Left Heart Chambers Research Articles

Mechanisms of exercise intolerance in patients with heart failure and preserved ejection fraction. Part II: The role of right heart chambers, vascular system and skeletal muscles

The main clinical manifestation of heart failure with preserved ejection fraction is poor exercise tolerance. In addi-tion to the dysfunction of the left heart chambers, which were presented in the first part of this review, many other disorders are involved in poor exercise tolerance in such patients: impairments of the right heart, vascular system and skeletal muscle. The second part of this review presents the mechanisms for the development of these disorders, as well as possible ways to correct them.

Structural and functional state of left ventricular myocardium in patients with stage II hypertension depending on galectin-3 and aldosterone levels

The analysis of structural and functional state of the left ventricular myocardium was conducted in the article, which concerned the determination of the general morphological and functional echocardiographic parameters of the heart according to the existing recommendations of the American Echocardiographic Society and the European Society of Cardiovascular Imaging; assessment of the relative dimensions/volumes of the LA (left atrium); determination of the structural-geometric remodeling variant of the left ventricular (LV) according to Ganau (1992) also determining the functions of the heart valves in patients with stage II 1-3 degrees hypertension, of different age and gender depending on plasma levels of galectin-3 and aldosterone. Determined the end-systolic (mm) and end-diastolic dimensions of the LV (mm), the thickness of the interventricular septum (mm) and the posterior wall of the LV (mm) in diastole, aortic diameter (AD, mm), size right atrium (RA, mm) and right ventricle (RV, mm), anterior-posterior size of the left atrium (LA, mm) and its index (ILA, mm/m2), LA volume (LPV, ml) and ejection fraction left ventricle (FV globe, %) by the modified Simpson method. LV mass (LVM, g) was estimated by the Penn Convention formula, and LVM index (LVM, g / m2) as the ratio of LVM to body surface area using the Du Bois nomogram (m2). The EchoCG in color Doppler mode measured the early (Ve) and late transmittal (Va) (m\s), their ratio (Ve\Va), the early LF filling time (DT), and the isovolumic LF relaxation time (IVRT) (ms). Statistical processing of the study results was performed using standard methods using the StatSoft Statistica v application package. 12.0 as recommended. In the case of quantitative values, the results were presented as medians and interquartile ranges (25 and 75 percentiles), in the case of relative values, as percentages (%). Comparison of the quantitative values in the groups was performed using the U-Mann-Whitney and Kruskal-Wallis ANOVA test, the relative values by the criterion χ2. A difference of p<0.05 was considered plausible. The obtained data demonstrate that relatively high levels (RH) of both galectin-3 (>2.4 pg/ml) and aldosterone (>325 pg/ml) are identified with significant morphological and functional changes in heart parameters, namely: worse structural-geometric remodeling of LV (increase in cases of concentric hypertrophy (CH) and decrease in cases with normal geometry (NG) of LV). In order to exclude the fact of cross-influence of neurohormones on echocardiographic parameters of the heart, the alignment of the groups in terms of aldosterone and galectin-3 levels was conducted. The analysis turned to be optimal in groups with galectin-3 level of ->2.0 and ≤2.0 pg/ml and aldosterone level of - >290 and ≤290 pg/ml. As a result, it was detected that galectin-3 has a greater pathophysiological effect than aldosterone on such indices as: an increase in aortic diameter; increase in right and left heart chambers dimensions; LVMMI (left ventricular myocardial mass index) value and increase in systolic, diastolic myocardial stress, increase in the number of cases with CH (concentric hypertrophy) and decrease in cases with normal geometry (NG) of LV. Aldosterone level is associated with an increase in dimension/volume indices of LA, calculated per patient’s body area.

Деформація лівих камер серця у жінок з гіпертонічною хворобою у стані постменопаузи залежно від наявності гіпертрофії лівого шлуночка та дилатації лівого передсердя

