathy. PMID:26740746

  9. Intraoperative Monitoring of Pulmonary Artery Physiology With Transesophageal Echocardiography in a Patient With an Extensive Pulmonary Aneurysm Undergoing Partial Nephrectomy.

    PubMed

    Plakke, Michael J; Maxwell, Cory D; Bottiger, Brandi A

    2016-09-01

    Surgical patients with pulmonary hypertension present a significant challenge to the anesthesiologist. Continuous perioperative monitoring of pulmonary artery (PA) pressure is recommended and most often accomplished with a PA catheter. Placement of a PA catheter may be difficult or contraindicated, and in these cases, transesophageal echocardiography is a useful alternative to monitor dynamic PA physiology. In this case, we used intraoperative transesophageal echocardiography to detect changes in peak PA pressure and guide clinical treatment in a patient with pulmonary hypertension and an extensive PA aneurysm undergoing partial nephrectomy. PMID:27580409

  10. Incremental value of live/real time three-dimensional over two-dimensional transesophageal echocardiography in the evaluation of right coronary artery fistula.

    PubMed

    Mishra, Jaymala; Puri, Hari Prakash; Hsiung, Ming C; Misra, Stuti; Khairnar, Prakash; Laxmi Gollamudi, Bhargavi; Patel, Adilahmed; Nanda, Navin C; Yin, Wei-Hsian; Wei, Jeng; Tsai, Shen-Kou; Sudhakar, Selvin

    2011-08-01

    We report an adult with a right coronary artery to right atrial fistula in whom live/real time three-dimensional transesophageal echocardiography with its ability to trace the entire course and obtain en face views of the fistula connections, was able to provide significant incremental information over two-dimensional transesophageal echocardiography. PMID:21752093

  11. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia.

    PubMed

    Araujo, Ana Carla Pereira de; Santos, Bruno F de Oliveira; Calasans, Flavia Ricci; Pinto, Ibraim M Francisco; Oliveira, Daniel Pio de; Melo, Luiza Dantas; Andrade, Stephanie Macedo; Tavares, Irlaneide da Silva; Sousa, Antonio Carlos Sobral; Oliveira, Joselina Luzia Menezes

    2014-11-01

    Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1) or positive (G2) for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016). The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022) and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively). Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.Fundamento: Estudos têm demonstrado a acurácia diagnóstica e o valor prognóstico da ecocardiografia com estresse f

  12. Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography

    PubMed Central

    2012-01-01

    Background A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE). Methods Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis. Results The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0

  13. Strain echocardiography is related to fibrosis and ventricular arrhythmias in hypertrophic cardiomyopathy

    PubMed Central

    Haland, Trine F.; Almaas, Vibeke M.; Hasselberg, Nina E.; Saberniak, Jørg; Leren, Ida S.; Hopp, Einar; Edvardsen, Thor; Haugaa, Kristina H.

    2016-01-01

    Aims Hypertrophic cardiomyopathy (HCM) patients are at risk of ventricular arrhythmias (VAs). We aimed to explore whether systolic function by strain echocardiography is related to VAs and to the extent of fibrosis by cardiac magnetic resonance imaging (CMR). Methods and results We included 150 HCM patients and 50 healthy individuals. VAs were defined as non-sustained and sustained ventricular tachycardia and aborted cardiac arrest. Left ventricular function was assessed by ejection fraction (EF) and by global longitudinal strain (GLS) assessed by speckle tracking echocardiography. Mechanical dispersion was calculated as standard deviation (SD) of time from Q/R on ECG to peak longitudinal strain in 16 left ventricular segments. Late gadolinium enhancement (LGE) was assessed by CMR. HCM patients had similar EF (61 ± 5% vs. 61 ± 8%, P = 0.77), but worse GLS (−15.7 ± 3.6% vs. −21.1 ± 1.9%, P < 0.001) and more pronounced mechanical dispersion (64 ± 22 vs. 36 ± 13 ms, P < 0.001) compared with healthy individuals. VAs were documented in 37 (25%) HCM patients. Patients with VAs had worse GLS (−14.1 ± 3.6% vs. −16.3 ± 3.4%, P < 0.01), more pronounced mechanical dispersion (79 ± 27 vs. 59 ± 16 ms, P < 0.001), and higher %LGE (6.1 ± 7.8% vs. 0.5 ± 1.4%, P < 0.001) than patients without VAs. Mechanical dispersion correlated with %LGE (R = 0.52, P < 0.001) and was independently associated with VAs (OR 1.6, 95% CI 1.1–2.3, P = 0.02) and improved risk stratification for VAs. Conclusion GLS, mechanical dispersion, and LGE were markers of VAs in HCM patients. Mechanical dispersion was a strong independent predictor of VAs and related to the extent of fibrosis. Strain echocardiography may improve risk stratification of VAs in HCM. PMID:26873460

  14. Is echocardiography or magnetic resonance imaging superior for precoarctation angioplasty evaluation?

    PubMed

    Mendelsohn, A M; Banerjee, A; Donnelly, L F; Schwartz, D C

    1997-09-01

    We compared the dimensions of the aorta obtained by two-dimensional transthoracic echocardiography (echo) (median, 2.5 mo preangioplasty) and magnetic resonance imaging (MRI) (median, 4.2 mo preangioplasty) to those obtained by angiography (cath) in 13 patients (age, 7.7 +/- 1.6 yr; mean +/- SEM) who underwent evaluation for coarctation balloon angioplasty between April 1993-January 1996. Echo measurements were obtained from the suprasternal and subcostal sagittal planes, MRI measurements from axial and sagittal oblique views, and cath measurements from the straight lateral or oblique views. Measurements of the diameters of the aortic isthmus, coarctation, descending aorta at the diaphragm, and isthmus length were made by all three modalities. Presence of aorto-aortic collaterals was determined, and the coarctation length was delineated. Investigators were blinded to other measurement data prior to statistical analysis. Data analysis by repeated analysis of variance (ANOVA) and Student-Newman-Keuls testing revealed no statistically significant difference between systolic pressure gradient by clinical examination (32.2 +/- 5.9 mm Hg), peak instantaneous Doppler evaluation (37.5 +/- 2.9 mm Hg), or preangioplasty systolic pressure gradient (32.1 +/- 3.3 mm Hg). With the exception of measurements of the descending aorta (echo, 11.7 +/- 0.9 mm vs. MRI, 13.3 +/- 0.8 mm vs. cath, 14.0 +/- 1.3 mm; P = 0.04), there was no statistically significant difference in dimensions of the aortic isthmus (9.2 +/- 0.6 mm vs. 10.5 +/- 0.9 mm vs. 10.8 +/- 0.9 mm), coarctation site diameter (4.8 +/- 0.6 mm vs. 5.6 +/- 0.9 mm vs. 5.3 +/- 0.8 mm), or isthmus length (12.4 +/- 2.1 mm vs. 12.1 +/- 2.2 mm vs. 10.9 +/- 1.7 mm). The correlation coefficients derived from comparisons of MRI vs. cath to echo vs. cath were similar for all dimensions except for isthmus length (P < 0.01). MRI demonstrated aorto-aortic collaterals more frequently than echo, while echocardiography better demonstrated

  15. Evaluation of Long Term Effect of RV Apical Pacing on Global LV Function by Echocardiography

    PubMed Central

    Tilkar, Mahendra; Jain, Siddhant; Mondal, Subrata; Sarkar, Piyabi; Modi, Nitin

    2016-01-01

    Introduction We very often face pacemaker implanted patients during follow-up with shortness of breath and effort intolerance inspite of normal clinical parameters. Aim The aim of our study is to evaluate the cause of effort intolerance and probable cause of sub-clinical Congestive Cardiac Failure (CCF) in a case of long term Right Ventricular (RV) apical pacing on global Left Ventricular (LV) function non- invasively by echocardiography. Materials and Methods We studied 54 patients (Male 42, Female 12) of complete heart block (CHB) with RV apical pacing (40 VVI and 14 DCP). Mean duration of pacing was 58+4 months. All patients underwent 24 hours Holter monitoring to determine the percentage of ventricular pacing beats. 2-D Echocardiography was done to assess the regional wall motion of abnormality and global LV ejection fraction by modified Simpson’s rule. These methods were coupled with the Doppler derived Myocardial Performance Index (MPI), tissue Doppler imaging, and mechanical regional dyssynchrony with 3-D Echocardiography. Data were analysed from 54 RV- apical paced patients and compared with age and body surface area of 60 controlled subjects (Male 46, Female 14). Results Evaluation of LV function in 54 patients demonstrated regional wall motion abnormality and Doppler study revealed both LV systolic and diastolic dysfunction compare with control subjects (regional wall motion abnormality 80±6% vs 30±3% with p-value<0.0001) which is proportional to the percentage of ventricular pacing beats (mean paced beat 78%). Global LVEF 50±4% vs 60±2% (p-valve <0.0001) and MPI 0.46 ±0.12 v/s 0.36±0.09 (p-value <0.0001). Conclusion RV–apical pacing induces iatrogenic electrical dyssynchrony which leads to remodeling of LV and produces mechanical dyssynchrony which is responsible for LV dysfunction. Alternate site of RV pacing and/or biventricular pacing should be done to maintain biventricular electrical synchrony which will preserve the LV function. PMID

  16. The Remarkable 50 Years of Imaging in HCM and How it Has Changed Diagnosis and Management: From M-Mode Echocardiography to CMR.

    PubMed

    Maron, Barry J; Maron, Martin S

    2016-07-01

    The almost 50-year odyssey of cardiac imaging in hypertrophic cardiomyopathy (HCM), revisited and described here, has been remarkable, particularly when viewed in the timeline of advances that occurred during a single generation of investigators. At each step along the way, from M-mode to 2-dimensional echocardiography to Doppler imaging, and finally over the last 10 years with the emergence of high-resolution tomographic cardiac magnetic resonance (CMR), evolution of the images generated by each new technology constituted a paradigm change over what was previously available. Together, these advances have transformed the noninvasive diagnosis and management of HCM in a number of important clinical respects. These changes include a more complete definition of the phenotype, resulting in more reliable clinical identification of patients and family members, defining mechanisms (and magnitude) of left ventricular outflow obstruction, and novel myocardial tissue characterization (including in vivo detection of fibrosis/scarring); notably, these advances afford more precise recognition of at-risk patients who are potential candidates for life-saving primary prevention defibrillator therapy. This evolution in imaging as applied to HCM has indelibly changed cardiovascular practice for this morphologically and clinically complex genetic disease. PMID:27388665

  17. Comparison of /sup 111/In platelet scintigraphy and two-dimensional echocardiography in the diagnosis of left ventricular thrombi

    SciTech Connect

    Ezekowitz, M.D.; Wilson, D.A.; Smith, E.O.; Burow, R.D.; Harrison, L.H. Jr.; Parker, D.E.; Elkins, R.C.; Peyton, M.; Taylor, F.B.

    1982-06-24

    In a study comparing /sup 111/In platelet scintigraphy and two-dimensional echocardiography as methods of identifying left ventricular thrombi, the results obtained with both techniques were verified at surgery or autopsy in 53 patients--34 with left ventricular aneurysms, and 19 with mitral-valve disease. Left ventricular thrombi were found at surgery or autopsy in 14 of the patients with aneurysms and in none of those with mitral-valve disease. Thirteen of 53 echocardiograms (25 per cent) were technically inadequate and excluded from the analysis. In the group with aneurysms, the sensitivity of scintigraphy in detecting thrombi was 71 per cent, and that of echocardiography was 77 per cent. The specificity of scintigraphy was 100 per cent, and that of echocardiography was 93 per cent. We conclude that /sup 111/In platelet scintigraphy and two-dimensional echocardiography have useful and complementary roles in the detection of left ventricular thrombi. Both these noninvasive techniques can be used to monitor therapy.

  18. Tornado-like appearance of spontaneous echo contrast assessed by real-time 3D transesophageal echocardiography.

    PubMed

    Otani, Kyoko; Takeuchi, Masaaki; Nakai, Hiromi; Kaku, Kyoko; Haruki, Nobuhiko; Yoshitani, Hidetoshi; Otsuji, Yutaka

    2009-06-01

    We report a case showing that real-time 3D transesophageal echocardiography provides unique information about the dynamic nature of spontaneous echo contrast (SEC) in 3D space and has the potential to provide better understanding of SEC. PMID:27278229

  19. A novel method to risk stratify patients undergoing exercise stress echocardiography using a set of combined criteria.

    PubMed

    Wong, Christopher B; Leung, Sue Ellen; Fukuyanagi, Sasa

    2015-03-01

    Background and Purposes A novel method using quantitative long-axis function and tissue Doppler in addition to wall motion analysis in exercise stress echocardiography was evaluated. We hypothesized that the novel criteria added additional accuracy in stress echocardiography. Methods Patients with chest pain and at low-to-intermediate risk for obstructive coronary artery disease (CAD) were retrospectively studied. They underwent stress echocardiography with attention to wall motion abnormalities, left ventricular long-axis function, and tissue Doppler measurement. Results The results showed that the combined novel criteria (i.e., classifying a case as positive if three out of the following four criteria were fulfilled: (1) abnormal segmental wall motion shortly after peak stress; (2) Ee wave after peak stress less than 10 cm/s and Ee/Aa ratio after peak stress less than 1; (3) Sm wave after peak stress less than 10.5 cm/s; (4) abnormal long-axis left ventricular function) offered a better accuracy for predicting obstructive CAD and future revascularization with a high sensitivity (100%) and high negative predictive value (100%) . Conclusion From a practical standpoint, the combined novel criteria may be useful in improving the diagnostic accuracy of stress echocardiography. PMID:25780326

  20. Four-dimensional echocardiography with spatiotemporal image correlation and inversion mode for detection of congenital heart disease.

    PubMed

    Qin, Yue; Zhang, Ying; Zhou, Xiaohang; Wang, Yu; Sun, Wei; Chen, Lizhu; Zhao, Dan; Zhan, Ying; Cai, Ailu

    2014-07-01

    The aim of this study was to evaluate the use of 4-D echocardiography with inversion mode and spatiotemporal image correlation (IM-STIC) in the detection of normal and abnormal fetal hearts. We retrospectively studied 112 normal fetuses and 16 fetuses with a confirmed diagnosis of congenital heart disease. Two volumes were acquired from each of the fetuses using transverse and sagittal sweeps. Volumes were reconstructed with IM-STIC. In normal fetuses, IM-STIC facilitated visualization of the interior structures of the fetal heart and great vessels. The visualization rates of intended planes obtained from IM-STIC 4D data ranged from 55% to 100%. In 16 fetuses with congenital heart disease, IM-STIC was able to display the cardiac malformations using digital casting. Some of the malformations were suspected during pre-natal 2-D echocardiography, and their pre-natal IM-STIC diagnoses were confirmed by post-natal echocardiography, surgery and/or autopsy. Hence, 4-D IM-STIC allows better visualization of complex congenital heart disease and should be considered a very useful addition to 2-D echocardiography. PMID:24785438

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

    PubMed Central

    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

    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

  2. Patient-Specific Mitral Valve Closure Prediction using 3D Echocardiography

    PubMed Central

    Burlina, Philippe; Sprouse, Chad; Mukherjee, Ryan; DeMenthon, Daniel; Abraham, Theodore

    2013-01-01

    This paper presents an approach to modeling the closure of the mitral valve using patient-specific anatomical information derived from 3D transesophageal echocardiography (3D TEE). Our approach uses physics-based modeling to solve for the stationary configuration of the closed valve structure from the patient-specific open valve structure, which is recovered using a user-in-the-loop, thin-tissue detector segmentation. The method utilizes a tensile shape finding approach based on energy minimization. This method is used to predict the aptitude of the mitral valve leaflets to coapt. We tested the method using ten intraoperative 3D TEE sequences by comparing (a) the closed valve configuration predicted from the segmented open valve, with (b) the segmented closed valve, taken as ground truth. Experiments show promising results, with prediction errors on par with 3D TEE resolution and with good potential for applications in pre-operative planning. PMID:23497987

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

    PubMed Central

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

    2014-01-01

    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

  4. Three- and four-dimensional ultrasound in fetal echocardiography: an up-to-date overview.

    PubMed

    Adriaanse, B M E; van Vugt, J M G; Haak, M C

    2016-09-01

    Congenital heart diseases (CHD) are the most commonly overlooked lesions in prenatal screening programs. Real-time two-dimensional ultrasound (2DUS) is the conventionally used tool for fetal echocardiography. Although continuous improvements in the hardware and post-processing software have resulted in a good image quality even in late first trimester, 2DUS still has its limitations. Four-dimensional ultrasound with spatiotemporal image correlation (STIC) is an automated volume acquisition, recording a single three-dimensional (3D) volume throughout a complete cardiac cycle, which results in a four-dimensional (4D) volume. STIC has the potential to increase the detection rate of CHD. The aim of this study is to provide a practical overview of the possibilities and (dis)advantages of STIC. A review of literature and evaluation of the current status and clinical value of 3D/4D ultrasound in prenatal screening and diagnosis of congenital heart disease are presented. PMID:26963426

  5. Appreciating the Strengths and Weaknesses of Transthoracic Echocardiography in Hemodynamic Assessments

    PubMed Central

    Huang, Stephen J.; McLean, Anthony S.

    2012-01-01

    Transthoracic echocardiography (TTE) is becoming the choice of hemodynamic assessment tool in many intensive care units. With an ever increasing number of training programs available worldwide, learning the skills to perform TTE is no longer a limiting factor. Instead, the future emphasis will be shifted to teach the users how to recognize measurement errors and artefacts (internal validity), to realize the limitations of TTE in various applications, and finally how to apply the information to the patient in question (external validity). This paper aims to achieve these objectives in a common area of TTE application—hemodynamic assessments. We explore the strengths and weaknesses of TTE in such assessments in this paper. Various methods of hemodynamic assessments, such as cardiac output measurements, estimation of preload, and assessment of fluid responsiveness, will be discussed. PMID:22454777

  6. Use of transoesophageal echocardiography during the peri-operative period for trauma patients.

    PubMed

    Smyth, K; Hebballi, R; Peterson, M K

    2010-12-01

    The medical facility at Camp Bastion continues to evolve as a consequence of the increased throughput of battlefield trauma patients. There is a requirement for rapid and accurate diagnosis of haemodynamic instability and continued haemodynamic monitoring throughout the peri-operative period. Transoesophageal echocardiography (TOE) has been used for this purpose in the arena of cardiac anaesthesia since the mid 1980s. It is being introduced to other peri-operative settings where severe haemodynamic instability is expected. The old proverb: 'There are none so blind as those who cannot see' (Jeremiah 5:21) is applicable to this topic, in that TOE is proven to be a rapid, portable, safe and effective tool in the assessment of the haemodynamically unstable patient. This paper explores the application of TOE for the assessment of the major causes of haemodynamic instability in the trauma population. PMID:21302659

  7. Low Cardiac Output Secondary to a Malpositioned Umbilical Venous Catheter: Value of Targeted Neonatal Echocardiography

    PubMed Central

    Weisz, Dany E.; Poon, Wei Bing; James, Andrew; McNamara, Patrick J.

    2014-01-01

    Systemic hypotension is common in very low birthweight preterm infants but the nature of the precipitating cause may be unclear. Targeted neonatal echocardiography (TnEcho) is being increasingly used to support hemodynamic decisions in the neonatal intensive care unit (NICU), including identifying impairments in the transitional circulation of preterm infants, providing timely re-evaluation after institution of therapies and evaluating the placement of indwelling catheters. We present a case of a preterm infant with systemic hypotension and low cardiac output secondary to a large transatrial shunt induced by a malpositioned umbilical venous catheter. Repositioning of the line led to resolution of the hemodynamic disturbance and clinical instability, highlighting the utility of TnEcho in the NICU. PMID:25032055

  8. [Undetected hypopharyngeal perforation with deep neck abscess and mediastinitis due to transesophageal echocardiography].

    PubMed

    Eichhorn, K W G; Bley, T A; Ridder, G J

    2003-11-01

    Hypopharyngeal perforation is a rare but dangerous complication caused by diagnostic procedures. If there is any suspicion of perforation of the upper airways and/or upper digestive tract, immediate diagnostic and therapeutic procedures are indicated. Possible complications of a hypopharyngeal perforation are deep neck infection with subsequent mediastinitis and haemorrhage from major cervical vessels, both of which have high mortality rates. We present the case of a 65 year old male patient with perforation of the hypopharynx after transesophageal echocardiography which was unrecognized for more than 1 week. Clinical symptoms of hypopharyngeal perforation may initially be unspecific. Esophagography (Gastrografin administration) and computed tomography as well as esophagoscopy are needed to certify the diagnosis and to evaluate the extent of the lesion. Pathological findings as well as diagnostic and therapeutic needs are demonstrated and discussed. PMID:14605709

  9. Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography.

    PubMed

    Okabe, Toshimasa; Julien, Howard M; Kaliyadan, Antony G; Siu, Henry; Marhefka, Gregary D

    2015-10-01

    In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment. PMID:26504446

  10. Automated Assessment of Right Ventricular Volumes and Function Using Three-Dimensional Transesophageal Echocardiography.

    PubMed

    Nillesen, Maartje M; van Dijk, Arie P J; Duijnhouwer, Anthonie L; Thijssen, Johan M; de Korte, Chris L

    2016-02-01

    Assessment of right ventricular (RV) function is known to be of diagnostic value in patients with RV dysfunction. Because of its complex anatomic shape, automated determination of the RV volume is difficult and strong reliance on geometric assumptions is not desired. A method for automated RV assessment was developed using three-dimensional (3-D) echocardiography without relying on a priori knowledge of the cardiac anatomy. A 3-D adaptive filtering technique that optimizes the discrimination between blood and myocardium was applied to facilitate endocardial border detection. Filtered image data were incorporated in a segmentation model to automatically detect the endocardial RV border. End-systolic and end-diastolic RV volumes, as well as ejection fraction, were computed from the automatically segmented endocardial surfaces and compared against reference volumes manually delineated by two expert cardiologists. The results reported good performance in terms of correlation and agreement with the results from the reference volumes. PMID:26633596

  11. Does intramedullary canal irrigation reduce fat emboli? A randomized clinical trial with transesophageal echocardiography.

    PubMed

    Zhao, Jiaqi; Zhang, Jianquan; Ji, Xiufeng; Li, Xuemei; Qian, Qirong; Xu, Qi

    2015-03-01

    The effect of medullary cavity irrigation on fat emboli during total knee arthroplasty (TKA) was evaluated. Thirty female patients with osteoarthritis were randomly assigned to undergo conventional TKA without irrigation (conventional group) or with medullary canal saline irrigation (irrigation group). The four-chamber view was monitored by transesophageal echocardiography (TEE) and echogenic reflections of fat emboli were observed. The grey-scale score and area ratio of fat emboli were calculated during TKA. Hemodynamic parameters were simultaneously monitored and showed no obvious change between two groups (P>0.05). The average grey-scale score (P=0.016) and area ratio (P=0.033) of emboli were significantly decreased in irrigation group. Removal of medullary contents by irrigation could significantly reduce the formation of fat emboli during TKA. PMID:25458091

  12. An investigation of cutting mechanics in 2 dimensional ultrasonic vibration assisted milling toward chip thickness and chip formation

    NASA Astrophysics Data System (ADS)

    Rasidi, I. I.; Rafai, N. H.; Rahim, E. A.; Kamaruddin, S. A.; Ding, H.; Cheng, K.

    2015-12-01

    The purpose of this paper is to investigate the effects of 2 dimensional Ultrasonic Vibration Assisted Milling (UVAM) cutting mechanics, considering tool path trajectory and the effect on the chip thickness. The theoretical modelling of cutting mechanics is focused by considering the trajectory of the tool locus into the workpiece during the machining. The studies found the major advantages of VAM are come from the intermittent tool tip interaction phenomena between cutting tool and workpiece. The reduction of thinning chip thickness formations can be identifying advantages from vibration assisted milling in 2 dimensional. The finding will be discussing the comparison between conventional machining the potential of the advantages toward the chip thickness and chip formation in conclusion.

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

    PubMed

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

    2012-06-01

    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 cm(2)/m(2) vs. stress 2.8 ± 0.4 cm(2)/m(2)) 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

  14. Ejection fraction determination without planimetry by two-dimensional echocardiography: a new method

    SciTech Connect

    Baran, A.O.; Rogal, G.J.; Nanda, N.C.

    1983-06-01

    A new method for determining ejection fraction by two-dimensional echocardiography was assessed in 60 patients undergoing angiography. In method A, the left ventricular minor axis was measured at the midventricular cavity level in end-systole and end-diastole using the apical four chamber view in the 60 patients. The left ventricular major axis was also measured from the left ventricular apex to the base of the mitral valve at end-systole and end-diastole. The ejection fraction was determined using a modified cylinder-ellipse algorithm. In method B, measurements of the left ventricular minor axis were made in 40 consecutive patients, at the upper, middle and lower thirds of the left ventricular cavity at end-systole and end-diastole of the same cardiac cycle and left ventricular major axis was measured as in method A. With use of the same algorithm, three regional ejection fractions were determined and averaged to yield the total ejection fraction. The two echocardiographic methods were compared with single plane cineangiography in all patients and with gated nuclear scanning in 14 patients. Reproducibility was assessed by interobserver comparison. Correlation was determined in all patients and then separately for those with echocardiographic wall motion abnormalities. This method directly measures fractional shortening of left ventricular major axis and ejection fraction values are not arbitrarily modified by type of wall motion abnormality. With this method, accurate measurement of ejection fraction can be made by two-dimensional echocardiography without planimetry. In the absence of echocardiographic wall motion abnormalities, a very simple method A suffices. If wall motion abnormalities are present, the regional ejection fraction method B provides excellent results.

  15. Diagnosis of Malignancy of Adult Mediastinal Tumors by Conventional and Transesophageal Echocardiography

    PubMed Central

    Zhou, Wei-Wei; Wang, Hong-Wei; Liu, Nan-Nan; Li, Jing-Jing; Yuan, Wei; Zhao, Rui; Xiang, Liang-Bi; Qi, Miao

    2015-01-01

    Background: Transesophageal echocardiography (TEE) is a well-established method for detecting and diagnosing heart tumors. In contrast, its role in assessing the presence, growth and evidence of malignant tumors originating from mediastinal sites remains unclear. The aim of this study was to compare the diagnostic impact of TEE and transthoracic echocardiography (TTE) for determining the localization, growth and malignancy of adult mediastinal tumors (MTs). Methods: In a prospective and investigator-blinded study, we evaluated 144 consecutive patients with MT lesions to assess the diagnostic impact of TEE and TTE for detecting the presence of tumors spreading both inside and outside of the heart and for determining infiltration and invasion using pathological examination results as a reference. Results: All tumor lesions were diagnosed and carefully evaluated by biopsy. Biopsy revealed malignant tumors in 79 patients and benign tumors in 65 patients. When compared to histological findings, TEE predicted malignancy from the presence of tumors spreading both inside and outside of the heart and from infiltration and invasion in 49/79 patients (62.0%). TTE predicted malignancy in only 8/79 patients (10.1%, P < 0.005). TEE visualized tumor lesions in 130 patients (90.3%) while the TTE visualized tumor lesions in 110 patients (76.4%) and was less effective at detecting MT lesions (P < 0.001). TTE and TEE could detect anterior MTs and adequately verified MTs (P > 0.05); TEE detected medium MTs better than TTE (P < 0.001). Conclusions: TEE is effective and superior to TTE for predicting the localization and growth of MTs as well as for accessing evidence of tumor malignancy. TTE and TEE were able to detect anterior MTs; TEE was able to detect medium MT better than TTE. PMID:25881598

  16. Role of echocardiography in diagnosis and risk stratification in heart failure with left ventricular systolic dysfunction

    PubMed Central

    Ciampi, Quirino; Villari, Bruno

    2007-01-01

    Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Echocardiography represents the "gold standard" in the assessment of LV systolic dysfunction and in the recognition of systolic heart failure, since dilatation of the LV results in alteration of intracardiac geometry and hemodynamics leading to increased morbidity and mortality. The functional mitral regurgitation is a consequence of adverse LV remodelling that occurs with a structurally normal valve and it is a marker of adverse prognosis. Diastolic dysfunction plays a major role in signs and symptoms of HF and in the risk stratification, and provides prognostic information independently in HF patients and impaired systolic function. Ultrasound lung comets are a simple echographic sign of extravascular lung water, more frequently associated with left ventricular diastolic and/or systolic dysfunction, which can integrate the clinical and pathophysiological information provided by conventional echocardiography and provide a useful information for prognostic stratification of HF patients. Contractile reserve is defined as the difference between values of an index of left ventricular contractility during peak stress and its baseline values and the presence of myocardial viability predicts a favorable outcome. A non-invasive echocardiographic method for the evaluation of force-frequency relationship has been proposed to assess the changes in contractility during stress echo. In conclusion, in HF patients, the evaluation of systolic, diastolic function and myocardial contractile reserve plays a fundamental role in the risk stratification. The highest risk is present in HF patients with a heart that is weak, big, noisy, stiff and wet. PMID:17910744

  17. Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction

    PubMed Central

    Friedberg, Mark K.; Nestaas, Eirik; Michel-Behnke, Ina

    2016-01-01

    Abstract Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging–derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH. PMID:27162612

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

    NASA Technical Reports Server (NTRS)

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

    1999-01-01

    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

  19. In-vivo continuous monitoring of mixed venous oxygen saturation by photoacoustic transesophageal echocardiography (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Li, Li; Subramaniam, Balachundhar; Aguirre, Aaron D.; Andrawes, Michael N.; Tearney, Guillermo J.

    2016-02-01

    Mixed venous oxygen saturation (SvO2), measured from pulmonary arteries, is a gold-standard measure of the dynamic balance between the oxygen supply and demand in the body. In critical care, continuous monitoring of SvO2 plays a vital role in early detection of circulatory shock and guiding goal-oriented resuscitation. In current clinical practice, SvO2 is measured by invasive pulmonary artery catheters (PAC), which are associated with a 10% risk of severe complications. To address the unmet clinical need for a non-invasive SvO2 monitor, we are developing a new technology termed photoacoustic transesophageal echocardiography (PA-TEE). PA-TEE integrates transesophageal echocardiography with photoacoustic oximetry, and enables continuous assessment of SvO2 through an esophageal probe that can be inserted into the body in a minimally invasive manner. We have constructed a clinically translatable PA-TEE prototype, which features a mobile OPO laser, a modified ultrasonography console and a dual-modality esophageal probe. Comprised of a rotatable acoustic array detector, a flexible optical fiber bundle and a light-integrating acoustic lens, the oximetric probe has an outer diameter smaller than 15 mm and will be tolerable for most patients. Through custom-made C++/Qt software, our device acquires and displays ultrasonic and photoacoustic images in real time to guide the deployment of the probe. SvO2 is calculated on-line and updated every second. PA-TEE has now been used to evaluate SvO2 in living swine. Our findings show that changing the fraction of oxygen in the inspired gas modulates SvO2 measured by PA-TEE. Statistic comparison between SvO2 measurements from PA-TEE in vivo the gold-standard laboratorial analysis on blood samples drawn from PACs will be presented.

