Conventional Echocardiographic Techniques Research Articles

Cardiovascular Adaptation in Fetal Growth Restriction: A Longitudinal Study From Fetuses at Term to the First Year of Life.

To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR). Prospective longitudinal study. Fetal Medicine Unit. Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months). Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography. Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups. Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, p < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, p < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (-19.0 vs. -16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, p < 0.01 for all). Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life.

Assessment of left and right ventricular systolic function in dogs with multicentric lymphoma

ObjectiveMyocardial dysfunction in cardio-oncology is generally thought to be related to the cardiotoxicity of chemotherapy treatment. However, it is known that some tumors have direct effects on myocardial function. These effects have already been studied in man, but there are no publications of these of the effects in dogs. Novel advanced echocardiographic techniques may allow early detection of myocardial dysfunction when compared to conventional echocardiographic techniques. This study aims to assess myocardial systolic function in dogs with multicentric lymphoma prior to initiation of chemotherapy. AnimalsFifteen dogs with multicentric lymphoma and nineteen healthy dogs. MethodsCase-control study. Dogs with multicentric lymphoma and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, standard and speckle tracking echocardiography to assess biventricular systolic function. ResultsThere were no differences between groups in terms of ejection fraction, fractional shortening, left ventricular systolic and diastolic diameter, tricuspid annular plane systolic excursion, mitral annular plane systolic excursion and fractional area change of the right ventricle (RV). However, there was a reduction in the values of global circumferential strain (p = 0.0003), RV strain (p = 0.01) and RV tissue motion annular displacement (p < 0.05) in the dogs with lymphoma when compared to the control group. ConclusionsSpeckle tracking techniques appear to demonstrate early systolic dysfunction, primarily affecting the RV, in dogs with lymphoma prior to chemotherapy treatment.

Right ventricular and atrial strain in patients with advanced melanoma undergoing immune checkpoint inhibitor therapy.

While immune checkpoint inhibitor (ICI) therapy significantly improves survival rates in advanced melanoma, ICI can evoke severe immune-related cardiovascular adverse events. Right ventricular (RV) dysfunction negatively impacts the outcomes in cardiovascular diseases and may be an early sign for overall cardiotoxicity. We aimed to assess RV function in melanoma patients undergoing ICI therapy using conventional echocardiographic and strain imaging techniques. We retrospectively examined 30 patients (40% women, age 59±13years) with advanced melanoma (stage III/IV) before and 4weeks after the start of ICI therapy (follow-up at 39±15days); n=15 of the patients received nivolumab, and n=15 received the combination therapy nivolumab/ipilimumab. Two-dimensional echocardiography with assessment of RV longitudinal strain of the free wall (RV-LSFW) and assessment of right atrial (RA) strain from speckle tracking was performed at baseline and after the start of ICI therapy. Short-term ICI therapy caused a reduction of RV-LSFW (-25.5±6.4% vs. -22.4±4.3%, P=0.002) and of RA strain during contraction phase (-10.6±3.5% vs. -7.7±3.1%, P=0.001). Conventional parameters including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and pulmonary artery systolic pressure were not different between the two time points (TAPSE 26±5 vs. 25±5mm, P=0.125; FAC 38±13% vs. 38±14%, P=0.750; and pulmonary artery systolic pressure 27±10 vs. 25±8mmHg, P=0.268). Analysis of RV and RA strain shows alterations even in a short-term follow-up, while changes in RV function are not visible by conventional RV parameters. Alterations in RV and RA strain could be early signs of cardiotoxicity and therefore should be assessed in patients undergoing ICI therapy.