The aim – to assess the longitudinal deformation (strain) of the left heart chambers in postmenopausal women with essential hypertension (EH), depending on the presence of left ventricular hypertrophy (LVH) and left atrial (LA) dilation.Materials and methods. The study involved 126 postmenopausal women: 100 patients with EH I–II stages of the main group and 26 practically healthy women of the comparison group. Patients with EH were divided into two groups: 32 patients without structural changes of the myocardium and 68 women with LVH and/or LA dilation. In all patients we performed ambulatory blood pressure monitoring, standard transthoracic echocardiography and speckle-tracking echocardiography. The global longitudinal strain (GLS) of LV and deformation of the endocardial (endo), middle (mid) and epicardial (epi) layers of myocardium were analyzed. Analysis of LA deformation was performed using two (from the beginning of the R-wave and from the apex of the R-wave) variants of ECG-synchronization. The LA longitudinal strain (LS) was evaluated in reservoir and contraction phase in two positions with the calculation of the GLS LA. Results and discussion. We found changes in LV multilayer deformation as LS decreasing in the endocardial, middle and epicardial layers in hypertensive patients in the early stages of disease, even before the development of LVH. Damage of LA deformation preceded its dilation. Both types of ECG-synchronization showed a statistically significant decrease of LA strain in the reservoir phase in all hypertensive patients in comparison with healthy women. A decreasing LA GLS in women with EH and structurally normal heart compared to the healthy group was detected only by using ECG-synchronization with R-wave, which is considered more universal.Conclusion. A decrease of LA and LV LS in postmenopausal women is recorded even before the development of LVH and LA dilation. The LV LS became lower in all layers of myocardium – from endocardial to epicardial. Changes in the LA LS in postmenopausal women with EH begin with a damage of reservoir phase even with normal size of LA and a LV myocardial mass index.

Mechanisms of exercise intolerance in patients with heart failure and preserved ejection fraction. Part I: The role of impairments in the left heart chambers

During exercise an increase in oxygen delivery to working muscles is achieved through well‑coordinated interaction of many organs and systems: the heart, lungs, blood vessels, skeletal muscles, and the autonomic nervous system. In heart failure with preserved left ventricular ejection fraction, all mechanisms involved in the normal exercise tolerance are impaired. In the first part of this review, the impairments of the left heart chambers are considered ‑ left ventricular diastolic dysfunction, the weakening of the contractile and chronotropic reserves, left atrium dysfunction; the possible ways of their medical correction are also presented.

Improved differential diagnosis of intracardiac and extracardiac shunts using acoustic intensity mapping of saline contrast studies.

The aim of this study was to test the hypothesis that temporal patterns of saline contrast entry into, and exit from the left heart are significantly different in intra- and extra-cardiac shunts and can be used to differentiate the shunt mechanism when Valsalva manoeuvre cannot be performed, or is of uncertain quality. We propose a novel approach of mapping the temporal changes in acoustic intensity (AI) within the left and right heart to identify and define these unique patterns. We screened cases of right to left shunting on resting agitated saline contrast echocardiograms with clinical criteria that identified the origin of shunting as either a patent foramen ovale or pulmonary arteriovenous malformation. Acoustic time-intensity curves were generated from the right and left heart chambers that reflected the change in saline contrast density over time. Several novel pre-specified parameters were measured from these curves, in addition to the standard heartbeat counting method, to characterize the entrance (wash-in) and exit (wash-out) patterns of saline contrast in the left heart. Statistical analysis showed that AI mapping provided superior differentiation of the two populations than did the traditional beat counting method. Diagnosis of shunt mechanism from saline contrast studies can be improved over current methods through the use of AI mapping to define the rapidity that peak contrast effect develops, the speed that the contrast effect decays, and the contrast intensity late in the recording.

Features of heart remodeling in patients with obstructive sleep apnea syndrome and its comorbid association with obesity in the context of the senilism concept

Aim. To analyze heart remodeling features in with obstructive sleep apnea syndrome and its association with obesity in the context of early cardiac aging.Material and methods. The study included 101 men, 41 patients with obstructive sleep apnea (OSA), 30 comorbid patients with OSA and obesity, the control group consisted of 30 healthy people. The average passport age of the patients was 40,4±6,7 years. Evaluation of OSA was carried out by cardiorespiratory monitoring, structural and functional features of the heart condition were studied using the echocardiography method, the average biological age was calculated.Results. Patients of both studied groups were characterized by structural and geometric rearrangement of the left heart chambers, transformation of physiological ellipsoid model into a spherical (left ventricle (LV) sphericity index 0,64±0,07 in the control group, 1,09±0,03 in the OSA group, 1,01±0,03 in the OSA + obesity group, p<0,05), LV hypertrophy (LV myocardial mass index was 78,1±23,9 in the group of healthy individuals, 98,1±11,4 in the OSA group and 116,0±29,4 in the OSA + obesity group, p<0,01). Systolic function in both study groups was preserved however, a tendency to stress of adaptive remodeling mechanisms was revealed. In addition, diastolic dysfunction was detected in both groups, in OSA group was associated with elasticity of the LV wall decrease, and in the OSA + obesity group, both with a violation of elasticity and an increase in the LV wall stiffness. The biological age of patients with OSA is 14% higher than the passport age, and with the association of OSA and obesity, by 39%.Conclusion. The obtained data prove impact of respiratory sleep disorders at heart remodeling as well as increased biological age. At the same time, the association of OSA with obesity has an additive adverse effect on the remodeling processes and the biological age of patients.