  20. Use of a Simple Criteria Set for Guiding Echocardiography in Nosocomial Staphylococcus aureus Bacteremia

    PubMed Central

    Fowler, Vance G.; Rieg, Siegbert; Peyerl-Hoffmann, Gabriele; Birkholz, Hanna; Hellmich, Martin; Kern, Winfried V.; Seifert, Harald

    2011-01-01

    (see the editorial commentary and Soriano and Mensa, on pages 10–12.) Background. Infective endocarditis (IE) is a severe complication in patients with nosocomial Staphylococcus aureus bacteremia (SAB). We sought to develop and validate criteria to identify patients at low risk for the development of IE in whom transesophageal echocardiography (TEE) might be dispensable. Methods. Consecutive patients with nosocomial SAB from independent cohorts in Europe (Invasive S. aureus Infection Cohort [INSTINCT]) and North America (S. aureus Bacteremia Group [SABG]) were evaluated for the presence of clinical criteria predicting an increased risk for the development of IE (ie, prolonged bacteremia of >4 days' duration, presence of a permanent intracardiac device, hemodialysis dependency, spinal infection, and nonvertebral osteomyelitis). Patients were observed closely for clinical signs and symptoms of IE during hospitalization and a 3-month follow-up period. Results. IE was present in 13 (4.3%) of 304 patients in the INSTINCT cohort and in 40 (9.3%) of 432 patients in the SABG cohort. Within 14 days after the first positive blood culture result, echocardiography was performed in 39.8% and 57.4% of patients in the INSTINCT and SABG cohorts, respectively. In patients with IE, the most common clinical prediction criteria present were prolonged bacteremia (69.2% vs 90% for INSTINCT vs SABG, respectively) and presence of a permanent intracardiac device (53.8% vs 32.5%). In total, 13 of 13 patients in the INSTINCT cohort and 39 of 40 patients in the SABG cohort with documented IE fulfilled at least 1 criterion (sensitivity, 100% vs. 97.5%; negative predictive value, 100% vs 99.2%). Conclusions. A simple criteria set for patients with nosocomial SAB can identify patients at low risk of IE. Patients who meet these criteria may not routinely require TEE. PMID:21653295

  1. Assessment of atrial septal defects in adults comparing cardiovascular magnetic resonance with transoesophageal echocardiography

    PubMed Central

    2010-01-01

    Background Many adult patients with secundum-type atrial septal defects (ASDs) are able to have these defects fixed percutaneously. Traditionally, this has involved an assessment of ASD size, geometry and atrial septal margins by transoesophageal echocardiography (TOE) prior to percutaneous closure. This is a semi-invasive technique, and all of the information obtained could potentially be obtained by non-invasive cardiovascular magnetic resonance (CMR). We compared the assessment of ASDs in consecutive patients being considered for percutaneous ASD closure using CMR and TOE. Methods Consecutive patients with ASDs diagnosed on transthoracic echocardiography (TTE) were invited to undergo both CMR and TOE. Assessment of atrial septal margins, maximal and minimal defect dimensions was performed with both techniques. Analyses between CMR and TOE were made using simple linear regression and Bland Altman Analyses. Results Total CMR scan time was 20 minutes, and comparable to the TOE examination time. A total of 20 patients (M:F = 5:15, mean age 42.8 years ± 15.7) were included in the analyses. There was an excellent agreement between CMR and TOE for estimation of maximum defect size (R = 0.87). The anterior inferior, anterior superior and posterior inferior margins could be assessed in all patients with CMR. The posterior superior margin could not be assessed in only one patient. Furthermore, in 1 patient in whom TOE was unable to be performed, CMR was used to successfully direct percutaneous ASD closure. Conclusions CMR agrees with TOE assessment of ASDs in the work-up for percutaneous closure. Potentially CMR could be used instead of TOE for this purpose. PMID:20663157

  2. Clinical utility, safety, acceptability and complications of transoesophageal echocardiography (TEE) in 901 patients.

    PubMed

    Chee, T S; Quek, S S; Ding, Z P; Chua, S M

    1995-10-01

    Transoesophageal echocardiography (TEE) has earned an important role in the evaluation of patients with cardiovascular diseases. We report our TEE experience in 901 patients who had suboptimal transthoracic echocardiographic studies performed between September 1989 and June 1993. The patient-population consisted of 459 females and 442 males, with an ethnic distribution of Chinese 76.5%, Malays 12.7%, Indians 8.5% and Others 2.3%. The mean age was 48 years. The main indications for TEE were: cardiac source of embolism (27.5%); native valve pathology (19.1%); atrial septal abnormality (9.7%); infective endocarditis (8.3%); intracardiac masses (7.0%); prosthetic valve dysfunction (6.3%); congenital heart diseases (4.6%); aortic diseases (3.4%) and miscellaneous (14.1%). The majority of the studies were done on in- and out-patients, with only 1.2% performed in the intensive care area and 1% intraoperatively. 82.6% of TEE intubation were accomplished within one minute and most of the TEE studies were completed within twenty minutes. There were ten failures (1.2%). Major complications occurred in 5 patients (0.6%) but there was no mortality. 90.5% of the studies were considered by the operators as additionally-informative or useful for clinical decision making. In a subgroup analysis, 90.6% of the patients who had undergone TEE indicated their willingness for repeat studies if required and TEE was able to increase the sensitivity of detecting a potential cardioembolic source from 10.3% to 29.5%. In conclusion, with increasing experience, TEE can be performed expeditiously and safely, with good acceptability by our local population. TEE provides useful or additional information that supplements standard transthoracic echocardiography in a wide-ranging spectrum of cardiac conditions. PMID:8882528

  3. The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study

    PubMed Central

    Beaton, Andrea; Lu, Jimmy C.; Aliku, Twalib; Dean, Peter; Gaur, Lasya; Weinberg, Jacqueline; Godown, Justin; Lwabi, Peter; Mirembe, Grace; Okello, Emmy; Reese, Allison; Shrestha-Astudillo, Ashley; Bradley-Hewitt, Tyler; Scheel, Janet; Webb, Catherine; McCarter, Robert; Ensing, Greg; Sable, Craig

    2015-01-01

    Aims The World Heart Federation (WHF) guidelines for rheumatic heart disease (RHD) are designed for a standard portable echocardiography (STAND) machine. A recent study in a tertiary care centre demonstrated that they also had good sensitivity and specificity when modified for use with handheld echocardiography (HAND). Our study aimed to evaluate the performance of HAND for early RHD diagnosis in the setting of a large-scale field screening. Methods and results STAND was performed in 4773 children in Gulu, Uganda, with 10% randomly assigned to also undergo HAND. Additionally, any child with mitral or aortic regurgitation also underwent HAND. Studies were performed by experienced echocardiographers and blindly reviewed by cardiologists using 2012 WHF criteria, which were modified slightly for HAND—due to the lack of spectral Doppler capability. Paired echocardiograms were performed in 1420 children (mean age 10.8 and 53% female), resulting in 1234 children who were normal, 133 who met criteria for borderline RHD, 47 who met criteria for definite RHD, and 6 who had other diagnoses. HAND had good sensitivity and specificity for RHD detection (78.9 and 87.2%, respectively), but was most sensitive for definite RHD (97.9%). Inter- and intra-reviewer agreement ranged between 66–83 and 71.4–94.1%, respectively. Conclusions HAND has good sensitivity and specificity for diagnosis of early RHD, performing best for definite RHD. Protocols for RHD detection utilizing HAND will need to include confirmation by STAND to avoid over-diagnosis. Strategies that evaluate simplified screening protocols and training of non-physicians hold promise for more wide spread deployment of HAND-based protocols. PMID:25564396

  4. Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction.

    PubMed

    Koestenberger, Martin; Friedberg, Mark K; Nestaas, Eirik; Michel-Behnke, Ina; Hansmann, Georg

    2016-03-01

    Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH. PMID:27162612

  5. Reliability of Aortic Stenosis Severity Classified by 3-Dimensional Echocardiography in the Prediction of Cardiovascular Events.

    PubMed

    Sato, Kimi; Seo, Yoshihiro; Ishizu, Tomoko; Nakajima, Hideki; Takeuchi, Masaaki; Izumo, Masaki; Suzuki, Kengo; Akashi, Yoshihiro J; Otsuji, Yutaka; Aonuma, Kazutaka

    2016-08-01

    The estimation of aortic valve area (AVA) by Doppler echocardiography-derived left ventricular stroke volume (LVSV) remains controversial. We hypothesized that AVA estimated from directly measured LVSV by 3-dimensional echocardiography (3DE) on the continuity equation might be more accurate in classifying aortic stenosis (AS) severity. We retrospectively enrolled 265 patients with moderate-to-severe AS with preserved ejection fraction. Indexed AVA (iAVA) was calculated using LVSV derived by 2D Doppler (iAVADop), Simpson's method (iAVASimp), and 3DE (iAVA3D). During a median follow-up period of 397 days (interquartile range 197 to 706 days), 135 patients experienced the composite end point (cardiac death 9%, aortic valve replacement 24%, and cardiovascular event 27%). Estimated iAVA3D and iAVASimp were significantly smaller than iAVADop and moderately correlated with peak aortic jet velocity. Upper septal hypertrophy was a major cause of discrepancy between iAVADop and iAVA3D methods. Based on the optimal cut-off point of iAVA for predicting peak aortic jet velocity >4.0 m/s, 141 patients (53%) were classified as severe AS and 124 patients (47%) as moderate AS by iAVADop. Indexed AVA3D classified 118 patients (45%) as severe and 147 patients (55%) as moderate AS. Of the 124 patients with moderate AS by iAVADop, 22 patients (18%) were reclassified as severe AS by iAVA3D and showed poor prognosis (hazard ratio 2.7, 95% CI 1.4 to 5.0; p = 0.001). In conclusion, 3DE might be superior in classifying patients with AS compared with Doppler method, particularly in patients with upper septal hypertrophy. PMID:27287062

  6. Assessment of zebrafish cardiac performance using Doppler echocardiography and power angiography.

    PubMed

    Ho, Yi-Lwun; Shau, Yio-Wha; Tsai, Huai-Jen; Lin, Lung-Chun; Huang, Por-Jau; Hsieh, Fon-Jou

    2002-09-01

    The zebrafish (Danio rerio) has become a new animal model for cardiac researches. Although it is equipped with a prototypical vertebrate heart, the zebrafish studies for cardiac mutations and genetic control of development can reveal some hints for solving human problems. Despite the simplicity of the zebrafish heart, the objective parameters of cardiac performance are not easily available, except for the morphological description, due to its small size. Because the four components (sinus venosus, atrium, ventricle and bulbus arteriosus) of the zebrafish heart are connected in series, we studied it by applying ultrasonic imaging methods for the vascular system. A total of 20 fishes that were ages of 3 to 4 months were studied. Their mean body weight and height were 562 +/- 173 mg and 4.6 +/- 0.7 cm, respectively. Power angiography and routine Doppler echocardiography were used to evaluate the cardiac performance of zebrafish at 25 degrees C and 15 degrees C. The zebrafish hearts could be easily identified with color Doppler (8.5 MHz) or power angiography (7 MHz). The ventricular filling flow contained two components (E and A-flow). The E-flow velocities were lower than the A-flow velocities at both 25 and 15 degrees C. The cycle length was prolonged (p < 0.05) and the velocities of ventricular filling and bulbus arteriosus decreased significantly at 15 degrees C (p < 0.05). A significant decrease in early diastolic deceleration slope and significant prolongation in early diastolic and late-diastolic deceleration times were found at a lower temperature (15 degrees C). The acceleration:deceleration ratio for early and late diastole also showed a significant difference at 15 degrees C. In conclusion, the cardiac performance of the zebrafish could be approached using commercially available clinical instruments equipped with Doppler echocardiography and power angiography. PMID:12401383

  7. Detection of myocardial viability by dobutamine stress echocardiography: incremental value of diastolic wall thickness measurement

    PubMed Central

    Zaglavara, T; Pillay, T; Karvounis, H; Haaverstad, R; Parharidis, G; Louridas, G; Kenny, A

    2005-01-01

    Objective: To assess the diagnostic accuracy of baseline diastolic wall thickness (DWT) alone and as an adjunct to dobutamine stress echocardiography (DSE) for prediction of myocardial viability in patients with ischaemic left ventricular (LV) dysfunction, with the recovery of resting function after revascularisation as the yardstick. Patients: 24 patients with ischaemic LV dysfunction (ejection fraction < 40%) scheduled for surgical revascularisation. Setting: Regional cardiothoracic centre. Methods: All patients underwent DSE before and resting echocardiography six months after revascularisation. DWT was measured in each of the 16 LV segments. A receiver operating characteristic (ROC) and a multi-ROC curve were generated to assess the ability of DWT alone and in combination with DSE to predict myocardial viability. Results: DWT > 0.6 cm provided a sensitivity of 80%, a specificity of 51%, and a negative predictive value of 80% for the prediction of viability in akinetic segments. DSE had an excellent specificity (92%) but a modest sensitivity (60%) in akinetic segments. A combination of improvement at DSE or DWT > 0.8 cm improved sensitivity (90% v 60%, p < 0.001) and negative predictive value (92% v 78%, p  =  0.03) in akinetic segments compared with DSE alone. This was achieved with some loss in specificity (75% v 92%, p  =  0.01) and positive predictive value (71% v 82%, p  =  0.79). Conclusions: DWT measurement may improve the sensitivity of DSE for the detection of myocardial viability. Akinetic segments with DWT > 0.8 cm have a good chance of recovery despite the absence of contractile reserve during DSE. Further testing may be required before excluding myocardial viability in these cases. PMID:15831644

  8. Right ventricular strain analysis from three-dimensional echocardiography by using temporally diffeomorphic motion estimation

    PubMed Central

    Zhu, Meihua; Ashraf, Muhammad; Broberg, Craig S.; Sahn, David J.; Song, Xubo

    2014-01-01

    Purpose: Quantitative analysis of right ventricle (RV) motion is important for study of the mechanism of congenital and acquired diseases. Unlike left ventricle (LV), motion estimation of RV is more difficult because of its complex shape and thin myocardium. Although attempts of finite element models on MR images and speckle tracking on echocardiography have shown promising results on RV strain analysis, these methods can be improved since the temporal smoothness of the motion is not considered. Methods: The authors have proposed a temporally diffeomorphic motion estimation method in which a spatiotemporal transformation is estimated by optimization of a registration energy functional of the velocity field in their earlier work. The proposed motion estimation method is a fully automatic process for general image sequences. The authors apply the method by combining with a semiautomatic myocardium segmentation method to the RV strain analysis of three-dimensional (3D) echocardiographic sequences of five open-chest pigs under different steady states. Results: The authors compare the peak two-point strains derived by their method with those estimated from the sonomicrometry, the results show that they have high correlation. The motion of the right ventricular free wall is studied by using segmental strains. The baseline sequence results show that the segmental strains in their methods are consistent with results obtained by other image modalities such as MRI. The image sequences of pacing steady states show that segments with the largest strain variation coincide with the pacing sites. Conclusions: The high correlation of the peak two-point strains of their method and sonomicrometry under different steady states demonstrates that their RV motion estimation has high accuracy. The closeness of the segmental strain of their method to those from MRI shows the feasibility of their method in the study of RV function by using 3D echocardiography. The strain analysis of the

  9. Experience of newly constructed echocardiography-database with video clips and color still images at the Echocardiography Lab of Nepal Medical College Teaching Hospital.

    PubMed

    Shrestha, B; Dhungel, S

    2008-09-01

    Reporting system after performing echocardiography is very poor in almost all hospitals of Nepal. Special but simple attempt effort has been introduced to transfer analog video images and color still images of echocardiographic investigation into a desk top computer using a locally available imported video capture system, Snazzi Movie Studio S4. Analog video signals are converted into MPEG2 and still color snaps are converted into JPEG format. Window media player can be used later on to review the video clips. All together 1059 patients including pediatric, adults and geriatric patients underwent echocardiographic evaluation at the Echo-lab of Nepal Medical College Teaching Hospital during 10th January 2007 to 9th May 2008. Age ranged from 2 months to 98 years. Mean+SD was 52.4 +/- 18.5 years. Male/female ratio was 0.8:1. More than half of the patients (64.3%) came from Kathmandu. Brahman/Chhetri (478, 45.1%), Tamang, Sherpa etc 278 (26.3%) and Newar (226, 21.3%) were the main echo-users. Elderly age group (>60 yr) comprised of more than one third of the patients (42.0%) followed by the age group of 45-59 yr (27.7%). No abnormality was detected in 133 (12.6%) patients. Valvular heart disease was noticed in more than half of patients (60.7%), followed by diastolic dysfunction (393, 14.0%) and left ventricular hypertrophy (210, 7.5%). This database is not very expensive but demand minimal extra time and energy. It will be a valuable tool to increase diagnostic accuracy and a great resource for academic purpose aiding in the improvement of cardiac care in Nepal. PMID:19253863

  10. Dobutamine echocardiography and thallium-201 imaging predict functional improvement after revascularisation in severe ischaemic left ventricular dysfunction.

    PubMed Central

    Senior, R.; Glenville, B.; Basu, S.; Sridhara, B. S.; Anagnostou, E.; Stanbridge, R.; Edmondson, S. J.; Handler, C. E.; Raftery, E. B.; Lahiri, A.

    1995-01-01

    OBJECTIVES--To evaluate the concordance between thallium-201 uptake and echocardiographic wall thickening, which are both indicators of potentially reversible myocardial dysfunction, in patients with chronic ischaemic left ventricular failure and to assess their relative contribution to predicting improvement in regional function after revascularisation in a subgroup. PATIENTS AND METHODS--45 patients with chronic ischaemic left ventricular dysfunction (mean (SD) ejection fraction 25 (8)%) underwent echocardiography before and after dobutamine infusion (10 micrograms/kg/min). Of these, 22 patients underwent rest echocardiography at a mean (SD) of 9 (1) weeks after revascularisation. 201Tl imaging was performed during dobutamine echocardiography and at rest, 1, and 4 h after treatment with sublingual glyceryl trinitrate on two separate days. Potentially reversible dysfunction was thought to be present when a myocardial segment contained a Tl score of > or = 3 (ascending score 1-4), or showed improved wall thickening of a dysynergic segment during dobutamine stimulation. RESULTS--Of the 201Tl protocols, the redistribution scan 1 h after treatment with glyceryl trinitrate best demonstrated myocardial viability. Concordance between 201Tl and dobutamine induced wall thickening was 82% (kappa = 0.59) for detecting potentially reversible myocardial dysfunction before revascularisation (n = 45). Regional function improved in 18 of 22 patients after revascularisation. There were 168 dysynergic segments before intervention. The sensitivity of echocardiography and 201Tl imaging for detecting "recoverable" or viable segments after revascularisation was 87% and 92% respectively and specificity was 82% and 78% respectively (P = NS). CONCLUSIONS--Dobutamine echocardiography and 201Tl imaging may be used to predict mechanical improvement in dysynergic segments after revascularisation in patients with chronic ischaemic left ventricular dysfunction. Images PMID:7488446

  11. Clinical Utility of Echocardiography for the Diagnosis and Management of Pulmonary Vascular Disease in Young Children With Chronic Lung Disease

    PubMed Central

    Mourani, Peter M.; Sontag, Marci K.; Younoszai, Adel; Ivy, D. Dunbar; Abman, Steven H.

    2011-01-01

    Objective The goal was to determine the clinical utility of Doppler echocardiography in predicting the presence and severity of pulmonary hypertension in patients with chronic lung disease who subsequently underwent cardiac catheterization. Methods A retrospective review of data for all patients <2 years of age with a diagnosis of bronchopulmonary dysplasia, congenital diaphragmatic hernia, or lung hypoplasia who underwent echocardiography and subsequently underwent cardiac catheterization for evaluation of pulmonary hypertension was performed. The accuracy of echocardiography in diagnosing pulmonary hypertension, on the basis of estimated systolic pulmonary artery pressure, was compared with the detection of pulmonary hypertension with the standard method of cardiac catheterization. Results Thirty-one linked measurements for 25 children were analyzed. Systolic pulmonary artery pressure could be estimated in 61% of studies, but there was poor correlation between echocardiography and cardiac catheterization measures of systolic pulmonary artery pressure in these infants. Compared with cardiac catheterization measurements, echocardiographic estimates of systolic pulmonary artery pressure diagnosed correctly the presence or absence of pulmonary hypertension in 79% of the studies in which systolic pulmonary artery pressure was estimated but determined the severity of pulmonary hypertension (severe pulmonary hypertension was defined as pulmonary/systemic pressure ratio of ≥0.67) correctly in only 47% of those studies. Seven (58%) of 12 children without estimated systolic pulmonary artery pressure demonstrated pulmonary hypertension during subsequent cardiac catheterization. In the absence of estimated systolic pulmonary artery pressure, qualitative echocardiographic findings, either alone or in combination, had worse predictive value for the diagnosis of pulmonary hypertension. Conclusion As used in clinical practice, echocardiography often identifies pulmonary

  12. Noninvasive Evaluation of Myocardial Systolic Dysfunction in the Early Stage of Kawasaki Disease: A Speckle-Tracking Echocardiography Study

    PubMed Central

    Hematian, Mohammad-Nasir; Torabi, Shirin; MalaKan-Rad, Elaheh; Sayadpour-Zanjani, Keyhan; Ziaee, Vahid; Lotfi-Tolkaldany, Masoumeh

    2015-01-01

    Background: Evaluation of myocardial function by speckle-tracking echocardiography is a new method for the early diagnosis of systolic dysfunction. Objectives: We aimed to determine myocardial speckle-tracking echocardiography indices in Kawasaki Disease (KD) patients and compare them with the same indices in control subjects. Patients and Methods: Thirty-two patients (65.5% males) with KD and 19 control subjects with normal echocardiography participated in this study. After their demographic characteristics and clinical findings were recorded, all the participants underwent transthoracic echocardiography. Strain (S), Strain Rate (SR), Time to Peak Strain (TPS), and Strain Rate (TPSR), longitudinal velocity and view point velocity images in the two, three, and four-chamber views were semi-automatically obtained via speckle-tracking echocardiography. Results: Among the patients, Twenty-four cases (75%) were younger than 4 years. Mean global S and SR was significantly reduced in the KD patients compared to controls (17.03 ± 1.28 vs. 20.22 ± 2.14% and 1.66 ± 0.16 vs. 1.97 ± 0.25 1/second, respectively), while there were no significant differences regarding mean TPS, TPSR, longitudinal velocity and view point velocity. Using repeated measure of analysis of variances, we observed that S and SR decreased from base to apical level in both groups. The change in the pattern of age adjusted mean S and SR across levels was significantly different between the groups (P < 0.001 for both parameters). Conclusions: We showed changes in S and SR assessed in KD patients versus control subjects in the acute phase of KD. However, we suggest that further studies be undertaken to compare S and SR in the acute phase and thereafter in KD patients. PMID:26199701

  13. Comparison of two- and three-dimensional transthoracic echocardiography to cardiac magnetic resonance imaging for assessment of paravalvular regurgitation after transcatheter aortic valve implantation.

    PubMed

    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

    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

  14. Assessment of Speckle-Tracking Echocardiography-Derived Global Deformation Parameters During Supine Exercise in Children.

    PubMed

    Liu, Michael Y; Tacy, Theresa; Chin, Clifford; Obayashi, Derek Y; Punn, Rajesh

    2016-03-01

    Exercise echocardiography is an underutilized tool in pediatrics with current applications including detecting segmental wall abnormalities, assessing the utility of global ventricular function, and measuring pulmonary hemodynamics. No prior study has applied speckle-tracking echocardiography (STE) during exercise echocardiography in children. The aim of this study was to determine the feasibility of measuring speckle-tracking-derived peak systolic velocities, global longitudinal and circumferential strain, and global strain rates at various phases of exercise. Ninety-seven healthy children underwent cardiopulmonary exercise testing using supine cycle ergometry. The exercise stress test consisted of baseline pulmonary function testing, monitoring of blood pressure and heart rate responses, electrocardiographic recordings, and oxygen saturations while subjects pedaled against a ramp protocol based on body weight. Echocardiographic measurements and specifically speckle-tracking analysis were performed during exercise at baseline, at a heart rate of 160 beats per minute and at 10 min after exercise. Peak systolic velocity, peak systolic strain, and peak systolic strain rate at these three phases were compared in the subjects in which all measurements were accurately obtained. We were able to complete peak velocity, strain, and strain rate measurements in all three exercise phases for 36 out of the 97 subjects tested. There was no significant difference between the feasibility of measuring circumferential versus longitudinal strain (p = 0.25, B-corrected = 0.75). In the 36 subjects studied, the magnitude of circumferential strain values decreased from -18.3 ± 4.8 to -13.7 ± 4.0 % from baseline to HR 160 (p < 0.0001, B-corrected < 0.0001), before returning to -19.6 ± 4.4 % at recovery (p = 0.19 when compared to baseline). Longitudinal strain did not vary significantly from baseline to HR 160 (from -17.7 ± 4.4 to -16.6 ± 4.4 %, p = 0

  15. Mitral annular disjunction in myxomatous mitral valve disease: a relevant abnormality recognizable by transthoracic echocardiography

    PubMed Central

    2010-01-01

    Background Mitral annular disjunction (MAD) consists of an altered spatial relation between the left atrial wall, the attachment of the mitral leaflets, and the top of the left ventricular (LV) free wall, manifested as a wide separation between the atrial wall-mitral valve junction and the top of the LV free wall. Originally described in association with myxomatous mitral valve disease, this abnormality was recently revisited by a surgical group that pointed its relevance for mitral valve reparability. The aims of this study were to investigate the echocardiographic prevalence of mitral annular disjunction in patients with myxomatous mitral valve disease, and to characterize the clinical profile and echocardiographic features of these patients. Methods We evaluated 38 patients with myxomatous mitral valve disease (mean age 57 ± 15 years; 18 females) and used standard transthoracic echocardiography for measuring the MAD. Mitral annular function, assessed by end-diastolic and end-systolic annular diameters, was compared between patients with and without MAD. We compared the incidence of arrhythmias in a subset of 21 patients studied with 24-hour Holter monitoring. Results MAD was present in 21 (55%) patients (mean length: 7.4 ± 8.7 mm), and was more common in women (61% vs 38% in men; p = 0.047). MAD patients more frequently presented chest pain (43% vs 12% in the absence of MAD; p = 0.07). Mitral annular function was significantly impaired in patients with MAD in whom the mitral annular diameter was paradoxically larger in systole than in diastole: the diastolic-to-systolic mitral annular diameter difference was -4,6 ± 4,7 mm in these patients vs 3,4 ± 1,1 mm in those without MAD (p < 0.001). The severity of MAD significantly correlated with the occurrence of non-sustained ventricular tachycardia (NSVT) on Holter monitoring: MAD›8.5 mm was a strong predictor for (NSVT), (area under ROC curve = 0.74 (95% CI, 0.5-0.9); sensitivity 67%, specificity 83%). There

  16. Effect of different anesthetic agents on left ventricular systolic function assessed by echocardiography in hamsters.

    PubMed

    Tanaka, D M; Romano, M M D; Carvalho, E E V; Oliveira, L F L; Souza, H C D; Maciel, B C; Salgado, H C; Fazan-Júnior, R; Simões, M V

    2016-01-01

    Determination of left ventricular ejection fraction (LVEF) using in vivo imaging is the cardiac functional parameter most frequently employed in preclinical research. However, there is considerable conflict regarding the effects of anesthetic agents on LVEF. This study aimed at assessing the effects of various anesthetic agents on LVEF in hamsters using transthoracic echocardiography. Twelve female hamsters were submitted to echocardiography imaging separated by 1-week intervals under the following conditions: 1) conscious animals, 2) animals anesthetized with isoflurane (inhaled ISO, 3 L/min), 3) animals anesthetized with thiopental (TP, 50 mg/kg, intraperitoneal), and 4) animals anesthetized with 100 mg/kg ketamine plus 10 mg/kg xylazine injected intramuscularly (K/X). LVEF obtained under the effect of anesthetics (ISO=62.2±3.1%, TP=66.2±2.7% and K/X=75.8±1.6%) was significantly lower than that obtained in conscious animals (87.5±1.7%, P<0.0001). The K/X combination elicited significantly higher LVEF values compared to ISO (P<0.001) and TP (P<0.05). K/X was associated with a lower dispersion of individual LVEF values compared to the other anesthetics. Under K/X, the left ventricular end diastolic diameter (LVdD) was increased (0.60±0.01 cm) compared to conscious animals (0.41±0.02 cm), ISO (0.51±0.02 cm), and TP (0.55±0.01 cm), P<0.0001. The heart rate observed with K/X was significantly lower than in the remaining conditions. These results indicate that the K/X combination may be the best anesthetic option for the in vivo assessment of cardiac systolic function in hamsters, being associated with a lower LVEF reduction compared to the other agents and showing values closer to those of conscious animals with a lower dispersion of results. PMID:27580004

  17. Effect of different anesthetic agents on left ventricular systolic function assessed by echocardiography in hamsters

    PubMed Central

    Tanaka, D.M.; Romano, M.M.D.; Carvalho, E.E.V.; Oliveira, L.F.L.; Souza, H.C.D.; Maciel, B.C.; Salgado, H.C.; Fazan-Júnior, R.; Simões, M.V.

    2016-01-01

    Determination of left ventricular ejection fraction (LVEF) using in vivo imaging is the cardiac functional parameter most frequently employed in preclinical research. However, there is considerable conflict regarding the effects of anesthetic agents on LVEF. This study aimed at assessing the effects of various anesthetic agents on LVEF in hamsters using transthoracic echocardiography. Twelve female hamsters were submitted to echocardiography imaging separated by 1-week intervals under the following conditions: 1) conscious animals, 2) animals anesthetized with isoflurane (inhaled ISO, 3 L/min), 3) animals anesthetized with thiopental (TP, 50 mg/kg, intraperitoneal), and 4) animals anesthetized with 100 mg/kg ketamine plus 10 mg/kg xylazine injected intramuscularly (K/X). LVEF obtained under the effect of anesthetics (ISO=62.2±3.1%, TP=66.2±2.7% and K/X=75.8±1.6%) was significantly lower than that obtained in conscious animals (87.5±1.7%, P<0.0001). The K/X combination elicited significantly higher LVEF values compared to ISO (P<0.001) and TP (P<0.05). K/X was associated with a lower dispersion of individual LVEF values compared to the other anesthetics. Under K/X, the left ventricular end diastolic diameter (LVdD) was increased (0.60±0.01 cm) compared to conscious animals (0.41±0.02 cm), ISO (0.51±0.02 cm), and TP (0.55±0.01 cm), P<0.0001. The heart rate observed with K/X was significantly lower than in the remaining conditions. These results indicate that the K/X combination may be the best anesthetic option for the in vivo assessment of cardiac systolic function in hamsters, being associated with a lower LVEF reduction compared to the other agents and showing values closer to those of conscious animals with a lower dispersion of results. PMID:27580004

  18. Focused Cardiac Ultrasound in Place of Repeat Echocardiography: Reliability and Cost Implications

    PubMed Central

    Kini, Vinay; Mehta, Nidhi; Mazurek, Jeremy A.; Ferrari, Victor A.; Epstein, Andrew J.; Groeneveld, Peter W.; Kirkpatrick, James N.

