2-dimensional Echocardiography Research Articles

P272 ROLE OF 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN DIANOSIS OF DYSFUNCTION OF MECHANICAL PROSTHESES

Abstract Infections with endocardial vegetation or the exuberant growth of neoendothelialization tissue (cloth –tissue overgrowth) in heart valve prostheses lead, among other complications, to the malfunction of the prostheses themselves due to obstruction. Among the diagnostic methods available to us, to achieve the diagnosis of prosthetic dysfunction, in recent years three–dimensional transesophageal echocardiography (3D TTE) has become increasingly imposed. We present two clinical cases of patients admitted to our Cardiology department Case 1: Patient of 62 years old, hospitalized for established congestive heart failure. In 2006 he underwent ascending aorta replacement with Dacron 28 prosthesis and aortic valve replacement with mechanical prosthesis (Sorin 25) for aortic bicuspid and ascending aortic aneurysm. During the last follow–up was observed a slight increase in the value of intraprosthetic gradients, as well as a variability in INR values. Physical examination showed signs of heart failure (NT–ProBNP >1000 pg/ml); normal inflammation indices (PCR <2.9 mg/l); ECG: sinus rhythm at 85 bpm with left ventricular overload; trans–thoracic echocardiography showed severe intraprosthetic aortic gradient (Gmax 132mmHg–Gmed 72mmHg), doubtful for cloth adhered to prosthetic discs; 3D TTE shoved hyperechoreflective image adhered to the posterior mobile element (5x9mm) which was fixed in semi–closure. Subsequently, the patient underwent prosthetic replacement surgery with biological prosthesis. Case 2: Patient of 67 years old, heavy smoker, hypertensive, with aortic mechanical prosthesis, a few weeks before hospitalized for Corynebacterium Jeikeium infection. Hospitalized again for fever with increased inflammation indices (CRP 202mg/l). A first TTE concluded for suspected endocarditis of the prosthesis; this doubt was also dissolved by 3D TTE which showed a soft protruding image of the posterior mobile element, preventing the opening and determining severe stenosis (Gmax 160mmHg–Gmed of 80 mmHg), so this patients was transferred to the cardiac surgery department. Conclusions 3D TTE is a method of rapid and safe execution that can be exploited not only pre– or intraoperatively but also to settle diagnostic suspicions not clarified by traditional 2d methods, even managing to distinguish cloth deposits from vegetation / abscesses.

Comprehensive Training Model for Procedural Guidance of Transcatheter Mitral Valve Edge-to-Edge Repair: Divide and Conquer Approach

Transcatheter edge-to-edge repair (TEER) of the mitral valve is a complex procedure requiring continuous image guidance with 2-dimensional and 3-dimensional transesophageal echocardiography. In this context, the role of the echocardiographer is of paramount importance. Training in interventional echocardiography for procedures such as TEER requires comprehending the complicated workflow of the hybrid operating room and advanced imaging skills that go beyond traditional echocardiography training to guide the procedure. Despite TEER being more commonly performed, the training structure for interventional echocardiographers is lagging, with many practitioners not having any formal training in image guidance for this procedure. In this context, novel training strategies must be developed to increase exposure and aid training. In this review, the authors present a step-wise approach to training for image guidance during TEER of the mitral valve. The authors have deconstructed this complex procedure into modular components and have incremental stages of training based on different steps of the procedure. At each step, trainees must demonstrate proficiency before advancing to the next step, thus ensuring a more structured approach to attaining proficiency in this complex procedure.

Left Ventricular Outflow Obstruction in D-Transposition of Great Arteries: A Rare Etiology

A 2-day old neonate [gender: male; weight: 3.2 kg; height: 53cm] presented to the authors institution with an arterial oxygen saturation of 74%. The child was receiving 6 cm H2O continuous positive airway pressure therapy [FIO2: 0.5] and was treated with a prostaglandin E1 infusion [10ng/kg/min]. Transthoracic echocardiography revealed situs solitus, levocardia, normal systemic and pulmonary venous drainage and a 6 mm non-restrictive atrial septal defect with a left to right shunt. The atrioventricular connections were concordant. The aorta was arising from the right ventricle with no right ventricular outflow obstruction [Figure 1]. The pulmonary artery was arising from the left ventricle with confluent good size branch pulmonary arteries with posterior deviation of the conal septum [Figure 2]. A large perimembranous (conoventricular type)1 ventricular septal defect with an inlet [6 mm] and outlet [6 mm] extension and an additional tiny apical defect were demonstrated [Figure 3]. A patent ductus arteriosus [2.7 mm] shunting left to right was also present (not shown). A 2-dimensional echocardiography image in the parasternal long axis view displayed an obstruction to the left ventricular outflow tract [white arrow] and a color Doppler blood flow map demonstrated turbulence in the outflow tract [Figure 4A,B]. In the subcostal view with the probe tilted anteriorly, color flow Doppler mapping showed the ventricular septal defect and also the blood flow acceleration across the left ventricular outflow tract [Figure 5, videolip-1]. At the area of turbulence, the jet width was 0.234 cm[Figure 6A]. A continuous wave Doppler interrogation of the area demonstrated a gradient of ≈ 25 mmHg [Figure 6B]. 2-dimensional transthoracic echocardiography interrogation in the subcostal view identified the etiology of the left ventricular outflow tract obstruction [Figure 7, Videoclip-2]. What is the diagnosis? Figure 2Transthoracic echocardiography image showing the relationship between the pulmonary artery and the left ventricle. View Large Image Figure Viewer Download Hi-res image Figure 3Subcostal 4-chamber transthoracic echocardiography image showing the perimembranous ventricular septal defect. View Large Image Figure Viewer Download Hi-res image Figure 4A&B. Parasternal long axis transthoracic echocardiography 2-dimensional image showing the obstruction in the left ventricular outflow tract ‘white arrow’ [A], and turbulence in the outflow tract by a color Doppler blood flow map ‘white arrow’[B]. View Large Image Figure Viewer Download Hi-res image Figure 5Subcostal transthoracic echocardiography image showing color Doppler flow acceleration over the left ventricular outflow tract and a ventricular septal defect. View Large Image Figure Viewer Download Hi-res image Figure 6A&B. Subcostal transthoracic echocardiography image showing the width of the obstruction [A] and the pressure gradient across the obstruction [B]. View Large Image Figure Viewer Download Hi-res image Figure 7A subcostal transthoracic echocardiography view showing the etiology of the left ventricular outflow tract obstruction in systole. View Large Image Figure Viewer Download Hi-res image