Intracardiac echocardiography for transseptal puncture. A guide for cardiac electrophysiologists.

The key to a successful catheterization of the left heart chambers is the safe transseptal puncture. Intracardiac echocardiography(ICE) is an attractive tool used in cardiac catheterization and electrophysiology labs to provide detailed images thatcan facilitate transseptal puncture. ICE permits a direct visualization of the endocardium and precisely locates the needle andthe sheath against the interatrial septum. Two different ICE catheters are available: a phased array and a mechanical transducer,both being currently used in clinical practice. This paper describes the technique used for guiding transseptal puncture withICE. Due to its advantages, ICE has currently become an important tool used to maximize the safety of the transseptal punctureand increase efficacy of interventional cardiology procedures.

Accuracy of new transthoracic 3D-echocardiographic automated software for left heart chamber quantification in children

A new three-dimensional echocardiographic (3DE) automated software (HeartModel) is now available to quantify left heart chamber. Our aims were to assess the feasibility of this software in children and its correlation with manual 3DE and cardiac magnetic resonance (CMR). Ninety-two children were prospectively included in 2 separate protocols. In protocol 1, 73 healthy children (8.8 ± 3.0 years) underwent 2D and 3D transthoracic echocardiography (EPIQ 7 C). LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LVEF and LA volume at ventricular end-systole (LAV) obtained with automated 3DE were compared with the manual 3DE measurements. In protocol 2, automated 3DE measurements from 19 children with cardiopathy (12.8 ± 2.9 years) were compared with CMR values. Intra and inter-observer variability were assessed. Automated 3DE was feasible in 77% of datasets and reduced significantly time required for indices analysis compared with manual 3DE (20 vs. 125 seconds). There was excellent correlation for LVEDV, LVESV and LAV between automated and manual 3DE ( R = 0.95) but less for LVEF ( R = 0.57). Compared with manual 3DE, automated 3DE slightly overestimated LVEDV, LVEF and LAV and slightly underestimated LVESV. There were excellent correlation for LV volumes between automated 3DE and CMR ( R = 0.94) but the correlation for LVEF was moderate ( R = 0.46). Compared with CMR, automated 3DE slightly underestimated LVEDV and LVESV (biase-7.5%), underestimated LAV (− 31.6%), and had a negligible bias for LVEF (1.0%). Intraobserver and interobserver variability for automated 3DE measurements were low (< 12% ( Fig. 1 )). HeartModel is promising software for fast assessment of left heart chamber volume and function. Its feasibility in children aged more than 5 years is good, with high reproducibility. The automated 3DE measurements were comparable to manual 3DE. Compared with CMR, LVEDV and LVEF measured by automated 3DE seem interesting in clinical practice.

Optimal Number of Heartbeats Required for Representing Left Chamber Volumes and Function in Patients with Rate-Controlled Atrial Fibrillation

The optimal number of heartbeats required for representing left heart chamber function in patients with atrial fibrillation (AFib) has not been extensively studied. To determine the optimal number, we performed an automated quantification analysis of three-dimensional echocardiography (3DE) data sets in 93 patients with AFib for whom 10-20 consecutive one-beat full-volume 3DE data sets were acquired twice. We measured left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), and maximal left atrial volume (LAVmax) in each heartbeat; each parameter was averaged using a serial number of heartbeats randomly selected, and these values were compared with the averaged value obtained from the entire set of heartbeats. Coverage probability was determined using predefined cutoff values, the relative percentage differences in LVEDV and LAVmax of 5%, and the absolute percentage differences in LVEF of 5%. The optimal number of heartbeats was defined as the minimum number of heartbeats showing coverage probability ≥95%. Out of 93 patients, 73 patients had acceptable left ventricular contour casts (feasibility, 78%), and 79 patients had acceptable left atrial contour casts (feasibility, 85%). Using the aforementioned criteria, the minimum optimal number of heartbeats was nine for LVEDV and six for LAVmax. The corresponding minimum optimal number of heartbeats for LVEF was eight. However, the results varied as a function of the size of the chamber, the left ventricular function, and whether the AFib ventricular rate was controlled. In patients with AFib, the optimal number of heartbeats required to obtain representative chamber volumes and function was six to nine heartbeats randomly selected using 3DE automated quantification software.