    2016-01-01

    Background Health care systems are increasingly moving toward models that emphasize the delivery of high-quality health care at lower costs. Rates of repeat echocardiography (two or more transthoracic echocardiographic studies performed within a short interval) are high and can contribute substantially to the cost of providing cardiovascular care. Certain findings from handheld ultrasound scans performed by echocardiographers have been shown to correlate well with findings on transthoracic echocardiography (TTE). It therefore may be feasible and cost effective to use expert focused cardiac ultrasound (eFCU) in place of repeat TTE for highly selected indications in certain settings. The aim of this study was to determine the reliability and cost implications of using eFCU in place of repeat TTE in selected inpatients. Methods Inpatients who underwent repeat TTE (prior TTE within 30 days) ordered for the assessment of ventricular function, pericardial effusion, or inferior vena cava collapse were prospectively enrolled. Subjects underwent eFCU in addition to TTE, and results were compared for correlation using the weighted κ statistic. The potential cost savings of using eFCU in place of TTE were modeled from the provider perspective (i.e., physicians and hospitals). Results Over 45 days, 105 patients were enrolled. The majority of scans were performed for assessment of left ventricular function and pericardial effusions. eFCU showed excellent correlation with TTE for most parameters, including left ventricular systolic function (κ = 0.80) and the presence and size of pericardial effusions (κ = 0.81) (P < .001 for both). Adoption of this eFCU protocol could save between $41 and $64 per study, or between $34,512 and $53,871 annually at the authors’ institution. Conclusions Findings from eFCU correlate well with those from TTE when used in the setting of repeat testing for assessment of ventricular function, pericardial effusion, and inferior vena cava collapse

  19. Speckle tracking echocardiography in chronic obstructive pulmonary disease and overlapping obstructive sleep apnea

    PubMed Central

    Pizarro, Carmen; van Essen, Fabian; Linnhoff, Fabian; Schueler, Robert; Hammerstingl, Christoph; Nickenig, Georg; Skowasch, Dirk; Weber, Marcel

    2016-01-01

    Background COPD and congestive heart failure represent two disease entities of growing global burden that share common etiological features. Therefore, we aimed to identify the degree of left ventricular (LV) dysfunction in COPD as a function of COPD severity stages and concurrently placed particular emphasis on the presence of overlapping obstructive sleep apnea (OSA). Methods A total of 85 COPD outpatients (64.1±10.4 years, 54.1% males) and 20 controls, matched for age, sex, and smoking habits, underwent speckle tracking echocardiography for LV longitudinal strain imaging. Complementary 12-lead electrocardiography, laboratory testing, and overnight screening for sleep-disordered breathing using the SOMNOcheck micro® device were performed. Results Contrary to conventional echocardiographic parameters, speckle tracking echocardiography revealed significant impairment in global LV strain among COPD patients compared to control smokers (−13.3%±5.4% vs −17.1%±1.8%, P=0.04). On a regional level, the apical septal LV strain was reduced in COPD (P=0.003) and associated with the degree of COPD severity (P=0.02). With regard to electrocardiographic findings, COPD patients exhibited a significantly higher mean heart rate than controls (71.4±13.0 beats per minute vs 60.3±7.7 beats per minute, P=0.001) that additionally increased over Global Initiative for Chronic Obstructive Lung Disease stages (P=0.01). Albeit not statistically significant, COPD led to elevated N-terminal pro-brain natriuretic peptide levels (453.2±909.0 pg/mL vs 96.8±70.0 pg/mL, P=0.08). As to somnological testing, the portion of COPD patients exhibiting overlapping OSA accounted for 5.9% and did not significantly vary either in comparison to controls (P=0.07) or throughout the COPD Global Initiative for Chronic Obstructive Lung Disease stages (P=0.49). COPD-OSA overlap solely correlated with nocturnal hypoxemic events, whereas LV performance status was unrelated to coexisting OSA. Conclusion

  20. Comparative Myocardial Deformation in 3 Myocardial Layers in Mice by Speckle Tracking Echocardiography

    PubMed Central

    Tee, Nicole; Gu, Yacui; Murni; Shim, Winston

    2015-01-01

    Background. Speckle tracking echocardiography (STE) using dedicated high-resolution ultrasound is a relatively new technique that is useful in assessing myocardial deformation in 3 myocardial layers in small animals. However, comparative studies of STE parameters acquired from murine are limited. Methods. A high-resolution rodent ultrasound machine (VSI Vevo 2100) and a clinically validated ultrasound machine (GE Vivid 7) were used to consecutively acquire echocardiography images from standardized parasternal long axis and short axis at midpapillary muscle level from 13 BALB/c mice. Speckle tracking strain (longitudinal, circumferential, and radial) from endocardial, myocardial, and epicardial layers was analyzed using vendor-specific offline analysis software. Results. Intersystem differences were not statistically significant in the global peak longitudinal strain (−16.8 ± 1.7% versus −18.7 ± 3.1%) and radial strain (46.8 ± 14.2% versus 41.0 ± 9.5%), except in the global peak circumferential strain (−16.9 ± 3.1% versus 27.0 ± 5.2%, P < 0.05). This was corroborated by Bland Altman analysis that revealed a weak agreement in circumferential strain (mean bias ± 1.96 SD of −10.12 ± 6.06%) between endocardium and midmyocardium. However, a good agreement was observed in longitudinal strain between midmyocardium/endocardium (mean bias ± 1.96 SD of −1.88 ± 3.93%) and between midmyocardium/epicardium (mean bias ± 1.96 SD of 3.63 ± 3.91%). Radial strain (mean bias ± 1.96 SD of −5.84 ± 17.70%) had wide limits of agreement between the two systems that indicated an increased variability. Conclusions. Our study shows that there is good reproducibility and agreement in longitudinal deformation of the 3 myocardial layers between the two ultrasound systems. Directional deformation gradients at endocardium, myocardium, and epicardium observed in mice were consistent to those reported in human subjects, thus attesting the clinical relevance of STE

  1. The value of transthoracic and transesophageal echocardiography for the diagnosis of the native aortic infective endocarditis valve complications: a case report and literature review.

    PubMed

    Molnar, Adrian; Sacui, Diana; Manole, Simona; Radulescu, Amanda; Beyer, Ruxandra

    2016-06-01

    Despite its current limitations transthoracic echocardiography is still widely used for the anatomical and functional evaluation of patients with infective endocarditis. However, all these limitations can be overcome by using transesophageal echocardiography. We present the case of a 42-year-old male patient, diagnosed with aortic valve infective endocarditis, whose transthoracic echocardiography showed only a cusp vegetation and aortic regurgitation, but raised the suspicion of periannular complications. The transesophageal echocardiography revealed a circular aortic root abscess and a ventricular septal defect with left-to-right shunt, and consequently leads to a complete different surgical tactical approach. The patient was urgently referred for surgery due to the rapid deterioration of the hemodynamic status, and had a good outcome on the short-term follow-up. PMID:27239664

  2. Oral Everolimus for Treatment of a Giant Left Ventricular Rhabdomyoma in a Neonate-Rapid Tumor Regression Documented by Real Time 3D Echocardiography.

    PubMed

    Wagner, Robert; Riede, Frank Thomas; Seki, Hiroshi; Hornemann, Frauke; Syrbe, Steffen; Daehnert, Ingo; Weidenbach, Michael

    2015-12-01

    The presented case reports on successful treatment with everolimus in a neonate with left ventricular giant rhabdomyoma. The authors used a different dosage regime compared to literature and documented rapid tumor regression by 3D echocardiography. PMID:26199144

  3. GRAV2D: an interactive 2-1/2 dimensional gravity modeling program (user's guide and documentation for Rev. 1)

    SciTech Connect

    Nutter, C.

    1980-11-01

    GRAV2D is an interactive computer program used for modeling 2-1/2 dimensional gravity data. A forward algorithm is used to give the theoretical attraction of gravity intensity at a station due to a perturbing body given by the initial model. The resultant model can then be adjusted for a better fit by a combination of manual adjustment, one-dimensional automatic search, and Marquardt inversion. GRAV2D has an interactive data management system for data manipulation and display built around subroutines to do a forward problem, a one-dimensional direct search and an inversion. This is a user's guide and documentation for GRAV2D.

  4. Circulating bubbles and breath-hold underwater fishing divers: a two-dimensional echocardiography and continuous wave Doppler study.

    PubMed

    Boussuges, A; Abdellaoui, S; Gardette, B; Sainty, J M

    1997-01-01

    Since the 1960s, decompression illness after breath-hold diving has been widely debated. The aim of this study was to detect circulating bubbles after breath-hold diving in underwater fishing divers. We used continuous Doppler (DUG, COMEX Pro) and transthoracic two-dimensional (2D) echocardiography (Kontron Sigma 1). This study was conducted during a training course organized by the French Federation of Subaquatic Sports at Minorca (Balearic Islands). Ten breath-hold divers performed repeated breath-hold dives for periods ranging from 2 to 6 h [mean maximum depth 35 meters of seawater (msw)]. A dive computer (Maestro Pro Beuchat, analyst PC interface) was used to record diving patterns. No circulating bubbles were detected in the right heart cavities (2D echocardiography) or in the pulmonary artery (continuous Doppler). However, this study had some limits: only 10 subjects were studied and the earliest detection was 3 min after immersion, further studies will thus be required. PMID:9444062

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

    PubMed Central

    2014-01-01

    (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

  6. Can Transthoracic Echocardiography Be Used to Predict Fluid Responsiveness in the Critically Ill Patient? A Systematic Review

    PubMed Central

    Mandeville, Justin C.; Colebourn, Claire L.

    2012-01-01

    Introduction. We systematically evaluated the use of transthoracic echocardiography in the assessment of dynamic markers of preload to predict fluid responsiveness in the critically ill adult patient. Methods. Studies in the critically ill using transthoracic echocardiography (TTE) to predict a response in stroke volume or cardiac output to a fluid load were selected. Selection was limited to English language and adult patients. Studies on patients with an open thorax or abdomen were excluded. Results. The predictive power of diagnostic accuracy of inferior vena cava diameter and transaortic Doppler signal changes with the respiratory cycle or passive leg raising in mechanically ventilated patients was strong throughout the articles reviewed. Limitations of the technique relate to patient tolerance of the procedure, adequacy of acoustic windows, and operator skill. Conclusions. Transthoracic echocardiographic techniques accurately predict fluid responsiveness in critically ill patients. Discriminative power is not affected by the technique selected. PMID:22400109

  7. Optimizing benefit from CRT: role of speckle tracking echocardiography, the importance of LV lead position and scar.

    PubMed

    Kydd, Anna C; McCormick, Liam M; Dutka, David P

    2012-09-01

    Cardiac resynchronization therapy is demonstrated to be effective in patients with advanced heart failure. Correcting mechanical dyssynchrony is proposed as the predominant mechanism of response. Achieving optimum left ventricular lead position, at the site of maximal mechanical dyssynchrony but away from transmural scar, is identified as one of the main determinants of both symptomatic and prognostic benefit. Strategies employing multimodality cardiac imaging techniques have been used to identify this optimal pacing site, in addition to any potential anatomical limitations to successful implantation. Speckle tracking echocardiography offers prospective lead targeting, incorporating pathophysiological determinants of cardiac resynchronization therapy response. This review considers the key factors in defining optimum left ventricular lead location, emphasizing the role of myocardial scar. The use of speckle tracking echocardiography and the potential for this technique to be incorporated into routine practice to guide the implant strategy in an individual patient is discussed. PMID:23116079

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

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

    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.

  9. Cross-sectional echocardiography. II. Analysis of mathematic models for quantifying volume of the formalin-fixed left ventricle.

    PubMed

    Wyatt, H L; Heng, M K; Meerbaum, S; Gueret, P; Hestenes, J; Dula, E; Corday, E

    1980-06-01

    Cross-sectional echocardiography was used to quantify volume in 21 canine left ventricles that were fixed in formalin and immersed in mineral oil. Area, length and diameter measurements were obtained from short- and long-axis cross-sectional images of the left ventricle and volume was calculated by seven mathematic models. Calculated volume was then compared, by linear regression and percent error analyses, with fluid volume of the left ventricle, obtained by filling the chamber with a known amount of fluid. Volumes ranged from 13-146 ml. Mathematic models using short-axis area and long-axis length gave higher correlation coefficients (r = 0.982 and r = 0.969) and lower mean errors (10-20%) than standard formulas previously used for M-mode echo and angiography. Thus, short-axis area analysis with cross-sectional echocardiography is well-suited for quantifying left ventricular volumes in dogs. PMID:7371124

  10. Lack of correlation between intracavitary thrombosis detected by cross sectional echocardiography and systemic emboli in patients with dilated cardiomyopathy.

    PubMed Central

    Ciaccheri, M; Castelli, G; Cecchi, F; Nannini, M; Santoro, G; Troiani, V; Zuppiroli, A; Dolara, A

    1989-01-01

    The correlation between intracavitary thrombosis detected by cross sectional echocardiography and systemic embolism was studied in 126 consecutive patients with idiopathic dilated cardiomyopathy who were examined from January 1980 to September 1987. A total of 1041 serial echocardiograms were obtained with 3.5 and 5 MHz transducers. The mean follow up period was 41.2 months. The survival rate was 88% at two years and 56% at five years. Echocardiography showed intracavitary thrombi in 14 (11.1%) patients; 13 were mural and 11 were localised at the apex of the left ventricle. Twelve patients (8.4%) had systemic emboli; this corresponded to an incidence of new embolic events of 1.4 for 100 patient-years. Patients with intracavitary thrombi or systemic emboli were treated with oral anticoagulants, as were nine in functional class IV of the New York Heart Association, for 61 patient-years. The cumulative observation period for the whole population study was 418 patient-years. None of the patients with intracavitary thrombosis had embolic complications and none of those with embolism had intracavitary thrombi. Rates of intracavitary thrombosis and systemic embolism in this series were low and there was no overlap between the two events. This may have been because the patients did not have severe dilated cardiomyopathy, because echocardiography did not detect all the thrombi, or because patients were treated with oral anticoagulants. The presence of intracardiac thrombosis detected by cross sectional echocardiography is not predictive of systemic embolism in patients with idiopathic dilated cardiomyopathy. Criteria for the use of the anticoagulant treatment remain largely empirical in these cases. Images Fig 1 Fig 2 PMID:2757871

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

    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.

  12. A case of saddle pulmonary embolus visualized on a transthoracic echocardiography in a 69-year-old female

    PubMed Central

    Poudel, Dilli Ram; Giri, Smith; Pathak, Ranjan; Hwang, Inyong; Alsafwah, Shadwan

    2016-01-01

    A 69-year-old female with history of immobilization presented with shortness of breath and generalized weakness and was found to have large saddle pulmonary embolus on CT scan. Further evaluation with a transthoracic echocardiography revealed a moderately enlarged and hypokinetic right ventricle with a pulmonary artery clot of about 1.5 cm seen at the bifurcation while the ultrasound of the legs was negative for deep vein thrombosis. PMID:27124169

  13. Diagnostic Performance of Echocardiography for the Detection of Acute Cardiac Allograft Rejection: A Systematic Review and Meta-Analysis

    PubMed Central

    Pan, Xudong; Sun, Lizhong

    2015-01-01

    Objective Many studies have addressed the diagnostic performance of echocardiography to evaluate acute cardiac allograft rejection compared with endomyocardial biopsy. But the existence of heterogeneity limited its clinical application. Thus, we conducted a comprehensive, systematic literature review and meta-analysis for the purpose. Methods Studies prior to September 1, 2014 identified by Medline/PubMed, EMBASE and Cochrance were examined by two independent reviews. We conducted meta-analysis by using Meta-DiSc 1.4 software. An assessment tool of QUADAS-2 was applied to evaluate the risk of bias and applicability of the studies. Results Thirty studies met the inclusion criteria of meta-analysis. The four parameters of pressure half time, isovolumic relaxation time, index of myocardial performance and late diastolic mitral annular motion velocity were included in the meta-analysis, with a pooled diagnostic odds ratio of 10.43, 6.89, 15.95 and 5.68 respectively, and the area under the summary receiver operating characteristic curves value of 0.829, 0.599, 0.871 and 0.685 respectively. Conclusion The meta-analysis and systematic review demonstrate that no single parameter of echocardiography showed a reliable diagnostic performance for acute cardiac allograft rejection. A result of echocardiography for ACAR should be comprehensively considered by physicians in the context of clinical presentations and imaging feature. PMID:25822627

  14. A low-cost digital filing system for echocardiography data with MPEG4 compression and its application to remote diagnosis.

    PubMed

    Umeda, Akira; Iwata, Yasushi; Okada, Yasumasa; Shimada, Megumi; Baba, Akiyasu; Minatogawa, Yasuyuki; Yamada, Takayasu; Chino, Masao; Watanabe, Takafumi; Akaishi, Makoto

    2004-12-01

    The high cost of digital echocardiographs and the large size of data files hinder the adoption of remote diagnosis of digitized echocardiography data. We have developed a low-cost digital filing system for echocardiography data. In this system, data from a conventional analog echocardiograph are captured using a personal computer (PC) equipped with an analog-to-digital converter board. Motion picture data are promptly compressed using a moving pictures expert group (MPEG) 4 codec. The digitized data with preliminary reports obtained in a rural hospital are then sent to cardiologists at distant urban general hospitals via the internet. The cardiologists can evaluate the data using widely available movie-viewing software (Windows Media Player). The diagnostic accuracy of this double-check system was confirmed by comparison with ordinary super-VHS videotapes. We have demonstrated that digitization of echocardiography data from a conventional analog echocardiograph and MPEG 4 compression can be performed using an ordinary PC-based system, and that this system enables highly efficient digital storage and remote diagnosis at low cost. PMID:15562270

  15. Appropriate Use Criteria in Echocardiography: An Observational Institutional Study with the Perspective of a Quality Improvement Project

    PubMed Central

    Rameh, Vanessa; Kossaify, Antoine

    2016-01-01

    BACKGROUND Appropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse, and preserving health-care resources. OBJECTIVES The aim of this study was to ascertain the AUC for transthoracic echocardiography in a university hospital and create a quality improvement project (QIP). METHODS The assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 AUC report. Indications were classified as appropriate, uncertain, or inappropriate, and patients not matching any of the abovementioned divisions were grouped in the nonfitting category. RESULTS Of the 501 eligible patients, 374 patients (74.66%) were in the appropriate group, 85 patients (16.96%) in the inappropriate group, 20 patients (3.99%) in the uncertain group, and 22 patients (4.39%) in the nonfitting category. DISCUSSION Interpretation and analysis of the obtained results are presented, along with the results of many comparable studies; moreover, a QIP was set up accordingly. CONCLUSION AUC are useful to assess local practice, preserve health-care resources, and improve clinical outcome. PMID:26917982

  16. Goal-directed transthoracic echocardiography during advanced cardiac life support: A pilot study using simulation to assess ability

    PubMed Central

    Greenstein, Yonatan Y.; Martin, Thomas J.; Rolnitzky, Linda; Felner, Kevin; Kaufman, Brian

    2015-01-01

    Introduction Goal-directed echocardiography (GDE) is used to answer specific clinical questions which provide invaluable information to physicians managing a hemodynamically unstable patient. We studied perception and ability of housestaff previously trained in GDE to accurately diagnose common causes of cardiac arrest during simulated advanced cardiac life support (ACLS); we compared their results to those of expert echocardiographers. Methods Eleven pulmonary and critical care medicine fellows, seven emergency medicine residents, and five cardiologists board-certified in echocardiography were enrolled. Baseline ability to acquire four transthoracic echocardiography views was assessed and participants were exposed to six simulated cardiac arrests and were asked to perform a GDE during ACLS. Housestaff performance was compared to the performance of five expert echocardiographers. Results Average baseline and scenario views by housestaff were of good or excellent quality 89% and 83% of the time, respectively. Expert average baseline and scenario views were always of good or excellent quality. Housestaff and experts made the correct diagnosis in 68% and 77% of cases, respectively. On average, participants required 1.5 pulse checks to make the correct diagnosis. 94% of housestaff perceived this study as an accurate assessment of ability. Conclusions In an ACLS compliant manner, housestaff are capable of diagnosing management altering pathologies the majority of the time and they reach similar diagnostic conclusions in the same amount of time as expert echocardiographers in a simulated cardiac arrest scenario. PMID:25932707

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

    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.

  18. Left ventricular assist device inflow cannula thrombus: characterization with two-dimensional transthoracic echocardiography.

    PubMed

    Missov, Emil

    2013-01-01

    Thrombotic complications are inherent to current generation nonpulsatile left ventricular assist devices. The clinical expression of device thrombosis ranges from catastrophic failure to protracted and indolent. We report the case of a 79-year-old patient who received a left ventricular assist device as destination therapy and presented only with vague clinical symptoms. He was found to have a large thrombus in close proximity with the inflow cannula at the left ventricular apex, raising the question of mechanical obstruction. We describe the step-by-step contrast-enhanced two-dimensional transthoracic echocardiographic examination which allowed to obtain diagnostic acoustic tomograms of the inflow cannula and obviated the need for any additional imaging modalities. Transthoracic echocardiography (TTE) is the most common imaging modality used in the clinical follow-up of left ventricular assist device recipients. A frequent clinical indication for TTE is to exclude left ventricular apical thrombus near the inflow cannula. Imaging of the inflow cannula at the left ventricular apex in the traditional apical 4 chamber, apical 2 chamber, and parasternal long axis views is challenging by TTE mainly because of poor acoustic windows, image artifacts, large body habitus, and operator experience. PMID:24172272

  19. Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

    PubMed Central

    Ayoub, Amal Mohamed; Keddeas, Viola William; Ali, Yasmin Abdelrazek; El Okl, Reham Atef

    2016-01-01

    BACKGROUND Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. METHODS We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). RESULTS There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson’s method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. CONCLUSION 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention. PMID:27385916

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

    SciTech Connect

    Kinsella, J.P.; Morrow, W.R.; Gerstmann, D.R.; Taylor, A.F.; deLemos, R.A. )

    1991-04-01

    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.

  1. Trans-esophageal echocardiography in off-pump coronary artery bypass grafting.

    PubMed

    Kapoor, Poonam Malhotra; Chowdhury, Ujjwal; Mandal, Banashree; Kiran, Usha; Karnatak, Rajendra

    2009-01-01

    Two features of off-pump coronary artery bypass (OPCAB) can lead to hemodynamic instability: transient occlusion of coronary arteries during distal anastomosis construction and displacement of the heart to provide access to distal coronary arteries. The position of the heart during OPCAB trans-esophageal echocardiography (TEE) can often provide an indication as to how much compression of the right or left ventricle has occurred. If either chamber is not filling, repositioning of the heart will be necessary. Close observation of the heart with TEE during periods of coronary occlusion may facilitate detection of worsening cardiac function as evidenced by weakening contraction, ventricular dilatation, or increasing mitral or tricuspid regurgitation. Haemodynamic changes are more pronounced with displacement of the heart to access posterior coronary arteries than anterior vessels. Cardiac manipulations during off-pump coronary artery bypass grafting (OPCABG) can lead to haemodynamic instability. This, along with distal anastomosis causing transient occlusion of coronary arteries, may cause transient hypotension with increased filling pressures. TEE is more helpful in this scenario. In these patients, TEE helps differentiate between cardiac dysfunction and secondary to myocardial ischemia in which regional wall motion abnormalities will be present from a much more common scenario where the increase in filling pressure is secondary to extra cardiac compression and provides the ability to detect mitral regurgitation (MR) with a color-flow Doppler, as well as assess right heart function. PMID:19602750

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

    PubMed

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

    2001-06-01

    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. PMID:11356605

  3. Frequency Dependence of Petechial Hemorrhage and Cardiomyocyte Injury Induced during Myocardial Contrast Echocardiography.

    PubMed

    Miller, Douglas L; Lu, Xiaofang; Fabiilli, Mario; Fields, Kristina; Dou, Chunyan

    2016-08-01

    Myocardial contrast echocardiography (MCE) for perfusion imaging can induce microscale bio-effects during intermittent high-Mechanical Index scans. The dependence of MCE-induced bio-effects on the ultrasonic frequency was examined in rats at 1.6, 2.5 and 3.5 MHz. Premature complexes were counted in the electrocardiogram, petechial hemorrhages with microvascular leakage on the heart surface were observed at the time of exposure, plasma troponin elevation was measured after 4 h and cardiomyocyte injury was detected at 24 h. Increasing response to exposure above an apparent threshold was observed for all endpoints at each frequency. The effects decreased with increasing ultrasonic frequency, and the thresholds increased. Linear regressions for frequency-dependent thresholds indicated coefficients and exponents of 0.6 and 1.07 for petechial hemorrhages, respectively, and 1.02 and 0.8 for cardiomyocyte death, compared with 1.9 and 0.5 (square root) for the guideline limit of the mechanical index. The results clarify the dependence of cardiac bio-effects on frequency, and should allow development of theoretical descriptions of the phenomena and improved safety guidance for MCE. PMID:27126240

  4. Pulse wave velocity correlates with aortic atherosclerosis assessed with transesophageal echocardiography.

    PubMed

    Szmigielski, C; Styczyński, G; Sobczyńska, M; Milewska, A; Placha, G; Kuch-Wocial, A

    2016-02-01

    Aortic pulse wave velocity (PWV) is a noninvasive vascular parameter that is related to cardiovascular risk. We studied the relationship between aortic PWV and aortic atherosclerosis assessed with transesophageal echocardiography (TEE). The patients referred for TEE before electrical cardioversion of atrial fibrillation were included in the study. Maximal intima-media thickness (IMT) including maximal atherosclerotic plaque thickness of the descending thoracic aorta was measured on TEE images. PWV was measured in those patients who had the sinus rhythm restored. Univariable linear regression was used to test associations between the parameters studied. Variables identified by linear regression, as significantly related to PWV, were further analyzed by multivariable linear regression models. We studied 99 patients (57 men, 42 women, mean age 70.4±11.5 years). With univariable regression, we found that PWV was significantly related to IMT (P<0.0001), age (P<0.0001) and pulse pressure (PP, P=0.005). There was no significant relationship between PWV and systolic, diastolic and mean blood pressures, as well as heart rate. The multivariable regression analysis, with all the variables significant in the univariable analysis in the model, showed that only IMT remained significantly related to PWV (P<0.0001, β=0.31), whereas age (P=0.18) and PP (P=0.16) were not. In conclusion, PWV is related to aortic atherosclerosis assessed with TEE independent of age and blood pressure. PMID:25903165

  5. Pulmonary vein antrum isolation guided by phased-array intracardiac echocardiography

    PubMed Central

    Scholten, M.F.; Thornton, A.S.; Mekel, J.; Rivero-Ayerza, M.J.; Marrouche, N.F.; Jordaens, L.J.

    2005-01-01

    Background Pulmonary vein isolation (PVI) has emerged as an important strategy in the treatment of patients with atrial fibrillation (AF). The two most frequently used techniques are segmental PVI and left atrial circumferential ablation. Aim To describe and discuss pulmonary vein antrum isolation guided by phased-array intracardiac echocardiography (ICE) as an alternative approach, and to present initial results. Methods Patients with symptomatic AF were included. The antra (the larger circumferential area around the PVs) were isolated guided by ICE. ICE was also used to titrate the ablation energy. Results 38 patients (3 with persistent AF) were included. Of the 35 patients with paroxysmal AF, 24 are without recurrences, and in six the incidence of paroxysms was significantly reduced after one procedure and a mean follow-up of 201 days. No major complications occurred. Conclusion Pulmonary vein antrum isolation guided by ICE is a promising technique in AF ablation and has the potential to avoid severe complications. ImagesFigure 1Figure 2Figure 4 PMID:25696440

  6. Feasibility of radial and circumferential strain analysis using 2D speckle tracking echocardiography in cats.

    PubMed

    Takano, Hiroshi; Isogai, Tomomi; Aoki, Takuma; Wakao, Yoshito; Fujii, Yoko

    2015-02-01

    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

  7. Automated Segmentation of the Right Ventricle in 3D Echocardiography: A Kalman Filter State Estimation Approach.

    PubMed

    Bersvendsen, Jorn; Orderud, Fredrik; Massey, Richard John; Fosså, Kristian; Gerard, Olivier; Urheim, Stig; Samset, Eigil

    2016-01-01

    As the right ventricle's (RV) role in cardiovascular diseases is being more widely recognized, interest in RV imaging, function and quantification is growing. However, there are currently few RV quantification methods for 3D echocardiography presented in the literature or commercially available. In this paper we propose an automated RV segmentation method for 3D echocardiographic images. We represent the RV geometry by a Doo-Sabin subdivision surface with deformation modes derived from a training set of manual segmentations. The segmentation is then represented as a state estimation problem and solved with an extended Kalman filter by combining the RV geometry with a motion model and edge detection. Validation was performed by comparing surface-surface distances, volumes and ejection fractions in 17 patients with aortic insufficiency between the proposed method, magnetic resonance imaging (MRI), and a manual echocardiographic reference. The algorithm was efficient with a mean computation time of 2.0 s. The mean absolute distances between the proposed and manual segmentations were 3.6 ± 0.7 mm. Good agreements of end diastolic volume, end systolic volume and ejection fraction with respect to MRI ( -26±24 mL , -16±26 mL and 0 ± 10%, respectively) and a manual echocardiographic reference (7 ± 30 mL, 13 ± 17 mL and -5±7% , respectively) were observed. PMID:26168434

  8. 3D reconstruction and quantitative assessment method of mitral eccentric regurgitation from color Doppler echocardiography

    NASA Astrophysics Data System (ADS)

    Liu, Qi; Ge, Yi Nan; Wang, Tian Fu; Zheng, Chang Qiong; Zheng, Yi

    2005-10-01

    Based on the two-dimensional color Doppler image in this article, multilane transesophageal rotational scanning method is used to acquire original Doppler echocardiography while echocardiogram is recorded synchronously. After filtering and interpolation, the surface rendering and volume rendering methods are performed. Through analyzing the color-bar information and the color Doppler flow image's superposition principle, the grayscale mitral anatomical structure and color-coded regurgitation velocity parameter were separated from color Doppler flow images, three-dimensional reconstruction of mitral structure and regurgitation velocity distribution was implemented separately, fusion visualization of the reconstructed regurgitation velocity distribution parameter with its corresponding 3D mitral anatomical structures was realized, which can be used in observing the position, phase, direction and measuring the jet length, area, volume, space distribution and severity level of the mitral regurgitation. In addition, in patients with eccentric mitral regurgitation, this new modality overcomes the inherent limitations of two-dimensional color Doppler flow image by depicting the full extent of the jet trajectory, the area of eccentric regurgitation on three-dimensional image was much larger than that on two-dimensional image, the area variation tendency and volume variation tendency of regurgitation have been shown in figure at different angle and different systolic phase. The study shows that three-dimensional color Doppler provides quantitative measurements of eccentric mitral regurgitation that are more accurate and reproducible than conventional color Doppler.

