American Society Of Echocardiography Research Articles

Echocardiographic Measurements in Normal Chinese Adults (EMINCA) II focusing on left ventricular and left atrial size and function by three-dimensional echocardiography.

Current guidelines encourage large studies in a diverse population to establish normal reference ranges for three-dimensional (3D) echocardiography for different ethnic groups. This study was designed to establish the normal values of 3D-left ventricular (LV) and left atrial (LA) volume and function in a nationwide, population-based cohort of healthy Han Chinese adults. A total of 1117 healthy volunteers aged 18-89 years were enrolled from 28 collaborating laboratories in China. Two sets of 3D echocardiographic instruments were used, and full-volume echocardiographic images were recorded and transmitted to a core laboratory for image analysis with a vendor-independent off-line workstation. Finally, 866 volunteers (mean age of 48.4 years, 402 men) were qualified for final analysis. Most parameters exhibited substantial differences between different sex and age groups, even after indexation by body surface area. The normal ranges of 3D-LV and 3D-LA volume and function differed from those recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines, presented by the World Alliance Societies of Echocardiography (WASE) study, and from the 2D values in the EMINCA study. The normal reference values of 3D echocardiography-derived LV and LA volume and function were established for the first time in healthy Han Chinese adults. Normal ranges of 3D-LV and 3D-LA echocardiographic measurements stratified with sex, age, and race should be recommended for clinical applications.

Intraoperative Echocardiography: Guide to Decision-Making.

This review aims to provide a concise overview of key recommendations, with a specific focus on common challenges faced by intraoperative echocardiographers when dealing with frequently encountered valvular pathologies and mechanical circulatory support. It offers valuable insights for medical practitioners in this field. The American Society of Echocardiography (ASE) and the American College of Cardiology/American Heart Association (ACC/AHA) have released updated comprehensive guidelines for the use of transesophageal echocardiography (TEE) for the assessment of cardiac structures and implanted devices to help guide intraoperative decision-making. Transesophageal echocardiography (TEE) is a regularly employed intraoperative diagnostic and monitoring tool, offering various modalities for the rapid evaluation of valvular and aortic pathology, hemodynamic disturbances, and cardiac function. It is particularly valuable in assessing and placing mechanical circulatory support (MCS) devices, providing views often challenging to obtain through transthoracic echocardiography. Additionally, intraoperative TEE can be used for decision-making in patients with valvular disease allowing incorporation of patient-specific and situational factors. Echocardiographers can employ this information in real-time to help guide surgical treatment selection such as repair, replacement, or deferral of intervention.

Assessment of Left Ventricular Hypertrophy Incidence and Antihypertensive Therapy Efficacy in Hypertensive Patients

Objectives: This study aimed to assess the incidence of left ventricular hypertrophy (LVH) in hypertensive individuals in Karachi, Pakistan, and to evaluate the effectiveness of antihypertensive therapy in preventing LVH. Methodology: A total of 200 hypertensive patients were referred from the Cardiac OPD to the Radiology department of Medicare Cardiac and General Hospital, Karachi, for echocardiography. Echocardiographic measurements of cardiac chambers were performed by expert echocardiographers, and left ventricular mass (LVM) was calculated using the formula recommended by the American Society of Echocardiography. Results: Among the hypertensive patients, 100 had uncontrolled blood pressure (≥140/90 mmHg) while 100 had controlled blood pressure (≤130/80 mmHg). The female-to-male ratio was 3:1, with ages ranging from 21 to 80 years. Patients with uncontrolled hypertension exhibited a higher mean body mass index (29 ± 5 kg/m2) and significantly elevated LVM (mean 154 ± 4 g/m2). Angiotensin receptor inhibitors were the most commonly prescribed and effective antihypertensive agents, either as monotherapy or in combination therapy (60%), demonstrating utility in preventing LVH. Conclusion: This study highlights a high incidence of LVH in uncontrolled hypertensive individuals compared to those with controlled hypertension. Transthoracic echocardiography emerged as a highly valuable, non-invasive tool for measuring LVM and assessing the effectiveness of antihypertensive therapy.