Left atrial deformation parameters among beta-thalassemia major patients

Abstract Introduction Atrial cardiomyopathy is present in a significant proportion of beta thalassemia major (β-TM) patients, complicating their clinical condition. The diagnosis of atrial cardiomyopathy is challenging using conventional echocardiographic techniques. Purpose In our study we aimed to identify the presence of atrial cardiomyopathy by applying novel echocardiographic techniques in these patients. Methods 56 β-TM patients (mean age 39.3±9 years, 50% male sex) and 30, age and sex matched, healthy controls were examined by transthoracic echocardiography. Conventional echocardiographic parameters were estimated alongside with deformation indices (left atrial strain at reservoir (LASr), conduit (LAScd) and contraction (LASct) phase respectively as well as left ventricular global longitudinal strain (GLS)). T2* was calculated by cardiac magnetic resonance imaging in β-TM patients. Results LAVI, E/e' ratio, GLS and left atrial deformation parameters differed between patients and controls. In patient group, left atrial deformation indices were correlated with LAVI, E/e' ratio, GLS and T2* (Table 1). GLS was also correlated with LAVI, but not with T2* or E/e' ratio. T2* was correlated only with left atrial deformation indices. Patient with prior episodes of atrial fibrillation were older, had increased E/e' and LAVI and impaired left atrial deformation indices but did not differ in terms of GLS or T2* (Figure 1). Patients with iron overload differed only in terms of left atrial deformation parameters. Conclusions Atrial deformation indices could be of clinical use in the early detection of atrial cardiomyopathy. Impaired left atrial strain may be associated with silent atrial fibrillation and be indicative of myocardial iron overload. Funding Acknowledgement Type of funding sources: None. Correlation tableScatter plot of T2* and LASr

Left and Right Ventricular Impairment Shortly After Correction of Tetralogy of Fallot

Surgical repair of Tetralogy of Fallot (ToF) is usually performed in the first months of life with low early postoperative mortality. During long-term follow-up, however, both right (RV) and left ventricular (LV) performances may deteriorate. Tissue Doppler imaging (TDI) and speckle tracking echocardiography (ST) can unmask a diminished RV and LV performance. The objective of the current study was to assess the cardiac performance before and shortly after corrective surgery in ToF patients using conventional, TDI and ST echocardiographic techniques. Thirty-six ToF patients after surgery were included. Transthoracic echocardiography including TDI and ST techniques was performed preoperatively and at hospital discharge after surgery (10 days to 4 weeks after surgery). Median age at surgery was 7.5 months [5.5–10.9]. Regarding the LV systolic function there was a significant decrease in interventricular septum (IVS) S′ at discharge as compared to preoperatively (pre IVS S′ = 5.4 ± 1.4; post IVS S′ = 3.9 ± 1.2; p < 0.001) and in global longitudinal peak strain (GLS) (pre = − 18.3 ± 3.4; post = − 14.2 ± 4.1; p = 0.003); but not in the fractional shortening (FS). Both conventional and TDI parameters showed a decrease in diastolic function at discharge. Tricuspid Annular Plane Systolic Excursion and RV S′ were significantly lower before discharge. When assessing the RV diastolic performance, only the TDI demonstrated a RV impairment. There was a negative correlation between age at surgery and postoperative LV GLS (R = − 0.41, p = 0.031). There seems to be an impairment in left and right ventricle performance at discharge after ToF corrective surgery compared to preoperatively. This is better determined with TDI and ST strain imaging than with conventional echocardiography.