  9. Catheter-based left atrial appendage occlusion procedure: role of echocardiography.

    PubMed

    Perk, Gila; Biner, Simon; Kronzon, Itzhak; Saric, Muhamed; Chinitz, Larry; Thompson, Keith; Shiota, Takahiro; Hussani, Asma; Lang, Roberto; Siegel, Robert; Kar, Saibal

    2012-02-01

    Atrial fibrillation is a common, clinically significant arrhythmic disorder that results in increased risk of morbidity and mortality in affected patients. Atrial fibrillation is more prevalent among men compared with women and the risk for developing atrial fibrillation increases with advancing age. Ischaemic stroke is the most common clinical manifestation of embolic events from atrial fibrillation. While anticoagulation treatment is the preferred treatment, unfortunately, many patients have contraindications for anticoagulation treatment making this option unavailable to them. Previous data have shown that most thrombi that form in association with non-valvular atrial fibrillation occur in the left atrial appendage (LAA). It has been suggested that isolating the LAA from the body of the left atrium might reduce the risk of embolic events and that LAA obliteration may be a treatment option for patients with atrial fibrillation who are not candidates for anticoagulation treatment. Several procedures have been developed for isolation of the LAA, including surgical procedures as well as catheter-based ones. In this paper, we will review the currently available techniques, emphasizing the catheter-based ones. We will examine the increasing role of real-time three-dimensional transoesophageal echocardiography for appropriate screening and patient selection for these procedures, intra-procedural guidance, and follow-up care. PMID:21903725

  10. Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography

    NASA Technical Reports Server (NTRS)

    Lin, S. S.; Tiong, I. Y.; Asher, C. R.; Murphy, M. T.; Thomas, J. D.; Griffin, B. P.

    2000-01-01

    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.

  11. Evaluation of left and right ventricular myocardial function after lung resection using speckle tracking echocardiography

    PubMed Central

    Wang, Zhenhua; Yuan, Jianjun; Chu, Wen; Kou, Yuhong; Zhang, Xijun

    2016-01-01

    Abstract The impact of major lung resections on myocardial function has not been well-investigated. We aimed to identify this impact through the use of speckle tracking echocardiography (STE) to evaluate the right and left ventricular myocardial function in patients who underwent lung resections. Thirty patients who had lung resections were recruited for this study. Ten patients who underwent pneumonectomies were matched by age and sex, with 20 patients who underwent lobectomies. STE was performed on both right and left ventricle (RV and LV). Strain values of pre and postlung resections were compared in both the pneumonectomy group and the lobectomy group. Comparison between the pneumonectomy group and the lobectomy group was also studied. Left ventricular ejection fraction remained normal (>55%), but significantly decreased after lung resection in both the pneumonectomy group and the lobectomy group. An accelerated heart rate was observed in both groups after lung resection, with the pneumonectomy group demonstrating extra rapid heart rate (P < 0.05). Strain values in the RV and LV decreased in both groups after lung resection, with the pneumonectomy group exhibiting a further decrease in longitudinal strain in LV and RV when compared with the lobectomy group (P < 0.05). Right and left ventricular dysfunction can occur after lung resection regardless of pneumonectomy or lobectomy, and lobectomy may have a less significant impact on myocardial functions. This study demonstrated that STE is able to detect acute cardiac dysfunction after lung resection. PMID:27495031

  12. Aortic stenosis in adults. Non-invasive estimation of pressure differences by continuous wave Doppler echocardiography.

    PubMed Central

    Hegrenaes, L; Hatle, L

    1985-01-01

    The peak and mean aortic transvalvar pressure differences measured invasively and non-invasively by continuous wave Doppler echocardiography were compared in 87 consecutive patients with aortic stenosis. The mean values were calculated from the maximal velocities of the aortic jet recorded with a spectral display of the Doppler frequency shifts and by applying a modified Bernoulli equation. Technically satisfactory velocity curves for estimating the mean pressure differences could not be obtained in three patients and invasive measurements were not obtained in two. In all patients the peak transvalvar pressure difference was calculated since the aortic jet was identified non-invasively. The peak and mean pressure differences measured invasively and non-invasively correlated well--with only minor underestimation of the pressure differences measured with the Doppler technique--regardless of age, sex, and the presence or absence of aortic valvar regurgitation, or other valvar lesions. With a systematic search for the highest velocities in the aortic jet and with on line spectral analysis of the Doppler frequencies the peak and the mean aortic pressure differences can be determined non-invasively with a high degree of precision in almost all patients. Images PMID:4052281

  13. Integration of trans-esophageal echocardiography with magnetic tracking technology for cardiac interventions

    NASA Astrophysics Data System (ADS)

    Moore, John T.; Wiles, Andrew D.; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Trejos, Ana Luisa; Patel, Rajni; Peters, Terry M.

    2010-02-01

    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.

  14. Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after cerebrovascular stroke

    PubMed Central

    Vogelgesang, Dirk; Dahm, Johannes B; Großmann, Holm; Hippe, Andre; Hummel, Astrid; Lotze, Christian; Vogelgesang, Silke

    2008-01-01

    Primary malignant cardiac tumors (cardiac angiosarcomas) are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT) scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease. PMID:19066013

  15. Essential training steps to achieving competency in the basic intraoperative transesophageal echocardiography examination for Chinese anesthesiologists.

    PubMed

    Peng, Yong G; Song, Haibo; Wang, E; Wang, Weipeng; Liu, Jin

    2015-03-01

    Guidelines for the intraoperative transesophageal echocardiography (TEE) examination have defined a detailed standard for medical professionals, particularly anesthesiologists, on how a TEE exam should proceed. Over the years, TEE has gained substantial popularity and emerged as a preferred monitoring modality to aid in perioperative management and decision making during hemodynamic instability situations or critical care settings. TEE training pathways and practice guidelines have been well established in western countries and many regions of the world. However, TEE training and practice information for anesthesiologists are lacking in China. As innovative technologies develop, other educational models have emerged to aid in obtaining competency in basic TEE exam. Hence, establishing a consensus on the ideal TEE training approach for anesthesiologists in China is urgently needed. Developing an effective curriculum that can be incorporated into an anesthesiology resident's overall training is also necessary to provide knowledge and skills toward competency in basic TEE exam. With evolving medical system reforms and increasing demands for intraoperative hemodynamic monitoring to accommodate surgical innovations, anesthesiology professionals are increasingly obliged to perform intraoperative TEE exams in their current and future practices. To overcome obstacles and achieve significant progress in using the TEE modality to help in intraoperative management and surgical decision making, publishing basic TEE training guidelines for China's anesthesiologists is an important endeavor. PMID:25337689

  16. Development of recognition software of heart to find the standard cross section on echocardiography.

    PubMed

    Masuda, Kohji; Matsuura, Hirotaka; Imai, Takao; Inoue, Hiroto

    2007-01-01

    We have developed an algorithm to find standard cross sections (the long-axis view and the short-axis view) of the heart from successive echograms. We first divided an echogram into small spatial regions and detected the typical motion of the mitral valve by analyzing the brightness variation and correlation coefficient among the regions. We have obtained 95% accuracy in the position of the valve through time series echogram of 25 normal volunteers. The recognized valve was visualized as a mark on the video stream. Furthermore, combining this technique with an optical flow method, we elucidated the region velocity of the wall motion of the left ventricle after centering the valve on echogram. By analyzing symmetry among region velocity, we have confirmed to distinguish between the long- and the short-axis view of heart. This algorism is applicable to instruction software to find standard cross section of the heart as an assistant of echocardiography. We are going to apply to more subjects who have heart disease and to contribute automatic diagnosis in the future. PMID:18001962

  17. Feasibility of radial and circumferential strain analysis using 2D speckle tracking echocardiography in cats

    PubMed Central

    TAKANO, Hiroshi; ISOGAI, Tomomi; AOKI, Takuma; WAKAO, Yoshito; FUJII, Yoko

    2014-01-01

    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

  18. Early Cardiac Valvular Changes in Ankylosing Spondylitis: A Transesophageal Echocardiography Study

    PubMed Central

    Park, So-Hee; Joe, Byung-Hyun; Hwang, Hui-Jeong; Park, Chang-Bum; Jin, Eun-Sun; Cho, Jin-Man; Kim, Chong-Jin; Bae, Jong-Hoa; Lee, Sang-Hoon

    2012-01-01

    Background This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients. Methods A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I (< 10 years, n = 50) and group II (≥ 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients. Results The thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers. Conclusion Thickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution. PMID:22509436

  19. Echocardiography as a Predicting Method in Diagnosis, Evaluation and Assessment of Children with Subvalvar Aortic Stenosis

    PubMed Central

    Bejiqi, Ramush; Bejiqi, Hana; Retkoceri, Ragip

    2016-01-01

    BACKGROUND: Obstruction to the left ventricular outflow of the heart may be above the aortic valve (5%), at the valve (74%), or in the subvalvar region (23%). These anomalies represent 3 to 6% of all patients with congenital heart defects (CHD), and it occurs more often in males (male-female ratio of 4:1). AIM: The purpose of this study was to determine the sensitivity and specificity of transthoracic echocardiography in diagnosis of discrete subaortic membrane, to determine convenient time for surgical intervention, and for identifying involvement of the aortic valve by subaortic shelf. MATERIAL AND METHODS: A retrospective review of the medical records and echocardiograms of 18 patients [14 male (77%) and 4 female (23%)] with discrete subaortic membrane, aged 11 month to 12 years, with mean age of 5 years and 3 month, diagnosed at the Pediatric Clinic in Prishtina, during the period September, 1999 and December, 2010 were done. RESULTS: Four patients, in neonatal age were operated from critical coarctation of the aorta and, initial signs of congestive heart failure were presented. 2 of them were operated in Belgrade, Serbia and 2 in Lausanne, Switzerland. CONCLUSION: In all presented patients bicuspid aortic valve was noted, but none of them subaortic membrane was registered. PMID:27275334

  20. Transthoracic echocardiography may be useful for preoperative cardiac evaluation of gynaecological patients undergoing routine surgery.

    PubMed

    Shrestha, B; Pradhan, P; Shakya, G R; Giri, A; Regmi, R; Dhungel, S

    2012-12-01

    Echocardiography has been an integral noninvasive tool for [preoperative] cardiac evaluation that provides with echocardiographic details which may also be useful to perioperative clinicians to tailor their anesthetic deliberation while dealing with preoperative patients. The objective of this study is preoperative evaluation of routine gynecological patients echocardiographically after being referred from respective internists or anesthesiologists. This was a prospective, nonrandomized study of elective 68 cases who underwent echocardiographic evaluation preoperatively from 15th July 2009 to 14th July 2012. The mean age of the patients was 52.1 +/- 10.3 years with the age range of 30-79 years. Valvular heart disease was the most common echocardiographic finding (129.4%) followed by left ventricular diastolic dysfunction, LVDD (48.5%) and left ventricular hypertrophy (22.1%). Systolic dysfunction was detected in 2.9% of patients and pulmonary arterial hypertension in 2.9% patients. Amongst patients referred after preoperative anaesthetic evaluation, patients had different cardiac lesions echocardiographically. Preoperative echocardiographic evaluation may provide important cardiac informations and values which might be employed by perioperative physicians to tailor their treatment. PMID:24579536

  1. Left Ventricular Strain and Rotation by 2-D Speckle Tracking Echocardiography Identify Early Alcoholic Cardiomyopathy.

    PubMed

    Wang, Yuanzheng; Li, Guangsen; Sun, Yanhong; Shan, Guoxin; Xu, Rui; Guo, Lijuan

    2016-08-01

    This study assessed whether 2-D speckle tracking echocardiography (STE) derived from left ventricular (LV) strain and rotation is capable of detecting LV dysfunction associated with alcoholic cardiomyopathy. Ninety-two male chronic alcoholic patients were grouped by alcohol intake amount and duration: mild (n = 30; >90 mg ethanol daily, 3-5 d per wk for 5-8 y); moderate (n = 30; >90-150 mg ethanol daily, 3-5 d per wk for 9-20 y); and severe (n = 32; >150 mg ethanol daily, 6-7 d per wk for >10 y). Thirty non-drinkers were recruited as healthy controls. Rotation and twist values were lower in the severe group compared with the other groups (p < 0.05). The moderate and severe alcohol groups demonstrated lower longitudinal, circumferential and radial strain values and early to late filling (E/A) ratios compared with the mild group and non-drinkers (all p < 0.05). 2-D STE-derived strain and rotation are reliable echocardiographic markers for detecting left ventricular dysfunction in patients at risk of developing alcoholic cardiomyopathy. PMID:27156014

  2. Assessment of mitral Björk-Shiley prosthetic dysfunction using digitised M mode echocardiography.

    PubMed Central

    Dawkins, K D; Cotter, L; Gibson, D G

    1984-01-01

    Digitised M mode echocardiograms were analysed in 22 patients with possible Björk-Shiley mitral prosthetic dysfunction. Patients with paraprosthetic mitral regurgitation had a significantly greater shortening fraction, an increased peak rate of dimension change during systole, and an increased peak velocity of circumferential fibre shortening than those with poor left ventricular function. Patients with a clotted prosthesis had lower values for shortening fraction and peak rate of dimension change during systole than patients with paraprosthetic regurgitation. In this latter group, the peak rate of dimension change during diastole and peak lengthening rate were greater than in either those patients with poor left ventricular function or those with a clotted prosthesis. In addition, the peak lengthening rate was greater in those with a clotted prosthesis than in those with poor left ventricular function. Thus M mode echocardiography is a useful method of assessing mitral prosthetic dysfunction and allows patients with paraprosthetic regurgitation to be distinguished from those with either poor left ventricular function or a clotted prosthesis. PMID:6691866

  3. Standardized Evaluation System for Left Ventricular Segmentation Algorithms in 3D Echocardiography.

    PubMed

    Bernard, Olivier; Bosch, Johan G; Heyde, Brecht; Alessandrini, Martino; Barbosa, Daniel; Camarasu-Pop, Sorina; Cervenansky, Frederic; Valette, Sebastien; Mirea, Oana; Bernier, Michel; Jodoin, Pierre-Marc; Domingos, Jaime Santo; Stebbing, Richard V; Keraudren, Kevin; Oktay, Ozan; Caballero, Jose; Shi, Wei; Rueckert, Daniel; Milletari, Fausto; Ahmadi, Seyed-Ahmad; Smistad, Erik; Lindseth, Frank; van Stralen, Maartje; Wang, Chen; Smedby, Orjan; Donal, Erwan; Monaghan, Mark; Papachristidis, Alex; Geleijnse, Marcel L; Galli, Elena; D'hooge, Jan

    2016-04-01

    Real-time 3D Echocardiography (RT3DE) has been proven to be an accurate tool for left ventricular (LV) volume assessment. However, identification of the LV endocardium remains a challenging task, mainly because of the low tissue/blood contrast of the images combined with typical artifacts. Several semi and fully automatic algorithms have been proposed for segmenting the endocardium in RT3DE data in order to extract relevant clinical indices, but a systematic and fair comparison between such methods has so far been impossible due to the lack of a publicly available common database. Here, we introduce a standardized evaluation framework to reliably evaluate and compare the performance of the algorithms developed to segment the LV border in RT3DE. A database consisting of 45 multivendor cardiac ultrasound recordings acquired at different centers with corresponding reference measurements from three experts are made available. The algorithms from nine research groups were quantitatively evaluated and compared using the proposed online platform. The results showed that the best methods produce promising results with respect to the experts' measurements for the extraction of clinical indices, and that they offer good segmentation precision in terms of mean distance error in the context of the experts' variability range. The platform remains open for new submissions. PMID:26625409

  4. Accretions of dark matter and dark energy onto (n+2)-dimensional Schwarzschild black hole and Morris-Thorne wormhole

    NASA Astrophysics Data System (ADS)

    Debnath, Ujjal

    2015-12-01

    In this work, we have studied accretion of the dark matter and dark energy onto of (n+2)-dimensional Schwarzschild black hole and Morris-Thorne wormhole. The mass and the rate of change of mass for (n+2)-dimensional Schwarzschild black hole and Morris-Thorne wormhole have been found. We have assumed some candidates of dark energy like holographic dark energy, new agegraphic dark energy, quintessence, tachyon, DBI-essence, etc. The black hole mass and the wormhole mass have been calculated in term of redshift when dark matter and above types of dark energies accrete onto them separately. We have shown that the black hole mass increases and wormhole mass decreases for holographic dark energy, new agegraphic dark energy, quintessence, tachyon accretion and the slope of increasing/decreasing of mass sensitively depends on the dimension. But for DBI-essence accretion, the black hole mass first increases and then decreases and the wormhole mass first decreases and then increases and the slope of increasing/decreasing of mass not sensitively depends on the dimension.

  5. Differentiation of acute renal failure and chronic renal failure by 2-dimensional analysis of urinary dipeptidase versus serum creatinine.

    PubMed

    Lee, S H; Kang, B Y; We, J S; Park, S K; Park, H S

    1999-03-01

    The differential diagnosis of acute renal failure (ARF) and chronic renal failure (CRF) may be possible by measuring urinary dipeptidase (Udpase) activity and serum creatinine (Scr) concentration. When the mass test of 246 individuals was examined on a 2-dimensional plot of Udpase (y-axis) versus Scr (x-axis) with the data obtained from healthy volunteers (n = 189), ARF (n = 19) and CRF (n = 38) patients, the characteristic distribution of each group was obvious. It is summarized by the mean values of healthy volunteers (1.44 +/- 0.39 mg/dL, 1.19 (0.59 mU/mL), ARF (6.04 +/- 5.04 mg/dL, 0.12 +/- 0.08 mU/mL), and CRF patients (8.72 +/- 2.93 mg/dL, 0.81 +/- 0.44 mU/mL). The healthy volunteers are distributed along the y-axis and the ARF patients the x-axis, thus separating the two groups 90 degrees apart. The CRF patients are scattered away from both x-, and y-axis. This 2-dimensional approach is thought to be very useful for the differential diagnosis of ARF suggesting Udpase as a new member of the marker enzymes of renal disease. PMID:10088177

  6. Quantitation of mitral regurgitation after percutaneous MitraClip repair: comparison of Doppler echocardiography and cardiac magnetic resonance imaging

    PubMed Central

    Strugnell, Wendy; Gaikwad, Niranjan; Ischenko, Matthew; Speranza, Vicki; Chan, Jonathan; Neill, Johanne; Platts, David; Scalia, Gregory M.; Burstow, Darryl J.; Walters, Darren L.

    2015-01-01

    Objective Percutaneous valve intervention for severe mitral regurgitation (MR) using the MitraClip is a novel technology. Quantitative assessment of residual MR by transthoracic echocardiography (TTE) is challenging, with multiple eccentric jets and artifact from the clips. Cardiovascular magnetic resonance (CMR) is the reference standard for left and right ventricular volumetric assessment. CMR phase-contrast flow imaging has superior reproducibility for quantitation of MR compared to echocardiography. The objective of this study was to establish the feasibility and reproducibility of CMR in quantitating residual MR after MitraClip insertion in a prospective study. Methods Twenty-five patients underwent successful MitraClip insertion. Nine were excluded due to non-magnetic resonance imaging (MRI) compatible implants or arrhythmia, leaving 16 who underwent a comprehensive CMR examination at 1.5 T (Siemens Aera) with multiplanar steady state free precession (SSFP) cine imaging (cine CMR), and phase-contrast flow acquisitions (flow CMR) at the mitral annulus atrial to the MitraClip, and the proximal aorta. Same-day echocardiography was performed with two-dimensional (2D) visualization and Doppler. CMR and echocardiographic data were independently and blindly analyzed by expert readers. Inter-rater comparison was made by concordance correlation coefficient (CCC) with 95% confidence intervals (CIs), and Bland-Altman (BA) methods. Results Mean age was 79 years, and mean LVEF was 44%±11% by CMR and 54%±16% by echocardiography. Inter-observer reproducibility of echocardiographic visual categorical grading by expert readers was poor, with a CCC of 0.475 (−0.7, 0.74). Echocardiographic Doppler regurgitant fraction reproducibility was modest (CCC 0.59, 0.15-0.84; BA mean difference −3.7%, −38% to 31%). CMR regurgitant fraction reproducibility was excellent (CCC 0.95, 0.86-0.98; BA mean difference −2.4%, −11.9 to 7.0), with a lower mean difference and narrower

  7. Three-dimensional transesophageal echocardiography for descending aortic atheroma: a preliminary study.

    PubMed

    Hammoudi, Nadjib; Ihaddaden, Malek; Lang, Sylvie; Laveau, Florent; Ederhy, Stephane; Michel, Pierre-Louis; Alamowitch, Sonia; Cohen, Ariel

    2014-12-01

    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

  8. Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography

    PubMed Central

    Shen, Xuedong; Aronow, Wilbert S.; Nair, Chandra K.; Korlakunta, Hema; Holmberg, Mark J.; Wang, Fenwei; Maciejewski, Stephanie; Esterbrooks, Dennis J.

    2011-01-01

    Introduction We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA). Material and methods We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ≥ 50% stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (≥ 70% narrowing). Results HRCA was present in 45 of 187 patients (24%). AA severity was grade I in 55 patients (29%), grade II in 71 patients (38%), grade III in 52 patients (28%), grade IV in 5 patients (3%), and grade V in 4 patients (2%). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76% and 81%, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p< 0.0001). During 41-month follow-up, 15 of 61 patients (25%) with AA >grade II and 10 of 126 patients (8%) with AA grade ≤ 2 died (p= 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ≤ grade II (p= 0.002). Conclusions AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality. PMID:22291734

  9. Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics

    PubMed Central

    Montealegre-Gallegos, Mario; Mahmood, Feroze; Kim, Han; Bergman, Remco; Mitchell, John D.; Bose, Ruma; Hawthorne, Katie M.; O’Halloran, T. David; Wong, Vanessa; Hess, Philip E.; Matyal, Robina

    2016-01-01

    Background: Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. Methods and Results: During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance. Conclusion: Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE. PMID:27052064

  10. Digital stress-echocardiography using a public domain program for the Macintosh personal computer.

    PubMed

    Albiero, R; Variola, A; Dander, B; Buonanno, C

    1995-12-01

    Left ventricular wall motion abnormalities secondary to stress-induced myocardial ischemia can be detected with difficulty by mentally comparing echocardiographic images sequentially recorded on videotape. Digital stress-echocardiography, a combination of ultrasound imaging and digital archiving technologies, at least partially can overcome this problem: the technique is based on reviewing images at rest and after stress (exercise or pharmacological) side by side in dual- or quad-screen digital format, in a synchronized cine-loop, as if obtained simultaneously. This technique however is presently not widely used, due to the high cost of most commercially available systems. We have developed a digital stress-echo system, which is easy to use and relatively inexpensive, running on a Macintosh II personal computer with 8-bit graphics. The 2-D echocardiographic images recorded on videotape are digitized offline using a video digitizing board. The image can be displayed and analyzed using the public domain NIH image software developed by Wayne Rasband, without loss in image quality and resolution, particularly if using Super-VHS videotape. We have made a macro procedure for the montage in a quad-screen format of four digital recorded echocardiographic cardiac cycles of six frames that takes only a little more time than commercially available systems. In conclusion, the use of a personal computer and low-cost software may help to make digital stress-echo techniques more widely feasible in the clinical setting and increase the diagnostic power of the ultrasound technique in the evaluation of patients with known or suspected coronary artery disease. PMID:8770533

  11. Pediatric digital echocardiography: a study of the analog-to-digital transition.

    PubMed

    Mathewson, J W; Perry, J C; Maginot, K R; Cocalis, M

    2000-06-01

    Limited information is available that describes the practical conversion of a pediatric echocardiography laboratory from videotape to a primarily digital format. To help pediatric echocardiographers begin to make the analog-to-digital transition, we report our pediatric digital acquisition protocol and the acquisition and storage parameters of 1000 unselected, consecutive digitally acquired studies of pediatric patients with known or suspected congenital or acquired heart disease. With the use of our acquisition protocol, a complete normal study requires 46 moving clips and 12 still-frame images. Five hundred consecutive patient studies acquired with "high" JPEG (Joint Photographers Experts Group) compression (group 1) were compared with the next 500 examinations acquired using "medium" JPEG compression (group 2) for number of moving clips, still images, and megabytes of storage space. No intergroup difference was found in the number of moving clips or still images. When JPEG compression was decreased from high to medium, the average clip storage requirement per patient increased, and the number of patients stored per 230-MB magneto optical disk decreased significantly. Non-ECG-triggered timed single-plane clips and still images required significantly more storage space than ECG-triggered single-beat clips and still images. The frequency of multiplane sweeps was.03% and was independent of diagnosis. With the use of high JPEG compression, the digital storage cost per patient was $1.90, which was 6.0 times greater than that for simultaneously recorded 120-minute VHS videotape. Many features of the digital paradigm, including decreased MOD storage space, enhanced serial study comparisons, random image access, and improved image quality, mitigate this cost differential. PMID:10849510

  12. Left ventricular systolic function during stress echocardiography exercise in subjects with asymptomatic hereditary hemochromatosis.

    PubMed

    Shizukuda, Yukitaka; Bolan, Charles D; Tripodi, Dorothy J; Yau, Yu-Ying; Smith, Kevin P; Sachdev, Vandana; Birdsall, Charles W; Sidenko, Stanislav; Waclawiw, Myron A; Leitman, Susan F; Rosing, Douglas R

    2006-09-01

    There is no information available on left ventricular (LV) systolic function and the response to stress echocardiography in asymptomatic subjects with hereditary hemochromatosis (HH). To evaluate this topic, 43 asymptomatic subjects with HH homozygous for the C282Y HFE gene mutation (22 untreated subjects [group A] and 21 long-term treated subjects [group B]) were compared with 21 age- and gender-matched normal volunteers negative for HFE mutations. Contractile reserve, as a measure of LV systolic function, was assessed using continuous echocardiographic imaging and electrocardiography during supine bicycle exercise. Nineteen subjects in group A had repeat tests after 6 months of induction phlebotomy therapy to assess the effect of iron removal. Exercise performance and hemodynamic variables of supine bicycle exercise were comparable between subjects with HH and controls. LV contractile reserve of asymptomatic subjects with HH was not impaired at either a 75-W submaximal exercise level (mean +/- SD difference in ejection fraction from baseline 13.8 +/- 6.2%, 11.5 +/- 6.8%, and 13.4 +/- 7.8% in groups A, B, and C, respectively; p = NS for all by analysis of variance) or at peak exercise (difference in ejection fraction from baseline 18.9 +/- 6.9%, 18.4 +/- 7.8%, and 20.3 +/- 8.1% in groups A, B, and C, respectively; p = NS for all by analysis of variance). However, the incidence of abnormal ischemic stress electrocardiographic responses was more frequent in subjects with HH as a whole (33%) compared with normal subjects (10%). Stress imaging revealed no regional wall motion abnormalities, suggesting that these were false-positive results. Iron removal by induction phlebotomy did not affect stress echocardiographic performance. In conclusion, LV systolic function during exercise in asymptomatic subjects with HH is preserved, and 6-month induction phlebotomy does not affect stress echocardiographic performance. PMID:16923464

  13. [Doppler echocardiography for the assessment of left ventricular diastolic function: methodology, clinical and prognostic value].

    PubMed

    Galderisi, Maurizio; Dini, Frank Lloyd; Temporelli, Pier Luigi; Colonna, Paolo; de Simone, Giovanni

    2004-02-01

    To date, left ventricular diastolic function can be clinically assessed by Doppler echocardiography. The Doppler recording of mitral inflow and pulmonary venous flow provides main information about ventricular diastolic properties. At the level of the mitral inflow we can measure the early diastolic peak velocity (E), atrial peak velocity and derive their ratio, the E velocity deceleration time and isovolumic relaxation time, and calculate atrial filling fraction. At the level of the pulmonary veins, the peak systolic velocity (S), the peak diastolic velocity (D), the S/D ratio, the peak of reverse atrial velocity and its duration, above all in terms of difference with the mitral A duration, characterize the different patterns of diastolic function. Also the new ultrasound technologies are clinically useful to define ventricular diastolic properties. The myocardial early diastolic velocity (Em) detectable by pulsed tissue Doppler at the level of the mitral annulus, and the flow propagation velocity (Vp) recordable by color M-mode of left ventricular inflow, both relatively preload-independent, are measurements related to tau, the reference hemodynamic variable. The E/Em and E/Vp ratios provide accurate estimation of the changes in left ventricular end-diastolic pressure. They allow us to distinguish the pseudonormal and restrictive patterns from the normal pattern and are, therefore, alternative tools to Valsalva maneuver of mitral inflow and pulmonary venous flow. The predictive value of the pattern of abnormal relaxation (grade I of diastolic dysfunction) and both the reversible and irreversible restrictive patterns (grade III and IV respectively) is now demonstrated and permits important prognostic stratification and appropriate therapeutic management. PMID:15080528

  14. Role of transthoracic echocardiography in the estimation of coronary sinus blood flow in coronary artery disease

    PubMed Central

    Meenakshi, K; Swaminathan, Srikumar; Manickam, Rajendran

    2013-01-01

    Background Coronary sinus blood flow (CSBF) is reduced in coronary artery disease (CAD). Objective To evaluate the usefulness of transthoracic echocardiography (TTE) in assessing CSBF in patients with CAD. Methods and results 232 patients with CAD, including 28 patients with acute myocardial infarction (AMI) (thrombolysed), 80 patients with unstable angina and delayed presentation MI, 80 patients admitted for coronary angiography (CAG) and 44 patients awaiting percutaneous transluminal coronary angioplasty (PTCA) were evaluated with TTE to obtain CSBF values; results were compared with those of controls. In the CAG group, the correlation between CSBF and lesion severity was assessed while in the thrombolysis and PTCA groups, CSBF levels before and after treatment were evaluated. The control group had a coronary sinus diameter of 8.73±2.08 mm and mean CSBF of 441±172 mL/min. Both the diameter and mean CSBF levels were reduced in patients with CAD. In the AMI group, patients with anterior wall myocardial infarction (AWMI) showed a greater percentage increase in CSBF after thrombolysis than patients with inferior wall myocardial infarction (IWMI). In the CAG group, patients with lower CSBF values (<300 mL/min) had more multivessel involvement, especially in patients with AWMI than in those with IWMI. In the PTCA group, patients with AWMI with initial CSBF levels <300 mL/min had a greater percentage increase in CSBF levels after stenting than patients with AWMI with CSBF values >300 mL/min. Conclusions Non-invasive assessment of CSBF by TTE is a simple, cost-effective, imaging modality in patients with CAD, especially for risk stratification and assessing therapeutic success.

  15. Fetal Cardiodynamics by Echocardiography in Insulin Dependent Maternal Diabetes and Its Correlation with Pregnancy Outcome

    PubMed Central

    Pilania, Rashmi; Rohit, Manoj K.; Suri, Vanita; Kumar, Praveen

    2016-01-01

    Introduction Maternal diabetes mellitus is associated with an increased risk of fetal and neonatal morbidity and mortality. Usual screening tests have not proved to be good prognostic indicators of fetal distress. Fetal cardiodynamics is potentially a useful screening tool. Aim To determine if cardiodynamics of the fetus differ in pregnancy with diabetes requiring insulin than those without and to determine whether cardiodynamics predict fetal and neonatal outcomes. Materials and Methods This prospective case control study was carried out in 40 pregnant women with diabetes who required insulin for blood sugar control. Twenty uncomplicated pregnant women were taken as controls. Systolic and diastolic cardiac functions along with interventricular septal thickness were assessed at 26-28 weeks and again at 34-36 weeks of gestation in fetuses by echocardiography. Fetal and neonatal adverse outcomes were evaluated in terms of major and minor morbidity. Results Among all parameters, E/A ratio across both mitral and tricuspid valves, myocardial performance index and cardiac output were significantly different in fetuses of diabetic mothers at both gestations. However, pulmonary vein pulsatility index and interventricular septal thickness were similar between the two groups. At 26-28 weeks of gestation myocardial performance index correlated with abnormal biophysical profile whereas cardiac output correlated with minor morbidity. At 34-36 weeks of gestation, cardiac output correlated with abnormal biophysical profile while both MPI and cardiac output correlated with minor morbidity. Conclusion Echocardiographic parameters of fetuses of diabetic women significantly differed from those of uncomplicated non-diabetic women. However, only myocardial performance index and cardiac output correlated with adverse fetal and neonatal outcomes.