Evaluation of Left-Sided Heart Chambers With Novel Echocardiographic Techniques in Men With Duchenne or Becker Muscular Dystrophy

Left ventricular systolic dysfunction (LVSD) is a common finding in patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies. Novel echocardiographic techniques have been used for the detection of LVSD in several heart diseases. We aim to compare cardiac anatomic and functional data studied by three-dimensional (3DE) and two-dimensional (2DE) echocardiography and to analyze the myocardial strain for the detection of early LVSD in DMD and BMD patients. We performed a cross-sectional study of 46 DMD and 14 BMD patients. We measured left atrium volume and left ventricle volumes and ejection fraction using 3DE and 2DE techniques. Myocardial strain analysis was derived from global longitudinal strain (GLS) measurements. GLS was measured by 2DE with the speckle tracking technique. The correlation between 3DE and 2DE for the measurement of left atrium volume as well as left ventricle diastolic and systolic volumes was strong. 2DE presented larger left atrium and left ventricle volumes. Left ventricle ejection fraction was similar between the two techniques. Myocardial strain analysis was able to detect early LVSD in 50.0% of DMD patients and in 9.1% of BMD patients. In conclusion, two-dimensional echocardiography appears to be a good alternative for the anatomical and functional evaluation of the left heart chambers in DMD and BMD patients. Myocardial strain analysis detects early LVSD in a sizable portion of patients with dystrophinopathies.

The possibilities of computed tomography using heart-axis-oriented multiplanar reformations in diagnostics of the great arteries transposition

This article contents the results of computed tomography with intravenous bolus contrast media administration data analysis in children with transposition and congenitally corrected transposition of the great arteries with the consequental performing of the multiplanar heart-axis-oriented reformations. Among 148 examined children transposition of great arteries was detected in 13 patients (9 boys and 4 girls aged 1-144 day of life); congenitally corrected transposition was found in 4 cases of children aged from 6 months to 15 years and 6 months (2 boys and 2 girls). In this article comprehensive anatomical criteria of each heart chamber morphology are presented and reformations where these criteria can be seen are shown. Also in the article is given comparative characterization of heart and great arteries structures in transposition and congenitally corrected transposition in every certain heart-axis-oriented reformation. By the results of consequently performed heart-axis-oriented reformations data analysis the peculiar anatomical signs of transposition and congenitally corrected transposition are determined. The results of data analysis show that from the list of offered reformations the peculiar anatomical signs of both kinds of transposition are significantly determined in long-axis of right ventricle inflow tract reformation, left heart chambers reformation, supply ventricle division reformation, short-axis reformation at the level of great arteries. Computed tomographic angiocardiography heart-axis-oriented multiplanar reformations permit full and correct assessment of heart and main vessels, which is important for planning of surgical treatment in congenital heart diseases.

Machine learning based automated dynamic quantification of left heart chamber volumes.

Studies have demonstrated the ability of a new automated algorithm for volumetric analysis of 3D echocardiographic (3DE) datasets to provide accurate and reproducible measurements of left ventricular and left atrial (LV, LA) volumes at end-systole and end-diastole. Recently, this methodology was expanded using a machine learning (ML) approach to automatically measure chamber volumes throughout the cardiac cycle, resulting in LV and LA volume-time curves. We aimed to validate ejection and filling parameters obtained from these curves by comparing them to independent well-validated reference techniques. We studied 20 patients referred for cardiac magnetic resonance (CMR) examinations, who underwent 3DE imaging the same day. Volume-time curves were obtained for both LV and LA chambers using the ML algorithm (Philips HeartModel), and independently conventional 3DE volumetric analysis (TomTec), and CMR images (slice-by-slice, frame-by-frame manual tracing). Automatically derived LV and LA volumes and ejection/filling parameters were compared against both reference techniques. Minor manual correction of the automatically detected LV and LA borders was needed in 4/20 and 5/20 cases, respectively. Time required to generate volume-time curves was 35 ± 17 s using ML algorithm, 3.6 ± 0.9 min using conventional 3DE analysis, and 96 ± 14 min using CMR. Volume-time curves obtained by all three techniques were similar in shape and magnitude. In both comparisons, ejection/filling parameters showed no significant inter-technique differences. Bland-Altman analysis confirmed small biases, despite wide limits of agreement. The automated ML algorithm can quickly measure dynamic LV and LA volumes and accurately analyse ejection/filling parameters. Incorporation of this algorithm into the clinical workflow may increase the utilization of 3DE imaging.

Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty.

Conventional hemodynamic parameters may not accurately predict symptomatic improvement after percutaneous mitral valvuloplasty (PMV). Changes in left heart chamber compliance following adequate relief o0066 mitral stenosis (MS) may be useful in determining functional capacity after PMV. This study aims to determine the acute effects of PMV on compliance of the left heart and whether its changes relate to the patient's functional capacity. One-hundred thirty-seven patients with severe MS undergoing PMV were enrolled. Left atrial (Ca ) and left ventricular (Cv ) compliance were invasively estimated and net atrioventricular compliance (Cav ) was calculated before and immediately after the procedure. B-type natriuretic peptide (BNP) levels were obtained before and 24 hr after the procedure. The primary endpoint was functional status at 6-month follow-up, and the secondary endpoint was a composite of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, or stroke in patients in whom PMV was successful. The mean age was 43 ± 12 years, and 119 patients were female (87%). After PMV, Ca and Cav improved significantly from 5.3 [IQR 3.2-8.2] mL/mmHg to 8.7 [5.3-19.2] mL/mmHg (P < 0.001) and 2.2 [1.6-3.4] to 2.8 [2.1-4.1] mL/mmHg (P < 0.001), respectively, whereas Cv did not change (4.6 [3.2-6.8] to 4.4 [3.1-5.6]; P = 0.637). Plasma BNP levels significantly decreased after PMV, with no correlation between its variation and changes in left chamber compliance. At 6-month follow-up, NYHA functional class remained unchanged in 32 patients (23%). By multivariable analyses, changes in Ca immediately after PMV (adjusted OR 1.42; 95% CI 95% 1.02 to 1.97; P = 0.037) and younger age (adjusted OR 0.95; CI 95% 0.92-0.98; P = 0.004), predicted improvement in functional capacity at 6-month follow-up, independent of postprocedural data. The secondary endpoint were predicted by post-PMV mean gradient (adjusted HR 1.363; 95% CI 95% 1.027-1.809; P = 0.032), and lack of functional improvement at 6-month follow-up (adjusted HR 4.959; 95% 1.708-14.403; P = 0.003). Ca and Cav increase significantly after PMV with no change in Cv . The improvement of Ca is an important predictor of functional status at 6-month follow up, independently of other hemodynamic data. Postprocedural mean gradient and lack of short-term symptomatic improvement were predictors of adverse outcome.

Feasibility of New Transthoracic Three-Dimensional Echocardiographic Automated Software for Left Heart Chamber Quantification in Children

New three-dimensional echocardiographic automated software (HeartModel) is now available to quantify the left heart chambers. The aims of this study were to assess the feasibility, reproducibility, and analysis time of this technique and its correlation with manual three-dimensional echocardiography (3DE) and cardiac magnetic resonance (CMR) in children. Ninety-two children (5-17years of age) were prospectively included in two separate protocols. In protocol 1, 73 healthy children underwent two-dimensional and three-dimensional transthoracic echocardiography. Left ventricular (LV) end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), and left atrial volume at ventricular end-systole (LAV) by automated 3DE were compared with the same measurements obtained using manual 3DE. In protocol 2, automated three-dimensional echocardiographic measurements from 19 children with cardiomyopathy were compared with CMR values. Automated 3DE was feasible in 77% of data sets and significantly reduced the analysis time compared with manual 3DE. In protocol 1, there were excellent correlations for LVEDV, LVESV, and LAV between automated 3DE and manual 3DE (r=0.89 to 0.99, P<.0001 for all) and a weak correlation for LVEF, despite contour adjustment (r=0.57, P<.0001). Automated 3DE overestimated LVEDV, LVEF, and LAV with small biases and underestimated LVESV with wider bias. With contour adjustment, the biases and limits of agreement were reduced (bias: LVEDV, 0.9mL; LVESV, -1.2mL; LVEF, 2.2%). In protocol 2, correlations between automated 3DE with contour edit and CMR were good for LV volumes and LAV (r=0.76 to 0.94, P<.0003 for all) but remained weak for LVEF (r=0.46, P=.05). Automated 3DE slightly underestimated LV volumes (relative bias, -7.2% to -7.8%) and significantly underestimated LAV (relative bias, -31.6%). The limits of agreement were clinically acceptable only for LVEDV. Finally, test-retest, intraobserver, and interobserver variability values were low (<12%). HeartModel is feasible, reproducible, faster than manual 3DE, and comparable with manual 3DE for measurements of LV and left atrial volumes in children >5years of age. However, compared with CMR, only LVEDV measured by automated 3DE with contour edit seems applicable for clinical practice.