Myocardial strain assessment by 2D Speckle Tracking to evaluate the effect of cardiac rehabilitation in patients with or without heart failure

Cardiac rehabilitation improves the subjective condition of the patient but little is known about associated structural and functional cardiac adaptations specifically the myocardial strain. To evaluate the impact of rehabilitation on structural and functional cardiac parameters using myocardial strain assessment by 2D Speckle Tracking. The study group consisted of 86 patients: 46 with heart failure with optimal medical treatment and 40 after acute myocardial infarction. A monocentric cohort study has included all patients who performed a 2-months cardiac rehabilitation program during 1 year. Clinical characteristics, a resting ECG, 2-dimensional Doppler echocardiography with tissue Doppler and strain imaging, and an incremental maximal exercise test on a bicycle ergometer were collected before and after the rehabilitation program. Paired student t-test for comparison and Pearson's correlation coefficient were used for the statistical analysis. Performance capacity was significantly improved after cardiac rehabilitation: performance in watts 112 W (±50) vs. 69.8 W (±34.5); effort test duration 10.7 min (±4.4) vs. 6.9 min (±3.1) and 6 min walking time 565 m (±127) vs. 496 m (±113). TEE parameters were significantly improved: LVFE 52.9% (±13) vs. 46.9% (±12.7), E/E’ 6.7 (±1.54) vs. 7.38 (±2.9). Significant difference of strain before and after cardiac rehabilitation 15.38% (+/4.72) vs. 14.12 (±4,79) has been also recorded. BNP level decreased by 29 ng/dL but not statistically significant from baseline. No significant correlation was found between biological, functional and TTE parameters. Strain imaging could be an interesting additional parameter to evaluate the positive response and structural improvement in patients with or without chronic heart failure who are undergoing cardiac rehabilitation (Table 1).

Comparative evaluation of echocardiographic and morphometric characteristics of the rat heart left ventricle

Purpose of the study. Comparative evaluation of echocardiographic and morphometric dimensions of the rat heart left ventricle. Materials and methods. The study included 10 outbred male rats weighing 160–180 g. The size of the heart left ventricle was assessed using echocardiography and morphometry. The measurements were carried out according to standard protocols. To perform morphometric measurements, hearts were stopped in systole with a lethal dose (1.0 mg/kg) of 0.025 % strophanthin K solution, and in diastole, by immersing the hearts in a chilled physiological solution (calcium-free medium). Results. It was shown that the systolic size of the left ventricle of the heart according to echocardiography is 1.79Ѓ}0.10 mm, and morphometry 1.64Ѓ}0.09 mm (p = 0,302); diastolic size of the left ventricle, respectively, 3.42Ѓ}0.16 mm and 3.66Ѓ}0.17 mm (р = 0,318). The detected discrepancies do not exceed 10 % and, apparently, are due to the fact that the physiological dimensions of the heart left ventricle are measured by a non-invasive echocardiographic method, and for morphometric measurements of the dimensions in the systole, the heart was stopped by injection of strophanthin K, which entails an overload of heart cells with Ca2+ ions and as a result, contracture of cardiomyocytes; post-mortem cardiac arrest in diastole, in a calcium-free environment, is accompanied by a loss of cardiac muscle tone and, therefore, dilatation of the left ventricle will naturally be greater than physiological. Conclusion. Noninvasive echocardiographic measurement of the size of the heart left ventricle fully reflects the actual size of the left ventricle of the rat heart (the difference does not exceed 10 %), i. e. echocardiographic measurements are valid.

Postpartum Detection of Diastolic Dysfunction and Nondipping Blood Pressure Profile in Women With Preeclampsia.