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

    PubMed

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

    2014-10-01

    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

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

    PubMed Central

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

    2013-01-01

    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

  18. Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions

    PubMed Central

    2012-01-01

    Background Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). Results On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a “four-chamber” and “LVOT view” was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0° and 25°. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. Conclusions This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases. PMID:22862855

  19. Changes in transmural distribution of myocardial perfusion assessed by quantitative intravenous myocardial contrast echocardiography in humans

    PubMed Central

    Fukuda, S; Muro, T; Hozumi, T; Watanabe, H; Shimada, K; Yoshiyama, M; Takeuchi, K; Yoshikawa, J

    2002-01-01

    Objective: To clarify whether changes in transmural distribution of myocardial perfusion under significant coronary artery stenosis can be assessed by quantitative intravenous myocardial contrast echocardiography (MCE) in humans. Methods: 31 patients underwent dipyridamole stress MCE and quantitative coronary angiography. Intravenous MCE was performed by continuous infusion of Levovist. Images were obtained from the apical four chamber view with alternating pulsing intervals both at rest and after dipyridamole infusion. Images were analysed offline by placing regions of interest over both endocardial and epicardial sides of the mid-septum. The background subtracted intensity versus pulsing interval plots were fitted to an exponential function, y = A (1 − e−βt), where A is plateau level and β is rate of rise. Results: Of the 31 patients, 16 had significant stenosis (> 70%) in the left anterior descending artery (group A) and 15 did not (group B). At rest, there were no differences in the A endocardial to epicardial ratio (A-EER) and β-EER between the two groups (mean (SD) 1.2 (0.6) v 1.2 (0.8) and 1.2 (0.7) v 1.1 (0.6), respectively, NS). During hyperaemia, β-EER in group A was significantly lower than that in group B (1.0 (0.5) v 1.4 (0.5), p < 0.05) and A-EER did not differ between the two groups (1.0 (0.5) v 1.2 (0.4), NS). Conclusions: Changes in transmural distribution of myocardial perfusion under significant coronary artery stenosis can be assessed by quantitative intravenous MCE in humans. PMID:12231594

  20. Temporal obesity trends in patients undergoing transthoracic echocardiography 2002-2006.

    PubMed

    Rao, Seshu C; Kusnetzky, Lisa L; Lan, Xiao; Main, Michael L

    2009-03-01

    In a recent data brief, the National Center for Health Statistics reported that obesity prevalence has plateaued in recent years, with no increase in obesity from 2003 to 2006. We have subjectively observed a marked increase in clinically severe obesity over this same period in patients presenting to our echocardiographic laboratory. The aim of this study was to determine temporal trends in obesity prevalence in patients presenting for transthoracic echocardiographic studies. A retrospective database analysis was performed using the Cardiovascular Consultants (Kansas City, Missouri) database (ProSolv Cardiovascular, Indianapolis, Indiana). The height and weight of patients who underwent transthoracic echocardiography in 2002 (n = 10,804) and 2006 (n = 17,556) were obtained. Body mass index was calculated as weight/height squared. Patients were grouped into 1 of 6 body mass index categories (underweight, normal weight, overweight, obese, morbidly obese, or super obese). Continuous variables were compared using Student's t test, and categorical variables were compared using chi-square test. In the 2 years, approximately (1/3) of patients were normal weight and (1/3) of patients were overweight. Obesity prevalence increased significantly (by nearly 8%) over the study period, with 28.1% of patients in the obese category by 2006. Clinically severe obesity (morbidly obese and super obese) increased dramatically from 2002 to 2006 (16%, p <0.008, and 41.7%, p <0.001, increases, respectively). In conclusion, clinically severe obesity has markedly increased in our midwestern echocardiographic laboratory in the period from 2002 to 2006. PMID:19231334

  1. Characteristics of Patent Foramen Ovale Associated with Cryptogenic Stroke: A Biplane Transesophageal Echocardiography Study

    NASA Technical Reports Server (NTRS)

    Homma, S.; DiTullio, M. R.; Sacco, R. L.; Mihalatos, D..; LiMandri, G.; Mohr, J. P.

    1994-01-01

    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.

  2. Doppler Echocardiography Inaccurately Estimates Right Ventricular Pressure in Children with Elevated Right Heart Pressure

    PubMed Central

    Groh, Georgeann K.; Levy, Philip T.; Holland, Mark R.; Murphy, Joshua J.; Sekarski, Timothy J.; Myers, Craig L.; Hartman, Diana P.; Roiger, Rebecca D.; Singh, Gautam K.

    2013-01-01

    Background Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been prospectively validated in children. The objective of this study was to evaluate the accuracy of DE in predicting simultaneously measured RV pressure by RHC in pediatric patients, and to determine if the degree of RV hypertension affects the accuracy of DE in assessing right heart pressure. Methods Eighty children (age 0–17.9 years, median 5.5 years) with two-ventricle physiology and a wide range of right heart pressures underwent simultaneous DE and RHC. The pressure gradient between the right ventricle and right atrium was directly measured by RHC and simultaneously estimated by DE using tricuspid valve regurgitation. Patients were then grouped based on RHC measured right ventricular systolic pressure (RVSP): group 1 (n=43) with RVSP <1/2 systemic systolic blood pressure (SBP); group 2 (n=37) with RVSP ≥1/2 SBP; group 3 (n=56) with RVSP <2/3 SBP; and group 4 (n=24) with RVSP ≥2/3 SBP. Correlation and Bland-Altman analyses were performed on all groups. Accuracy was predefined as 95% limits of agreement within ±10mmHg. Results Despite a reasonable correlation between DE and RHC in all groups, there was poor agreement between techniques as RVSP/SBP increased. DE was inaccurate in 1/43 (2%) patients in group 1 versus 9/37 (24%) in group 2, and was inaccurate in 1/56 (2%) in group 3 versus 8/24 (33%) in group 4. Over- and underestimation occurred equally in all groups. Conclusion DE inaccurately estimates right ventricular pressure in children with elevated right heart pressure. It should not be relied upon as the sole method of assessing right heart hemodynamics in children with RV hypertension. PMID:24183542

  3. [Wall motion abnormalities and hemodynamic parameters in patients with left bundle branch block during exercise echocardiography].

    PubMed

    Dupliakov, D V; Vozhdaeva, Z I; Sysuenkova, E V; Zemlianova, M E; Lotina, A S; Goleva, S V; Svetlakova, A P; Khokhlunov, S M

    2011-01-01

    Study aim was to investigate dynamics of local contractility and hemodynamic parameters during exercise stress echocardiography (EEcho) in patients with left bundle branch block (LBBB). We examined 23 patients (15 men, 8 women) aged 48-65 years (mean age 53.9+/-8.1 years). Bicycle EEcho was accomplished according to standard protocol. Patients without clinical signs of ischemic heart disease (n=11) comprised group 1, patients after myocardial infarction (n=12) - group 2 (subgroup 2A - with negative test result, subgroup 2B - with worsening of local left ventricular contractility during EEcho). At baseline group 1 patients had significantly better hemodynamic parameters (ejection fraction - EF, left ventricular end diastolic volume - LVEDV) and no abnormalities of local contractility. Exercise tolerance was also the highest in this group. Insignificant worsening of postexercise EF occurred in patients of subgroup 2B (from 46+/-10.5 to 44,2+/-9.4%). In group 1 EF significantly increased (from 56.8+/-10.5% to 64.7+/-15.4%, <0.05), in subgroup 2A tendency to EF increase up to 48.7+/-9.9% was registered. Lowering of local contractility abnormalities index was noted also only in patients of subgroup 2B (from 1.54+/-0.4 to 2.17+/-0.37 (p<0.01). LVEDV compared with initial values tended to decrease in both groups (however differences between groups were not significant). Positive echocardiographic response was associated with significant changes of transmitral blood flow. Angiographically clean coronary arteries were found in 8 of 10 patients in group 1. Six group 2 patients with history of typical clinical picture of angina and myocardial infarction) had multivessel lesions in coronary vascular bed. EEcho result was positive in 5 of 6 group 2 patients. Thus EEcho possesses high potential for diagnosis of coronary atherosclerosis in patients with LBBB. This allows recommending it as a first line method in patients with this pathology. PMID:21623720

  4. [Changes in the left ventricular function in hemodialyzed patients. Role of Doppler echocardiography].

    PubMed

    Cavarra, M; Lo Giudice, P; Statella, P; Liuzzo, G; Circo, A

    1993-09-01

    The aim of this study was to provide a further contribution to the study on the alterations of left ventricular diastolic function induced by dialysis, using simple indexes of diastolic function obtained with Doppler. The study is conduced in 15 patients with renal failure aged between 22 and 51 years old by means of echocardiography M-2D a pulsed Doppler analysis of the left ventricular refilling flow, evaluated before and after dialysis. By the results is risen up that the dLA has had a significant reduction (p = 0.032), the dSLV have undergone a reduction that is not being significant, while the dDLV has had a significant reduction (p = 0.029), shortening fraction is improved even if in a not significant manner. Also the Doppler indexes has had a behaviour homogeneous in the group of studied patients. Early ventricular refilling is reduced, as showed by the reduction of E, consequence of the reduction preload, while the diastolic late refilling has showed a little increment, expressed by the increase af the peak A. The variations of these indexes, even if not statistically significant, express an alteration of pattern diastolic Doppler caused by both the reduction of preload and the alteration of ventricular relaxation. Besides this alteration, to our notice, is not to consider expression of myocardial compromise in this group studied patients. It would be however useful enlargement of the study to greater number of patients with follow-up for better comprehension of this cardiopathy and makes a more individual treatment of these patients. PMID:8259230

  5. Red cell distribution width as a predictor of left atrial spontaneous echo contrast in echocardiography.

    PubMed

    Gerede, Demet M; Kaya, Cansın T; Vurgun, Veysel K; Acıbuca, Aynur; Tak, Bahar T; Ongun, Aydan; Kılıckap, Mustafa; Erol, Cetin

    2015-04-01

    Red cell distribution width (RDW) represents the heterogeneity of red blood cells (anisocytosis). Spontaneous echo contrast (SEC) is thought to be a manifestation of red cell aggregation and it has been linked to the development of thromboemboli. The aim of this study was to evaluate the association between RDW levels and the presence of left atrial SEC (LASEC). One-hundred and 72 patients who underwent transesophageal echocardiography for various indications were enrolled in the study. All patients were categorized into 2 groups according to the presence of LASEC and into 4 groups according to the severity of LASEC. The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups. The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001). When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001). In the ROC analysis, an RDW level >13.8% had 70% sensitivity and 89.2% specificity in predicting LASEC (area under the curve = 0.834, P < 0.0001, 95% CI 0.656-0.773). In multivariate analysis, RDW levels >13.8% and the presence of atrial fibrillation were independently associated with LASEC (odds ratio [OR] 1.697; 95% confidence interval [CI] 1.198-2.085; P = 0.001 and OR 1.586; 95% CI 1.195-2.098; P = 0.003, respectively]. Elevated RDW value is associated with the presence and the severity of SEC. RDW may be a useful marker and independent predictor for the presence of SEC. PMID:25860216

  6. Red cell Distribution Width as a Predictor of Left Atrial Spontaneous Echo Contrast in Echocardiography

    PubMed Central

    Gerede, Demet M.; Kaya, Cansın T.; Vurgun, Veysel K.; Acıbuca, Aynur; Tak, Bahar T.; Ongun, Aydan; Kılıckap, Mustafa; Erol, Cetin

    2015-01-01

    Abstract Red cell distribution width (RDW) represents the heterogeneity of red blood cells (anisocytosis). Spontaneous echo contrast (SEC) is thought to be a manifestation of red cell aggregation and it has been linked to the development of thromboemboli. The aim of this study was to evaluate the association between RDW levels and the presence of left atrial SEC (LASEC). One-hundred and 72 patients who underwent transesophageal echocardiography for various indications were enrolled in the study. All patients were categorized into 2 groups according to the presence of LASEC and into 4 groups according to the severity of LASEC. The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups. The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001). When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001). In the ROC analysis, an RDW level >13.8% had 70% sensitivity and 89.2% specificity in predicting LASEC (area under the curve = 0.834, P < 0.0001, 95% CI 0.656–0.773). In multivariate analysis, RDW levels >13.8% and the presence of atrial fibrillation were independently associated with LASEC (odds ratio [OR] 1.697; 95% confidence interval [CI] 1.198–2.085; P = 0.001 and OR 1.586; 95% CI 1.195–2.098; P = 0.003, respectively]. Elevated RDW value is associated with the presence and the severity of SEC. RDW may be a useful marker and independent predictor for the presence of SEC. PMID:25860216

  7. Temporally diffeomorphic cardiac motion estimation from three-dimensional echocardiography by minimization of intensity consistency error

    PubMed Central

    Zhang, Zhijun; Ashraf, Muhammad; Sahn, David J.; Song, Xubo

    2014-01-01

    Purpose: Quantitative analysis of cardiac motion is important for evaluation of heart function. Three dimensional (3D) echocardiography is among the most frequently used imaging modalities for motion estimation because it is convenient, real-time, low-cost, and nonionizing. However, motion estimation from 3D echocardiographic sequences is still a challenging problem due to low image quality and image corruption by noise and artifacts. Methods: The authors have developed a temporally diffeomorphic motion estimation approach in which the velocity field instead of the displacement field was optimized. The optimal velocity field optimizes a novel similarity function, which we call the intensity consistency error, defined as multiple consecutive frames evolving to each time point. The optimization problem is solved by using the steepest descent method. Results: Experiments with simulated datasets, images of an ex vivo rabbit phantom, images of in vivo open-chest pig hearts, and healthy human images were used to validate the authors’ method. Simulated and real cardiac sequences tests showed that results in the authors’ method are more accurate than other competing temporal diffeomorphic methods. Tests with sonomicrometry showed that the tracked crystal positions have good agreement with ground truth and the authors’ method has higher accuracy than the temporal diffeomorphic free-form deformation (TDFFD) method. Validation with an open-access human cardiac dataset showed that the authors’ method has smaller feature tracking errors than both TDFFD and frame-to-frame methods. Conclusions: The authors proposed a diffeomorphic motion estimation method with temporal smoothness by constraining the velocity field to have maximum local intensity consistency within multiple consecutive frames. The estimated motion using the authors’ method has good temporal consistency and is more accurate than other temporally diffeomorphic motion estimation methods. PMID:24784402

  8. Right ventricular function assessment using tissue Doppler imaging and speckle tracking echocardiography

    PubMed Central

    Pietrzak, Radosław

    2014-01-01

    Modern echocardiographic techniques, i.e. tissue Doppler imaging and speckle tracking echocardiography, allow for an assessment of global and regional right ventricular function. The right ventricular myocardial performance index and tricuspid annulus motion are used in the assessment of global right ventricular function, whereas duration of the cardiac cycle phases and myocardial velocities are used in the assessment of regional function. Strain and strain rate allow for an evaluation of both regional and global myocardial function. Literature reports provide data on the usefulness of these methods in patients with pressure and volume overload as well as with direct myocardial damage involving the right ventricle. In pulmonary hypertension, S’ wave assessment may be used for therapeutic efficacy evaluation. Longitudinal strain reduction indicates an increased risk of vascular events, while an increased value of myocardial performance index is a predictor for a survival in pulmonary hypertension. A decreased S’ wave velocity is associated with limited pulmonary vascular flow in patients with pulmonary embolism. In patients after atrial baffle repair for transposition of the great arteries, decreased longitudinal strain was an independent predictor for heart failure. A statistically significant decrease in both the S’ wave as well as acceleration during isovolumic contraction were observed in arrhythmogenic right ventricular cardiomyopathy. S’ wave and global right ventricular longitudinal strain values were lower in patients in the acute phase of myocardial infarction involving the right ventricle compared to the corresponding parameters in healthy individuals. In the case of tetralogy of Fallot correction, the evaluation of S’ wave velocity may prove useful in identifying patients with reduced cardiac systolic reserve; a good correlation was also found between the global right ventricular longitudinal strain and right ventricular ejection fraction in MRI

  9. Evaluation of transesophageal echocardiography in detecting cardiac sources of emboli in ischemic stroke patients

    PubMed Central

    Toodeji, Mohammad Amin; Izadi, Sadegh; Shariat, Abdolhamid; Nikoo, Mohamad Hosin

    2015-01-01

    Background: Embolus is one of the causes of ischemic stroke that can be due to cardiac sources such as valvular heart diseases and atrial fibrillation and atheroma of the aorta. Transesophageal echocardiography (TEE) is superior in identifying potential cardiac sources of emboli. Due to insufficient data on TEE findings in ischemic stroke in Iran, the present study was done to evaluate TEE in detecting cardiac sources of emboli. The main aim of this study was to describe the cardiogenic sources of emboli using TEE in the ischemic stroke patients. Methods: This is a cross-sectional study conducted during a 13-month period from January 2012 to February 2013 in Shiraz Nemazee teaching hospital. Patients admitted with stroke diagnosis were included; but hemorrhagic stroke cases were excluded. 229 patients with ischemic stroke diagnosis were included and underwent TEE. Results: Causes of cardiac emboli were detected in 65 cases (40.7%) and categorized to high-risk (29.7%) and potential risk (11%). High risk cardiac sources included atrial fibrillation (8.7%), mitral valve disease (MS or MI) 11 cases (4.75%), aortic valve disease (AS or AI) 8 (3.5%), prosthetic valve 3 (1.35%), dilated cardiomyopathy 45 (19.65%) and congestive heart failure with ejection fraction < 30% in 8 cases (3.5%). Potential cardiac sources of emboli comprised 7 cases (3.05%) of septal aneurysm, 4 (1.75%) left ventricular hypokinesia, 13 (5.7%) mitral annular calcification and 9 cases (3.95%) complex atheroma in the ascending aorta or proximal arch. Conclusion: Our study showed that high risk cardiac sources of emboli can be detected using TEE in a considerable percentage of ischemic stroke patients. The most common high risk cardiac etiologies were dilated cardiomyopathy and valvular heart diseases. PMID:26793628

  10. Staphylococcus aureus bacteraemia: evaluation of the role of transoesophageal echocardiography in identifying clinically unsuspected endocarditis.

    PubMed

    Incani, A; Hair, C; Purnell, P; O'Brien, D P; Cheng, A C; Appelbe, A; Athan, E

    2013-08-01

    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

  11. Intracardiac echocardiography guided transeptal catheter injection of microspheres for assessment of cerebral microcirculation in experimental models.

    PubMed

    Bellapart, Judith; Dunster, Kimble R; Diab, Sara; Platts, David G; Raffel, Christopher; Gabrielian, Levon; Maybauer, Marc O; Barnett, Adrian; Boots, Robert James; Fraser, John F

    2013-01-01

    The use of microspheres for the determination of regional microvascular blood flow (RMBF) has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02; 0.57-1.02 mL/min/g, slice 04; 0.45-1.42 mL/min/g, slice 06; 0.35-1.87 mL/min/g, slice 08; 0.46-1.77 mL/min/g, slice 10; 0.34-1.28 mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models. PMID:24102032

  12. Venous and paradoxical air embolism in the sitting position. A prospective study with transoesophageal echocardiography.

    PubMed

    Papadopoulos, G; Kuhly, P; Brock, M; Rudolph, K H; Link, J; Eyrich, K

    1994-01-01

    This prospective study investigates the frequency of patent foramen ovale (PFO), venous air embolism (VAE) and paradoxical air embolism (PAE) by transoesophageal echocardiography (TOE) in neurosurgical patients operated on in the sitting position. The risk of PAE after exclusion of PFO is assessed. A PFO was identified by pre-operative TOE and VAE and PAE by continuous intraoperative TOE. Sixty-two patients were divided into two groups, 22 patients were studied in group 1 (posterior fossa surgery) and group 2 (cervical surgery) contained 40 patients. Pre-operative TOE demonstrated a PFO in 5 of the 22 patients in group 1 (23%). Patients with proven PFO were excluded from the sitting position. Two further patients of this group (12% of 17 patients), in whom a PFO had been excluded pre-operatively, nevertheless had PAE, air occurring in all cavities of the heart. In group 2 the incidence of PFO was 4 out of 40 patients (10%). No PAE was observed in this group. Three morphological types of VAE with different haemodynamic and ventilation changes were demonstrated. VAE was observed in 76% of all posterior fossa operations and in 25% of cervical laminectomies. We conclude that a pre-operative search for PFO is mandatory considering its incidence of 23% in group 1 and of 10% in group 2, and the risk of PAE. If a PFO is detected, the sitting position should be avoided. A residual risk for PAE remains despite exclusion of PFO because the reliability of TOE is limited. TOE is the method of choice for detecting VAE and PAE. PMID:8042546

  13. Speckle Tracking Echocardiography to Evaluate for Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease.

    PubMed

    Rice, Jessica L; Stream, Amanda R; Fox, Daniel L; Geraci, Mark W; Vandivier, R William; Dorosz, Jennifer L; Bull, Todd M

    2016-10-01

    Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD), increasing morbidity and mortality. Current echocardiographic measures have poor predictive value for the diagnosis of PH in COPD. Right ventricular (RV) strain obtained by speckle tracking echocardiography (STE) is a measure of myocardial deformation which correlates with RV function and survival in subjects with pulmonary arterial hypertension. We hypothesized that RV strain measurements would be feasible and correlate with invasive hemodynamic measurements in patients with COPD. Retrospective analysis of RV strain values from subjects with severe COPD with echocardiogram within 48 hours of right heart catheterization was performed. First, 54 subjects were included in the analysis. Right ventricular systolic pressure (RVSP) and RV strain could be estimated in 31% and 57%, respectively. Then, 61% had RV-focused apical views, and of those, RV strain could be obtained for 94%. RV free wall strain correlated with PVR (r = 0.41, p = 0.02). Subjects with pulmonary vascular resistance (PVR) > 3 Wood units (WU) had less negative (worse) RV free wall strain values than those with PVR ≤ 3 WU, with a median strain of -20 (-23, -12) versus -23 (-29, -15), p < 0.05. A receiver operating characteristic curve demonstrated an RV free wall strain of > -23 to be 92% sensitive and 44% specific for identifying PVR > 3 WU (AUC 0.71). RV strain estimates are feasible in the majority of subjects with severe COPD. RV strain correlates with PVR and may improve screening for PH in subjects with COPD. PMID:26829151

  14. Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study.

    PubMed

    Cavallari, Ilaria; Mega, Simona; Goffredo, Costanza; Patti, Giuseppe; Chello, Massimo; Di Sciascio, Germano

    2015-06-01

    Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P < 0.001). HHE resulted in a consistent save of waiting time because it was performed the same day of clinical evaluation whereas patients waited 10.1 ± 6.1 days for a standard echocardiography (P < 0.001). This study suggests the potential role of HHE for pre-operative evaluation of selected patients undergoing non-cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography. PMID:25985940

  15. A new 2-dimensional method for constructing visualized treatment objectives for distraction osteogenesis of the short mandible.

    PubMed

    van Beek, H

    2010-01-01

    Open bite development during distraction of the mandible is common and partly due to inaccurate planning of the treatment. Conflicting guidelines exist in the literature. A method for Visualized Treatment Objective (VTO) construction is presented as an aid for determining the correct orientation of monodirectional and multidirectional distractors. Distraction on the left and on the right side of the mandible takes place in a parallel manner in order to maintain intercondylar width. It follows that in the absence of marked asymmetry, the amount of mandibular body distraction, the amount of ramus distraction and (should it apply), the amount of closure of the gonial angle, can be derived from a simple 2-dimensional plan. After presurgical orthodontic treatment, a cephalogram is taken and a VTO is constructed, that aims at a good occlusion with the enhanced mandible in centric relation, with little or no change of the original position of the rami. PMID:19837600

  16. Impact of mode partition noise in free-running gain-switched Fabry-Perot laser for 2-dimensional OCDMA.

    PubMed

    Wang, Xu; Chan, Kam

    2004-07-26

    Free-running gain-switched Fabry-Perot laser diode is an appropriate incoherent broadband optical source for incoherent 2-dimensional optical code division multiple access. However, the mode partition noise (MPN) in the laser seriously degrades performance. We derived a bit error rate (BER) expression in the presence of MPN using the power spectra of the laser. The theory agreed with the experimental results. There was a power penalty and BER floor due to the MPN in the laser. Therefore, this scheme should be operated with a sufficiently large number of modes. At least 9 modes should be used for error-free transmission at 1 Gbit/s for the laser we investigated in this work. PMID:19483858

  17. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging.

    PubMed

    Lancellotti, Patrizio; Pibarot, Philippe; Chambers, John; Edvardsen, Thor; Delgado, Victoria; Dulgheru, Raluca; Pepi, Mauro; Cosyns, Bernard; Dweck, Mark R; Garbi, Madalina; Magne, Julien; Nieman, Koen; Rosenhek, Raphael; Bernard, Anne; Lowenstein, Jorge; Vieira, Marcelo Luiz Campos; Rabischoffsky, Arnaldo; Vyhmeister, Rodrigo Hernández; Zhou, Xiao; Zhang, Yun; Zamorano, Jose-Luis; Habib, Gilbert

    2016-06-01

    Prosthetic heart valve (PHV) dysfunction is rare but potentially life-threatening. Although often challenging, establishing the exact cause of PHV dysfunction is essential to determine the appropriate treatment strategy. In clinical practice, a comprehensive approach that integrates several parameters of valve morphology and function assessed with 2D/3D transthoracic and transoesophageal echocardiography is a key to appropriately detect and quantitate PHV dysfunction. Cinefluoroscopy, multidetector computed tomography, cardiac magnetic resonance imaging, and to a lesser extent, nuclear imaging are complementary tools for the diagnosis and management of PHV complications. The present document provides recommendations for the use of multimodality imaging in the assessment of PHVs. PMID:27143783

  18. Transesophageal echocardiography guided patent ductus arteriosus occlusion in adults with severe pulmonary hypertension through a parasternal approach

    PubMed Central

    Dai, Xiao-Fu; Chen, Liang-Wan; Chen, Dong-Zhong; Chen, Qiang; Zhen, Guo-Zhong; Zhang, Gui-Can

    2015-01-01

    Between April 2010 and April 2014, 39 consective adult patients (> 18 years) with PDA associated severe pulmonary hypertension underwent transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach. Among 39 patients, the procedure was successful in 32 cases (82.1%) and failed in 7 cases (17.9%). In the failed cases, 3 cases had a large residual shunt and 4 cases had persistent pulmonary hypertension. The mean minimum miameter of the successfully closed PDAs was 15.2 ± 2.1 mm (range 9 to 24), and the mean diameter of the mushroom-shaped occluder was 17.5 ± 2.5 mm (range 11 to 26). The pulmonary artery pressure decreased significantly after occlusion (P < 0.05), but there were no significant differences in the aortic pressure and blood oxygen saturation before and after occlusion (P > 0.05). Echocardiography performed on the first postoperative day showed decreased volume within the left atrium, left ventricle, and pulmonary artery in 23 cases, decreased volume within the left atrium and left ventricle in 4 cases, and no change in the volume of the atrium and ventricle in 3 cases. A minor residual shunt was observed in 6 cases. The posteroanterior chest X-ray showed improved pulmonary congestion in all cases and significantly reduced cardiothoracic ratio in 25 cases. Patients were followed-up at least for 1 year. No symptoms including palpitation, dyspnoea, or chest tightness were observed. The heart function ranged from NYHA class I to II. A minor residual shunt was observed only in one case. There were varying degrees of decrease in volume within the atrium and ventricle. In conclusion, transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach is a feasible and effective method for the treatment of PDA in adults with severe pulmonary hypertension. PMID:26722416

  19. Head to Head Comparison of Stress Echocardiography with Exercise Electrocardiography for the Detection of Coronary Artery Stenosis in Women

    PubMed Central

    Kim, Mi-Na; Kim, Su-A; Kim, Yong-Hyun; Hong, Soon Jun; Park, Seong-Mi; Shin, Mi Seung; Kim, Myung-A; Hong, Kyoung-Soon; Shin, Gil Ja

    2016-01-01

    Background Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women. Methods 202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS). Results The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability. Conclusion In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain. PMID:27358706

  20. Effect of streptozotocin-induced diabetes on myocardial blood flow reserve assessed by myocardial contrast echocardiography in rats

    PubMed Central

    Cosyns, Bernard; Droogmans, Steven; Hernot, Sophie; Degaillier, Céline; Garbar, Christian; Weytjens, Caroline; Roosens, Bram; Schoors, Danny; Lahoutte, Tony; Franken, Philippe R; Van Camp, Guy

    2008-01-01

    The role of structural and functional abnormalities of small vessels in diabetes cardiomyopathy remains unclear. Myocardial contrast echocardiography allows the quantification of myocardial blood flow at rest and during dipyridamole infusion. The aim of the study was to determine the myocardial blood flow reserve in normal rats compared with Streptozotocin-induced diabetic rats using contrast echocardiography. We prospectively studied 40 Wistar rats. Diabetes was induced by intravenous streptozotocin in 20 rats. All rats underwent baseline and stress (dipyridamole: 20 mg/kg) high power intermittent imaging in short axis view under anaesthesia baseline and after six months. Myocardial blood flow was determined and compared at rest and after dipyridamole in both populations. The myocardial blood flow reserve was calculated and compared in the 2 groups. Parameters of left ventricular function were determined from the M-mode tracings and histological examination was performed in all rats at the end of the study. At six months, myocardial blood flow reserve was significantly lower in diabetic rats compared to controls (3.09 ± 0.98 vs. 1.28 ± 0.67 ml min-1 g-1; p < 0.05). There were also a significant decrease in left ventricular function and a decreased capillary surface area and diameter at histology in the diabetic group. In this animal study, diabetes induced a functional alteration of the coronary microcirculation, as demonstrated by contrast echocardiography, a decrease in capillary density and of the cardiac systolic function. These findings may offer new insights into the underlying mechanisms of diabetes cardiomyopathy. PMID:18764943

  1. Echocardiography-guided percutaneous per-ventricular laser ablation of ventricular septum: in vivo study in a canine model.