The Incremental Benefit of Color Tissue Doppler in Fetal Arrhythmia Assessment

Accurate fetal arrhythmia (FA) diagnosis is key for effective management. Currently, FA assessment relies on standard echocardiography-based techniques (M mode and spectral Doppler), which require adequate fetal position and cursor alignment to define temporal relationships of mechanical events. Few data exist on the application of color Doppler tissue imaging (c-DTI) in FA assessment. The aim of this study was to examine the feasibility and clinical applicability of c-DTI in FA assessment in comparison with standard techniques. Pregnancies with diagnosed FA were prospectively recruited to undergo c-DTI following fetal echocardiography. Multiple-cycle four-chamber clips in any orientation were recorded (mean frame rate, 180±16 frames/sec). With offline analysis, sample volumes were placed on atrial (A) and ventricular (V) free walls for simultaneous recordings. Atrial and ventricular rates, intervals (for atrial-ventricular conduction and tachyarrhythmia mechanism), and relationships were assessed to decipher FA mechanism. FA diagnosis by c-DTI, conventional echocardiographic techniques, and postnatal electrocardiography and/or Holter monitoring were compared. FA was assessed by c-DTI in 45 pregnancies at 15 to 39weeks, including 16 with atrial and/or ventricular ectopic beats; 18 with supraventricular tachyarrhythmias, including ectopic atrial tachycardia in 11, atrioventricular reentrant tachycardia in four, atrial flutter in two, and intermittent atrial flutter and junctional ectopic rhythm in one; three with ventricular tachycardias; and eight with bradycardias or atrioventricular conduction pathology, including five with complete atrioventricular block (AVB), one with first-degree AVB evolving into complete AVB, one with second-degree AVB, and one with sinus bradycardia. After training, FA diagnosis by c-DTI could be made irrespective of fetal orientation within 10 to 15min. FA diagnosis by c-DTI concurred with standard techniques in 41 cases (91%), with additional findings identified by c-DTI in 10. c-DTI led to new FA diagnoses in four cases (9%) not definable by standard techniques. FA diagnosis by c-DTI was confirmed in all 20 with persistent arrhythmias after birth, including three with new diagnoses defined by c-DTI. c-DTI was particularly helpful in deciphering SVT mechanism (long vs short ventricular-atrial interval) in all 18 cases, whereas standard techniques permitted definition in only half. c-DTI with offline analysis permits rapid and accurate definition of FA mechanism, providing new information in nearly one-third of affected pregnancies.

Comparison of Conventional and Advanced Echocardiographic Techniques in Early Detection of Cardiotoxicity in Patients Undergoing Cancer Chemotherapy

Abstract Context: The assessment of left ventricular ejection fraction (LVEF) is the most important component in prediction and detection of cardiotoxicity in patients undergoing cancer chemotherapy. LVEF may not be sensitive enough to pick the cardiotoxicity early since drop in LVEF occurs in the last and irreversible stage. A 10%–15% early reduction in global longitudinal strain (GLS) by speckle tracking echocardiography proposed to be the earliest indicator of myocardial dysfunction. Aims: The aim of this study was to compare the early detection of cardiotoxicity (at 0 and 3 months) using drop in LVEF with two-dimensional echocardiography (2DE), three-dimensional echocardiography (3DE), and GLS techniques. Settings and Design: This was a prospective cohort study of patients attending cardiooncology clinic in a tertiary care institute. Subjects and Methods: Newly diagnosed 75 cases of cancer of various etiologies, for whom cardiotoxic chemotherapy drugs has to be used, were included from January 2016 to June 2016. Statistical Analysis Used: Data were analyzed with Pearson’s Chi-square test, mean, standard deviation, and 95% confidence interval. Results: A total of 17 (22.6%) subjects out of 75, had drop in LVEF by GLS (&lt;−18.9%) as compared to 5 (6.6%) in 2DE and 7 (9.3%) in 3DE at 3 months with statistically significant P values (P = 0.0001). In the 17 subjects who had significant fall in GLS at 3 months, the mean GLS was −16.17 ± 1.55% with a significant reduction of 13.48% from baseline. Conclusion: Reduction in GLS preceded decrease in ejection fraction. Early detection allows modification of chemotherapeutic regimens and medical intervention preventing the irreversible cardiac damage.

Echocardiography in ST-elevation myocardial infarction

Echocardiography is an imaging technique of paramount importance for the management of patients with ST-elevation myocardial infarction. In particular, this technique may be useful for diagnosis and is essential for prognosis and to guide drug therapy. The role in the recognition of mechanical complications and in the identification and management of other complications such as pericarditis and left ventricular thrombosis is also crucial. Finally, echocardiography offers important information for the prediction of the arrhythmic risk and the study of left ventricular remodeling. In recent years, speckle-tracking echocardiography has been added to conventional echocardiographic techniques, showing additional value for diagnostic and prognostic indications, but further confirmations are needed.

Detection of Early Right Ventricular Dysfunction in Young Patients With Thalassemia Major Using Tissue Doppler Imaging.