Left ventricular diastolic dysfunction and nocturnal "nondipping" of blood pressure detected via ambulatory blood pressure monitoring are predictors of increased cardiovascular morbidity. A prospective cohort study including normotensive women with a history of preeclampsia in their current pregnancy was conducted. All cases were subjected to 24-hour ambulatory blood pressure monitoring and 2-dimensional transthoracic echocardiography 3 months after delivery. This study included 128 women with a mean (SD) age of 28.6 (5.1) years and a mean (SD) basal blood pressure of 123.1 (6.4)/74.6 (5.9) mm Hg. Among the participants, 90 (70.3%) exhibited an ambulatory blood pressure monitoring profile illustrating nocturnal blood pressure "dipping" (the mean night to day time blood pressure ratio ≤ 0.9), whereas 38 (29.7%) were nondippers. Diastolic dysfunction (impaired left ventricular relaxation) was present in 28 nondippers (73.7%), whereas none of the dippers exhibited diastolic dysfunction. Women with severe preeclampsia were more frequently nondippers (35.5% vs 24.2%; P = .02) and experienced diastolic dysfunction (29% vs 15%; P = .01) than were those with mild preeclampsia. Severe preeclampsia (odds ratio [OR], 1.08; 95% CI, 1.05-10.56; P < .001) and history of recurrent preeclampsia (OR, 1.36; 95% CI, 1.3-4.26; P ≤ .001) were significant predictors for nondipping status and diastolic dysfunction (OR, 1.55; 95% CI, 1.1-2.2; and OR, 1.23; 95% CI, 1.2-2.2, respectively; P < .05). Women with a history of preeclampsia were at higher risk for developing late cardiovascular events. The severity and recurrence of preeclampsia were significant predictors of both nondipping profile and diastolic dysfunction.

Right Ventricular Outflow Tract Stenting is a Safe and Effective Bridge to Definitive Repair in Symptomatic Infants With Tetralogy of Fallot1.

Right ventricular outflow tract (RVOT) stent angioplasty is a palliative procedure for neonates and infants with symptomatic tetralogy of Fallot prior to surgical repair. We review our institutional outcomes of RVOT stenting. Retrospective review of all infants with tetralogy of Fallot under 3 months of age who underwent primary native RVOT stent angioplasty at The Children's Hospital at Westmead, Sydney, Australia between January 2010 and December 2020. Demographics and echocardiographic pulmonary artery dimensions were collected pre-stent angioplasty and prior to surgical repair. Twenty (20) infants underwent primary RVOT stenting. Median age at stent was 14 days (interquartile range [IQR] 7-32) and median weight 2.7 kg (IQR 2.1-3.4). Three patients underwent hybrid per-ventricular procedures. Indication for RVOT stenting was recurrent hyper-cyanotic spells in 12 (60%) and duct-dependent pulmonary blood flow in 8 (40%). Saturations increased from a median of 80% (IQR 75-85) to 91% (IQR 90-95) post procedure (P<0.001). A single major complication occurred: transient complete atrioventricular dissociation requiring isoprenaline infusion for <24 hours. Twelve (12, 60%) required catheter re-intervention prior to definitive repair for further augmentation of pulmonary blood flow. There were two non-cardiac deaths distant from the stent procedure, but prior to surgical repair. Median right and left pulmonary artery Z-scores increased respectively from -2.06 (IQR -2.99 to -0.17) and -1.2 (IQR -2.59 to -0.14) prior to RVOT stent, to -0.74 (IQR [-1.21 to 0.26], P=0.01) and 0.06 (IQR [-1.87 to 1.15], P=0.006) by the time of definitive repair. Eighteen (18) patients achieved definitive repair at a median age of 6.1 months (IQR 4.7-7.3). Palliation with more than one RVOT stent was associated with an increased duration of cardiac bypass (P=0.035) and cross-clamp (P=0.044) time at definitive repair. In symptomatic neonates and infants with tetralogy of Fallot at high-risk of peri-operative complications, RVOT stent angioplasty can safely and effectively augment pulmonary blood flow prior to definitive repair.

Multimodality Quantitative Assessment of Aortic Regurgitation: A Systematic Review.

We performed a systematic review on the agreement and reproducibility of 3 advanced imaging methods, 3-dimensional echocardiography (3DE), cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR), for quantifying aortic regurgitation (AR) severity. Medline, Embase, and Cochrane databases were systematically searched using the PICO model from inception to February 4, 2022, for publications that quantified AR severity with 3DE, CCT, or CMR. Measurement agreement and intraobserver and interobserver reproducibility results were extracted from each study. Study quality was assessed using the QUADAS-2 tool. Forty-two publications with 2176 patients with AR were identified. For 3DE, vena contracta (VC) width, VC area, and effective regurgitant orifice area had higher correlations with AR volume than the 2-dimensional echocardiography (2DE)-derived VC width. CCT-derived regurgitant volume had moderate-to-good correlations with 2DE. CMR regurgitant volume measurements had lower intraobserver and interobserver variabilities because of improved endocardial definition, fewer geometric assumptions, and less angle dependence for flow measurements when compared with 2DE. 3DE color flow convergence methods used to quantify AR severity were superior to 2DE methods and could be used in patients with adequate echocardiographic windows. CCT methods also demonstrated improvements over 2DE methods. Although this method is limited due to the radiation exposure, it could play a role in patients with poor echocardiographic windows unable to tolerate CMR. CMR demonstrated the smallest intraobserver and interobserver variability in evaluating AR severity and is a reasonable option for those where the echocardiographic results are mixed and for clinical trials.