    PubMed

    He, Guangbin; Sun, Chao; Zhang, Xiangkong; Zuo, Lei; Qin, Haiying; Zheng, Minjuan; Zhou, Xiaodong; Liu, Liwen

    2016-05-01

    Surgical myectomy and ethanol ablation are established intervention strategies for left ventricular outflow obstruction in hypertrophic cardiomyopathy. Safety and efficacy limitations of these interventions call for a minimally invasive, potentially safer, and more efficacious strategy. In this study, we aimed to evaluate the feasibility of echocardiography-guided percutaneous per-ventricular laser ablation of a ventricular septum in a canine model. Six domestic dogs were chosen for the study. A 21G needle was inserted into the right ventricle with its tip reaching the targeted basal to mid-septum, after which laser ablation was performed as follows: 1-W laser for 3 min (180 J) at the basal segment and 5 min (300 J) at middle segment of the septum, respectively. Echocardiography, blood chemistry tests, and pathology examination were performed to assess the results of laser ablation. No death or major complications, i.e., tamponade, pericardial effusion, or ventricular fibrillation, occurred. The laser-ablated areas were well demarcated in the results of the pathological examination. The diameters of the ablated regions were 4.42 ± 0.57 and 5.28 ± 0.83 mm for 3 and 5 min ablation, respectively. Pre-ablation and post-ablation, cardiac enzymes were found to increase significantly while no significant differences were found among M-mode, 2D (LVEF), pulsed-wave (PW) Doppler, and tissue Doppler imaging (TDI) measurements. Contrast echocardiography confirmed the perfusion defects in the ablated regions. Microscopically, the ablated myocardium showed coagulative changes and a sparse distribution of disappearing nuclei and an increase in eosinophil number were observed. Our study suggests that percutaneous and per-ventricular laser ablation of the septum is feasible, potentially safe and efficacious, and warrants further investigation and validation. PMID:26861985

  2. Left ventricular wall thickness in patients with hypertrophic cardiomyopathy: a comparison between cardiac magnetic resonance imaging and echocardiography.

    PubMed

    Corona-Villalobos, Celia P; Sorensen, Lars L; Pozios, Iraklis; Chu, Linda; Eng, John; Abraham, Maria Roselle; Abraham, Theodore P; Kamel, Ihab R; Zimmerman, Stefan L

    2016-06-01

    We assessed whether cardiac MRI (CMR) and echocardiography (echo) have significant differences measuring left ventricular (LV) wall thickness (WT) in hypertrophic cardiomyopathy (HCM) as performed in the clinical routine. Retrospectively identified, clinically diagnosed HCM patients with interventricular-septal (IVS) pattern hypertrophy who underwent CMR and echo within the same day were included. Left Ventricular WT was measured by CMR in two planes and compared to both echo and contrast echo (cecho). 72 subjects, mean age 50.7 ± 16.2 years, 68 % males. Interventricular septal WT by echo and CMR planes showed good to excellent correlation. However, measurements of the postero-lateral wall showed poor correlation. Bland-Altman plots showed greater maximal IVS WT by echo compared to CMR measurement [SAX = 1.7 mm (-5.8, 9.3); LVOT = 1.1 mm (-5.6, 7.8)]. Differences were smaller between cecho and CMR [SAX = 0.8 mm (-9.2, 10.8); LVOT = -0.2 mm (-10.0, 9.6)]. Severity of WT by quartiles showed greater differences between echo and SAX CMR WT compared to cecho. Echocardiography typically measures greater WT than CMR, with the largest differences in moderate to severe hypertrophy. Contrast echocardiography more closely approximates CMR measurements of WT. These findings have potential clinical implications for risk stratification of subjects with HCM. PMID:26896038

  3. Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji--a novel approach in a resource-poor setting.

    PubMed

    Colquhoun, Samantha M; Carapetis, Jonathan R; Kado, Joseph H; Reeves, Benjamin M; Remenyi, Boglarka; May, William; Wilson, Nigel J; Steer, Andrew C

    2013-08-01

    We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses' skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses' results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions. PMID:23040535

  4. Identification of high-risk patients with acute coronary syndrome using point-of-care echocardiography in the ED.

    PubMed

    Frenkel, Oron; Riguzzi, Christine; Nagdev, Arun

    2014-06-01

    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

  5. Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient.

    PubMed

    López-Pardo, Francisco; Urbano-Moral, Jose Angel; González-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; López-Haldon, Jose E

    2015-11-01

    Parachute mitral valve (PMV) is a rare congenital anomaly of the mitral valve apparatus usually evidenced in infants and young children. Adult presentation is extremely rare and is generally mild in terms of mitral stenosis. A 73-year-old woman was admitted to the emergency department due to progressive dyspnea, with NYHA functional class IV symptoms on presentation. The echocardiographic examination identified a PMV with moderate mitral stenosis and a secondary smaller subvalvular mitral orifice. The report shows the usefulness of three-dimensional transesophageal echocardiography in the detection and quantification of this rare anomaly. PMID:26096823

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

    PubMed Central

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

    1995-01-01

    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

  7. McGRATH MAC video laryngoscope for insertion of a transoesophageal echocardiography probe

    PubMed Central

    Ishida, Takashi; Kiuchi, Chiaki; Sekiguchi, Takemi; Tsujimoto, Takatoshi; Kawamata, Mikito

    2016-01-01

    BACKGROUND Transoesophageal echocardiography (TOE) probe insertion in anaesthetised patients can cause pharyngeal and oesophageal injuries. Kim et al. have shown that insertion assisted by a Macintosh laryngoscope can reduce such complications but it may sometimes be difficult to observe the passage of a TOE probe. The McGRATH MAC (McGRATH) has been shown to provide a better view of the glottis, piriform fossa and oesophageal inlet during tracheal intubation than the Macintosh. OBJECTIVE We hypothesised that the McGRATH provided better visualisation of the oesophageal inlet and was useful as an aid to TOE probe placement, possibly reducing the incidence of pharyngeal injury related to insertion, compared with the Macintosh. DESIGN A randomised controlled trial. SETTING The study was conducted in a university hospital from February to December 2014. PATIENTS One hundred patients undergoing elective surgery under intraoperative TOE monitoring were randomised to either a Macintosh group or a McGRATH group. INTERVENTIONS Macintosh and McGRATH were used to visualise the passage of the TOE probe and guide its insertion. MAIN OUTCOME MEASURES Visibility of the oesophageal inlet, the number of TOE insertion attempts and incidence of pharyngeal mucosal injury after the TOE probe had been removed were assessed. RESULTS The percentage of patients in whom the oesophageal inlet was visible was higher in the McGRATH group (88%) than in the Macintosh group (41%) (P < 0.01). The number of TOE probe insertion attempts was significantly smaller in the McGRATH group than in the Macintosh group (P = 0.039). The incidence of pharyngeal mucosal injury was significantly smaller in the McGRATH group (4%) than in the Macintosh group (16%; P = 0.042). CONCLUSION The McGRATH provided a better view of the oesophageal inlet and was useful as an aid to TOE probe placement, possibly reducing the incidence of pharyngeal injury related to its insertion. TRIAL REGISTRATION University

  8. A maximum likelihood approach to diffeomorphic speckle tracking for 3D strain estimation in echocardiography.

    PubMed

    Curiale, Ariel H; Vegas-Sánchez-Ferrero, Gonzalo; Bosch, Johan G; Aja-Fernández, Santiago

    2015-08-01

    The strain and strain-rate measures are commonly used for the analysis and assessment of regional myocardial function. In echocardiography (EC), the strain analysis became possible using Tissue Doppler Imaging (TDI). Unfortunately, this modality shows an important limitation: the angle between the myocardial movement and the ultrasound beam should be small to provide reliable measures. This constraint makes it difficult to provide strain measures of the entire myocardium. Alternative non-Doppler techniques such as Speckle Tracking (ST) can provide strain measures without angle constraints. However, the spatial resolution and the noisy appearance of speckle still make the strain estimation a challenging task in EC. Several maximum likelihood approaches have been proposed to statistically characterize the behavior of speckle, which results in a better performance of speckle tracking. However, those models do not consider common transformations to achieve the final B-mode image (e.g. interpolation). This paper proposes a new maximum likelihood approach for speckle tracking which effectively characterizes speckle of the final B-mode image. Its formulation provides a diffeomorphic scheme than can be efficiently optimized with a second-order method. The novelty of the method is threefold: First, the statistical characterization of speckle generalizes conventional speckle models (Rayleigh, Nakagami and Gamma) to a more versatile model for real data. Second, the formulation includes local correlation to increase the efficiency of frame-to-frame speckle tracking. Third, a probabilistic myocardial tissue characterization is used to automatically identify more reliable myocardial motions. The accuracy and agreement assessment was evaluated on a set of 16 synthetic image sequences for three different scenarios: normal, acute ischemia and acute dyssynchrony. The proposed method was compared to six speckle tracking methods. Results revealed that the proposed method is the most

  9. Speckle tracking echocardiography in mature Irish Wolfhound dogs: technical feasibility, measurement error and reference intervals

    PubMed Central

    2013-01-01

    Background Two-dimensional strain measurements obtained by speckle tracking echocardiography (STE) have been reported in both humans and dogs. Incorporation of this technique into canine clinical practice requires the availability of measurements from clinically normal dogs, ideally of the same breed, taken under normal clinical conditions. The aims of this prospective study were to assess if it is possible to obtain STE data during a routine echocardiographic examination in Irish Wolfhound dogs and that these data will provide reference values and an estimation of measurement error. Methods Fifty- four healthy mature Irish Wolfhounds were used. These were scanned under normal clinical conditions to obtain in one session both standard echocardiographic parameters and STE data. Measurement error was determined separately in 5 healthy mature Irish Wolfhounds. Results Eight dogs were rejected by the software algorithm for reasons of image quality, resulting in a total of 46 dogs (85.2%) being included in the statistical analysis. In 46 dogs it was possible to obtain STE data from three scanning planes, as well as to measure the rotation of the left ventricle at two levels and thus calculate the torsion of the heart. The mean peak radial strain at the cardiac apex (RS-apex) was 45.1 ± 10.4% (n = 44), and the mean peak radial strain at the base (RS-base) was 36.9 ± 14.7% (n = 46). The mean peak circumferential strain at the apex (CS-apex) was -24.8 ± 6.2% (n = 44), and the mean peak circumferential strain at the heart base (CS-base) was -15.9 ± 3.2% (n = 44). The mean peak longitudinal strain (LS) was -16.2 ± 3.0% (n = 46). The calculated mean peak torsion of the heart was 11.6 ± 5.1 degrees (n = 45). The measurement error was 24.8%, 26.4%, 11.5%, 6.7%, 9.0% and 10 degrees, for RS-apex, RS-base, CS-apex, CS-base, LS and torsion, respectively. Conclusions It is concluded that this technique can be included in a normal

  10. Evaluation of cardiac functions in juvenile systemic lupus erythematosus with two-dimensional speckle tracking echocardiography.

    PubMed

    Dedeoglu, Reyhan; Şahin, Sezgin; Koka, Aida; Öztunç, Funda; Adroviç, Amra; Barut, Kenan; Cengiz, Dicle; Kasapçopur, Özgür

    2016-08-01

    The aim of this study was to investigate subclinical systolic and diastolic dysfunction in juvenile-onset systemic lupus erythematosus (j-SLE) patients with speckle tracking echocardiography (STE) and the effects of disease activity on left ventricular (LV) regional functions. Thirty-five patients with j-SLE and 30 healthy children (control group) were evaluated between January and August 2015. STE was performed on all patients and controls. Medical records, including diagnosis criteria, age at diagnosis, and duration of disease, were evaluated. SLE disease activity was assessed using the SLE Disease Activity Index (SLEDAI). j-SLE patients had lower ejection fraction than did control subjects but still within normal range. LV end-diastolic and end-systolic dimensions were significantly larger in j-SLE patients (32.43 ± 3.2 vs 28.3 ± 3.1 and 21.1 ± 1.9 vs 18.9.0 ± 2.2, respectively; p = 0.001). There was a significant reduction in longitudinal strain of LV segments in the j-SLE patients compared with controls. J-SLE patients were further divided into subgroups. Group 1 comprised patients having SLEDAI scores >8 at the onset of disease but who improved with therapy during follow-up. Group 2 included j-SLE patients with SLEDAI scores >8 at diagnosis and persistently >4 at the end of follow-up. In the LV mid-inferior and mid-inferolateral segments, STE strain measurements of group 2 were significantly lower than those of group 1 (15.9 ± 6.4 vs 20.0 ± 4.4, 17.9 ± 7.2 vs 23.2 ± 3.8; p = 0.075, p = 0.055, respectively). Simple and non-invasive STE would be helpful in predicting cardiovascular prognosis with new therapeutic medications/interventions or in objectively comparing the effects of immunosuppressive drugs in comparison with preceding STE evaluation. PMID:27139514

  11. Utility of three-dimensional echocardiography in assessing and predicting response to cardiac resynchronization therapy

    PubMed Central

    Lau, Ching; Abdel-Qadir, Husam M; Lashevsky, Ilan; Hansen, Mark; Crystal, Eugene; Joyner, Campbell

    2010-01-01

    BACKGROUND Cardiac resynchronization therapy (CRT) can be a valuable treatment for heart failure. However, there are high nonresponse rates using current CRT inclusion criteria. OBJECTIVE To assess the value of three-dimensional echocardiography (3DE) in predicting response to CRT. METHODS Functional assessments and 3DE were performed in heart failure patients pre-CRT, 24 h post-CRT and six to 12 months after CRT. The dyssynchrony index (DI) was calculated as the SD of the time to minimum volume in 16 left ventricle segments corrected by heart rate. Response to CRT was defined as functional improvement (alive at late follow-up with improvement by one New York Heart Association class) and a decrease in left ventricular end-systolic volume by 15% or greater at six to 12 months follow-up. RESULTS A total of 53 patients were enrolled. Average 3DE acquisition time was less than 5 min. Seventy-two per cent of patients showed functional improvement, while 43% showed functional and echocardiographic evidence of response. Baseline DI and the decrease in DI at 24 h were both correlated with reverse remodelling. Responders had higher baseline DI values compared with nonresponders (mean 16.8 versus 7.1, P<0.001), and showed a greater decrease in DI values at 24 h (mean decrease 7.9 versus 0.7, P<0.001). All responders had baseline DI values of greater than 10 (negative predictive value of 100%). A decrease in the DI value by more than 5 at 24 h in patients with a baseline DI of greater than 10 identified responders with a positive predictive value of 83%. CONCLUSIONS 3DE may be valuable in predicting response to CRT. A baseline DI cut-off of greater than 10 in our patients excluded reverse remodelling to CRT. In addition, the decrease in DI at 24 h had a high positive predictive value for long-term response to CRT. PMID:21076720

  12. Hemodynamic changes of the middle hepatic vein in patients with pulmonary hypertension using echocardiography.

    PubMed

    Sun, Dan Dan; Hou, Chuan Ju; Yuan, Li Jun; Duan, Yun You; Hou, Ying; Zhou, Fang Ping

    2015-01-01

    The aim of this study was to analyze the changes of the middle hepatic vein (MHV) spectra in patients with pulmonary hypertension (PH) caused by congenital heart disease (CHD) and determine the proper parameters of MHV to predict PH. Eighty patients with CHD were included, whose pulmonary artery pressure was measured via right heart catheterization, and the MHV spectra were detected via echocardiography. The peak value of velocity (V) and velocity time integral (VTI) of the waves, including S wave, D wave and A wave, were measured at the end of inspiration. The values of the MHV parameters that were predictive of PH were evaluated and their cut-off points were determined. Compared with the control group, V of S wave (S), VTI of S wave (SVTI), V of D wave (D), VTI of D wave (DVTI) decreased and V of A wave (A), VTI of A wave (AVTI), A/S, AVTI/SVTI, A/(S+D), AVTI/ (SVTI+DVTI) increased in the PH group. These differences were statistically significant (P<0.05). A correlation analysis determined that the ratios of A/S, A/(S+D), AVTI/(SVTI+DVTI) were positively correlated with pulmonary artery mean pressure (r=0.529,0.575,0.438,P<0.001). An ROC curve analysis determined that the diagnostic effect of A/(S+D) was superior to the other two parameters. On the ROC curve, when the ratio of A/(S+D) was 0.30, the sensitivity was 85.37% and specificity was 75.00% for predicting PH. The spectral parameters of MHV, including the ratios of A/S, A/(S+D) and AVTI/(SVTI+DVTI), increased with increasing pulmonary pressure in CHD patients. When the ratio of A/(S+D) was 0.30 in MHV spectra, it had sufficient sensitivity and specificity for diagnosing PH, and this method could be used as a new non-invasive complementary echocardiographic parameter for predicting PH. PMID:25821961

  13. Surgery for ruptured sinus of valsalva aneurysm into right ventricular outflow tract: role of intraoperative 2D and real time 3D transesophageal echocardiography.

    PubMed

    Gadhinglajkar, Shrinivas; Sreedhar, Rupa

    2010-08-01

    A major limitation of the 2D echocardiography during surgery for a complex cardiac lesion is its inability to provide an accurate spatial orientation of the structure. The real time 3D transesophageal echocardiography (RT-3D-TEE) technology available in Philips IE 33 ultrasound machine is relatively new to an operation suite. We evaluated its intraoperative utility in a patient, who was operated for repair of a ruptured sinus of Valsalva aneurysm (RSOVA) and closure of a supracristal ventricular septal defect. The VSD and RSOVA were visualized through different virtual windows in a more promising way on intraoperative RT-3D-TEE than on the 2D echocardiography. The acquired images could be virtually cropped and displayed in anatomical views to the operating surgeon for a clear orientation to the anatomy of the lesion. RT-3D-TEE is a potential intraoperative monitoring tool in surgeries for complex cardiac lesions. PMID:21050263

  14. Endocardial left ventricle feature tracking and reconstruction from tri-plane trans-esophageal echocardiography data

    NASA Astrophysics Data System (ADS)

    Dangi, Shusil; Ben-Zikri, Yehuda K.; Cahill, Nathan; Schwarz, Karl Q.; Linte, Cristian A.

    2015-03-01

    Two-dimensional (2D) ultrasound (US) has been the clinical standard for over two decades for monitoring and assessing cardiac function and providing support via intra-operative visualization and guidance for minimally invasive cardiac interventions. Developments in three-dimensional (3D) image acquisition and transducer design and technology have revolutionized echocardiography imaging enabling both real-time 3D trans-esophageal and intra-cardiac image acquisition. However, in most cases the clinicians do not access the entire 3D image volume when analyzing the data, rather they focus on several key views that render the cardiac anatomy of interest during the US imaging exam. This approach enables image acquisition at a much higher spatial and temporal resolution. Two such common approaches are the bi-plane and tri-plane data acquisition protocols; as their name states, the former comprises two orthogonal image views, while the latter depicts the cardiac anatomy based on three co-axially intersecting views spaced at 600 to one another. Since cardiac anatomy is continuously changing, the intra-operative anatomy depicted using real-time US imaging also needs to be updated by tracking the key features of interest and endocardial left ventricle (LV) boundaries. Therefore, rapid automatic feature tracking in US images is critical for three reasons: 1) to perform cardiac function assessment; 2) to identify location of surgical targets for accurate tool to target navigation and on-target instrument positioning; and 3) to enable pre- to intra-op image registration as a means to fuse pre-op CT or MR images used during planning with intra-operative images for enhanced guidance. In this paper we utilize monogenic filtering, graph-cut based segmentation and robust spline smoothing in a combined work flow to process the acquired tri-plane TEE time series US images and demonstrate robust and accurate tracking of the LV endocardial features. We reconstruct the endocardial LV

  15. NT-proBNP <95 ng/l can exclude pulmonary hypertension on echocardiography at diagnostic workup in patients with interstitial lung disease

    PubMed Central

    Andersen, Charlotte; Mellemkjær, Søren; Hilberg, Ole; Bendstrup, Elisabeth

    2016-01-01

    Background Pulmonary hypertension (PH) is a serious complication to interstitial lung disease (ILD) and has a poor prognosis. PH is often diagnosed by screening with echocardiography followed by right heart catheterisation. A previous study has shown that a value of NT-pro-brain natriuretic peptide (NT-proBNP) <95 ng/l could be used to rule out PH in patients with ILD. Aim To evaluate this rule-out test for PH in a new cohort of incident patients with ILD. Methods An established database with data from 148 consecutive patients referred from January 2012 to October 2014 was used to identify patients and obtain data from echocardiography, NT-proBNP, diagnosis and lung function. Signs of PH on echocardiography were defined as a tricuspid pressure gradient (TR) ≥40 mmHg, decreased right ventricular systolic function or dilatation. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of NT-proBNP >95 ng/l for signs of PH on echocardiography were calculated. The study was approved by the Danish Health Authority. Results In 118 patients, data from both echocardiography and measurements of NT-proBNP were available. Eleven of these were screened positive for PH on echocardiography. Sensitivity, specificity, NPV and PPV of NT-proBNP <95 ng/l for PH were 100, 44, 16 and 100%, respectively. Furthermore, no patients with left heart failure as the cause of dyspnoea were missed using this cut-off value. Conclusion NT-proBNP <95 ng/l precludes a positive echocardiographic screen for PH in ILD patients at referral for diagnostic workup. PMID:27478030

  16. Speckle tracking echocardiography in the critically ill: enticing research with minimal clinical practicality or the answer to non-invasive cardiac assessment?

    PubMed

    S, Orde; Sj, Huang; As, Mclean

    2016-09-01

    Echocardiography is developing rapidly. Speckle tracking echocardiography is the latest semi-automatic tool that has potential to quantitatively describe cardiac dysfunction that may be unrecognised by conventional echocardiography. It is a non-Doppler, angle-independent, feasible and reproducible method to evaluate myocardial function in both non-critically ill and critically ill populations. Increasingly it has become a standard measure of both left and right ventricle function in specific patient groups, e.g. chemotherapy-induced cardiomyopathy or pulmonary hypertension. To date there are few studies in the critically ill, predominantly in sepsis, yet all describe dysfunction beyond standard measures. Other areas of interest include heart-lung interactions, right ventricle function and twist and torsion of the heart. A word of caution is required, however, in that speckle tracking echocardiography is far from perfect and is more challenging, particularly in the critically ill, than implied by many published studies. It takes time to learn and perform and most values are not validated, particularly in the critically ill. We should be cautious in accepting that the latest software used in cardiology cohorts will automatically be the answer in the critically ill. Even with these limitations the technology is enticing and results fascinating. We are uncovering previously undescribed dysfunction and although it currently is essentially a research-based activity, there is great promise as a clinical tool as echocardiography analysis becomes more automated, and potentially speckle tracking echocardiography could help describe cardiac function in critical illness more accurately than is possible with current techniques. PMID:27608336

  17. The relation between transaortic pressure difference and flow during dobutamine stress echocardiography in patients with aortic stenosis

    PubMed Central

    Takeda, S; Rimington, H; Chambers, J

    1999-01-01

    OBJECTIVE—To investigate the relation between transaortic pressure difference and flow in patients with aortic stenosis.
METHODS—50 asymptomatic patients with all grades of aortic stenosis were studied using dobutamine stress echocardiography. Individual plots of mean pressure drop against flow were drawn. Comparisons were made between grades of aortic stenosis as defined by the continuity equation.
RESULTS—A significant linear relation between pressure difference and flow was found in 34 patients (68%). There was a significant curvilinear relation in four (8%), while no significant regression line could be fitted in 12 (24%). In the 34 patients with linear fits, the slopes (mean (SD)) were 0.08 (0.07) in mild, 0.10 (0.04) in moderate, and 0.22 (0.16) in severe aortic stenosis (p = 0.0055).
CONCLUSIONS—Transaortic pressure difference can be related directly to flow in many patients with all grades of aortic stenosis. However, there are individual differences in slope and intercept suggesting that resistance calculated at rest may not always be representative. Raw pressure drop/flow plots may be an alternative method of describing valve function.


Keywords: aortic stenosis; continuity equation; resistance; Doppler echocardiography PMID:10377300

  18. Assessment of left ventricular longitudinal function in cats with subclinical hypertrophic cardiomyopathy using tissue Doppler imaging and speckle tracking echocardiography

    PubMed Central

    SUGIMOTO, Keisuke; FUJII, Yoko; SUNAHARA, Hiroshi; AOKI, Takuma

    2015-01-01

    Hypertrophic cardiomyopathy (HCM) in cats is characterized by concentric left ventricular (LV) hypertrophy and both diastolic and systolic dysfunction. Although impaired cardiac function detected by tissue Doppler imaging (TDI) in cats with HCM was previously reported, reference ranges of TDI in normal cats and cats with HCM have been reported as widely variable. Two-dimensional speckle tracking echocardiography (STE) was useful for assessment of cardiac function in human patients with HCM, but clinical utility was not known in cats. The aim of this study was to assess global and segmental LV myocardial function using STE in cats with HCM whose TDI variables were within the reference range. A total of 35 cats of different breeds were enrolled in this study. The HCM group (n=22) was cats diagnosed as HCM without left atrial enlargement and with normal TDI measurements. HCM cats were further divided into a segmental hypertrophy (S-HCM) group and a diffuse hypertrophy (D-HCM) group. The control group consisted of 13 clinically healthy cats. No cats in any group showed any clinical symptoms. Conventional echocardiography, TDI, and global and segmental STE indices were evaluated and compared between groups. Only the longitudinal strain rate during early diastole was significantly decreased in both HCM groups, even in all segments including those without hypertrophy in S-HCM group. This study suggests that STE parameters are the more sensitive variables compared with conventional TDI parameters to detect early myocardial diastolic dysfunction in cats with HCM. PMID:25877405

  19. Intraoperative two-dimensional echocardiography and color flow Doppler imaging: a basic transesophageal single plane patient examination sequence.

    PubMed Central

    Rafferty, T. D.; Lippmann, H.

    1993-01-01

    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

  20. Annular sizing using real-time three-dimensional intracardiac echocardiography-guided trans-catheter aortic valve replacement

    PubMed Central

    Rendon, Alejandro; Hamid, Tahir; Kanaganayagam, Gajen; Karunaratne, Devinda; Mahadevan, Vaikom S

    2016-01-01

    Objective Transcatheter aortic valve replacement (TAVR) has been established as an alternative therapy for patients with severe aortic stenosis who are unfit for the surgical aortic valve replacements. Pre and periprocedural imaging for the TAVR procedure is the key to procedural success. Currently transesophageal echocardiography (TOE), including real-time three-dimensional (RT-3D) imaging TOE, has been used for peri-interventional monitoring and guidance for TAVR. We describe our initial experience with real-time three-dimensional intracardiac echocardiography (RT-3DICE), imaging technology for the use in the TAVR procedure. Methods We used RT-3DICE using an ACUSON SC2000 2.0v (Siemens Medical Solution), and a 10F AcuNav V catheter (Siemens-Acuson, Inc, Mountain View, California, USA) in addition to preoperative multislice CT (MSCT) in total of five patients undergoing TAVR procedure. Results Aortic annulus and sinus of valsalva diameters were measured using RT-3DICE. Aortic valve measurements obtained using RT-3DICE are comparable to those obtained using MSCT with no significant difference in our patients. Conclusions This small study of five patients shows the safe use of RT-3DICE in TAVR Procedure and may help the procedures performed under local anaesthesia without the need for TOE. PMID:27158522

  1. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography.

    PubMed

    Sicari, Rosa; Galderisi, Maurizio; Voigt, Jens-Uwe; Habib, Gilbert; Zamorano, Jose L; Lancellotti, Patrizio; Badano, Luigi P

    2011-02-01

    Pocket-size imaging devices are a completely new type of echo machines which have recently reached the market. They are very cheap, smartphone-size hand-held echo machines with limited technical capabilities. The aim of this European Association of Echocardiography (EAE) position paper is to provide recommendations on the use of pocket-size imaging devices in the clinical arena by profiling the educational needs of potential users other than cardiologists experts in echo. EAE recommendations about pocket-size imaging devices can be summarized in: (1) pocket-size imaging devices do not provide a complete diagnostic echocardiographic examination. The range of indications for their use is therefore limited. (2) Imaging assessment with pocket-size imaging devices should be reported as part of the physical examination of the patient. Image data should be stored according to the applicable national rules for technical examinations. (3) With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended for all users. The certification should be limited to the clinical questions that can potentially be answered by pocket-size devices. (4) The patient has to be informed that an examination with the current generation of pocket-size imaging devices does not replace a complete echocardiogram. PMID:21216764

  2. Usefulness of intraoperative transesophageal echocardiography in predicting the degree of mitral regurgitation secondary to atrioventricular defect in children.

    PubMed

    Lee, H R; Montenegro, L M; Nicolson, S C; Gaynor, J W; Spray, T L; Rychik, J

    1999-03-01

    The objectives of this study were to determine the validity of the grade of mitral regurgitation (MR) as imaged by intraoperative transesophageal echocardiography (TEE) in predicting the grade of MR at follow-up. Intraoperative TEE and corresponding follow-up transthoracic studies were retrospectively reviewed and the regurgitant jet area to left atrial area ratio was used to quantify the MR. Patient records were reviewed to identify factors contributing to the development of a certain grade of MR. Intraoperative TEE was useful in detecting severe MR that required further repair at the same time. However, discrepancy in the grade of MR at follow-up was noted in 47% of patients (21 of 47) and unchanged grade of MR was found only in 53% of patients (26 of 47). Blood pressures were significantly lower and heart rates higher intraoperatively. Initial preoperative grade of MR and type of atrioventricular canal defect did not predispose for a particular grade of MR at follow-up. The grade of MR by intraoperative TEE does not predict the grade of MR at follow-up as imaged by transthoracic echocardiography. PMID:10080431

  3. Percutaneous closure of interatrial communications in adults – prospective embolism prevention study with two- and three-dimensional echocardiography

    PubMed Central

    Knebel, Fabian; Gliech, Volker; Walde, Torsten; Panda, Alexander; Sanad, Wasiem; Eddicks, Stephan; Baumann, Gert; Borges, Adrian C

    2004-01-01

    Background Patients with interatrial communications after paradoxical embolic events are at risk for recurrent thromboembolism. We hypothesized that transcatheter closure of the defects would result in long-term prevention of systemic embolism and performed clinical and echocardiographic follow-up. Methods We included 161 patients (mean age 46.8 ± 11 years, 83 females) with patent foramen ovale or atrial septal defect and at least one documented paradoxical systemic thrombembolic event and/or a large atrial shunting. Results The implantation procedure was successfully performed without major complications in all patients and minor complications in 2.5%. Two and / or three dimensional echocardiography was performed before and after 4 weeks and 12 months using a multiplane transoesophageal probe. After 4 weeks and 6 months two patients had minimal shunting. These residual defects were closed with a second device implantation without shunting after further 4 weeks. During a follow-up of 324.3 patient years (range, 13 to 19 months), recurrent embolic events occurred in only 1 patient (0.6%). Conclusion After primary paradoxical systemic embolism, results of transcatheter occlusion of the interatrial communications are dependent on the closure device system and can prevent further secondary embolic events for up to 1 year after the percutaneous closure. Three dimensional echocardiography provides dynamic features of the defects and the post closure status and may lead to an improved understanding and diagnosis of the interatrial defect. PMID:15151699

  4. A systematic method for using 3D echocardiography to evaluate tricuspid valve insufficiency in hypoplastic left heart syndrome

    PubMed Central

    Mart, Christopher Robin; Eckhauser, Aaron Wesley; Murri, Michael; Su, Jason Thomas

    2014-01-01

    With surgical palliation of hypoplastic left heart syndrome (HLHS), the tricuspid valve (TV) becomes the systemic atrioventricular valve and moderate/severe TV insufficiency (TVI), an adverse risk factor for survival to Fontan, has been reported in up to 35% of patients prior to stage I palliation. Precise echocardiographic identification of the mechanism of TVI cannot be determined by two-dimensional echocardiography. Three-dimensional echocardiography (3DE) can provide significant insight into the mechanisms of TVI. It is the intent of this report to propose a systematic method on how to evaluate and display 3DE images of the TV in HLHS which has not been done previously. TV anatomy, function, and the known mechanisms of insufficiency are reviewed. We defined three regions of the TV (anterior, posterior, septal) that can help define valve “leaflets” that incorporates the many variations of TV anatomy. To determine how the surgeon views the TV, a picture of a pathologic specimen of the TV was placed on a computer screen and rotated until it was oriented as it appears during surgery, the “surgeons view.” We have proposed a systematic method for evaluating and displaying the TV using 3DE which can provide significant insight into the mechanisms causing TVI in HLHS. This has the potential to improve both the surgical approach to repairing the valve and, ultimately, patient outcomes. PMID:25298694

  5. Assessment of left ventricular contraction by parametric analysis of main motion (PAMM): theory and application for echocardiography

    NASA Astrophysics Data System (ADS)

    Ruiz Dominguez, C.; Kachenoura, N.; DeCesare, A.; Delouche, A.; Lim, P.; Gérard, O.; Herment, A.; Diebold, B.; Frouin, F.