Poor Agreement Between Preoperative Transthoracic Echocardiography and Intraoperative Transesophageal Echocardiography for Grading Diastolic Dysfunction

BACKGROUND: Guidelines for the evaluation and grading of diastolic dysfunction are available for transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) is used for this purpose intraoperatively but the level of agreement between these 2 imaging modalities for grading diastolic dysfunction is unknown. We assessed agreement between awake preoperative TTE and intraoperative TEE for grading diastolic dysfunction. METHODS: In 98 patients undergoing cardiac surgery, key Doppler measurements were obtained using TTE and TEE at the following time points: TTE before anesthesia induction (TTEawake), TTE following anesthesia induction (TTEanesth), and TEE following anesthesia induction (TEEanesth). The primary endpoint was grade of diastolic dysfunction categorized by a simplified algorithm, and measured by TTEawake and TEEanesth, for which the weighted κ statistic assessed observed agreement beyond chance. Secondary endpoints were peak early diastolic lateral mitral annular tissue velocity (e’lat) and the ratio of peak early diastolic mitral inflow velocity (E) to e’lat (E/e’lat), measured by TTEawake and TEEanesth, were compared using Bland-Altman limits of agreement. RESULTS: Disagreement in grading diastolic dysfunction by ≥1 grade occurred in 43 (54%) of 79 patients and by ≥2 grades in 8 (10%) patients with paired measurements for analysis, yielding a weighted κ of 0.35 (95% confidence interval [CI], 0.19–0.51) for the observed level of agreement beyond chance. Bland-Altman analysis of paired data for e’lat and E/e’lat demonstrated a mean difference (95% CI) of 0.51 (−0.06 to 1.09) and 0.70 (0.07–1.34), respectively, for measurements made by TTEawake compared to TEEanesth. The percentage (95% CI) of paired measurements for e’lat and E/e’lat that lay outside the [−2, +2] study-specified boundary of acceptable agreement was 36% (27%–48%) and 39% (29%–51%), respectively. Results were generally robust to sensitivity analyses, including comparing measurements between TTEawake and TTEanesth, between TTEanesth and TEEanesth, and after regrading diastolic dysfunction by the American Society of Echocardiography (ASE)/European Association of CardioVascular Imaging (EACVI) algorithm. CONCLUSIONS: There was poor agreement between TTEawake and TEEanesth for grading diastolic dysfunction by a simplified algorithm, with disagreement by ≥1 grade in 54% and by ≥2 grades in 10% of the evaluable cohort. Future studies, including comparing the prognostic utility of TTEawake and TEEanesth for clinically important adverse outcomes that may be a consequence of diastolic dysfunction, are needed to understand whether this disagreement reflects random variability in Doppler variables, misclassification by the changed technique and physiological conditions of intraoperative TEE, or the accurate detection of a clinically relevant change in diastolic dysfunction.

Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: Recommendations From the American Society of Echocardiography.

Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: Recommendations From the American Society of Echocardiography.

Contribution of the left atrial speckle tracking in the evaluation of left ventricule filling pressure in acute coronary syndromes

Abstract Introduction A non invasive estimation of diastolic function with echocardiography according to consensual methods, ie American society of Echocardiography (ASE) / European association of cardiovascular imaging (EACVI) algorithm 2018, is considered an integral essential part of the clinical evaluation of patients presenting with symptoms of acute coronary syndrome (ACS). Left atrial (LA) longitudinal strain in the frame of speckle tracking echocardiography (STE) was reported recently to have additive diagnostic value to assess left ventricle (LV) filling pressures (LVFP) in a large spectrum of cardiovascular diseases. Our study aim is to assess the accuracy of LA strain in evaluating LVFP in patients with ACS, as a single parameter. Methods Our study was monocentric in our cardiology department led prospectively between April 20, 2022, and June 30, 2022. We included all patients admitted to our department for evolving ST elevation (STEMI) or non-ST elevation (NSTEMI) myocardial infarction (<48 hours from onset of symptoms). Echocardiographic measurements were performed according to ASE/EACVI in less than 24 hours. They were divided into two groups according to the elevation of LVFP group 1 with non-elevated LVFP vs group with elevated LVF. LA-GS was assessed using images obtained in apical 4- and 2-chamber views , with attention to optimal visualization of the LA. The endocardial border of the LA was traced manually. Left atrial reservoir strain (LARS) was calculated from LV-end diastole, and pump strain (LAPS) after the onset of the p-wave in the electrocardiogram. Results Fifty patients were included in our study. The mean age was 59 ± 12 years. 72%(36) of our population was men. 34%(17) of the population had elevated LVFP (Group2) with a male predominance of 82% (14). They were active smokers in 64% (11), 52%(9) had hypertension, 70% (12) had diabetes mellitus, 47%(8) had dyslipidemia and 35% (6) were hospitalized for NSTEMI. The mean LARS and LAPS were 26.9%, and 15.2% in group 1 vs 15.1%, and 7.1% respectively in group 2 with a difference statically significative p = 0.001, and p = 0.002 respectively. The area under the curve was 0.910 (LARS) and 0.850 (LAPS). The best cut-off for the LAPS was 11.5% with 100% of sensibility and 63% of specificity, for the LARS the best cut-off was 18% with 95% of sensibility and 66% of specificity. Conclusion LA-GS includes a reproducible and simple method for LVFP assessment in ACS. it provides an additional variable that can contribute when one of the other parameters is missing.