SERCA2a Agonist Effects on Cardiac Performance During Exercise in Heart Failure With Preserved Ejection Fraction

BackgroundImpaired ventricular relaxation influences left ventricular pressures during exercise in heart failure with preserved ejection fraction (HFpEF). Sarco/endoplasmic reticulum calcium-adenosine triphosphatase (SERCA2a) facilitates myocardial relaxation by increasing calcium reuptake and is impaired in HFpEF. ObjectivesThis study sought to investigate the effects of istaroxime, a SERCA2 agonist, on lusitropic and hemodynamic function during exercise in patients with HFpEF and control subjects. MethodsEleven control subjects (7 male, 4 female) and 15 patients with HFpEF (8 male, 7 female) performed upright cycle exercise with right-sided heart catheterization. Participants received istaroxime (0.5 μg/kg/min) or saline placebo (single-blind, crossover design). Cardiac output, pulmonary capillary wedge pressure (PCWP), and diastolic function were measured at rest and during submaximal exercise. In an exploratory analysis (Hedge's g), 7 patients with HFpEF received higher-dose istaroxime (1.0 μg/kg/min). End-systolic elastance (Ees) was calculated by dividing systolic blood pressure (SBP) × 0.9 by end-systolic volume (ESV) (on 3-dimensional echocardiography). ResultsPatients with HFpEF had higher PCWP (25 ± 10 mm Hg vs 12 ± 5 mm Hg; P < 0.001) and lower tissue Doppler velocities during exercise. Istaroxime (0.5 μg/kg/min) had no effect on resting or exercise measures in patients with HFpEF or control subjects. Control subjects had a larger increase in Ees (Δ 1.55 ± 0.99 mm Hg/mL vs Δ 0.86 ± 1.31 mm Hg/mL; P = 0.03), driven by lower ESV. Comparing placebo and istaroxime 1.0 μg/kg/min during exercise, PCWP during the 1.0 μg/kg/min istaroxime dose was slightly lower (Δ 2.2 mm Hg; Hedge's g = 0.30). There were no effects on diastolic function, but there were increases in SBP and s′, suggesting a mild inotropic effect. ConclusionsLow-dose istaroxime had no effect on cardiac filling pressure or parameters of relaxation in patients with HFpEF during exercise. Higher doses of istaroxime may have been more effective in reducing exercise PCWP in patients with HFpEF. (Hemodynamic Response to Exercise in HFpEF Patients After Upregulation of SERCA2a; NCT02772068)

Three-Tesla magnetic resonance imaging of left ventricular volume and function in comparison with computed tomography and echocardiography.

This study investigated the correlation between 3-Tesla magnetic resonance imaging (MRI) and 256 multiple-slice computed tomography (MSCT) or 2-dimensional echocardiography (ECHO) in evaluating left ventricle. Forty patients were retrospectively enrolled to undergo cardiac MSCT, 3-Tesla MRI and 2-dimensional ECHO within 1 week. The end-diastolic (EDV) and end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were analyzed and compared. MSCT was highly significantly correlated with MRI. Compared with MRI, MSCT slightly overestimated ESV for about 8.7 mL, but slightly underestimated EF and SV for about 6.8% and 5.8 mL, respectively. A high consistency existed between MSCT and MRI, with the 95% limit of agreement (-19.6, 25.4) mL for EDV, (-2.6,20.1) mL for ESV, (-28.3,16.6) mL for SV, and (-18.8%,5.1) % for EF. ECHO was also significantly correlated with MRI. The ECHO slightly underestimated the left ventricular function compared with MRI, with an underestimation of 9.4 mL for EDV, 3.5 mL for ESV, 5.8 mL for SV and 1.0% for EF. A wider agreement limit existed between MRI and ECHO. MSCT has a better correlation and agreement relationship with MRI parameters than 2-dimensional ECHO in assessing the left ventricle and may serve as a possible alternative to MRI.

Detection of right ventricular dysfunction by three – dimensional echocardiography and two - dimensional speckle tracking in breast cancer patients receiving anthracycline- based chemotherapy

