Echocardiography In Valvular Heart Disease Research Articles

Stress echocardiography in valvular heart disease.

Valvular heart disease (VHD) has been a significant health problem, particularly in developed countries, in relation to the aging population. Recent developments in the management of VHD require a more accurate assessment of disease severity to determine the need for transcatheter interventions or open heart surgery. Stress echocardiography is a crucial imaging modality for identifying the underlying pathology of VHD. Optimal administration of exercise or intravenous drugs may reveal hemodynamic abnormalities under stress without posing an invasive risk. Therefore, the implementation of stress echocardiography is recommended for determining interventional indications and risk stratification in mitral regurgitation and aortic stenosis. In addition, recent evidence has accumulated regarding the usefulness of stress echocardiography in various conditions including mitral stenosis, aortic regurgitation, and post-interventional VHD. Here, we summarize the current evidence and future perspectives on stress echocardiography in VHD.

Impact of Appropriate Use Criteria for Transthoracic Echocardiography in Valvular Heart Disease on Clinical Outcomes

The association between appropriate use criteria for transthoracic echocardiography (TTE) and clinical outcomes is unknown for patients with valvular heart disease (VHD). The aim of this study was to identify the association of TTE appropriateness with downstream cardiac tests and clinical outcomes in patients with VHD over 365days. A subset of 2,297 patients with VHD across six Ontario academic hospitals was selected from the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly) trial and linked to administrative databases. Each patient's index TTE was classified as "rarely appropriate" (rA) versus "appropriate" (comprising "appropriate" and "may be appropriate" TTE according to the 2011 appropriate use criteria). Overall, 431 of 452 patients with rA TTE were matched 1:1 with patients with appropriate TTE using propensity scores to account for measured confounding. Matched patients with rA TTE were less likely to undergo repeat TTE (relative risk, 0.46; 95% CI, 0.33-0.66) or cardiac catheterization (relative risk, 0.27; 95% CI, 0.16-0.47) at 90days compared with patients with appropriate TTE. rA TTE was significantly associated with a decreased hazard of aortic valve intervention (hazard ratio, 0.40; 95% CI, 0.14-0.42), all-cause hospitalization (hazard ratio, 0.44; 95% CI, 0.34-0.57), and death (hazard ratio, 0.31; 95% CI, 0.15-0.66) over 365days of follow-up. Patients with appropriate TTE for VHD were more likely to undergo subsequent cardiac testing within 90days and valve intervention within 1year than those with a rA TTE. The 2011 appropriate use criteria for TTE have important clinical implications for outcomes in patient with VHD.

Clinical application of stress echocardiography in valvular heart disease: an expert consensus of the Working Group on Valvular Heart Disease of the Polish Cardiac Society.

Valvular heart diseases (VHDs) constitute an increasing problem both as a consequence of population aging and as the sequelae of other heart diseases. Accurate diagnosis is essential for correct clinical decision‑making; however, in many patients, transthoracic and transesophageal echocardiography is insufficient. Stress echocardiography (SE) proved to be a useful tool allowing for simultaneous assessment of left ventricular contractile reserve and HVD hemodynamics under conditions of physiological or pharmacological stress. It is recommended for assessing the severity of VHD, guiding the choice of treatment, as well as for surgical risk stratification. It can be applied both in asymptomatic patients with severe VHD and in symptomatic individuals with moderate disease. In patients with VHD, SE can be performed either as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE). The first modality is recommended to unmask symptoms or abnormal blood pressure response in patients with aortic stenosis (AS) who report to be asymptomatic or in those with mitral stenosis with discordance between clinical symptoms and the severity of valve disease on transthoracic echocardiography. In asymptomatic patients with paradoxical low‑flow, low‑gradient (LFLG) AS, ESE can be used to assess the severity of stenosis. On the other hand, low‑dose DSE can be a useful diagnostic tool in classical LFLG AS, providing information on stenosis severity and contractile reserve. Moreover, SE is indicated in patients with prosthetic valve when there is discordance between symptoms and echocardiographic findings. It is also recommended in high‑risk surgical patients with VHD with poor functional capacity and more than 2 clinical risk factors. The present paper discusses in detail the use of SE in VHD.

Clinical application of stress echocardiography for valvular heart disease.