A preliminary study on the standard value of left ventricular mechanic dyssynchrony by speckle tracking

Abstract Background Speckle tracking imaging automatic functional imaging (AFI) is a new method to measure left ventricular mechanical dyssynchrony. Parameter peak strain dispersion (PSD) is the standard deviation when the long axial strain of 17 segments of the left ventricle (LV) reach there’s peak. There is no unified standard value at present. Li C[1] included 59 healthy women aged 43.08 ± 8.22 years old, whose PSD was 31.44±3.83ms. Ji X[2] included 57 healthy volunteers aged 43.30 ±6.03 years old whose PSD value was 23.8±2.2ms. Some studies referred to the standard range of Yu index and used PSD>32.6ms as an indicator of left ventricular mechanic dyssynchrony. Purpose To investigate the standard value range of PSD and PSD/R-R interval. Methods Healthy volunteers who came to our hospital for physical examination from March 2020 to September 2021 were included, excluding hypertension, diabetes, hyperlipidemia, coronary heart disease and other diseases. According to the 20∼29 years old, 30∼39 years old, 40∼49 years old, 50∼59 years old, 60∼69 years old and 70∼79 years old, 10 males and 10 females were included, respectively. GE Vivid E95 was used to collect echocardiographic images, and the following parameters were measured: ①The general parameters of the heart, such as the diameter of the atrium(LA) and the left ventricle (LV) and the thickness of the left ventricular wall .; ②the values of PSD and PSD/ R-R interval. The normal distribution parameters were represented by mean plus or minus the standard deviation. Analysis of variance and post hoc test (LSDt-test) were used to analyse measured values statistically. Results Values of general echocardiographic data such as BSA, atrial and ventricular diameter, interventricular septal thickness, left ventricular posterior wall thickness, and LV ejection fraction were consistent with the guideline of Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging published in 2015. The range of PSD values for subjects in this study was 43±9ms, and the maximum was 65ms. The range of PSD/R-R was 5±1%, and the maximum was 7%. The values of PSD and PSD/R-R were 36±5ms(27∼45ms) and 4.4±0.76%(3∼6.4%) for 20∼39 years old, 42±5ms(34.9-54ms), 5.0±0.8%(3.5-6.7%) in 40∼59 years; 51±8ms(34∼65ms), 5.8±0.9%(3.9∼7%) in age 60∼79. Conclusions The preliminary study has shown that left ventricular mechanical dyssynchrony is associated with age. The standard value range of PSD is inconsistent in different age groups, and PSD and PSD/R-R values increase with age.PSD values at different agesBar chart of PSD values at different age

Increasing left ventricular mass and mortality in 303,548 men and women investigated with echocardiography