BackgroundDespite the cardiotoxic effect of anthracycline on the left ventricle (LV) was totally identified. The assessment of the anthracycline effect on the right ventricle(RV) by conventional echocardiography was a challenge due to its complex geometry. We aimed to evaluate the impact of anthracycline on the RV volume and function using 3 dimensional –echocardiography (3DE) and 2 dimensional -speckle tracking echocardiography (2D-STE) in patients with breast cancer.MethodsThis prospective study was conducted on 66 female patients with breast cancer receiving anthracycline chemotherapy, in addition to full echocardiography, 2D-STE and 3DE evaluation of RV function and volume were done at baseline, after 4th cycle of chemotherapy, six and nine months after the end of chemotherapy.ResultsCardiotoxicity from anthracycline occurred in 18 patients whose LV ejection fraction became significantly reduced after 9 months of therapy according to that, the patients were divided into the non-cardiotoxic group (n:48) and the cardiotoxic group (n:18). At cardiotoxic group, 3D RV end-systolic volume, and 3D RV end-diastolic volume increased significantly at 6 months and continued till 9 months after the therapy end compared to baseline values (42.50 ± 5.98 vs. 50.44 ± 7.01, p = 0.005) and (86.78 ± 9.16 vs. 95.78 ± 9.23, p = 0.021).LV global longitudinal strain (GLS) showed a significant reduction early after 6 months of therapy, 2D GLS and free wall longitudinal strain (FWLS) of RV were significantly decreased at 6 months and continued till 9 months after therapy (-22.54 ± 0.79 vs. -19.53 ± 1.32, p = 0.001) and (-24.67 ± 1.27vs. -22.22 ± 1.41, p = 0.001) respectively. The variation of RV FWLS was a predictor of cardiotoxicity, the relative drop of RV FWLS > 19.3% had 83% sensitivity and 71% specificity, (AUC = 0.82) to identify patients who developed cardiotoxicity.Conclusion3DE is a promising modality in recognizing the early changes in RV volumes and minute alteration in RV function and 2D-STE is a reliable predictor of RV systolic dysfunction which identify the subclinical affliction.

Revealing Mitral Valve Cleft Using Real-Time 3-Dimensional Echocardiography in Children with Mitral Regurgitation.

Mitral valve cleft (MVC) is the most common cause of congenital mitral regurgitation (MR). MVC may be located on the anterior or posterior leaflets. We evaluated children with moderate-to-severe MR using 3D transthoracic echocardiography (3DTTE) to diagnose MVC and determine the location, shape and size of MVC. Twenty-one patients under 18years of age with moderate-to-severe MR without symptoms who were suspected of having MVC were included in the study. The patients' history and clinical data were obtained from the medical records. 2D and 3D imaging were performed with a high-quality machine (EPIQ CVx). A vena contracta (VC) of colour Doppler regurgitated jet 3-7 and ≥ 7mm defined moderate-to-severe regurgitation. An isolated anterior leaflet cleft (ALC) was detected in four patients, an isolated posterior leaflet cleft (PLC) in 12 patients, and both an ALC and PLC in five patients. VC was larger in patients with ALCs than PLCs (8.85mm vs. 6.64mm). Global LV longitudinal strain was better in the ALC group than in the PLC and both-posterior-and anterior MVC groups (- 24.7, - 24.3, and - 24%, respectively). Global circumferential strain was better in the ALC group (- 28.9%) and reduced in the bi-leaflet MVC group (- 28.6%). 3DTTE for visualisation of the MV can be successfully implemented in children and should be proposed during follow-up. AMVC and bi-leaflet MVC results in severe regurgitation and bi-leaflet MVC may be the reason for systolic dysfunction determined before clinically proven symptoms in the future.

Circulating miR-20b-5p and miR-330-3p are novel biomarkers for progression of atrial fibrillation: Intracardiac/extracardiac plasma sample analysis by small RNA sequencing.

Circulating microRNAs (miRNAs, miR) have been considered as biomarkers reflecting the underlying pathophysiology in atrial fibrillation (AF). Nevertheless, miRNA expression in the peripheral blood samples might not reflect a cardiac phenomenon since most miRNAs are expressed in numerous organs. This study aimed to identify the cardiac-specific circulating miRNAs as biomarkers for AF. Plasma samples were obtained from a luminal coronary sinus catheter (CS, cardiac-specific samples) and femoral venous sheath (FV, peripheral samples) in patients with AF and paroxysmal supraventricular tachycardia (control, CTL) undergoing catheter ablation. The circulating miRNA profiles were analyzed by small RNA sequencing. Differently expressed miRNAs between AF and CTL were identified in each sample of the CS and FV; miRNAs exhibiting similar expression patterns in the CS and FV samples were selected as candidates for cardiac-specific biomarkers. The selected miRNAs were related to the outcome of catheter ablation of AF. Small RNA sequencing detected 849 miRNAs. Among the top 30 most differently expressed miRNAs between AF and CTL, circulating hsa-miR-20b-5p, hsa-miR-330-3p, and hsa-miR-204-5p had a similar pattern in the CS and FV samples. Another set of peripheral blood samples was obtained from AF patients undergoing catheter ablation (n = 141). The expression of the miR-20b-5p and miR-330-3p, but not the miR-204-5p, negatively correlated with the echocardiographic left-atrial dimension and was decreased in patients with AF recurrence as compared to those without AF recurrence during a 1-year follow-up. Circulating miR-20b-5p and miR-330-3p can be cardiac-specific biomarkers for atrial remodeling progression and arrhythmia recurrence after catheter ablation in AF patients.

Application of 3-Dimensional Fetal Echocardiography in the Detection of Hidden Extended Ventricular Septal Defect.