Stress echocardiography is widely used to assess several cardiovascular diseases, including ischemic heart disease, valvular heart disease (VHD), heart failure, congenital heart disease, and pulmonary hypertension. In valvular heart disease with asymptomatic severe or symptomatic non-severe status, stress echocardiography plays a central role in the management. As of 2017, the updated American College of Cardiology/American Heart Association and European Society of Cardiology/European Association for Cardio-Thoracic Surgery VHD guidelines recommended stress testing to (1) confirm symptoms and (2) evaluate the hemodynamic response to exercise. In patients with undetermined VHD severity in the presence of low-flow status, it can also be helpful to determine whether the VHD is severe based on flow-dependent changes in response to stress. The clinical indications of stress echocardiography in VHD have expanded with growing evidence for prognosis and being an early marker for interventions. As a result, demand has increased in major cardiology societies for the standardization of stress echocardiography in VHD. Echocardiographic centers should be aware of the clinical potential of stress echocardiography to ensure its optimal application and performance in VHD. This article reviews the clinical application of stress echocardiography, including dobutamine, semisupine bicycle, treadmill, and leg-positive pressure for VHD patient management, and focuses on the current consensus regarding the use of stress echocardiography in VHD. Stress echocardiography is safe and should be encouraged, especially in heart valve clinics, to understand the complex mechanism in asymptomatic patients.

Three dimensional echocardiography in valvular heart disease

Although cardiac structures exist in three dimensions, two dimensional (2-D) echocardiography only provides information in a single tomographic plane, the orientation of which is determined by the ultrasound window. Accordingly the use of geometric assumptions and/or mental integration of information from multiple 2-D images are needed to assess cardiac function and structure. Advances in ultrasound technology and image reconstruction have opened up the possibility of using three dimensional (3-D) techniques in both quantitative applications such as measurement of ventricular volumes and qualitative applications such as the assessment of valve stenosis or regurgitation. Further technical improvements in terms of real-time 3-D imaging and development of 3-D transoesophageal echo (TOE ) probes; have opened up further applications including intra-operative guidance of percutaneous valve interventions.

Role of modern 3D echocardiography in valvular heart disease.

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

Three-dimensional Echocardiography in Valvular Heart Disease

Recent technologic advances in 3-dimensional (3D) echocardiography, using parallel processing to scan a pyramidal volume, have allowed for a superior ability to describe valvular anatomy using both transthoracic and transesophageal echocardiography. Although still in evolution and at an early phase of adaptation with respect to its clinical application, 3D echocardiography has emerged as an important clinical tool in the assessment of valvular heart disease. Three-dimensional echocardiography provides unique perspectives of valvular structures by presenting "en face" views of valvular structures, allowing for a better understanding of the topographical aspects of pathology, and a refined definition of the spatial relationships of intracardiac structures. Three-dimensional echocardiography makes available indices not described by 2D echocardiography and has been demonstrated to be superior to 2D echocardiography in a variety of valvular disease scenarios. The information gained from 3D echocardiography has especially made an impact in guiding clinical decisions in the evaluation of mitral valve (MV) disease. The decision of early surgery in degenerative MV disease is based on the suitability of repair, and the suitability of repair is generally based on echocardiography. The superior understanding of MV anatomy afforded by 3D echocardiography has been shown to be quite valuable in this setting. This review will describe the contemporary use of 3D echocardiography in the assessment of valvular heart disease, including MV, aortic, tricuspid, and prosthetic valve abnormalities. This article illustrates how 3D echocardiography can complement current echocardiography techniques in the management of valvular heart disease.

Three‐Dimensional Echocardiography in Valvular Heart Disease

Two-dimensional echocardiography (2DE) with color Doppler has been the standard tool for assessing valvular heart disease. However, this requires conceptualizing three-dimensional (3D) valvular anatomy from individual 2D slices, which is inadequate for complex valvular abnormalities. Similarly, Doppler-based methods are inherently limited by several assumptions and are influenced by hemodynamics and concomitant valvular disease. 3DE has improved both morphological and functional assessment of valvular heart disease. It provides additional morphological information, which leads to better understanding of the mechanism of valvular dysfunction and surgical planning. 3D planimetry has proven to be accurate in the evaluation of valvular stenosis. This direct assessment eliminates measurement errors and could potentially serve as new gold standard. The continuity equation for aortic stenosis can be simplified by directly measuring left ventricular outflow tract area and stroke volume. In patients with valvular regurgitation, vena contracta area can be directly measured by using 3D color Doppler which is more accurate than the standard 2D methods. By applying hemi-elliptical formula or directly measuring isovelocity surface area, 3DE has significantly improved the accuracy in regurgitant severity assessment. This is particularly useful in patients with eccentric jets. 3DE has an advantage over 2DE in assessment of tricuspid valve due to its complex geometry. Direct planimetry of orifice area in tricuspid stenosis, or vena contracta area in tricuspid regurgitation are promising although validation studies are needed before they can be applied for clinical decision making. 3DE has not been widely studied in pulmonic valve disease but preliminary data indicate that it is feasible.