Abstract Background and Aims Left ventricular hypertrophy (LVH) categories are based on left ventricular mass index (LVMi). This study aimed to generate sex-stratified, statistically-derived thresholds of mortality according to LVMi within a large, real-world patient cohort. Methods and Results Echocardiographic and linked mortality data were extracted from the National Echocardiography Database of Australia. LVH categories were first defined according to American Society of Echocardiography (ASE) criteria in 303,548 adults comprising 155,668 men (aged 61.3±17.3 years) and 147,880 women (61.8±18.3 years). Sex-specific mild to severe thresholds of increasing 5-year mortality based on LVMi increments were generated. Overall, 36,198 men (23.3%) and 38,898 women (26.3%) had LVH. Actual 5-year mortality rose from 16.9%-38.3% and 11.9%-31.2% in men and women with no LVH versus LVH, respectively. The statistical threshold at which LVMi was associated with increased mortality was lower than traditional LVH criteria in both men (Figure A, ≥88g/m2 versus ≥115g/m2) and women (Figure B, ≥82g/m2 versus ≥95g/m2). For men versus lowest-risk LVMi, the fully adjusted risk of 5-year mortality was 14% (95%CI 1.03-1.25) and 68% higher (95%CI 1.49-1.90) when LVMi levels were mildly (88 to <116) to severely (≥140g/m2) increased, respectively. In women, the equivalent LVMi thresholds of 82 to <112 and ≥140g/m2 were associated with a 13% (95%CI 1.03-1.24), and 81% higher (95%CI 1.58-2.08) 5-year mortality risk. Conclusion A high proportion of men and women have LVMi levels associated with elevated mortality risk that are lower than those traditionally used to diagnose or manage LVH. Such individuals may benefit from more proactive recognition and clinical management.

Abstract 18420: Appropriateness and Cost Analysis of Adult Inpatient Transthoracic Echocardiograms in a Community Hospital

Introduction: Although inpatient transthoracic echocardiograms (TTEs) are important for guiding patient management, their overuse could be a concern leading to delayed discharges, unnecessary burden on hospital staff, and increased hospital costs. We analyzed the appropriateness, benefits, cost expenditure and unnecessary burden of TTE testing. Methods: A retrospective cohort analysis of a subset of patients undergoing TTEs in 2022 from a community hospital was performed. Appropriateness of use criteria (AUC) in accordance with American Society of Echocardiography and alteration in medical management was evaluated by 3 independent reviewers. Hospital cost analysis was performed based on median TTE cost ($682), yearly total adult TTEs performed (n=4,636), AUC criteria, and alteration in management under Maryland all-payer insurance model. Results: In 234 TTEs matched by age, gender, and race, AUC was not met in 32.5% of patients. Most TTEs were indicated for LV function assessment and ACS (Figure). Change in management was significantly higher in patients who met vs. not meeting AUC (54 vs. 11%, p<0.001). In patients meeting AUC, men had a higher change in management compared to women (61 vs. 46%, p = 0.05). No significant differences were found in the percentage of patients who benefitted from inpatient TTE by subgroups based on indications, except for cardiac trauma. Inappropriate TTE testing led to a yearly loss of approximately $313,000 in hospital revenue and an additional loss of $150,000/year for every 5% of patients who meet AUC with no alteration in medical management. Conclusion: In this community hospital analysis, nearly one-third of adult inpatient TTEs were obtained outside the recommendations of established guidelines. Strategies to improve adherence to ASE guidelines and patient selection for TTE testing are warranted to reduce unnecessary resource utilization and healthcare costs.

Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis.

About 20% of patients develop cardiac decompensation within the first year after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for cardiac decompensation remain poorly defined. We aimed to evaluate predictors of cardiac decompensation after TIPS insertion in a large, well-defined cohort of patients with liver cirrhosis. 234 cirrhotic patients who received a TIPS at Hannover Medical School were retrospectively followed up for one year to assess the incidence of cardiac decompensation. Echocardiographic parameters and established diagnostic criteria for cardiac impairment (e.g. by the American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI)) were investigated for an association with cardiac decompensation in a competing risk analysis. Survival was analyzed using a multivariable cox regression analysis adjusting for Freiburg index of post-TIPS survival. Predominant TIPS indication was ascites (83%). Median age was 59years, median MELD-score 12% and 58% were male. Overall, 41 patients (18%) developed cardiac decompensation within one year after TIPS insertion. Diastolic dysfunction according to the ASE/EACVI was diagnosed in 26% of patients at baseline and was linked to a significantly higher risk for cardiac decompensation (p=0.025) after TIPS. When investigating individual echocardiographic baseline parameters, only pathological E/A (<0.8 or >2) was identified as a risk factor for cardiac decompensation (p=0.015). Mortality and liver transplantation (n=50) were significantly higher among patients who developed cardiac decompensation (HR=5.29, p<0.001) as well as in patients with a pathological E/A (HR=2.34, p=0.006). Cardiac high-risk status (44% of patients) was strongly linked to cardiac decompensation (HR=2.93, p=0.002) and mortality (HR=2.24, p=0.012). Cardiac decompensation after TIPS is a frequent and important complication and is associated with reduced survival. American Society of Echocardiography/EACVI criteria and E/A seem to be the best parameters to predict the cardiac risk in cirrhotic patients undergoing TIPS insertion.