HomeCirculation: Cardiovascular ImagingAhead of PrintApplication of 3-Dimensional Fetal Echocardiography in the Detection of Hidden Extended Ventricular Septal Defect No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessApplication of 3-Dimensional Fetal Echocardiography in the Detection of Hidden Extended Ventricular Septal Defect Gioia Mastromoro, MD, Valerio Romano, MD, Riccardo Riccardi, MD, Luigi Orfeo, MD and Gerardo Piacentini, MD Gioia MastromoroGioia Mastromoro https://orcid.org/0000-0003-0788-1683 Department of Experimental Medicine, Sapienza University of Rome, Italy (G.M.). Department of Laboratory Medicine (G.M.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Search for more papers by this author , Valerio RomanoValerio Romano Fetal and Pediatric Cardiology Unit (V.R., R.R., L.O., G.P.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Neonatology and Neonatal Intensive Care Unit (V.R., R.R., G.P.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Search for more papers by this author , Riccardo RiccardiRiccardo Riccardi Fetal and Pediatric Cardiology Unit (V.R., R.R., L.O., G.P.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Neonatology and Neonatal Intensive Care Unit (V.R., R.R., G.P.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Search for more papers by this author , Luigi OrfeoLuigi Orfeo Fetal and Pediatric Cardiology Unit (V.R., R.R., L.O., G.P.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Search for more papers by this author and Gerardo PiacentiniGerardo Piacentini Correspondence to: Gerardo Piacentini, MD, Fetal and Pediatric Cardiology Unit, Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186 Rome, Italy. Email E-mail Address: [email protected] https://orcid.org/0000-0001-6854-8441 Fetal and Pediatric Cardiology Unit (V.R., R.R., L.O., G.P.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Neonatology and Neonatal Intensive Care Unit (V.R., R.R., G.P.), Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Rome, Italy. Search for more papers by this author Originally published6 Mar 2023https://doi.org/10.1161/CIRCIMAGING.122.014658Circulation: Cardiovascular Imaging. 2023;0:e014658FootnotesFor Sources of Funding and Disclosures, see page XXX.Correspondence to: Gerardo Piacentini, MD, Fetal and Pediatric Cardiology Unit, Fatebenefratelli Isola Tiberina, Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186 Rome, Italy. Email gerardo.[email protected]it Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.122.014658PMID: 36876499 Originally publishedMarch 6, 2023 Keywordshumansheart defectscongenitalpregnancyechocardiography, three-dimensionalheart septal defects, ventricularPDF download Advertisement SubjectsEchocardiography

Abstract PD8-03: Beta blockers and/or ACE inhibitors as cardioprotective strategy for patients affected by nonmetastatic breast cancer who are receiving an anthracycline-based chemotherapy (SAFE - NCT02236806): final results of a randomized trial

Abstract Introduction. Several studies have evaluated cardioprotective strategies to prevent myocardial dysfunction in patients who are receiving cardiotoxic therapies. Angiotensin-converting enzyme inhibitors and β-blockers are recommended first-line agents for heart failure. However, the optimal approach still represents a controversial issue. We hypothesized whether pharmacological cardioprevention could reduce subclinical heart damage in patients with breast cancer who are being treated with an anthracycline-based chemotherapy. Patients and methods. The SAFE trial was a 4-arm, randomized, phase 3, double-blind, placebo-controlled, national multicentric study conducted at eight oncology departments in Italy. The study recruitment was conducted between July 2015 and June 2020. A prespecified interim analysis on 174 women at 12 months was reported in 2020. Patients were eligible for trial inclusion if they had indication to receive primary or postoperative systemic therapy using an anthracycline-based regimen. Patients with a prior diagnosis of cardiovascular disease were excluded. Cardioprotective therapy (bisoprolol, ramipril, or both drugs compared with placebo) was administered for one year from the initiation of chemotherapy or until the end of trastuzumab therapy in case of ERBB2-positive patients. Doses for all groups were systematically up-titrated up to the daily target dose of bisoprolol (5mg, once daily), ramipril (5mg, once daily), and placebo, if tolerated. The primary end point was defined as detection of any subclinical impairment (worsening 10%) in myocardial function and deformation measured at 24 months using 3-dimensional (3D) echocardiography, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS). ClinicalTrials.gov identifier: NCT2236806. Results. 262 women (median age, 48 years; range, 24-75 years) were enrolled and treated in the study. We analyzed patients who had completed the pre-planned cardiological assessment at 24 months. Baseline demographic, tumor, and cardiovascular profiles were similar between groups. All patients received an anthracycline-based chemotherapy, 215 patients received at least three cycles of anthracyclines (range 1-6), 223 patients received also a taxanes-based chemotherapy, and 84 cases were treated with adjuvant trastuzumab. Sixty patients were treated with neoadjuvant chemotherapy, 157 cases received adjuvant endocrine therapy, and 128 patients had postoperative radiation therapy. GLS worsened 10% or greater in 68% of patients enrolled in the placebo arm, 15%, 13%, and 13% in the ramipril, bisoprolol, and ramipril plus bisoprolol arms, respectively (P &amp;lt; 0.05). A reduction of 10% or greater in 3D-LVEF was observed in 19% in the placebo arm, 11% in the ramipril arm, 11% in the bisoprolol arm, and 7% in the ramipril plus bisoprolol arm (P &amp;lt; 0.05). Study drugs were well tolerated with no serious adverse events, the ramipril plus bisoprolol arm showed significantly more toxic effects and had a significantly higher rate of allocated treatment discontinuation as compared to the other arms. Conclusions. Cardioprotective pharmacological strategies in patients who were affected by breast cancer and were receiving an anthracycline-based chemotherapy are well tolerated and protect against cancer therapy–related LVEF decline and heart remodeling. Citation Format: Icro Meattini, Carlotta Becherini, Luca Visani, Calogero Saieva, Viola Salvestrini, Francesca Martella, Carlotta Bacci, Elena Molinara, Mario Airoldi, Maria Riccarda Del Bene, Domenico Amoroso, Luigi Coltelli, Isacco Desideri, Vieri Scotti, Marco Bernini, Lorenzo Orzalesi, Jacopo Nori, Simonetta Bianchi, Giuseppe Barletta, Lorenzo Livi. Beta blockers and/or ACE inhibitors as cardioprotective strategy for patients affected by nonmetastatic breast cancer who are receiving an anthracycline-based chemotherapy (SAFE - NCT02236806): final results of a randomized trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-03.