BackgroundMyocardial iron overload is the most common cause of mortality in patients with thalassemia major (TM), also known as beta-thalassemia. T2* cardiovascular magnetic resonance imaging (MRI) is the best way of monitoring cardiac iron, and new echocardiographic techniques can be used to assess cardiac function.ObjectivesThe aim of this study was to assess the systolic and diastolic right ventricular (RV) function of patients with TM using tissue Doppler imaging (TDI) and to determine whether this echocardiographic technique is an adequate diagnostic tool for the screening and detection of subclinical cardiac dysfunction.Patients and MethodsEighty-four patients with TM were evaluated by conventional echocardiography and pulse-wave TDI. The data of the TM group (Group 1) were compared with that of 85 age- and sex-matched healthy controls (Group 2). Cardiovascular T2* MRI examinations were performed in 49 of the 85 patients.ResultsThe patients with TM had significantly lower values for weight, height, body mass index, systolic arterial pressure, deceleration time, E’/A’, and ejection time (ET) than the controls. Group 1 also had significantly higher values for peak early diastolic velocity (E) over peak late diastolic velocity (A), peak early diastolic velocity of TDI (E’), peak late diastolic velocity of TDI (A’), E/E’, isovolumetric relaxation time, isovolumetric contraction time, and RV magnetic perfusion imaging (MPI) than Group 2.ConclusionsRV diastolic dysfunction occurs before systolic deterioration in patients with TM and cannot be screened with conventional echocardiographic techniques. In routine practice, TDI measurements, MPI (for global function) and the E/E’ parameter (for diastolic function) can be used to screen and detect early RV dysfunction.

Association between aortic stiffness and left ventricular function in inflammatory bowel disease.

Recent studies have reported an increased incidence of both aortic stiffness and left ventricular (LV) systolic and diastolic dysfunction in patients with inflammatory bowel disease (IBD). However, the association between aortic stiffness and the LV function has not been fully defined. We aimed to investigate the relationship between aortic stiffness and the LV function in IBD patients. Seventy-two patients with IBD (56 cases of ulcerative colitis and 16 cases of Crohn's disease) and 50 healthy controls were consecutively enrolled in this study. The LV systolic and diastolic functions were assessed using conventional echocardiographic techniques, including tissue Doppler echocardiography. The degree of aortic strain and distensibility were calculated based on the aortic diameters measured on M-mode echocardiography at thelevel of 3 cm above the aortic valve and the blood pressure values obtained on sphygmomanometry. There were significant differences between the IBD and control group in the degree of aortic strain and distensibility. Significant differences were also observed between the patient and control groups in the parameters of the LV systolic and diastolic functions. Moreover, aortic stiffness was found to be associated with the LV function in the patient group. There is a significant relationship between aortic stiffness and LV systolic and diastolic dysfunction in patients with IBD, based on the findings of this study. The parameters of aortic elasticity measured according to 2-dimensional echocardiographic methods can be beneficial for predicting early cardiovascular risk in cases of IBD. (.

Assessment of the Utility of the SeptalE/(E′×S′)Ratio and Tissue Doppler Index in Predicting Left Ventricular Remodeling after Acute Myocardial Infarction

Background. The aim of this study is to show whether the septal E/(E′ × S′) ratio assessed by tissue Doppler echocardiography can predict left ventricular remodeling after first ST segment elevation myocardial infarction treated successfully with primary percutaneous intervention. Methods. Consecutive patients (n = 111) presenting with acute anterior myocardial infarction for the first time in their life were enrolled. All patients underwent successful primary percutaneous coronary intervention. Standard and tissue Doppler echocardiography were performed in the first 24-36 hours of admission. Echocardiographic examination was repeated after 6 months to reassess left ventricular volumes. Septal E/(E′ × S′) ratio was assessed by pulsed Doppler echocardiography. Results. Group 1 consisted of 33 patients with left ventricular (LV) remodeling, and Group 2 had 78 patients without LV remodeling. E/(E′ × S′) was significantly higher in Group 1 (4.1 ± 1.9 versus 1.65 ± 1.32, p = 0.001). The optimal cutoff value for E/(E′ × S′) ratio was 2.34 with 87.0% sensitivity and 82.1% specificity. Conclusion. Septal E/(E′ × S′) values measured after the acute anterior myocardial infarction can strongly predict LV remodeling in the 6-month follow-up. In the risk assessment, the septal E/(E′ × S′) can be evaluated together with the conventional echocardiographic techniques.

Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Assessed by Echocardiography Predicts Adverse Clinical Outcome

Among studies describing the phenotype of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), significant discrepancy exists regarding the extent and impact of left ventricular (LV) involvement. The capability of conventional and new quantitative echocardiographic techniques to accurately detect LV involvement in ARVD/C remains unknown. The aim of this study was to test the hypothesis that accuratedetection of LV involvement on echocardiography identifies patients at additional risk for cardiac events during follow-up. Thirty-eight patients with ARVD/C, 16 pathogenic mutation-positive relatives, and 55 healthy control subjects were prospectively enrolled. Conventional echocardiography with additional deformation imaging was performed in all subjects to detect LV involvement. In a subgroup (n=27), cardiac magnetic resonance imaging was performed with late enhancement. All patients and relatives were prospectively followed for events (sustained ventricular tachycardia, appropriate implantable cardioverter-defibrillator intervention, suddencardiac death, and heart transplantation). Conventional echocardiography detected LV involvement in 32% of patients with ARVD/C and in none of the relatives. Deformation imaging revealed LV involvement in 68% of patients with ARVD/C and 25% of relatives and was correlated closely with late enhancement on cardiac magnetic resonance imaging. During a mean follow-up period of 5.9±2.3years, 20 patients with ARVD/C (53%) experienced events, and no events occurred in the relatives. LV involvement detected by deformation imaging (hazard ratio, 4.9; 95% CI, 1.7-14.2) and right ventricular outflow tract enlargement (hazard ratio, 1.2; 95% CI, 1.1-1.3) were the only independentpredictors of outcomes. Deformation imaging detected a high incidence of LV involvement in patients with ARVD/C and their relatives. Compared with conventional echocardiography, deformation imaging is superior in detecting minor LV involvement. LV involvement and an enlarged right ventricular outflow tract are independent prognostic markers of outcomes.

Echocardiographic evaluation of right ventricular function in congenital heart disease.

This review aims to provide an overview of conventional and novel indices used in clinical and research arenas for evaluation of right ventricular (RV) function in congenital heart diseases with a dual-chambered circulation. Articles cited in this review were selected using PubMed search of publications in English with no date limits. The search terms included "echocardiography", "right ventricle", "RV function", "cardiac function", and "congenital heart disease". Key references were also searched for additional publications. Articles related to description of echocardiographic techniques in the evaluation of subpulmonary or systemic RV function and their applications in congenital cardiac malformations were retrieved and reviewed. Three approaches have been used to evaluate subpulmonary and systemic RV function: (1) assessment of changes in RV size in the cardiac cycle, (2) determination of Doppler-derived velocities and systolic and diastolic time intervals, and (3) quantification of myocardial velocities and deformation. Conventional and novel echocardiographic techniques enable the evaluation of subpulmonary and systemic RV function. Novel echocardiographic techniques have further allowed quantification of RV volumes and direct interrogation of myocardial deformation. These new techniques show promise in a more comprehensive evaluation beyond "eye-balling" of RV function in the growing population of adolescent and adult congenital heart patients.

Detection of subclinical right ventricular systolic dysfunction in patients with mitral stenosis by two dimensional strain and strain rate imaging

Abstract Introduction Right ventricular (RV) systolic dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Conventional echocardiographic techniques have some limitations in the assessment of RV function. Aim of the work To evaluate the role of two dimensional (2D) longitudinal systolic strain and strain rate imaging in detection of subclinical RV systolic dysfunction in patients with moderate-severe MS. Patients and methods Fifty patients with isolated MS (moderate-severe) and 30 healthy control subjects constituted the study population. Conventional echocardiography, pulsed wave tissue Doppler imaging (TDI) of the tricuspid annulus and 2D longitudinal segmental and global RV systolic strain (RV-GLS) and strain rate (RV-GLSr) measurements were obtained. Results Patients with MS had significantly lower RV-GLS and RV-GLSr compared to control subjects (−19.67 ± 6.23 vs. −24.19 ± 3.25, P P = 0.02, respectively). Conclusion Patients with MS had significantly lower 2D RV-GLS and RV-GLSr compared to control group. 2D RV-GLS and RV-GLSr imaging appear to be useful in detection of subclinical RV systolic dysfunction in patients with MS.