Impact of Advanced Cardiac Sonographers on Exam Completeness in the Echocardiography Laboratory

Objective: Laboratory accreditation has been shown to impact variability and completeness. However, little data exist demonstrating the impact of personnel credentialing on completeness and efficiency. Therefore, the aim of this study was to evaluate exam completeness and efficiency among staff with an advanced cardiac sonographer (ACS) credential, Registered Diagnostic Cardiac Sonographer or Registered Cardiac Sonographer and noncredentialed staff. Materials and Methods: Retrospective review of adult and pediatric echocardiograms at eight facilities in three states. Exam completeness was compared with Intersocietal Accreditation Commission (IAC) standards and completeness by pathology was compared with the American Society of Echocardiography (ASE) standards. Results: This study was based on the review of 1147 patient cases. Of the cases reviewed, 60.3% were performed by credentialed (non-ACS) sonographers, 28.3% were completed by credentialed ACS, and 11.3% by noncredentialed staff. The credentialed staff completed exams ≤ 12 hours. The exams were reviewed for compliance with IAC standards and completed by ACS staff: 80.0% in aortic stenosis and 55.6% in non-ACS staff. Those patient cases for mitral regurgitation (14/19) were 73.7% IAC compliant, cases completed by credentialed non-ACS (20/56) were 35.7% compliant, and those completed by noncredentialed sonographers (2/11) only 18.2% were compliant. Cases specific to patent ductus arteriosus were 92.1% compliant with IAC standards that were completed by ACS compared with 77.9% completed by non-ACS staff. Cases of pulmonary hypertension were also evaluated for IAC compliance and 61.8% met the standard with ASE versus 41.7% completed by non-ACS. Conclusion: Examinations performed by ACS are more often complete in important pathology. Examination efficiency is highest among credentialed sonographers.

Prognostic Significance of Diastolic Dysfunction in Type 2 Diabetes Mellitus Patients With Sepsis and Septic Shock: Insights From a Longitudinal Tertiary Care Study.

Sepsis is one of the leading contributors to global mortality and morbidity, causing multi-organ failure, mainly involving cardiovascular failure, both systolic and diastolic dysfunction, leading to adverse clinical outcomes. There is little clinical data on the correlation with the mortality ofpatients with type 2 diabetes mellitus (T2DM) with sepsis and septic shock and left ventricular diastolic dysfunction. Our study sought to assess whether the severity of diastolic dysfunction could predict 28-day mortality. The study included T2DM patients admitted to the intensive care unit (ICU) with sepsisand septic shock defined according to the Third International Consensus Definitions for Sepsis and Septic Shock at a tertiary care center in northern India. A total of 132 patients (age = 61.01 ± 13.12 years; 62% male; mean APACHE II (Acute Physiology and Chronic Health Evaluation II) score = 25.74 ± 4.79; Sequential Organ Failure Assessment (SOFA) score = 12.34 ± 3.36) underwent transthoracic echocardiography within two hours of ICU admission till 28 days of admission or till mortality occurred. Clinical variables (APACHE II and SOFA score) and cardiac biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), troponin I, and creatine phosphokinase-MB, were measured at the time of admission and after 72 hours to compare with mortality. Diastolic dysfunction was defined according to the American Society of Echocardiography (ASE) 2009 guidelines, classifying subjects into grade 0 (normal), if early diastolic velocity (e') ≥ 8 cm/s; grade 1 (impaired relaxation), if e' < 8 cm/s and early (E) to late (A) ventricular filling velocities (E/A) ratio < 0.8; grade 2 (pseudo normal), if e' < 8 cm/s, E/A = 0.8-1.5, and peak E-wave velocity by the peak e' velocity (E/e') ratio = 9-12; and grade 3 (restrictive), if e' < 8 cm/s, E/A > 2, deceleration time (DT) < 160 ms, and E/e' ≥ 13. Thirty-seven (40.65%) out of 132 patients had diastolic dysfunction on initial echocardiography, while 54 (59.34%) had diastolic dysfunction on at least subsequent echocardiography. Total mortality was 68.93% with the highest mortality (100%) observed among those with grade 3 diastolic dysfunction. The 28-day mortality with diastolic dysfunction in sepsis and septic shock patients showed significant results (p < 0.001), indicating that with a higherE/A ratio or higher grade of diastolic dysfunction with the increase in SOFA score, the early ICU mortality is the highest and have the shortest duration of ICU stay with mean ± SD = 6.2 ± 2.48, as compared to other grades with 100% mortality. Also, the cardiac biomarkerNT-pro-BNP was markedly elevated with a mean ± SD value of 503 ± 269.3 pg/ml, indicating early predicted mortality.No correlation was detected between mortality and the mean levels of fasting blood sugar, postprandial blood sugar, and glycosylated hemoglobin. Our study concluded that diastolic dysfunction is an important and strongest independent mortality predictor in patients with T2DM with severe sepsis and septic shock, and the higher the grade of diastolic dysfunction, the higher the mortality with the lowest mean ICU stay.