Accuracy of new transthoracic 3D echocardiographic automated software for left heart chamber quantification in children

A new three-dimensional echocardiographic (3DE) automated software (HeartModel) is now available to quantify left heart chamber. The aims of this study were to assess the feasibility of this technique in children; and its correlation with manual 3DE and cardiac magnetic resonance (CMR) for measuring left ventricular (LV) and left atrium (LA) volumes and LV ejection fraction (LVEF). Ninety-two children (5 to 17 years) were prospectively included in two separate protocols. In protocol, 1, 73 healthy children (8.8 ± 3.0 years) underwent 2D and 3D transthoracic echocardiography (EPIQ 7 C, X5-1, Philips Healthcare). LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LVEF and LA volume at ventricular end-systole (LAV) obtained with automated 3DE ( Fig. 1 ) were compared with the manual 3DE measurements. In protocol 2, automated 3DE measurements from 19 children with cardiopathy (12.8 ± 2.9 years) were compared with CMR values. Test-retest, intraobserver and interobserver variability and the mean analysis time per patient were also examined for 3DE measurements. Automated 3DE was feasible in 77% of datasets and reduced significantly the mean time per patient required for indices analysis compared with manual 3DE (20 ± 2 versus 125 ± 24 seconds, P < 0.0001), even when contour adjustment was performed (29 ± 10, p < 0.0001). In protocol 1, there was excellent correlation for LVEDV, LVESV and LAV between automated and manual 3DE ( r = 0.89 to 0.99, all P < 0.0001) but less for LVEF despite contour adjustment ( r = 0.56 to 0.57, all P < 0.0001). Compared with manual 3DE, automated 3DE without contour edit overestimated LVEDV, LVEF and LAV with small biases and underestimated LVESV with wider bias. With contour adjustment, the biases and limits of agreement (LOA) were reduced (biases: 0.9 mL for LVEDV, −1.2 mL for LVESV, 2.2% for LVEF; relative biases: 1.3% for LVEDV, −4.5% for LVESV). In protocol 2, there were excellent correlation for LV volumes and moderate correlation for LAV between automated 3DE with contour edit and CMR (r = 0.76 to 0.94, all p < 0.0003) but the correlation for LVEF remained weak (r = 0.46, p = 0.05). Compared with CMR, automated 3DE with contour edit slightly underestimated LVEDV and LVESV (relative biases: −7.2 to −7.8%), underestimated LAV with larger bias (relative bias: −31.6%), and had a negligible bias for LVEF (1.0%). However, LOA were clinically acceptable only for LVEDV and LVEF. Test-retest, intraobserver and interobserver variability for automated 3DE measurements were low (< 12%). HeartModel is a promising software for fast assessment of left heart chamber volume and function. Its feasibility in children aged more than 5 years is good, with high reproducibility. The automated 3DE measurements of LV and LA volumes are comparable to manual 3DE, especially when contour adjustment of automated 3DE values is performed. Compared with CMR, LVEDV and LVEF measured by automated 3DE with contour edit seem interesting in clinical practice.

Cardiac multispiral computed tomography: optimization of examination’s protocol for non-invasive cardaic mapping before catheter ablation of atrial fibrrillation