1236: Three-dimensional echocardiography in valvular heart disease: An overview

1236: Three-dimensional echocardiography in valvular heart disease: An overview

Impact of three-dimensional echocardiography in valvular heart disease

Recent advances in the field of three-dimensional (3D) echocardiography have allowed improved visualization of cardiac structures. These advances have also provided valuable insights into cardiac function. The purpose of this review is to describe the recent developments in 3D echocardiography in assessing valvular heart disease. Application of 3D echocardiography to valvular heart disease has improved with advances made in both the hardware and software components of 3D ultrasound systems. The most significant advancement has been the development of a matrix transducer that is capable of rapid real-time 3D acquisition and rendering. There have been many studies evaluating 3D echocardiographic assessment of mitral valve disease, aortic valve disease, as well as congenital heart disease using both real-time 3D transthoracic echocardiography (TTE) as well as off-line reconstructed 3D images from transesophageal echocardiography (TEE) using post image processing. More recent studies have combined the structural 3D information with color Doppler 3D imaging, providing qualitative functional information. Developments in the field of 3D ultrasound imaging have allowed better qualitative assessment of valvular structures. The addition of color flow Doppler to the 3D imaging has provided improved visualization of regurgitant lesions and holds great promise for improved quantitative assessment of such lesions. The ongoing miniaturization of transducers and improvements in hardware and software components of ultrasound systems will certainly enhance both the ease of image acquisition as well as image quality, which should result in more precise quantitation of valvular dysfunction. However, clinical benefits of 3D echocardiography are yet to be demonstrated in properly conducted clinical trials, which are needed for wider acceptance of this technique.

915 Diagnostic contribution of routine 3-dimensional echocardiography in valvular heart disease

915 Diagnostic contribution of routine 3-dimensional echocardiography in valvular heart disease

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography)

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography)

Echocardiography in valvular heart disease.

Transthoracic Doppler echocardiography continues to play a predominant role in the evaluation of patients with valvular heart disease. Current efforts in the research arena have been focused on improving the accuracy of techniques, as well as in further describing the shortcomings. Accurate quantitation of valvular regurgitation continues to be a major stumbling block. However, more sophisticated techniques are being successfully applied to obviate some of the limitations of color flow imaging. Transesophageal echocardiography has provided a new window and clarity of resolution that greatly facilitates evaluation of valvular heart disease in cases where the transthoracic approach is limited, particularly in patients with prosthetic valves.

Echocardiography in valvular heart disease.

Clinical applications of echocardiography continue to grow and be refined with the development of newer technology and the resultant increase in clinical studies. The reliability of echocardiography applied to patients with valvular heart disease has been very well established in determining pressure gradient, stenotic valve area, right-sided cardiac pressure, and ventricular responses (dimension and global systolic function) to pressure and volume overload. Less well established are the determination of regurgitation severity, the role of echocardiography in endocarditis, and the use of the echocardiographic information in clinical decision-making. These issues have been dealt with extensively in the most recent literature. Through superb visualization of the native and prosthetic valvular apparatus by transesophageal echocardiography, new morphologic and functional observations continue to be made.

Echocardiography in valvular heart disease.

Last year alone, more than 140 reports on echocardiography and its different technical modalities (M-mode, two-dimensional, transesophageal, intraoperative, Doppler, and so forth.) in valvular heart disease were published in peer-reviewed journals. In this review we focus on selected papers that we believe made significant contributions to the diagnosis and management of valvular heart disease. Although intraoperative transesophageal echocardiography has been used for over 10 years and is widely accepted in certain clinical situations, this method continues to develop rapidly and to offer new insights into the identification and management of common valvular heart diseases such as mitral valve regurgitation, reconstruction, and infective endocarditis with its complications. In addition to adding to its undisputable advantages in the diagnosis of valvular lesions, new developments in Doppler echocardiography will add to the previously identified technical and methodologic limitations of this technique.

Echocardiography in valvular heart disease

In 1990, echocardiography continued to develop rapidly, with new applications in the operating room and new solutions to common problems in the management of valvular heart disease. The newly published experiences with transesophageal and epicardial intraoperative echocardiography from Duke and the Cleveland Clinic illustrate the utility of these methods. Refinement of our concepts of mitral valve prolapse has occurred, along with echo Doppler support for awaiting symptoms prior to valve replacement in aortic stenosis.

Echocardiography in valvular heart disease.

Shah, Pravin M. M.D.; Shakudo, Masahiro M.D.; Bansal, Ramesh C. M.D. Author Information

Echocardiography in valvular heart disease

Echocardiography in valvular heart disease

Echocardiography in valvular heart disease

Echocardiography is a useful new technique that allows for the diagnosis and assessment of the severity of various forms of valvular heart disease. It is a safe and noninvasive procedure that can readily be used on the critically ill as well as the ambulatory patient. Since the examination can be easily repeated, echocardiography can be used to study a patient over an extended period of time to follow the severity of the disease. With proper care and experience in the performance and interpretation, the cardiologist can derive much useful information to aid in the initial evaluation and long-term follow-up of patients with various forms of valvular disease. With improvements in instrumentation and the use of newer techniques, the usefulness of ultrasound will be further enhanced.