Comparison of echocardiographic methods for calculating left ventricular mass in elite rugby football league athletes and the impact on chamber geometry.

Recommendations for the echocardiographic assessment of left ventricular (LV) mass in the athlete suggest the use of the linear method using a two-tiered classification system (2TC). The aims of this study were to compare the linear method and the area-length (A-L) method for LV mass in elite rugby football league (RFL) athletes and to establish how any differences impact the classification of LV geometry using 2TC and four-tier (4TC) classification systems. Two hundred and twenty (220) male RFL athletes aged 25 ± 5 (14-34 years) were recruited. All athletes underwent echocardiography and LV mass was calculated by the American Society of Echocardiography (ASE) corrected Linear equation (2D) and the A-L method. Left ventricular mass Index (LVMi) was used with relative wall thickness to determine geometry in the 2TC and with concentricity and LV end diastolic volume index for the 4TC. Method specific recommended cut-offs were utilised. Higher values of absolute (197 ± 34 vs. 181 ± 34 g; p < 0.0001) and indexed (92 ± 13 vs. 85 ± 13 g/m2; p < 0.0001) measures of LV mass were obtained from A-L compared to the linear method. Normal LV geometry was demonstrated in 98.2% and 80% of athletes whilst eccentric hypertrophy in 1.4% and 19.5% for linear and A-L respectively. Both methods provided 0.5% as having concentric remodelling and 0% as having concentric hypertrophy. Allocation to the 4TC resulted in 97% and 80% with normal geometry, 0% and 8.6% with eccentric dilated hypertrophy, 0% and 7.7% with eccentric non-dilated hypertrophy, 1.4% and 0.5% with concentric remodelling and 1.4% and 3% with concentric non-dilated hypertrophy for linear and A-L methods respectively. No participants had concentric dilated hypertrophy from either methods. The linear and A-L method for calculation of LV mass in RFL athletes are not interchangeable with significantly higher values obtained using A-L method impacting on geometry classification. More athletes present with eccentric hypertrophy using 2TC and eccentric dilated/non-dilated using 4TC. Further studies should be aimed at establishing the association of A-L methods of LV mass and application of the 4TC to the multi-factorial demographics of the athlete.

Early detection of reduced left ventricular systolic function by 2D speckle tracking echocardiography in patients with primary mitral regurgitation in a Vietnamese cohort.

Background: Mitral regurgitation (MR) is a common heart valve disease, causing many serious complications in several organ systems, especially the cardiovascular system. The 2D speckle tracking echocardiography (STE) is a new technique for detecting potential cardiac dysfunction when only tissue function abnormalities are present. The study aimed to assess left ventricular (LV) systolic function early by STE in patients with primary MR through global LV deformity along the global longitudinal strain (GLS). Methods: An analytical cross-sectional study was performed on 46 patients with moderate to severe primary MR as recommended by the American Society of Echocardiography (ASE) 2017. Results: The prevalence of patients with GLS reduction with ejection fraction (EF) >60%, New York Heart Association (NYHA) I, and left ventricular internal diameter systolic (LVIDs) <40mm was 38.1%, 35.7%, and 39.5%, respectively. 100% of patients with EF<60% and LVIDs ≥40mm had reduced GLS (<16%). The GLS index strongly correlates with the NYHA classification, degree of MR, EF, and echocardiographic parameters. Conclusion: GLS index gives a significant sign in the early detection of cardiac function abnormalities before symptoms or other echocardiographic parameters in patients with MR.