Purpose:to develop optimal technique of cardiac multidetector computed tomography (MDCT) before noninvasive cardiac mapping before cateter ablation of atrial fibrillation.Materials and methods.94 patients with atrial fibrillation were included in study (60 males, 34 females; mean age = 58.3 ± 10 years; mean body mass index (BMI) = 29.9 ± ± 4.8). The patients were divided into 2 groups: I – 80 patients who underwent computer tomography (CT)-protocol for noninvasive cardiac mapping with standard contrast enhancement (single-bolus protocol); II – 14 patients who underwent CT with modified contrast enhancement technique with preliminary contrast injection (prebolus). To detect thrombotic masses in the left auricle the low-dose delayed phase was performed. The analysis of individual features of pulmonary veins, left atrium and adjacent structures was performed. Contrast enhancement of heart chambers was assessed by mean attenuation and homogeneity measurement.Results and discussion.The typical anatomy of the right pulmonary veins was in 93.6% of cases; right middle pulmonary vein in 5.3%; right segmental veins in 1.1%. The typical anatomy at the left side was in 57.4% of cases; common vestibulum of the left pulmonary veins in 18.1%; common left trunk in 24.5%. Volume enlargement of the left atrium (LA) was in 96.8% of patients. In 6 cases left auricle thrombosis was suspected, low-dose delayed phase was performed. In 2 cases filling defects in left auricle persisted, thrombosis was proved by transesophageal echocardiography. With the single-bolus injection protocol the contrast enhancement of left heart chambers was best (mean attenuation of blood in LA = 296 ± 84 HU, in left ventricle (LV) = 286 ± 83 HU), but the contrast enhancement and homogeneity of the chambers were insufficient (mean attenuation of blood in right atrium (RA) = 179 ± 97 HU, in right ventricle (RV) = 176 ± 80 HU). With prebolus protocol the contrast enhancement and homogeneity of all chambers were optimal (mean attenuation of blood in LA = 259 ± 31 HU, in LV = 286 ± 83 HU, in RA = 270 ± 92 HU, in RV = 253 ± 80 HU). This allowed making more accurate epi-endocardial heart models in the noninvasive cardiac mapping and operation planning.Conclusion.MDCT with standard contrast enhancement protocol provides detailed information about anatomy and size of pulmonary veins, the left atrium volume, the presence of intracardiac masses (including thrombotic masses), the anatomy of adjacent structures. The modified contrast enhancement technique with preliminary contrast injection (prebolus) allows to receive optimal contrast enhancement of all heart chambers and to make high accurate epi-endocardial models of both the right and left sides of the heart in case of noninvasive cardiac mapping.

Both-sided native valve infective endocarditis in a drug addict with incidental pneumoconiosis

Involvement of both right and left heart chambers with infective endocarditis is extremely rare. In this case report, we aimed to present a rare case of Infective endocarditis (IE) in an intravenous & inhalational drug misuse involving both cardiac chambers with incidental pneumoconiosis.

Left ventricular chamber geometry in cardiomyopathies: insights from a computerized anatomical study.

AimsSome authors have hypothesized that left ventricular chamber dilatation in ischaemic and idiopathic cardiomyopathies results in spherical transformation. Aiming to characterize how this transformation occurs, a study was performed by comparing normal and dilated specimens regarding sphericity and proportionality in left heart chambers. It is important to provide data for the development of therapeutic strategies in these diseases.Methods and resultsAn anatomical study was performed by comparing normal (n = 10), ischaemic (n = 15), and idiopathic (n = 18) dilated human cardiomyopathic specimens regarding left ventricular chambers and their segmental proportionality to normal hearts. It was performed by capturing and processing images with proper software in three different levels of left ventricular chamber (basal, equatorial, and apical). These obtained data were analysed based on sphericity and proportionality by two dedicated indexes. Spherical shape: Calculated segmental indexes showed that dilated specimens were not spherical because they were smaller than as expected for a spherical shape (all values were <70% of a perfect sphere). Proportionality: There was no difference between basal index perimeters among groups, but apical index was lower in dilated specimens than in normal hearts, and so dilatation was not proportional to normal hearts.ConclusionsLeft ventricular chambers of anatomical specimens with dilated cardiomyopathies did not display a spherical shape and were not proportional to normal hearts.

Feasibility and reproducibility of new 3D automatic software for left heart chamber quantification in children