Values of new ultrasonic imaging methods for the diagnosis of apical Takotsubo syndrome.

Takotsubo syndrome (TTS) is a multifactorial disease contributed to by several pathological factors. It is characterized by transient left ventricular dysfunction, and patients with TTS can spontaneously recover within days or weeks. This study's objective was to investigate the ultrasonic characteristics of TTS during different periods and assess the clinical application value of real-time 3-dimensional echocardiography (RT-3DE) and speckle tracking imaging (STI) in TTS. In this prospective cohort study, the patients with apical TTS were evaluated by echocardiography on admission (within 1-3 days) and after 4 and 8 weeks. RT-3DE was performed to observe the structure and function of the left ventricle (LV). LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV), and ejection fraction (LVEF) were calculated. The longitudinal peak systolic strain (LPSS) of all LV myocardial segments was acquired by 2D STI. For comparison, 20 healthy individuals were included as normal controls. A total of 16 patients with TTS were included. Their LV was characterized as an "octopus pot" in morphology with obvious hypokinesis on admission. The LVEDV, LVESV, LVSV, and LVEF were 84.23±10.67, 55.94±8.51, 28.31±8.06 mL, and 33.59%±4.12%, respectively, in patients with TTS on admission with a significant difference from those of the controls (P=0.005, P<0.001, P<0.001, and P<0.001, respectively). A definite improvement was found upon follow-up, with these parameters even returning to normal morphology after 8 weeks. The LVEDV, LVESV, LVSV, and LVEF were 75.79±6.86, 28.05±4.33, 47.81±3.57 mL, and 63.02%±3.92%, respectively, in TTS patients after 8 weeks with no significant difference from those of the controls (P=0.907, P=0.235, P=0.162, and P=0.052, respectively). A significant decrease in LPSS was also found in patients with TTS on admission. In the eighth week of follow-up, the LPSS of the apical and middle segments in TTS patients remained significantly decreased compared with that of the normal controls (-18.54%±4.69% vs. -24.29%±3.46%, P<0.001; -19.38%±2.88% vs. -22.36%±3.23%, P<0.001), but that of the basal segments in TTS patients returned to normal and there was no significant differences from the normal controls (-20.75%±2.91% vs. -21.51%±2.85%; P=0.055). RT-3DE and STI played an indispensable role in visually and quantitatively inspecting the abnormalities of patients with TTS, including in diagnosis and follow-up.

Left ventricular function assessed with two-dimensional speckle tracking and three-dimensional echocardiography in patients with obstructive sleep apnea

Objective: To investigate left ventricular function by two-dimensional (2D) speckle tracking and three-dimensional (3D) echocardiography in obstructive sleep apnea (OSA) patients. Subject and method: Patients who were diagnosed with OSA based on the results of full polysomnography and had apnea- hypopnea index values &gt; 5 events/hour of sleep were included in the study. All patient underwent polysomnography recording. Comprehensive 2-dimensional echocardiography were performed to all subjects according to American Society of Echocardiography guidelines [5], followed by real-time 3D echocardiography. Result: From June 2021 to June 2022, there were 46 OSA patients were included in the study. Mean age of OSA patients 51.3 ± 11.7 years. Men 63% (29/46), women 37% (15/46). The apnea-hypopnea index, percentage of total sleep time with an oxygen saturation level &lt; 90%, arousal index increased in OSA patients. E/E’ increased (12.6 ± 4.3), GLS mildly reduced (-16.5 ± 3.8%) while other echocardiographic parameters were in normal range. Results of ANOVA showed an increase in the following LA parameters on 3D echocardiography according to the levels of OSA severity: LV mass index, 3D maximum LA volume, 3D maximum LA volume index, E/E’ were significantly higher in the severe OSA group compared with the moderate OSA and the mild OSA (p&lt;0.05 for all). There was a decrease in the E’ velocity and global longitudinal strain (GLS) (p&lt;0.05 for all). Conclusion: In patients with obstructive sleep apnea, the severity of OSA was associated with lower E′ velocity, greater E/E′ ratio, larger 3D LV volume, greater LV mass index, and poorer left ventricular global longitudinal strain.