    2005-07-01

    The computerized study of the regional contraction of the left ventricle has undergone numerous developments, particularly in relation to echocardiography. A new method, parametric analysis of main motion (PAMM), is proposed in order to synthesize the information contained in a cine loop of images in parametric images. PAMM determines, for the intensity variation time curves (IVTC) observed in each pixel, two amplitude coefficients characterizing the continuous component and the alternating component; the variable component is generated from a mother curve by introducing a time shift coefficient and a scale coefficient. Two approaches, a PAMM data driven and a PAMM model driven (simpler and faster), are proposed. On the basis of the four coefficients, an amplitude image and an image of mean contraction time are synthesized and interpreted by a cardiologist. In all cases, both PAMM methods allow better IVTC adjustment than the other methods of parametric imaging used in echocardiography. A preliminary database comprising 70 segments is scored and compared with the visual analysis, taken from a consensus of two expert interpreters. The levels of absolute and relative concordance are 79% and 97%. PAMM model driven is a promising method for the rapid detection of abnormalities in left ventricle contraction.

  6. Left ventricular radial colour and longitudinal pulsed-wave tissue Doppler echocardiography in 39 healthy domestic pet rabbits.

    PubMed

    Casamian-Sorrosal, Domingo; Saunders, Richard; Browne, William; Elliot, Sarah; Fonfara, Sonja

    2014-10-01

    This paper reports radial colour and longitudinal mitral annulus pulsed-wave tissue Doppler findings in a large cohort of healthy, adult pet rabbits. Thirty-nine rabbits (22 Dwarf Lops, 14 French Lops and three Alaskans) underwent conscious echocardiography. The median age of the rabbits was 22 months and the median weight was 2.8 kg (Dwarf Lop 2.4 kg/French Lop 6.0 kg). Adequate radial colour and longitudinal pulsed-wave tissue Doppler traces were obtained in 100% and 85% of cases, respectively. Most systolic tissue Doppler parameters were significantly higher in French Lops than in Dwarf Lops. Separation of mitral inflow diastolic waves was present in 40% of cases using conventional spectral Doppler and in >60% of cases using pulsed-wave tissue Doppler which could be beneficial when evaluating diastolic function in rabbits. This study can be used as a reference for normal echocardiographic tissue Doppler values for adult rabbits undergoing conscious echocardiography in clinical practice. PMID:25089025

  7. Multimodality evaluation of ventricular function: comparison of cardiac magnetic resonance imaging, echocardiography, and planar and SPECT blood pool imaging

    NASA Astrophysics Data System (ADS)

    Feiglin, David H.; Krol, Andrzej; Tillapaugh-Fay, Gwen M.; Szeverenyi, Nikolaus M.; Thomas, Frank D.

    2001-05-01

    Fifteen patients underwent resting echocardiography (EC), ECG gated cardiac MR ventriculography (MRV) and blood pool planar and SPECT ventriculography (SPV) sequentially on the same day. In addition, 36 patients had sequential ECG gated blood pool and SPV and 20 normal volunteers, age > 18 years, had sequential ECG gated cardiac MRI performed on both Siemens closed, 1.5T, and open, 0.2T, magnets. Echocardiography was performed using a HP 5500 system equipped with an S4 transducer in 2D mode. MRV at 0.2T and 1.5T used a circular polarized body coil. Nuclear Medicine studies used 25 mCi Tc- 99m labeled red blood cells. Gated planar and SPV were acquired on a dual head Siemens E-Cam system. We have found that MRV affords the most accurate measurement of ventricular function. SPV and MRV provide similar estimations of left ventricular function (LVEF). Further, SPV consistently provides higher LVEF, as compared to the planar data simultaneously acquired. Observed significant differences in intermodality measurements indicate that follow up studies in patients, especially in patients whose management is critically dependent on functional measurement changes, should be monitored by one modality only.

  8. Noninvasive aortic bloodflow by Pulsed Doppler Echocardiography (PDE) compared to cardiac output by the direct Fick procedure

    NASA Technical Reports Server (NTRS)

    1980-01-01

    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.

  9. Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography.

    PubMed

    Veronesi, Federico; Corsi, Cristiana; Sugeng, Lissa; Caiani, Enrico G; Weinert, Lynn; Mor-Avi, Victor; Cerutti, Sergio; Lamberti, Claudio; Lang, Roberto M

    2008-04-01

    Mitral regurgitation (MR) in dilated cardiomyopathy (DCM-MR) and MR in ischemic cardiomyopathy (ISC-MR) usually occurs as a result of mitral annulus (MA) dilatation and papillary muscle displacement secondary to global left ventricle remodelling. We propose a method to determine MA area and motion throughout the cardiac cycle and to define papillary muscle position in 3-dimensional space using real-time 3-dimensional echocardiography. Real-time 3-dimensional echocardiography was performed in 24 healthy individuals, and in 30 patients with DCM-MR (n = 15) or ISC-MR (n = 15). Significant intergroup differences were noted in MA surface area (control: 6.4 +/- 1.7 cm(2); DCM-MR: 11.1 +/- 2.6 cm(2); ISC-MR: 9.0 +/- 2.0 cm(2)) and in peak MA motion (control: 8.7 +/- 3.0 mm; DCM-MR: 3.4 +/- 1.7 mm; ISC-MR: 4.9 +/- 1.5 mm). In patients with DCM-MR, papillary muscle symmetry was preserved, whereas in patients with ISC-MR, papillary tethering lengths were unequal as a result of wall-motion abnormalities. Our methodology for dynamic volumetric measurements of the mitral apparatus allows better understanding of MR mechanisms. PMID:17681731

  10. Carrier-number fluctuations in the 2-dimensional electron gas at the LaAlO{sub 3}/SrTiO{sub 3} interface

    SciTech Connect

    Barone, C. Romeo, F.; Pagano, S.; Di Gennaro, E.; Miletto Granozio, F.; Scotti di Uccio, U.; Pallecchi, I.; Marrè, D.

    2013-12-02

    The voltage-spectral density S{sub V} (f) of the 2-dimensional electron gas formed at the interface of LaAlO{sub 3}/SrTiO{sub 3} has been thoroughly investigated. The low-frequency component has a clear 1/f behavior with a quadratic bias current dependence, attributed to resistance fluctuations. However, its temperature dependence is inconsistent with the classical Hooge model, based on carrier-mobility fluctuations. The experimental results are, instead, explained in terms of carrier-number fluctuations, due to an excitation-trapping mechanism of the 2-dimensional electron gas.

  11. Carrier-number fluctuations in the 2-dimensional electron gas at the LaAlO3/SrTiO3 interface

    NASA Astrophysics Data System (ADS)

    Barone, C.; Romeo, F.; Pagano, S.; Di Gennaro, E.; Miletto Granozio, F.; Pallecchi, I.; Marrè, D.; Scotti di Uccio, U.

    2013-12-01

    The voltage-spectral density SV (f) of the 2-dimensional electron gas formed at the interface of LaAlO3/SrTiO3 has been thoroughly investigated. The low-frequency component has a clear 1/f behavior with a quadratic bias current dependence, attributed to resistance fluctuations. However, its temperature dependence is inconsistent with the classical Hooge model, based on carrier-mobility fluctuations. The experimental results are, instead, explained in terms of carrier-number fluctuations, due to an excitation-trapping mechanism of the 2-dimensional electron gas.

  12. Optimal Charging Profiles with Minimal Intercalation-Induced Stresses for Lithium-Ion Batteries Using Reformulated Pseudo 2-Dimensional Models

    SciTech Connect

    Suthar, B; Northrop, PWC; Braatz, RD; Subramanian, VR

    2014-07-30

    This paper illustrates the application of dynamic optimization in obtaining the optimal current profile for charging a lithium-ion battery by restricting the intercalation-induced stresses to a pre-determined limit estimated using a pseudo 2-dimensional (P2D). model. This paper focuses on the problem of maximizing the charge stored in a given time while restricting capacity fade due to intercalation-induced stresses. Conventional charging profiles for lithium-ion batteries (e.g., constant current followed by constant voltage or CC-CV) are not derived by considering capacity fade mechanisms, which are not only inefficient in terms of life-time usage of the batteries but are also slower by not taking into account the changing dynamics of the system. (C) The Author(s) 2014. Published by ECS. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives 4.0 License (CC BY-NC-ND, http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is not changed in any way and is properly cited. For permission for commercial reuse, please email: oa@electrochem.org. All rights reserved.

  13. Effect of bile salts stress on protein synthesis of Lactobacillus casei Zhang revealed by 2-dimensional gel electrophoresis.

    PubMed

    Wu, R; Sun, Z; Wu, J; Meng, H; Zhang, H

    2010-08-01

    Lactobacillus casei Zhang, isolated from koumiss in Inner Mongolia of China, is known from previous findings to be tolerant to bile salts. Bile salts secreted by mammals act as a natural antibacterial barrier and may serve as a component of innate immunity, as they have limited antagonistic effect against resident microflora. In this work, we compared the growth and protein expression patterns of L. casei Zhang with and without bile salts. Twenty-six proteins were found to be differentially expressed using 2-dimensional gel electrophoresis. Peptide mass fingerprinting was used to identify these proteins. Further verification by using real-time, quantitative reverse transcription-PCR and bioinformatics analysis showed that the implicated pathways are involved with a complex physiological response under bile salts stress, particularly including cell protection (DnaK and GroEL), modifications in cell membranes (NagA, GalU, and PyrD), and key components of central metabolism (PFK, PGM, CysK, LuxS, PepC, and EF-Tu). These results provide insight on the protein expression pattern of L. casei under bile salts stress and offer a new perspective for the molecular mechanisms involved in stress tolerance and adaptation of bacteria. PMID:20655455

  14. Porcine salivary analysis by 2-dimensional gel electrophoresis in 3 models of acute stress: A pilot study

    PubMed Central

    Fuentes-Rubio, María; Cerón, José J.; de Torre, Carlos; Escribano, Damián; Gutiérrez, Ana M.; Tecles, Fernando

    2014-01-01

    The purpose of this research was to study changes in the salivary proteome of healthy pigs in stressful situations to identify any potential new salivary biomarker of stress. Three groups of animals were subjected to 3 stress models: snaring restraint followed by simulated sampling of vena cava blood; brief transport by road; and restriction of movement in a digestibility cage. Saliva was obtained from each animal before and 15 and 30 min after the induction of stress. The samples from the animals that showed the greatest increase in salivary cortisol concentration were pooled and run on 2-dimensional gels. Coomassie Brilliant Blue R-250 was used for spot detection and mass spectrometry for spot identification. Statistical analyses showed that 2 proteins had significant differences in expression before and after the induction of stress. These proteins were identified as odorant-binding protein and fragments of albumin. Further studies will be necessary to confirm the value of using these proteins as salivary biomarkers of stress in pigs. PMID:24688174

  15. Phase change memory devices formed by using 2 dimensional layered Graphene-In2 Se3 van der Waals heterostructure

    NASA Astrophysics Data System (ADS)

    Choi, Min Sup; Yang, Chenxi; Ra, Chang Ho; Yoo, Won Jong

    Indium selenide (In2Se3) is one of the unique materials which have both a layered structure and phase change property. One of the advantages of using 2 dimensional (2D) materials is their potential to form van der Waals heterostructures which enable unique physical properties and novel quantum device functions, which cannot be achieved in 2D material alone. In this study, we fabricated vertically stacked graphene-In2Se3 heterostructured memory devices. The fabricated devices showed a rapid increase of current conduction, which is attributed to the phase transition of In2Se3. The TEM images demonstrated that In2Se3 transformed from polycrystalline to layered structure thanks to the effective thermal confinement effect between graphene and In2Se3, attributed to the low thermal conductivity of layered materials in vertical direction. In addition, the current conduction could be controlled effectively by applying different pulse voltages, showing stable retention and endurance characteristics. It is thought that the differently bonded states contribute to this control process. This study demonstrates the possibility of Graphene-In2Se3 van der Waals heterostructure as 2D based future memory electronics. This work was supported by the National Research Foundation of Korea(NRF) Grant funded by the Korea government(MEST) (No. 2013R1A2A2A01015516).

  16. Echocardiography and cardiac MRI in mutation-negative hypertrophic cardiomyopathy in an older patient: a case defining the need for ICD.

    PubMed

    Rodriguez, Fatima; Degnan, Kathleen O; Seidman, Christine E; Mangion, Judy R

    2014-08-01

    We report the case of a 67-year-old man with hypertrophic cardiomyopathy who presented for a second opinion about implantable cardio-defibrillator (ICD) placement after a witnessed syncopal episode. Despite his older age, being mutation-negative, and having a maximal septal thickness of 2.2 cm on echocardiography, he demonstrated rapid progression of myocardial fibrosis on cardiac MRI, correlating to ventricular tachyarrhythmias and syncope. We review the role of echocardiography and cardiac MRI in optimizing medical care for such patients who may not otherwise meet criteria for an ICD placement or further interventions. PMID:24816179

  17. Preoperative morphological analysis by transesophageal echocardiography and predictive value of plasma landiolol concentration during systolic anterior motion mitral valve repair : a report of three cases.

    PubMed

    Yoshimura, Manabu; Kunisawa, Takayuki; Iida, Takafumi; Matsumoto, Megumi; Takakai, Hayato; Kanda, Hirotsugu; Kurosawa, Atsushi; Takahata, Osamu; Iwasaki, Hiroshi

    2014-06-01

    We report three cases with systolic anterior motion (SAM) after mitral valve plasty. Preoperative mitral valve morphology is a risk factor for SAM. The morphological characteristics of SAM have been revealed in several studies. We found a small distance between coaptation and the interventricular septum in all cases, and cases 2, and 3 had a low AL/PL ratio, whereas case 3 had a large PML, which was revealed by transesophageal echocardiography. With the use of 3D transesophageal echocardiography, when mitral valve prolapse was investigated, in all three cases, it was easy to specify lesions. The issue for the future is 3D analysis when SAM is occurring. PMID:24162450

  18. Variability of M-Mode Versus Two-Dimensional Echocardiography Measurements in Children With Dilated Cardiomyopathy

    PubMed Central

    Margossian, Renee; Sleeper, Lynn A.; Canter, Charles E.; Chen, Shan; Tani, Lloyd Y.; Shirali, Girish; Szwast, Anita; Tierney, Elif Seda Selamet; Campbell, M. Jay; Golding, Fraser; Wang, Yanli; Altmann, Karen; Colan, Steven D.

    2015-01-01

    M-mode and 2-dimensional (2D) echocardio-graphic imaging are routinely used to quantify left-ventricular (LV) size and function in pediatric patients with dilated cardiomyopathy (DCM). The reproducibility of and correlation between these techniques are unknown. This analysis sought to compare interreader, intrareader, and interacquisition reproducibility of M-mode versus 2D measurements in pediatric DCM patients. The Ventricular Volume Variability study of the Pediatric Heart Network is a multicenter, prospective, observational study assessing the course of chronic DCM in children. Two sonographers performed baseline image acquisitions locally, and two readers performed measurements at the echocardiographic core laboratory. One reader repeated measurements 1 month later. These data were used to assess reproducibility and agreement between M-mode and 2D measurements. One hundred sixty-nine subjects were enrolled. M-mode had similar or greater reproducibility in both intrareader and interreader settings for LV dimensions, shortening fraction (SF), and most wall thicknesses. In contrast, 2D reproducibility was similar or better for nearly all variables in the interacquisition setting but not for SF. Interacquisition variability was approximately twice the intrareader variability. LV dimensions by either modality consistently had high reproducibility and had the highest agreement between modalities. In pediatric DCM patients, variability of linear echocardiographic assessment could be minimized by relying on a single reader and using a consistent method (M-mode or 2D) for serial measurements, preferably M-mode when SF is the primary variable of interest. Except for LV dimensions, M-mode and 2D values should not be used interchangeably due to poor agreement. PMID:24265000

  19. Variability of M-mode versus two-dimensional echocardiography measurements in children with dilated cardiomyopathy.

    PubMed

    Lee, Caroline K; Margossian, Renee; Sleeper, Lynn A; Canter, Charles E; Chen, Shan; Tani, Lloyd Y; Shirali, Girish; Szwast, Anita; Tierney, Elif Seda Selamet; Campbell, M Jay; Golding, Fraser; Wang, Yanli; Altmann, Karen; Colan, Steven D

    2014-04-01

    M-mode and 2-dimensional (2D) echocardiographic imaging are routinely used to quantify left-ventricular (LV) size and function in pediatric patients with dilated cardiomyopathy (DCM). The reproducibility of and correlation between these techniques are unknown. This analysis sought to compare interreader, intrareader, and interacquisition reproducibility of M-mode versus 2D measurements in pediatric DCM patients. The Ventricular Volume Variability study of the Pediatric Heart Network is a multicenter, prospective, observational study assessing the course of chronic DCM in children. Two sonographers performed baseline image acquisitions locally, and two readers performed measurements at the echocardiographic core laboratory. One reader repeated measurements 1 month later. These data were used to assess reproducibility and agreement between M-mode and 2D measurements. One hundred sixty-nine subjects were enrolled. M-mode had similar or greater reproducibility in both intrareader and interreader settings for LV dimensions, shortening fraction (SF), and most wall thicknesses. In contrast, 2D reproducibility was similar or better for nearly all variables in the interacquisition setting but not for SF. Interacquisition variability was approximately twice the intrareader variability. LV dimensions by either modality consistently had high reproducibility and had the highest agreement between modalities. In pediatric DCM patients, variability of linear echocardiographic assessment could be minimized by relying on a single reader and using a consistent method (M-mode or 2D) for serial measurements, preferably M-mode when SF is the primary variable of interest. Except for LV dimensions, M-mode and 2D values should not be used interchangeably due to poor agreement. PMID:24265000

  20. Sources of variation in assessing left atrial functions by 2D speckle-tracking echocardiography.

    PubMed

    Rimbaş, Roxana Cristina; Mihăilă, Sorina; Vinereanu, Dragoş

    2016-03-01

    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

  1. Diagnostics of Titan's stratospheric dynamics using Cassini/CIRS data and the 2-dimensional IPSL circulation model

    NASA Astrophysics Data System (ADS)

    Crespin, A.; Lebonnois, S.; Vinatier, S.; Bézard, B.; Coustenis, A.; Teanby, N. A.; Achterberg, R. K.; Rannou, P.; Hourdin, F.

    2008-10-01

    The dynamics of Titan's stratosphere is discussed in this study, based on a comparison between observations by the CIRS instrument on board the Cassini spacecraft, and results of the 2-dimensional circulation model developed at the Institute Pierre-Simon Laplace, available at http://www.lmd.jussieu.fr/titanDbase [Rannou, P., Lebonnois, S., Hourdin, F., Luz, D., 2005. Adv. Space Res. 36, 2194-2198]. The comparison aims at both evaluating the model's capabilities and interpreting the observations concerning: (1) dynamical and thermal structure using temperature retrievals from Cassini/CIRS and the vertical profile of zonal wind at the Huygens landing site obtained by Huygens/DWE; and (2) vertical and latitudinal profiles of stratospheric gases deduced from Cassini/CIRS data. The modeled thermal structure is similar to that inferred from observations (Cassini/CIRS and Earth-based observations). However, the upper stratosphere (above 0.05 mbar) is systematically too hot in the 2D-CM, and therefore the stratopause region is not well represented. This bias may be related to the haze structure and to misrepresented radiative effects in this region, such as the cooling effect of hydrogen cyanide (HCN). The 2D-CM produces a strong atmospheric superrotation, with zonal winds reaching 200 m s -1 at high winter latitudes between 200 and 300 km altitude (0.1-1 mbar). The modeled zonal winds are in good agreement with retrieved wind fields from occultation observations, Cassini/CIRS and Huygens/DWE. Changes to the thermal structure are coupled to changes in the meridional circulation and polar vortex extension, and therefore affect chemical distributions, especially in winter polar regions. When a higher altitude haze production source is used, the resulting modeled meridional circulation is weaker and the vertical and horizontal mixing due to the polar vortex is less extended in latitude. There is an overall good agreement between modeled chemical distributions and observations

  2. Exercise echocardiography predicts development of left ventricular dysfunction in medically and surgically treated patients with asymptomatic severe aortic regurgitation

    PubMed Central

    Wahi, S; Haluska, B; Pasquet, A; Case, C; Rimmerman, C; Marwick, T

    2000-01-01

    OBJECTIVE—To assess resting and exercise echocardiography for prediction of left ventricular dysfunction in patients with significant asymptomatic aortic regurgitation.
DESIGN—Cohort study of patients with aortic regurgitation.
SETTING—Tertiary referral centre specialising in valvar surgery.
PATIENTS—61 patients (38 men, 23 women; mean (SD) age 53 (14) years) with asymptomatic or minimally symptomatic aortic regurgitation and no known coronary artery disease; 35 were treated medically and 26 had aortic valve replacement.
INTERVENTIONS—Exercise echocardiography was used to evaluate ejection fraction, which was measured on the resting and post-stress images using the modified Simpson method. Patients with an increment of ejection fraction after exercise were denoted as having contractile reserve (CR+); those without an increment were labelled CR−.
MAIN OUTCOME MEASURES—Standard univariate and multivariate methods and receiver operating characteristic analyses were used to assess the ability of contractile reserve to predict follow up ejection fraction.
RESULTS—In the 35 medically treated patients, 13 of 21 (62%) with CR+ (mean (SD) ejection fraction increment 7 (3)%) had preserved ejection fraction on follow up. In the 14 patients with CR− (ejection fraction decrement 8 (4)%), 13 (93%) had a decrement of ejection fraction on follow up from 60 (5)% at baseline to 54 (3)% on follow up (p = 0.005). Age, resting left ventricular dimensions, medical treatment, aortic regurgitation severity, exercise capacity, and rate-pressure product were similar in both CR+ and CR− groups. Among the 26 surgical patients, 13 showed CR+ (ejection fraction increase 9 (5)%), all of whom had an increase in ejection fraction on follow up (from 49% to 59%). Of 13 surgical patients with CR− (ejection fraction decrease 7 (5)%), 10 (77%) showed the same or worse ejection fraction on postoperative follow up

  3. Measurement of myocardial perfusion and infarction size using computer-aided diagnosis system for myocardial contrast echocardiography.

    PubMed

    Du, Guo-Qing; Xue, Jing-Yi; Guo, Yanhui; Chen, Shuang; Du, Pei; Wu, Yan; Wang, Yu-Hang; Zong, Li-Qiu; Tian, Jia-Wei

    2015-09-01

    Proper evaluation of myocardial microvascular perfusion and assessment of infarct size is critical for clinicians. We have developed a novel computer-aided diagnosis (CAD) approach for myocardial contrast echocardiography (MCE) to measure myocardial perfusion and infarct size. Rabbits underwent 15 min of coronary occlusion followed by reperfusion (group I, n = 15) or 60 min of coronary occlusion followed by reperfusion (group II, n = 15). Myocardial contrast echocardiography was performed before and 7 d after ischemia/reperfusion, and images were analyzed with the CAD system on the basis of eliminating particle swarm optimization clustering analysis. The myocardium was quickly and accurately detected using contrast-enhanced images, myocardial perfusion was quantitatively calibrated and a color-coded map calibrated by contrast intensity and automatically produced by the CAD system was used to outline the infarction region. Calibrated contrast intensity was significantly lower in infarct regions than in non-infarct regions, allowing differentiation of abnormal and normal myocardial perfusion. Receiver operating characteristic curve analysis documented that -54-pixel contrast intensity was an optimal cutoff point for the identification of infarcted myocardium with a sensitivity of 95.45% and specificity of 87.50%. Infarct sizes obtained using myocardial perfusion defect analysis of original contrast images and the contrast intensity-based color-coded map in computerized images were compared with infarct sizes measured using triphenyltetrazolium chloride staining. Use of the proposed CAD approach provided observers with more information. The infarct sizes obtained with myocardial perfusion defect analysis, the contrast intensity-based color-coded map and triphenyltetrazolium chloride staining were 23.72 ± 8.41%, 21.77 ± 7.8% and 18.21 ± 4.40% (% left ventricle) respectively (p > 0.05), indicating that computerized myocardial contrast echocardiography can

  4. Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of sinus of valsalva aneurysm rupture.

    PubMed

    Raslan, Saleem; Nanda, Navin C; Lloyd, Lancelot; Khairnar, Prakash; Reilly, Stephanie D; Holman, William L

    2011-09-01

    We present an adult patient with rupture of the right sinus of Valsalva aneurysm in whom the two-dimensional transesophageal echocardiogram failed to show the rupture. On the other hand, live/real time three-dimensional transesophageal echocardiography clearly delineated the site of rupture into the pericardium and mediastinum. PMID:21827544

  5. Comparison of left ventricular ejection fraction values obtained using invasive contrast left ventriculography, two-dimensional echocardiography, and gated single-photon emission computed tomography

    PubMed Central

    Garg, Nadish; Dresser, Thomas; Aggarwal, Kul; Gupta, Vishal; Mittal, Mayank K; Alpert, Martin A

    2016-01-01

    Objectives: Left ventricular ejection fraction can be measured by a variety of invasive and non-invasive cardiac techniques. This study assesses the relation of three diagnostic modalities to each other in the measurement of left ventricular ejection fraction: invasive contrast left ventriculography, two-dimensional echocardiography, and quantitative gated single-photon emission computed tomography. Methods: Retrospective chart review was conducted on 58 patients hospitalized with chest pain, who underwent left ventricular ejection fraction evaluation using each of the aforementioned modalities within a 3-month period not interrupted by myocardial infarction or revascularization. Results: The mean left ventricular ejection fraction values were as follows: invasive contrast left ventriculography (0.44±0.15), two-dimensional echocardiography (0.46±0.13), and gated single-photon emission computed tomography (0.37±0.10). Correlations coefficients and associated p values were as follows: invasive contrast left ventriculography versus two-dimensional echocardiography (r=0.69, p<0.001), invasive contrast left ventriculography versus gated single-photon emission computed tomography (r=0.80, p<0.0001), and gated single-photon emission computed tomography versus two-dimensional echocardiography (r=0.69, p<0.001). Conclusion: Our results indicate that strong positive correlations exist among the three techniques studied.

  6. Real time three-dimensional transesophageal echocardiography guided coronary sinus cannulation during CARILLON mitral annuloplasty device therapy for a patient with chronic severe mitral regurgitation.

    PubMed

    Mahmoud, Hani M; Al-Ghamdi, Mohammed A; Ghabashi, Abdullah E

    2015-01-01

    The coronary sinus (CS) has become a clinically important structure especially through its role in providing access for different cardiac procedures such as arrhythmia ablation, biventricular pacing and recently, percutaneous valvular interventions. Fluoroscopy with or without two-dimensional transesophageal echocardiography is the widely used method for guidance. A 78-year-old female patient undergoing percutaneous CARILLON mitral annuloplasty device therapy for chronic severe symptomatic mitral regurgitation. After insertion of the CS catheter through the right internal jugular vein, multiple trials for CS cannulation guided by fluoroscopy and two-dimensional transesophageal echocardiography were unsuccessful. So, real time three-dimensional zoom mode was used. Then, the volume was rotated to have the anatomically oriented enface view of the interatrial septum from the right atrial perspective. The CS ostium was identified adjacent to the eustachian valve. Then the catheter was reintroduced through the superior vena cava into the right atrium then easily navigated to cannulate the CS ostium. The position was confirmed by the fluoroscopically known course of the CS plus the pattern of the invasive pressure wave form. CS cannulation is not always feasible using fluoroscopy and/or two-dimensional Echocardiography guidance. Real time three-dimensional transesophageal echocardiography can be used to guide CS cannulation as it provides an anatomically oriented and informative enface view of the CS ostium. It can help reducing fluoroscopic radiation time. PMID:25231878

  7. Effects of antithrombotic drugs in patients with left ventricular thrombi: assessment with indium-111 platelet imaging and two-dimensional echocardiography

    SciTech Connect

    Stratton, J.R.; Ritchie, J.L.

    1984-03-01

    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.

  8. Comparison of Gated SPECT Myocardial Perfusion Imaging with Echocardiography for the Measurement of Left Ventricular Volumes and Ejection Fraction in Patients With Severe Heart Failure

    PubMed Central

    Shojaeifard, Maryam; Ghaedian, Tahereh; Yaghoobi, Nahid; Malek, Hadi; Firoozabadi, Hasan; Bitarafan-Rajabi, Ahmad; Haghjoo, Majid; Amin, Ahmad; Azizian, Nasrin; Rastgou, Feridoon

    2015-01-01

    Background: Gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is known as a feasible tool for the measurement of left ventricular ejection fraction (EF) and volumes, which are of great importance in the management and follow-up of patients with coronary artery diseases. However, considering the technical shortcomings of SPECT in the presence of perfusion defect, the accuracy of this method in heart failure patients is still controversial. Objectives: The aim of the present study was to compare the results from gated SPECT MPI with those from echocardiography in heart failure patients to compare echocardiographically-derived left ventricular dimension and function data to those from gated SPECT MPI in heart failure patients. Patients and Methods: Forty-one patients with severely reduced left ventricular systolic function (EF ≤ 35%) who were referred for gated SPECT MPI were prospectively enrolled. Quantification of EF, end-diastolic volume (EDV), and end-systolic volume (ESV) was performed by using quantitative gated spect (QGS) (QGS, version 0.4, May 2009) and emory cardiac toolbox (ECTb) (ECTb, revision 1.0, copyright 2007) software packages. EF, EDV, and ESV were also measured with two-dimensional echocardiography within 3 days after MPI. Results: A good correlation was found between echocardiographically-derived EF, EDV, and ESV and the values derived using QGS (r = 0.67, r = 0.78, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001) and ECTb (r = 0.68, 0.79, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001). However, Bland-Altman plots indicated significantly different mean values for EF, 11.4 and 20.9 using QGS and ECTb, respectively, as compared with echocardiography. ECTb-derived EDV was also significantly higher than the EDV measured with echocardiography and QGS. The highest correlation between echocardiography and gated SPECT MPI was found for mean values of ESV different. Conclusions: Gated

  9. Measurement of left ventricular torsion using block-matching-based speckle tracking for two-dimensional echocardiography

    NASA Astrophysics Data System (ADS)

    Sun, Feng-Rong; Wang, Xiao-Jing; Wu, Qiang; Yao, Gui-Hua; Zhang, Yun

    2013-01-01

    Left ventricular (LV) torsion is a sensitive and global index of LV systolic and diastolic function, but how to noninvasively measure it is challenging. Two-dimensional echocardiography and the block-matching based speckle tracking method were used to measure LV torsion. Main advantages of the proposed method over the previous ones are summarized as follows: (1) The method is automatic, except for manually selecting some endocardium points on the end-diastolic frame in initialization step. (2) The diamond search strategy is applied, with a spatial smoothness constraint introduced into the sum of absolute differences matching criterion; and the reference frame during the search is determined adaptively. (3) The method is capable of removing abnormal measurement data automatically. The proposed method was validated against that using Doppler tissue imaging and some preliminary clinical experimental studies were presented to illustrate clinical values of the proposed method.