Predicting readmission for heart failure patients by echocardiographic assessment of elevated left atrial pressure

BackgroundPathophysiologically, an elevated left ventricular (LV) filling pressure is the major reason for heart failure (HF) readmission. The 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines provide a simplified algorithm for the echocardiographic assessment of LV filling pressure; however, this algorithm is yet to be sufficiently validated. Materials and MethodsWe retrospectively studied 139 consecutive patients with acute decompensated HF. High estimated left atrial pressure (eLAP) was defined according to the 2016 ASE/EACVI guidelines. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for HF readmission within one year of discharge. ResultsAcross the study cohort, 68 patients (49%) did not have a high eLAP, 32 (23%) had an indeterminate eLAP, and 39 (28%) had a high eLAP. The number of HF readmission events within one year in the without high eLAP, indeterminate, and high eLAP groups were 4 (7.5%), 5 (18.5%), and 10 (33.3%), respectively. The HF readmission rate was significantly higher in patients with high eLAP than in those without high eLAP. Multivariate analysis revealed high eLAP (odds ratio, 5.924; 95% confidence interval, 1.664–21.087; P = 0.006) as a significant risk factor for HF readmission within one year. Furthermore, the exploratory analysis of the two-year outcomes revealed a similar finding: patients with high eLAP had a significantly higher rate of readmission for HF. ConclusionsThe present study demonstrated that echocardiographic assessment of elevated LAP based on the 2016 ASE/EACVI guidelines is clinically valid for predicting readmission in patients with HF.

Pericardial Effusion and Cardiac Tamponade Pathophysiology and New Approaches to Treatment.

The objective of this manuscript is to examine up-to-date approaches to the diagnosis and treatment of pericardial effusions and cardiac tamponade. Recent recommendations from the American Society of Echocardiography and the European Society of Cardiology have improved our management of the patient with pericardial effusion and cardiac tamponade, but significant knowledge gaps remain. Novel diagnostic and triage strategies have been suggested, and recent information have improved our facility to assess the presence and size of a pericardial effusion, assess its hemodynamic impact, and determine its cause. Despite these recent findings, there is a scarcity of evidence-based data to direct the management of pericardial effusion and cardiac tamponade. While the first-line function of echocardiography in managing these disorders is undisputed, there are increasingly niche functions for multimodality imaging.

The efficacy and safety of patent Foramen Ovale Closure for Refractory Epilepsy (PFOC-RE): a prospectively randomized control trial of an innovative surgical therapy for refractory epilepsy patients with PFO of high-grade right-to-left shunt

BackgroundA significant proportion of patients with epilepsy have an unknown etiology and lack effective targeted therapeutic drugs. Patent Foramen Ovale (PFO) induces hypoxia and microembolism, leading to cerebral neurological dysfunction and increased epilepsy risk. This study aims to assess the efficacy and safety of PFO closure for relieving epileptic seizures in patients with refractory epilepsy associated with PFO.Methods/designRecruitment takes place at the West China Hospital of Sichuan University, China, for an open-label, randomized controlled clinical trial. The trial will include 110 patients with refractory epilepsy and PFO. Disease diagnoses will conform to the diagnostic criteria of the International League Against Epilepsy (ILAE) for refractory epilepsy and the American Society of Echocardiography (ASE) for PFO. Refractory epilepsy and high-grade right-to-left shunt (RLS) of the PFO will be further diagnosed using 24-hour video electroencephalogram and transthoracic echocardiography with contrast injection, respectively. Eligible participants require a secondary or higher volume of RLS.Trial registrationChinese Clinical Trial Registry (ChiCTR2200065681). Registered on November 11, 2022.

The use of quality improvement interventions in reducing rarely appropriate echocardiograms: A systematic review and meta-analysis.