New 3D automatic software (Heart model (HM), Philips Healthcare, Andover, Massachusetts) is now available to quantify left heart chamber size and function. Its feasibility and accuracy in children have not been reported. The aim of this study was to assess feasibility and reproducibility of HM in healthy children, and to compare LV indices obtained by this technique with classic 2D biplane method. Sixty consecutive healthy children aged more than 5 years were included (mean age 6.5 years, mean weight 20.8 kg). All infants underwent TTE (Epic 7, X5-1, Philips Healthcare, Andover, Massachusetts). Left ventricle (LV) end-systolic and end-diastolic volumes, LV ejection fraction (EF) and left atrium (LA) end-systolic volume were obtained by biplane Simpson method. 3D dataset was obtained from apical 4-chamber view and analyzed using HM software. LV indices obtained by the two methods were compared. Feasibility of HM was 80%, in 30 cases (62.5%) with contour adjustment and 18 cases (37.5%) without contour adjustment. Intraobserver variability was (0%, 4% and 8% for HM without contour adjustment, HM with contour adjustment, and biplane method respectively). Interobserver variability was (6% and 12% for HM with contour adjustment and biplane method respectively). Test- retest variability for HM was 6.5%. Correlation between HM and biplane measurements was strong ( r = 0.85 to 0.94). LVEF obtained by HM was lower than that obtained by biplane method (bias −8%). However, LV volumes and LA end-systolic volume were larger (bias +12 and +8 respectively) ( Fig. 1 ). HM is a promising software for assessment of left heart chamber volume and function. Its feasibility in infants aged more than 5 years is good with excellent reproducibility. Working is going on to validate this technique in children with congenital heart disease and to compare it with MRI measurement as the gold standard.

Ехокардіоґрафічна оцінка динаміки правошлуночкової функції у пацієнтів з гіпертонічною хворобою протягом медикаментозного лікування

Aim. Study the functional changes and assess the dynamics of the longitudinal kinetics of the right ventricular myocardium in patients with hypertensive heart disease on the background of treatment. Materials and Methods. It was included 30 patients with hypertensive heart disease second degree and diastolic dysfunction of left ventricle. Individualized treatment was chosen for patients to achieve a normal level of blood pressure during 6 months of study. Echocardiography was performed before the research and after 6 months of antihypertensive treatment. The standard measurements of left heart chambers were performed, left ventricular ejection fraction was measured by method biplane Simpson, left ventricular mass myocardial index was calculated. The sizes of the right ventricular chambers were obtained from apex four-chamber view. From this view index TAPSE was measured and diastolic function of both ventricles was assessed by pulse-wave Doppler imaging. The longitudinal myocardial kinetics of the left and right ventricles was assessed by pulse-wave tissue Doppler imaging, obtaining systolic (peak velocity Sm, contraction time СТm) and diastolic (early velocity Em, atrial velocity Am, ratio Em/Am, deceleration time DTEm and isovolumic relaxation time IVRTm) indexes. Ratio E/Em and tissue myocardial performance index MPIm were calculated. The dynamics of longitudinal right ventricular kinetics was analyzed after 6 months of antihypertensive treatment. Results and Discussion. In study group the mean age of patients was 55,5±5,8 years. Blood pressure before treatment was 161/103±17,9/10,8 mmHg, after 6 months of treatment - 134/83±9,4/7,8 mmHg respectively (p<0,001). The sizes of the left and right atriums, left ventricular myocardial mass index, right ventricular longitudinal size and wall were considerably decreased after treatment by the results of echocardiography. There wasn't significant dynamics of the TAPSE value. By the results of pulse-wave Doppler imaging the first type of diastolic dysfunction was predominated in 83% for the right ventricle. The right ventricular diastolic function improved in parallel with the positive changes in left ventricular diastolic filling after the treatment. Right ventricular early diastolic myocardial velocity Еm (from 0,08±0,013 m/s to 0,11±0,015 m/s, р<0,001) and ratio Em/Am (from 0,70±0,150 to 0,90±0,194, р<0,001) were significantly higher, deceleration time DTEm (from 162±52 ms to 131±37 ms, р <0,001) and isovolumic relaxation time IVRTm (from 26±23 ms to 16±13 ms, р<0,001) were significantly lower by the results of pulse-wave tissue Doppler imaging. Tissue myocardial performance index MPIm was significantly lower (from 0,31±0,117 to 0,25±0,069, р<0,001), that pointed to improvement of global longitudinal right ventricular myocardial kinetics. Reverse right ventricular remodeling under the influence of medicaments that suppress the renin-angiotensin-aldosterone system, helps to improve its diastolic function. Another possible pathogenetic mechanism is the improvement of the endothelial function of the blood vessels of the pulmonary circulation. Conclusions. Longitudinal diastolic function of the right ventricle is improved in patients with hypertensive heart disease after 6 months of antihypertensive treatment. There are the parallel changes of longitudinal right and left ventricular myocardium kinetics, assessed by pulse-wave tissue Doppler imaging, with lowering blood pressure. The indexes of the longitudinal right ventricular myocardium kinetics can be important criteria to assess the development of the early signs of heart failure and the influence of treatment on right ventricular dysfunction.