New onset atrial fibrillation after coronary artery bypasses grafting; an evaluation of mechanical left atrial function.

This study attempted to identify the role of combined conventional and novel echocardiographic techniques in evaluation of left atrial (LA) function to predict the postoperative atrial fibrillation (POAF). In this cross-sectional study, subjects with sinus rhythm who were candidates for CABG were enrolled. Preoperative LA function was evaluated by conventional echocardiography and 2-dimensional strain imaging based-velocity vector imaging (VVI). VVI-derived systolic peak positive, early and late diastolic strain rate were measured. Using tissue Doppler study, systolic peak velocities (Sm), early diastole (Em), atrial systole (Am) and AEMi were also measured. The patients were observed during their hospital stay. The primary endpoint of the study was postoperative AF lasting > 5 minutes. POAF occurred in 12.7% of patients. Age, LA volume index (LAVI), LA area, LA empting fraction (LAeF) and cardiopulmonary bypass time were found to be the independent predictors of POAF. TDI-derived velocities were similar in study groups. LA systolic strain rate (SRs) and early diastolic strain rate were impaired in patients with no significant difference between those who developed POAF and those who did not. Conventional echocardiography could be used as a feasible method for evaluating subclinical atrial dysfunction in patients undergoing CABG and the use of VVI- based 2-dimensional strain imaging may need further studies.

PC.49 Assessment of Myocardial Function in Preterm Infants with Chronic Lung Disease using Tissue Doppler Imaging

BackgroundChronic lung disease (CLD), defined as oxygen requirement at 36 weeks corrected gestational age (CGA) is a significant neonatal morbidity which can have adverse effects on cardiac function until at...

Functional Assessment for Congenital Heart Disease

Significant improvement in survival of children with congenital cardiac malformations has resulted in an increasing population of adolescent and adult patients with congenital heart disease. Of the long-term cardiac problems, ventricular dysfunction remains an important issue of concern. Despite corrective or palliative repair of congenital heart lesions, the right ventricle, which may be the subpulmonary or systemic ventricular chamber, and the functional single ventricle are particularly vulnerable to functional impairment. Regular assessment of cardiac function constitutes an important aspect in the long-term follow up of patients with congenital heart disease. Echocardiography remains the most useful imaging modality for longitudinal monitoring of cardiac function. Conventional echocardiographic assessment has focused primarily on quantification of changes in ventricular size and blood flow velocities during the cardiac cycles. Advances in echocardiographic technologies including tissue Doppler imaging and speckle tracking echocardiography have enabled direct interrogation of myocardial deformation. In this review, the issues of ventricular dysfunction in congenital heart disease, conventional echocardiographic and novel myocardial deformation imaging techniques, and clinical applications of these techniques in the functional assessment of congenital heart disease are discussed.

Mid-Aortic Syndrome Demonstrated by Three-Dimensional Computed Tomography: Case Report

A 14-year-old male patient was admitted to our clinic for evaluation of systemic arterial hypertension. His right and left arm arterial blood pressures were extremely high and measured 200/120 and 180/120 mmHg, respectively. His bilateral femoral pulses were weak, and lower limb blood pressures could not be measured. By conventional echocardiography, increased left ventricular wall thickness, narrowed lumen size, and disturbed antegrade flow at the lower thoracic part of aorta were shown (Fig. 1, Movie clip 1). Three-dimensional computed tomography (CT) clearly demonstrated a long-segment severe coarctation involving the distal half of thoracic aorta (Fig. 2). The affected segment was 3 cm in length, and the intra-aortic lumen size decreased gradually to \95 % of the expected lumen size. Intrarenal part of the abdominal aorta was also narrowed, and there were no stenosis in the other branches of the aorta. Multiple aortico-aortic collaterals were also detected by CT evaluation. Cranial magnetic resonance imaging and ophthalmologic examinations were normal, and serum inflammatory markers were within the normal ranges. Thus, the patient was diagnosed with an idiopathic form of mid-aortic syndrome (MAS). Due to long-segment involvement of aorta, percutaneous transluminal angioplasty of the aorta could not be performed. We therefore planned aorta‐aortic bypass graft surgery for this patient. MAS is a rare congenital abnormality characterized by segmental narrowing of the abdominal or distal descending thoracic aorta [2‐5]. It is frequently seen with stenosis of the renal and mesenteric arteries. It can be acquired or congenital. Acquired forms are usually associated with neurofibromatosis, fibromuscular dysplasia, retroperitoneal fibrosis, Williams syndrome, mucopolysaccharidosis, and giant-cell arteritis [2, 4]. Three-dimensional CT can provide more detailed information regarding cardiovascular structures than conventional echocardiographic techniques. MAS can cause severe renovascular hypertension in children and adolescents. It is generally difficult to manage the hypertension which requires treatment with several