The volume of cardiac imaging continues to increase, with many tests performed for rarely appropriate indications. Appropriate use criteria (AUC) documents were published by the American Society of Echocardiography and American College of Cardiology, with quality improvement (QI) interventions developed in various institutions. However, the effectiveness of these interventions has not been assessed in a systematic fashion. We searched Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL for studies reporting association between cardiac imaging, AUC and QI. The search was not restricted to time or publication status. We selected studies assessing the effect of QI interventions on performance of rarely appropriate echocardiograms. The primary endpoint was reduction of rarely appropriate testing. Nine studies with 22,070 patients met inclusion criteria. Mean follow up was 15 months (1-60 months). QI interventions resulted in statistically significant reduction in rarely appropriate tests (OR 0.52, 95% CI: .41-.66; p < .01). The effects of QI interventions were analyzed over both the short (<3 months) and long-term (>3 months) post intervention (OR 0.62, 95% CI: .49-.79; p < .01 in the short term, and OR 0.47, 95% CI: .35-.62; p < .01 in the long term). Subgroup analysis of the type of intervention, classified as education tools or decision support tools showed both significantly reduced rarely appropriate testing (OR 0.54, 95% CI: .41-.73; p < .01; OR .47, 95% CI: .36-.61; p < .01). Adding a feedback tool did not change the effect compared to not using a feedback tool (OR 0.49 vs. 0.57, 95% CI: .36-.68 vs. 39-.84; p > .05). QI interventions are associated with a significant reduction in performance of rarely appropriate echocardiography testing, the effects of which persist over time. Both education and decision support tools were effective, while adding feedback tools did not result in further reduction of ordering rarely appropriate studies.

Imaging for implementation of heart failure guidelines.

The classification of heart failure with implications for pharmacological therapeutic interventions rests on defining ejection fraction (EF) which is an imaging parameter. Imaging can provide diagnostic clues as to aetiology of heart failure; it can also guide and help assess response to treatment. Echocardiography, CMR, cardiac computed tomography, positron emission tomography, and Tc 99 m pyrophosphate scanning provide information about the aetiology of heart failure. Further, echocardiography plays the primary role in the evaluation of LV diastolic function and the estimation of left ventricular (LV) filling pressures both at rest and with exercise during diastolic stress testing. Heart failure guidelines recognize four stages (A, B, C, and D) for heart failure. Cardiac imaging along with risk factors and clinical status is needed for identifying these stages. There are joint societal echocardiographic guidelines by American Society of Echocardiography (ASE) of Echocardiography and European Association of Cardiovascular Imaging that are applicable to the imaging of heart failure patients. There are also separate guidelines for the evaluation of patients being considered for LV assist device implantation and for multimodality imaging of patients with heart failure and preserved EF. Cardiac catheterization is needed in patients whose haemodynamic status is uncertain after clinical and echocardiographic evaluation and to evaluate for coronary artery disease. Myocardial biopsy can identify the presence of myocarditis or specific infiltrative diseases when the findings by non-invasive imaging are not conclusive.

Diastolic Function Assessment by Echocardiography at Dhulilkhel Hospital

IntroductionDiastolic dysfunction (DD) is understood as impaired Left ventricular relaxation. Echocardiography is the key in diagnosis. In 2016 recommendation by American Society of Echocardiography(ASE) and the European Association of Cardiovascular Imaging (EACVI) was updated. In our country we do not have a general consensus. Diastolic dysfunction is reported on the basis of E/A ratio of mitral flow, that has the chance of missing a lot of patients with pseudo-normalization. This study carried out to look at importance of evaluation of other parameters to diagnose a patient with diastolic dysfunction.Methods: It is a retrospective cross-sectional descriptive study. Echocardiography report from the year 2018 and 2019 was collected from database and the patients with diagnosis of Diastolic dysfunction were selected. Patient profile and the echocardiographic parameter were recorded. Echocardiography was reported according to 2016 ASE and EACVI update.Results: Total of 1982 patients selected for analysis. E/A &lt; 0.8 was seen in 702(35.4%) patients, E/A 0.8- 2.0 was seen in 1136 (57.3%) patients and E/A &gt; 2.0 was found in 144(7.3%) patients. The most common finding being E/e’ 1470 (74.2%) of patients followed by TR velocity &gt; 2.8m/s 1422 (71.7%), Septal e’ velocity &lt; 7 cm/s or Lateral e’ velocity &lt;10 cm/s 1334 (67.3%) and LA area &gt;20 cm2 1286 (64.8%) respectively.Conclusions: Diastolic dysfunction should be evaluated using all the parameters recommended by 2016 ASE andEACVI guideline update. Measurement of only E/A ratio has a chance of missing large number of patient with DD.