A morphological study comparing heart size measurement on chest radiograph with echocardiography in local population.

To investigate heart size on chest X-ray via cardiothoracic ratio, and to correlate it with echocardiographic measurements. The comparative analytical, cross-sectional study was conducted at the Pakistan Navy Station Shifa Hospital, Karachi, between January 2021 and July 2021. The radiological parameters were measured on chest X-rays posterior-anterior view, and the echocardiographic parameters were measured using 2-dimensional transthoracic echocardiography. The absence or presence of cardiomegaly on both imaging modalities was modelled as a binary categorical variable and compared. Data was analysed using SPSS 23. Of the 79 participants, 44(55.7%) were males and 35(44.3%) were females. The mean age of the sample was 52.71±14.54 years. There were 28(35.44%) enlarged hearts on chest X-ray and 46(58.22%) on echocardiography. The sensitivity and specificity of chest X-ray were 54.35% and 90.90%, respectively. The positive and negative predictive values were 89.28% and 58.82%, respectively. The accuracy of chest X-ray in identifying an enlarged heart was 69.62%. The cardiac silhouette on a chest X-ray could demonstrate heart size through simple measurements with high specificity and reasonable accuracy. However, a normal heart size on chest X-ray may not have a normal function.

Two-dimensional echocardiographic and strain values of the proximal thoracic aorta in a normal sub-Saharan African population

BackgroundThere is limited data regarding reference ranges for aortic dimensions in African populations. This study aims to establish normal reference ranges for echocardiographic dimensions and circumferential strain (CS) of the proximal thoracic aorta in a healthy sub-Saharan African population.MethodsThis was a secondary analysis of data from a prospective cross-sectional study of 88 participants conducted at Chris Hani Baragwanath Hospital (2017–2019). Aortic measurements were obtained as per the 2015 American Society of Echocardiography guidelines using a Philips iE33 system. Circumferential Strain was measured using Philips QLAB version 11.0 software offline semi-automated analysis of speckle-based strain 2-D speckle-tracking software (Amsterdam, The Netherlands).ResultsMean age was 37.22 ± 10.79 years (41% male). The mean diameter at the aortic annulus, sinuses, sino-tubular junction (STJ) and ascending aorta (AAO) were 19.11 ± 2.38 mm, 27.40 ± 6.11 mm, 25.32 ± 3.52 mm and 25.36 ± 3.38 mm, respectively. Males had larger absolute and indexed aortic diameters at all levels when compared to females. The mean aorta CS was 11.97 ± 5.05%. There was no significant difference in CS based on gender (12.19 ± 5.04% vs 11.51 ± 5.02%, P = 0.267). On multivariate linear regression analysis, male sex was the most significant predictor of increased diameter at the level of the aortic annulus (r = 0.17, P = 0.014), body surface area was the most significant predictor at the sinuses (r = 0.17, P = 0.014) and AAO (r = 0.30, P < 0.001), while age was the most significant predictor at the STJ (r = 0.27, P = 0.004). There was a negative correlation between age and aortic CS (r = − 0.12, P < 0.001). The most important predictor of aorta CS was age, on multivariate analysis (r = − 0.19, P = 0.024).ConclusionsThis study provides normal reference ranges for dimensions of the proximal aorta and circumferential strain (CS) in a sub-Saharan African population according to age, sex, and body habitus. It serves as a platform for future larger studies and allows for risk stratification of cardiovascular disease in an African population.

Reverse Cardiac Remodeling Response and Its Effect on Quality of Life After initiation of Sacubitril/valsartan in Heart Failure with Reduced Ejection Fraction

Objective: To evaluate if switching therapy from an angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) to sacubitril/valsartan induces incremental left ventricular (LV) reverse remodeling and the effect of switching on quality of life (QOL) in heart failure with reduced ejection fraction (HFrEF). Methodology: This prospective multicenter study included 100 patients with HFrEF. The patients were subdivided into two equal groups: Group one included patients who were switched to sacubitril/valsartan and group two included patients continued on ACEIs or ARBs as control group. The patients were subjected to medical history taking, clinical examination, heart failure related data, New York Heart Association (NYHA) functional classification, blood samples and chemistry, transthoracic echocardiography (TTE) and quality of life assessment. Results: There was marked improvement in all two dimensional (2D) echocardiography parameters, as left ventricular end-systolic volume (LVESVI), left ventricular end-diastolic volume index (LVEDVI) and left atrium volume index (LAVI) which significantly reduced after 3 months of therapy with significant improvement in LV function (P-value &lt; 0.05). Moreover, mitral regurgitation (MR) severity significantly decreased (P-value &lt; 0.05). Regarding quality of life, there was a significant improvement in QOL. KCCQ score was significantly improved after 3 months of treatment (P-value &lt; 0.05). Conclusion: In HFrEF patients, sacubitril/valsartan significantly improves LV function; furthermore, it induces incremental LV reverse remodeling as well as improves QOL.