Tissue Doppler Imaging and Two-Dimensional Speckle Tracking of Left Ventricular Function in Healthy Horses After Clenbuterol Application

The cardiac effects of high dosages of the ß2-adrenergic agent clenbuterol have been the focus of several histological, biochemical and echocardiographic studies in the past. Possible effects of a therapeutic dosage on myocardial contractility and velocities have not been evaluated using tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2DST) in equine medicine. Twenty-five healthy horses were treated over 14 days with clenbuterol in a normal dosage (0.8 μg/kg every 12 hours). Before and after the treatment, an echocardiographic examination was performed using B-mode, M-mode, color flow Doppler, and tissue Doppler imaging (TDI). In all horses, the radial and circumferential myocardial functions were recorded in the right parasternal short-axis view (SAX). Pulsed-wave (PW) and color TDI were used for evaluation of peak and mean myocardial velocities; myocardial deformation was documented in 2DST. An improvement of diastolic function after clenbuterol treatment was demonstrated by a significant increase of the early diastolic radial wall motion velocity (Em) in all myocardial sections except the right ventricular free wall (RVFW) in TDI, as well as an increase of the E/A quotient in the left ventricular free wall (LVFW) and the interventricular septum (IVS). Shortened time intervals, in particular in the LVFW and a tendency of increase of all deformation parameters showed improved relaxation characteristics of the cardiac muscle after treatment. The results can be interpreted as beginning physiologic cardiac hypertrophy due to clenbuterol treatment. No signs of increased rigidity or reduced compliance of the heart muscle could be found at the applied dosage. This study demonstrates the sensitivity of TDI and 2DST in equine cardiology to detect myocardial remodeling before the appearance of obvious findings in conventional echocardiographic techniques. This technique can be used to detect pharmacologic effects on myocardial function.

Normal Reference Ranges for Echocardiography: rationale, study design, and methodology (NORRE Study)

Availability of normative reference values for cardiac chamber dimensions, volumes, mass, and function is a prerequisite for the accurate application of echocardiography for both clinical and research purposes. However, due to the lack of consistency in current echocardiographic 'reference values', their use for clinical decision-making remains questionable. The aim of the 'Normal Reference Ranges for Echocardiography Study (NORRE Study)' is to obtain a set of 'normal values' for cardiac chamber geometry and function in a large cohort of healthy Caucasian individuals aged over a wide range of ages (25-75 years) using both conventional and advanced echocardiographic techniques. The NORRE Study is a large prospective, observational multicentre study in which transthoracic echocardiographic studies will be acquired in 22 laboratories accredited by the European Association of Cardiovascular Imaging and in one laboratory in the USA accredited by ICAEL. The final sample size has been estimated in 1100 normal subjects in whom M-mode, 2D, and 3D imaging, colour Doppler, pulsed-wave Doppler, pulsed-wave tissue Doppler, and colour tissue Doppler imaging data will be obtained. All studies will be sent to a central echocardiographic core laboratory for quantitative analysis. Multiple studies will be performed for reproducibility analysis. After completion of the NORRE Study, uniform reference limits according to age, gender, and anthropometric parameters will be available to standardize the quantitative interpretation of echocardiography.