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

    SciTech Connect

    Das, Shaoli; Parekh, Ranjan

    2010-10-26

    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%.

  11. The ability of live three-dimensional transesophageal echocardiography to evaluate the attachment site of intracardiac tumors.

    PubMed

    Khairnar, Prakash; Hsiung, Ming C; Mishra, Stuti; Nanda, Navin C; Daly, David D; Nayyar, Gaurav; Patel, Adilahmed; Mishra, Jaymala; Chuang, Yi-Cheng; Tsai, Shen-Kou; Yin, Wei-Hsin; Wei, Jeng

    2011-10-01

    In this study, a case of a right ventricular myxoma and a case of a right ventricular hemangioma are used to demonstrate the ability of live three-dimensional transesophageal echocardiography (3DTEE) to assess the site of tumor attachment. Because 3DTEE has the ability to visualize desired structures in multiple planes, we defined the attached portion of the tumors and measured the en face view dimensions. In addition, the improved ability of 3DTEE to evaluate tissue characteristics allowed differentiation of the heterogeneous myxoma and highly vascular hemangioma. On the contrary, because two-dimensional (2D) TEE only allows structures to be viewed in a 2D plane, the attachment site can be located but complete delineation and measurement of area is not possible. As surgical options become less invasive, accurate attachment site location and size will become more important to ensure complete excision. PMID:21929586

  12. [Anesthetic Management Using Transesophageal Echocardiography and EV1000 in a Patient with Ebstein's Anomary Undergoing Scoliosis Surgery].

    PubMed

    Tanimura, Kazuki; Miura, Yukiko; Ishii, Hisanari

    2016-02-01

    An 18-year-old female patinet with Ebstein anomaly underwent surgical repair of scoliosis under total intravenous anesthesia. In addtition to normal monitors, we used transesophageal echocardiography (TEE) and EV1000 (Edwards Lifesciences, Irvine, USA), which show stroke volume variation and stroke volume index simultaneously in a rectangular coordinates. TEE detected reversal of intracardiac shunt which caused SpO2 decrease during fixing screws at thoracic vertebrae, then manual ventilation with oxygen unproved SpO2. Because of a high venous pressure due to Ebstein anomaly, surgical bleeding seemed to be larger than usual. By using EV1000, volume status and cardiac contractility were estimated and adequate volume loading and inoptrope injection were performed to stabilize circulatory condition. The operation was completed without any cardiac and respiratory complications. PMID:27017770

  13. Novel ways to noninvasively detect inflammation of the myocardium: contrast-enhanced MRI and myocardial contrast echocardiography

    PubMed Central

    van den Brink, M.R.; Geluk, C.A.; Lindner, J.R.; Velthuis, B.K.; Vonken, E.J.; Cramer, M.J.M.

    2003-01-01

    Both contrast-enhanced magnetic resonance imaging (CE-MRI) and myocardial contrast echocardiography (MCE) are promising tools to detect cardiac inflammation. CE-MRI can be used to characterise the location and extent of myocardial inflammation, since areas of abnormal signal enhancement associated with regional wall motion abnormalities reliably indicate areas of active myocarditis. In MCE, chemically composed microbubbles can be visualised by ultrasound and used to determine the status of the cardiac microvasculature. If there is any inflammation the microbubbles will be phagocytosed by neutrophils and monocytes, thus enabling the degree of inflammation to be assessed. These noninvasive techniques may allow early diagnosis and accurate evaluation of myocardial inflammation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696203

  14. Non-invasive assessment of functional strain lines in the real human left ventricle via speckle tracking echocardiography.

    PubMed

    Evangelista, A; Gabriele, S; Nardinocchi, P; Piras, P; Puddu, P E; Teresi, L; Torromeo, C; Varano, V

    2015-02-01

    A mechanics-based analysis of data from three-dimensional speckle tracking echocardiography is proposed, aimed at investigating deformations in myocardium and at assessing shape and function of distinct strain lines corresponding to the principal strain lines of the cardiac tissue. The analysis is based on the application of a protocol of measurement of the endocardial and epicardial principal strain lines, which was already tested on simulated left ventricles. In contrast with similar studies, it is established that endocardial principal strain lines cannot be identified with any structural fibers, not even along the systolic phase and is suggested that it is due to the capacity of the endocardial surface to contrast the dilation of the left ventricle. PMID:25547026

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

    NASA Astrophysics Data System (ADS)

    Das, Shaoli; Parekh, Ranjan

    2010-10-01

    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%.

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

    PubMed

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

    1989-10-01

    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

  17. Registration of 2D cardiac images to real-time 3D ultrasound volumes for 3D stress echocardiography

    NASA Astrophysics Data System (ADS)

    Leung, K. Y. Esther; van Stralen, Marijn; Voormolen, Marco M.; van Burken, Gerard; Nemes, Attila; ten Cate, Folkert J.; Geleijnse, Marcel L.; de Jong, Nico; van der Steen, Antonius F. W.; Reiber, Johan H. C.; Bosch, Johan G.

    2006-03-01

    Three-dimensional (3D) stress echocardiography is a novel technique for diagnosing cardiac dysfunction, by comparing wall motion of the left ventricle under different stages of stress. For quantitative comparison of this motion, it is essential to register the ultrasound data. We propose an intensity based rigid registration method to retrieve two-dimensional (2D) four-chamber (4C), two-chamber, and short-axis planes from the 3D data set acquired in the stress stage, using manually selected 2D planes in the rest stage as reference. The algorithm uses the Nelder-Mead simplex optimization to find the optimal transformation of one uniform scaling, three rotation, and three translation parameters. We compared registration using the SAD, SSD, and NCC metrics, performed on four resolution levels of a Gaussian pyramid. The registration's effectiveness was assessed by comparing the 3D positions of the registered apex and mitral valve midpoints and 4C direction with the manually selected results. The registration was tested on data from 20 patients. Best results were found using the NCC metric on data downsampled with factor two: mean registration errors were 8.1mm, 5.4mm, and 8.0° in the apex position, mitral valve position, and 4C direction respectively. The errors were close to the interobserver (7.1mm, 3.8mm, 7.4°) and intraobserver variability (5.2mm, 3.3mm, 7.0°), and better than the error before registration (9.4mm, 9.0mm, 9.9°). We demonstrated that the registration algorithm visually and quantitatively improves the alignment of rest and stress data sets, performing similar to manual alignment. This will improve automated analysis in 3D stress echocardiography.

  18. Physiological basis in the assessment of myocardial mechanics using speckle-tracking echocardiography 2D. Part I

    PubMed Central

    Karolczak, Maciej Aleksander

    2016-01-01

    In this paper, the authors attempt to concisely present the anatomical and pathophysiological bases as well as the principles for echocardiographic evaluation of mechanical aspects of cardiac function based on speckle tracking method. This technique uses a phenomenon involving the formation of characteristic image units, referred to as speckles or acoustic markers, which are stable during cardiac cycle, on a two-dimensional echocardiographic picture. Changes in the position of these speckles throughout the cardiac cycle, which are monitored and analyzed semi-automatically by a computer system, reflect deformation of both, cardiac ventricle as a whole as well as its individual anatomical segments. The values of strain and the strain rate, as well as the range and velocity of the movement of these markers, which are in close relationship with multiple hemodynamic parameters, can be visualized as various types of charts – linear, two- and three-dimensional – as well as numerical values, enabling deeper insight into the mechanical and hemodynamic aspects of cardiac function in health and disease. The use of information obtained based on speckle tracking echocardiography allows to understand previously unclear mechanisms of physiological and pathophysiological processes. The first part of the study discusses the formation of a two-dimensional ultrasound image and the speckles, as well as the technical aspects of tracking their movement. The second part presents in more detail the methodology of speckle-tracking echocardiography, the characteristic abnormalities of cardiac mechanics presenting in different clinical entities, and the limitations related to given clinical and technical issues. PMID:27446598

  19. The Incidence of Patent Foramen Ovale in 1,000 Consecutive Patients: A Contrast Transesophageal Echocardiography Study

    NASA Technical Reports Server (NTRS)

    Fisher, Daniel C.; Fisher, Edward A.; Budd, Jacqueline H.; Rosen, Stacey E.; Goldman, Martin E.

    1995-01-01

    Study objective: Patent foramen ovale (PFO) is present in 10 to 35% of people and has been reported to be an important risk factor for cardioembolic cerebrovascular accidents (CVAs) and transient ischemic attacks (TIAS), especially in younger patients. While contrast transthoracic echocardiography has been used to detect PFO, contrast transesophageal echocardiography (TEE) has a greater sensitivity. Prior studies reported the incidence of PFO in patients presenting with a CVA or TIA. Design: To determine the incidence of PFO in a more general population, we reviewed 1,000 consecutive TEES performed with contrast and color Doppler for the presence of PFO and other cardioembolic risk factors, including atrial septal aneurysm (ASA), aortic plaque, atrial fibrillation (AFib), and atrial thrombi. While imaging with monoplane or biplane TEE, multiple injections of agitated saline solution were injected during cough or Valsalva maneuver to detect flow through a PFO. Patients: There were 482 male and 518 female patients with mean age of 60 + 17 years (range 11 to 93 years). Results: Patent foramen ovale was found in 9.2% of all patients and, though seen in all age groups divided by decade, the incidence in patients aged 40 to 49 years was greater than those aged 70 to 79 years (12.96% vs 6.15%',, p=0.03). Contrast TEE had a much higher detection rate than color Doppler alone. Importantly, there was no greater incidence of PFO in patients with CVA vs thos without CVA, or in male vs female patients. Also, there was a very strong correlation between the presence of ASA and PFO (p<.001). Conclusion: Thus, PFO detected by TEE, frequently seen with ASA, is seen in all age groups and does not in itself present a risk factor for CVA. The association of PFO with peripheral thrombosis and CVA needs further study.

  20. Comprehensive Two-Dimensional Interrogation of the Tricuspid Valve Using Knowledge Derived from Three-Dimensional Echocardiography

    PubMed Central

    Addetia, Karima; Yamat, Megan; Mediratta, Anuj; Medvedofsky, Diego; Patel, Mita; Ferrara, Preston; Mor-Avi, Victor; Lang, Roberto M.

    2016-01-01

    Background Accurate identification of tricuspid valve (TV) leaflets by two-dimensional (2D) transthoracic echocardiography is difficult because of variability in the intersection between the imaging plane and leaflets. Using information obtained from multiplanar reconstruction (MPR) of three-dimensional (3D) data sets, the investigators sought to define “novel” 2D views that would allow targeted interrogation of TV leaflets using 2D transthoracic echocardiography. Methods Images of the TV in the standard 2D views (apical four chamber, right ventricular focused, right ventricular inflow, and parasternal short axis) and 3D data sets were acquired from the same probe position in 106 adults. Three-dimensional MPR was used to determine which leaflet combination was seen in the 2D image: anterior and septal, anterior and posterior, anterior alone, or posterior and septal. Using this analysis, 2D landmarks were identified to define nonstandard TV views tailored to depict specific leaflets. Two-dimensional images in these views and 3D data sets were then prospectively collected in 54 additional patients. Three independent readers analyzed these 2D views to determine TV leaflet combinations, and their interpretation was compared with 3D MPR–derived reference. Results Three-dimensional MPR views made it possible to define six nonstandard 2D views on the basis of anatomic clues and landmarks, which consistently depicted all the aforementioned leaflet combinations. When these six views were prospectively tested, the agreement of TV leaflet identification against 3D MPR was excellent (κ = 0.88, κ = 0.93, and κ = 0.98). Conclusion The nonstandard 2D views defined in this study allow accurate TV leaflet identification and may thus be useful when localization of TV leaflet pathology is clinically important. (J Am Soc Echocardiogr 2016;29:74–82.) PMID:26427537

  1. [Heart and sports: modifications of electrocardiogram, late potentials and echocardiography. Study of 75 sportsmen and 46 witnesses].

    PubMed

    Moustaghfir, A; Hda, A; Benyass, A; Zahi, M; Boukili, A; Ohayon, V; Hamani, A; Archane, M I

    2002-09-01

    The authors report the results of prospective study, which compared 75 sports subjects and 45 witnesses. All subjects were male, the differentiating parameter being the type of sport practiced. This work analysed surface Electrocardiogramme, thransthoracic echocardiography and high amplification ECG. The statistical study used the student test t compare means and the Chi2 test for the percentages, the signification limit was fixed to 5%. Clinically, our two series didn't show a significant statistical difference, concerning: age, weight, height or arterial pressure. On the electrocardiographical level, the sport's men have a lower cardiac frequency (p = 0.005), a larger PR space (p = 0.05), an important Sokolow parameter (p < 0.005), and repolarisation disorders represented, essentially by negative T waves (p = 0.02) and an upper movement of ST segment in V2-V3 (p < 0.005). Echocardiography showed a dilatation of the right cavities: right auricular (p = 0.0125) and right ventricular (p = 0.025). Move over, it has been showed that the sport's men left ventricular walls were tabor (septal wall, p = 0.0125), (posterior wall, p = 0.025), despite a difference in the values of the left ventricular telediastolic diameter (4 mm average in the two series). The signification limit was not reached and it was also showed that the left auricular was also dilated (p = 0.025). The study of the delayed Potentials, tried to bring an explication to certain sudden deaths of sport's men which are to date unexplained and which could have a rhythmical origin? It is also to be noted that sport's men present more delayed ventricular Potentials. However, the statistical signification was not reached (p = 0.07). PMID:12471796

  2. The influence of acute unloading on left ventricular strain and strain rate by speckle tracking echocardiography in a porcine model.

    PubMed

    Dahle, Geir Olav; Stangeland, Lodve; Moen, Christian Arvei; Salminen, Pirjo-Riitta; Haaverstad, Rune; Matre, Knut; Grong, Ketil

    2016-05-15

    Noninvasive measurements of myocardial strain and strain rate by speckle tracking echocardiography correlate to cardiac contractile state but also to load, which may weaken their value as indices of inotropy. In a porcine model, we investigated the influence of acute dynamic preload reductions on left ventricular strain and strain rate and their relation to the pressure-conductance catheter-derived preload recruitable stroke work (PRSW) and peak positive first derivative of left ventricular pressure (LV-dP/dtmax). Speckle tracking strain and strain rate in the longitudinal, circumferential, and radial directions were measured during acute dynamic reductions of end-diastolic volume during three different myocardial inotropic states. Both strain and strain rate were sensitive to unloading of the left ventricle (P < 0.001), but the load dependency for strain rate was modest compared with strain. Changes in longitudinal and circumferential strain correlated more strongly to changes in end-diastolic volume (r = -0.86 and r = -0.72) than did radial strain (r = 0.35). Longitudinal, circumferential, and radial strain significantly correlated with LV-dP/dtmax (r = -0.53, r = -0.46, and r = 0.86), whereas only radial strain correlated with PRSW (r = 0.55). Strain rate in the longitudinal, circumferential and radial direction significantly correlated with both PRSW (r = -0.64, r = -0.58, and r = 0.74) and LV-dP/dtmax (r = -0.95, r = -0.70, and r = 0.85). In conclusion, the speckle tracking echocardiography-derived strain rate is more robust to dynamic ventricular unloading than strain. Longitudinal and circumferential strain could not predict load-independent contractility. Strain rates, and especially in the radial direction, are good predictors of preload-independent inotropic markers derived from conductance catheter. PMID:26968547

  3. The advantages of live/real time three-dimensional transesophageal echocardiography during assessments of pulmonary stenosis.

    PubMed

    Kemaloğlu Öz, Tuğba; Özpamuk Karadeniz, Fatma; Akyüz, Şükrü; Ünal Dayı, Şennur; Esen Zencirci, Aycan; Atasoy, Işıl; Ösken, Altuğ; Eren, Mehmet

    2016-04-01

    This report sought to compare live/real-time three-dimensional transesophageal echocardiography (3D-TEE) with two-dimensional transesophageal echocardiography (2D-TEE) and to determine whether there are advantages to using 3D-TEE on patients with pulmonary stenosis (PS). Sixteen consecutive adult patients (50 % male and 50 % female; mean age 33 ± 13.4 years) with PS and indications of TEE were prospectively enrolled in this study. Following this, initial 2D-TEE and 3D-TEE examinations were performed, and 3D-TEE images were analyzed using an off-line Q-lab software system. Finally, the 2D-TEE and 3D-TEE findings were compared. In the present study, 3D-TEE allowed us to obtain the en face views of pulmonary valves (PVs) in all but one patient. While this patient was without a PV due to a previous tetralogy of Fallot operation, we could detect the type of PV in the other 15 (93.7 %) patients by using 3D-TEE. Due to poor image quality, the most stenotic area was not measurable in only one (6.2 %) of the patients. In eight (50 %) of the patients, severity and localization of stenosis were more precisely determined with 3DTEE than with 2D-TEE. The PVs' maximal annulus dimensions were found to be significantly larger when they were measured using 3D modalities. This study provides evidence of the incremental value of using 3D-TEE rather than 2D-TEE during assessments of PS, specifically in cases where special conditions (pregnancy, pulmonary regurgitation, and concomitant atrial septal defects) cause recordings of the transvalvular peak gradient to be inaccurate. Therefore, 3D-TEE should be used as a complementary imaging tool to 2D-TEE during routine echocardiographic examinations. PMID:26613764

  4. The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia: a single-center experience.

    PubMed

    Katsanos, Aristeidis H; Patsouras, Dimitrios; Tsivgoulis, Georgios; Kosmidou, Maria; Katsanos, Konstantinos H; Kyritsis, Athanassios P; Giannopoulos, Sotirios

    2016-04-01

    The diagnostic utility of transesophageal echocardiography (TEE) has often been challenged in patients with cryptogenic stroke (CS). We estimated the prevalence of different findings on TEE examination of CS patients, their impact on secondary stroke prevention and the presence of potential age or gender disparities. We reviewed all TEE examinations that were performed in a single echocardiography laboratory during a 7-year-old period to identify CS patients that underwent investigation with TEE. Of the 518 total TEE examinations, we identified 88 CS patients. TEE revealed abnormal findings in 69.3 % of them. Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were identified in 30.6 and 22.7 % of the patients. Ascending aorta and aortic arch atheromatosis was present in 26.1 % of the patients, with complex atheromatosis diagnosed in 14.7 % of them. Cardiac myxomas were uncovered in 2.3 %. Thrombi in the left atrium and in cardiac valves were reported in 3.4 and 2.3 % of the patients, respectively. Based on TEE findings, the therapeutic management would be very likely modified in 9.1 % of the patients. Subgroup analysis revealed no gender disparities on the prevalence of TEE findings and in secondary stroke prevention, while linear regression analyses revealed significant associations of age with the prevalence of PFO, ASA, aorta atheromatosis and complex aorta atheromatosis. TEE examination should be included in the diagnostic work-up of all CS patients, irrespective of age and gender status, since it can reveal potential sources of embolism and has a significant impact for secondary stroke prevention. PMID:26705252

  5. Three-dimensional echocardiography in the evaluation of global and regional function in patients with recent myocardial infarction: a comparison with magnetic resonance imaging.

    PubMed

    Thorstensen, Anders; Dalen, Håvard; Hala, Pavel; Kiss, Gabriel; D'hooge, Jan; Torp, Hans; Støylen, Asbjørn; Amundsen, Brage

    2013-07-01

    We aimed to compare three-dimensional (3D) and two-dimensional (2D) echocardiography in the evaluation of patients with recent myocardial infarction (MI), using late-enhancement magnetic resonance imaging (LE-MRI) as a reference method. Echocardiography and LE-MRI were performed approximately 1 month after first-time MI in 58 patients. Echocardiography was also performed on 35 healthy controls. Left ventricular (LV) ejection fraction by 3D echocardiography (3D-LVEF), 3D wall-motion score (WMS), 2D-WMS, 3D speckle tracking-based longitudinal, circumferential, transmural and area strain, and 2D speckle tracking-based longitudinal strain (LS) were measured. The global correlations to infarct size by LE-MRI were significantly higher (P < 0.03) for 3D-WMS and 2D-WMS compared with 3D-LVEF and the 4 different measurements of 3D strain, and 2D global longitudinal strain (GLS) was more closely correlated to LE-MRI than 3D GLS (P < 0.03). The segmental correlations to infarct size by LE-MRI were also significantly higher (P < 0.04) for 3D-WMS, 2D-WMS, and 2D LS compared with the other indices. Three-dimensional WMS showed a sensitivity of 76% and a specificity of 72% for identification of LV infarct size >12%, and a sensitivity of 73% and a specificity of 95% for identification of segments with transmural infarct extension. Three-dimensional WMS and 2D gray-scale echocardiography showed the strongest correlations to LE-MRI. The tested 3D strain method suffers from low temporal and spatial resolution in 3D acquisitions and added diagnostic value could not be proven. PMID:23347171

  6. Thermodynamics and ideal glass transition on the surface of a monatomic system modeled as quasi "2-dimensional" recursive lattices

    NASA Astrophysics Data System (ADS)

    Huang, Ran

    Two quasi 2-dimensional recursive lattices formed by planar elements have been designed to investigate the surface thermodynamics of monatomic Ising glass system with the aim to study the metastability of supercooled liquids and the ideal glass transition. Both lattices are constructed as hybrids of a Husimi lattice representing the bulk and lower dimensional recursive trees representing the surface. The coordination number, i.e. the number of neighbor sites surrounding one site, is designed to be 3 on the surface and 4 inside the bulk to mimic the 2D regular square lattice case. The recursive properties of recursive lattices were adopted to obtain exact thermodynamic calculations without approximation. The model has a strong anti-ferromagnetic interaction to give rise to an ordered phase identified as a crystal, and a metastable solution is also found to represent the amorphous phase. Interactions between particles farther away than the nearest neighbor distance are taken into consideration. The calculations were done with C/C++ programs. A recursive calculation technique was employed to approach an exact description of the system with the ratio of partial partition functions (PPF) on each site of the lattice. Thermal properties including free energy, energy density and entropy of the ideal crystal and supercooled liquid state of the model on the surface are calculated by the PPF. By analyzing the free energies and entropies of the crystal and supercooled liquid state, we are able to identify the melting transition and the second order ideal glass transition on the surface. The effects of different energy terms that produce competitions between crystallization and glass transition are studied. The results show that due to the coordination number change, the transition temperature on the surface decreases significantly compared to the transition temperature of the bulk system obtained in our previous research. Our theoretical calculation agrees with experiments and

  7. Simulating the Osceola Mudflow Lahar Event in the Pacific Northwest using a GPU Based 2-Dimensional Hydraulic Model

    NASA Astrophysics Data System (ADS)

    Katz, B. G.; Eppert, S.; Lohmann, D.; Li, S.; Goteti, G.; Kaheil, Y. H.

    2011-12-01

    At 4,400 meters, Mount Rainer has been the point of origin for several major lahar events. The largest event, termed the "Osceola Mudflow," occurred 5,500 years ago and covered an area of approximately 550km2 with a total volume of deposited material from 2 to 4km3. Particularly deadly, large lahars are estimated to have maximum flow velocities in of 100km/h with a density often described as "Flowing Concrete." While rare, these events typically cause total destruction within a lahar inundation zone. It is estimated that approximately 150,000 people live on top of previous deposits left by lahars which can be triggered by anything from earthquakes to glacial and chemical erosion of volcanic bedrock over time to liquefaction caused by extreme rainfall events. A novel methodology utilizing a 2 dimensional hydraulic model has been implemented allowing for high resolution (30m) lahar inundation maps to be generated. The utility of this model above or in addition to other methodologies such as that of Iverson (1998), lies in its portability to other lahar zones as well as its ability to model any total volume specified by the user. The process for generating lahar flood plains requires few inputs including: a Digital Terrain Map of any resolution (DTM), a mask defining the locations for lahar genesis, a raster of friction coefficients, and a time series depicting uniform material accumulation over the genesis mask which is allowed to flow down-slope. Finally, a significant improvement in speed has been made for solving the two dimensional model by utilizing the latest in graphics processing unit (GPU) technology which has resulted in a greater than 200 times speed up in model run time over previous CPU-based methods. The model runs for the Osceola Mudflow compare favorably with USGS derived inundation regions as derived using field measurements and GIS based approaches such as the LAHARZ program suit. Overall gradation of low to high risk match well, however the new

  8. Hydraulic Modeling of Alluvial Fans along the Truckee Canal using the 2-Dimensional Model SRH2D

    NASA Astrophysics Data System (ADS)

    Wright, J.; Kallio, R.; Sankovich, V.

    2013-12-01

    Alluvial fans are gently sloping, fan-shaped landforms created by sediment deposition at the ends of mountain valleys. Their gentle slopes and scenic vistas are attractive to developers. Unfortunately, alluvial fans are highly flood-prone, and the flow paths of flood events are highly variable, thereby placing human developments at risk. Many studies have been performed on alluvial fans in the arid west because of the uncertainty of their flow paths and flood extents. Most of these studies have been focused on flood elevations and mitigation. This study is not focused on the flood elevations. Rather, it is focused on the attenuation effects of alluvial fans on floods entering and potentially failing a Reclamation canal. The Truckee Canal diverts water from the Truckee River to Lahontan Reservoir. The drainage areas along the canal are alluvial fans with complex distributary channel networks . Ideally, in nature, the sediment grain-size distribution along the alluvial fan flow paths would provide enough infiltration and subsurface storage to attenuate floods entering the canal and reduce risk to low levels. Human development, however, can prevent the natural losses from occurring due to concentrated flows within the alluvial fan. While the concentrated flows might mitigate flood risk inside the fan, they do not lower the flood risk of the canal. A 2-dimensional hydraulic model, SRH-2D, was coupled to a 1-dimensional rainfall-runoff model to estimate the flood attenuation effects of the alluvial fan network surrounding an 11 mile stretch of the Truckee Canal near Fernley, Nevada. Floods having annual exceedance probabilities ranging from 1/10 to 1/100 were computed and analyzed. SRH-2D uses a zonal approach for modeling river systems, allowing areas to be divided into separate zones based on physical parameters such as surface roughness and infiltration. One of the major features of SRH-2D is the adoption of an unstructured hybrid mixed element mesh, which is based

  9. Early change in left atrial function in patients treated with anthracyclines assessed by real-time three-dimensional echocardiography

    PubMed Central

    Shi, Jing; Guo, Ye; Cheng, Leilei; Song, Feiyan; Shu, Xianhong

    2016-01-01

    Real-time three-dimensional echocardiography(RT-3DE) has allowed a better assessment of LA volumes and function. We sought to assess the early change in left atrial size and function in patients treated with anthracyclines using RT-3DE. 61 patients aged 44.9 ± 11.9 years with large B-cell non-Hodgkin lymphoma treated with doxorubicin were studied. Blood collection and echocardiography were performed at baseline and 1 day after completion of the chemotherapy. Global longitudinal strain (GLS), maximum, minimum and pre-atrial contraction LA volumes were measured and reservoir, conduit and booster pump function were assessed. Despite normal LVEF, passive emptying percent of total emptying (0.51 ± 0.14 vs. 0.40 ± 0.12, P < 0.001) and passive emptying index (0.29 ± 0.10 vs. 0.23 ± 0.06, P < 0.001) were remarkably reduced compared to baseline values, while active emptying percent of total emptying (0.49 ± 0.14 vs. 0.60 ± 0.12, P < 0.001) and active emptying index (0.41 ± 0.16 vs. 0.47 ± 0.16, P = 0.048) were increased. GLS (−21.64 ± 2.83 vs. −17.30 ± 2.50) was markedly reduced, cTnT levels was elevated from 0.005 ± 0.004 to 0.020 ± 0.026 ng/mL at the completion of chemotherapy (P all  < 0.001). Early LA functional change occur after doxorubicin exposure in patients with preserved LVEF, which could be detected by RT-3DE. PMID:27149058

  10. Second-generation real-time three-dimensional echocardiography. Finally on its way into clinical cardiology?

    PubMed

    von Bardeleben, R S; Kühl, H P; Mohr-Kahaly, S; Franke, A

    2004-01-01

    Three-dimensional (3D) echocardiographic imaging has been introduced as a tool to improve the assessment of both morphologic and functional parameters of the cardiovascular system. In the past, data acquisition was limited due to time-consuming sequential acquisition of multiple triggered 2D image planes from 10-60 heart cycles using transesophageal rotational, transthoracic rotational or transthoracic freehand approaches. Recent improvements in the size of matrix array probes and in computing power of modern ultrasound equipment have significantly increased both spatial and temporal resolution of "second-generation" real-time 3D scanners. Although the superiority of 3D echocardiography in the determination of ventricular volume, ventricular mass or valvular orifice area had already been demonstrated in the late 1990s, widespread use in clinical cardiology was limited on account of difficulties in acquisition and post-processing. Clinical use of modern 3D echocardiography is boosted by the marked reduction in acquisition time and the unique possibility of on-line rendering on the ultrasound system. The ability to visualize a virtual 3D surface in real time-although limited to a sector size of about 30 degrees-offers new insights into cardiac pathomorpholgy even in patients with arrhythmias and may in realtime 3D-contrast flow analysis. Analysis of wide-angle 3D datasets (90 by 90 degree pyramidal shape) is possible by combining the 3D information of several [4-7] consecutive heart cycles. 3D datasets including the complete left ventricle provide comprehensive information on ventricular and mitral valve morphology and function. Qualitative and quantitative analyses of regional wall motion at rest and during stress become possible. Combination with 3D color Doppler data allows additional assessment of valvular function as well as determination of flow in the left ventricular outflow tract and across septal defects. The integration and future quantification of these

  11. Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation.

    PubMed

    Menting, Myrthe E; van Grootel, Roderick W J; van den Bosch, Annemien E; Eindhoven, Jannet A; McGhie, Jackie S; Cuypers, Judith A A E; Witsenburg, Maarten; Helbing, Willem A; Roos-Hesselink, Jolien W

    2016-05-01

    Despite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with patient and echocardiographic characteristics. In this cross-sectional study, patients with re