Modified Simpson Method Research Articles

Left atrial function of patients with atrial fibrillation undergoing thoracoscopic hybrid ablation.

Thoracoscopic hybrid ablation is an effective and safe rhythm control strategy for patients with complex forms of atrial fibrillation. Its effect on left atrial function has not yet been studied. In a retrospective single-centre analysis of patients undergoing thoracoscopic hybrid ablation, the left atrial emptying fraction was calculated using the biplane modified Simpson method in the apical 2- and 4-chamber views on transthoracic echocardiography. Left atrial strain (reservoir, conduction and contractility) was quantified using dedicated software. Sixty-seven patients were included (mean age 64 years, long-standing persistent atrial fibrillation in 69%, median atrial fibrillation history duration 64 months). At baseline, left atrial function and contractility were poor. The reservoir and contractile strain improved postprocedure compared to baseline [15 (standard deviation (SD): 8) and 17 (SD: 6); P = 0.013; 3 (SD: 5) and 4 (SD: 4), P = 0.008], whereas the left atrial volume indexed to the body surface area was reduced [51 ml/m2 (SD: 14) and 47 ml/m2 (SD: 18), P = 0.0024]. In patients with preoperative (long-standing) persistent atrial fibrillation and in patients with rhythm restoration, improvements in the emptying fraction, (reservoir and contractile) strain and the left ventricular ejection fraction were observed, whereas the left atrial volume decreased (P < 0.05). In this cohort of patients with severely diseased left atria, improvement in left atrial contractility and in the emptying fraction after thoracoscopic hybrid ablation for atrial fibrillation in patients with persistent atrial fibrillation is mainly due to rhythm restoration. Interestingly, the procedure itself also results in improved left atrial reservoir strain and reversed left atrial remodelling by reducing left atrial volume.

CT coronary angiography as an alternative imaging method to ascertain cardiac output and its correlation with echocardiography

To assess the feasibility and accuracy of cardiac output (CO) obtained using a test bolus in patients scanned with single-source prospective-gated cardiac computed tomography (CT), and comparing it with CO obtained from unenhanced two-dimensional (2D) echocardiography using biplane Simpson's method. In the present study, 100 patients with a mean age of 55±12 years who underwent coronary CT angiography with prospective electrocardiogram (ECG)-gated CT in which the scan delay was evaluated using a test bolus. The time-attenuation curves obtained from the test bolus were used to calculate the CO of the patients. The CO obtained was then compared with that obtained after follow-up 2D echocardiography using biplane modified Simpson method. Linear regression was calculated between the CO and contrast enhancement: CO=-0.16(HUmax)+7.65. The study showed good correlation between the two methods with r=0.77, p<0.001. On Bland-Altman analysis, no significant difference was noted between the two methods. This less researched method for CO estimation appears feasible; however, the clinical usefulness of this parameter is uncertain in absence of further clinical and reference standard validation.

Comparison of visual estimation and quantitative measurement of left ventricular ejection fraction in untrained perioperative echocardiographers

BackgroundPerioperative evaluation of the left ventricular systolic function is essential information to help diagnose and manage life-threatening perioperative emergencies. Although quantifying the left ventricular ejection fraction (LVEF) is recommended to determine the left ventricular function, it may not always be feasible in emergency perioperative settings. This study compared the visual estimation of LVEF (eyeballing) by noncardiac anesthesiologists with the quantitative LVEF measured using a modified Simpson’s biplane method.MethodsTransesophageal echocardiographic (TEE) studies of 35 patients were selected and 3 different echocardiographic views (the mid-esophageal four chamber view, the mid-esophageal two chamber view, and the transgastric mid-papillary short axis view) were recovered from each study and displayed in random order. Two cardiac anesthesiologists certified in perioperative echocardiography independently measured LVEF using the modified Simpson method and categorized LVEF into five grades: hyperdynamic LVEF, normal, mildly reduced LVEF, moderately reduced LVEF and severely reduced LVEF. Seven noncardiac anesthesiologists with limited experience in echocardiography also reviewed the same TEE studies and estimated the LVEF and graded LV function. The precision of the LV function classification and the correlation between visual estimation of LVEF and quantitative LVEF were calculated. The agreement of measurements between the two methods was also assessed.ResultsPearson’s correlation between the LVEF estimated by the participants and the quantitative LVEF using the modified Simpson method was 0.818 (p < 0.001). Of a total of 245 responses, 120 (49.0%) responses were correct grading of the LV function. Participants were able to classify the LV function more accurately in the LV function grades 1 and 5 (65.3%). The 95% level of agreement of the Bland-Altman method was − 11.3-24.5. -21.9-22.6, − 23.1-26.5, − 20.5-22.0 and − 26.6-11.1 for LV grade 1 to 5, respectively.ConclusionVisual estimation of LVEF in perioperative TEE has acceptable accuracy in untrained echocardiographers and can be used for rescue TEE.

Solution of Volterra integral equations of the 2nd kind with bulge function using Aboodh transform

A large class of complexities in mathematical physics, applied mathematics, and engineering are expressed as differential equations with few additions and certain conditions. This research article studies the solution of Volterra integral equations of the second kind where bulge functions take as a known function. To obtain an analytical solution, this study uses the Aboodh transform, the Aboodh inverse transform and the convolution theorem whereas it would be required to discover the precise solution of VIEs. We will also compare it with a numerical solution using a modified Simpson method, and finally, we will represent it graphically.

Comparison between cryoballoon and radiofrequency for atrial fibrillation ablation in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency (RF) and cryoballoon (CB) ablation are the most commonly performed methods for catheter ablation in patients with atrial fibrillation (AF). However, data regarding AF ablation in patients with reduced left ventricular ejection fraction (LVEF) is scarce. Purpose We aimed to compare the safety and efficacy of RF and CB AF ablation in heart failure (HF) patients with LVEF &amp;lt;50%. Methods HF patients whose LVEF &amp;lt; 50% were included in this retrospective study. Transthoracic echocardiography (TTE) was performed to evaluate LVEF by using Modified Simpson method before and after the procedure. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period. Results Eighty-nine (n = 42 CB and n = 47 RF) HF patients were enrolled and baseline characteristics were listed in Table-1. There was no significant difference in AF recurrence rate between the groups [16 (38.1 %) in CB and 12 (25.5 %) in RF, respectively, P = 0.296] during the follow up of median 16.5 (10.25-24) and 11 (9-17) months (Figure-1). There was significant increase in LVEF (39.52 ± 7.77 vs. 46.30 ± 10.95, P &amp;lt; 0.001) and decrease in brain natriuretic peptide (BNP) [230 (10-1653.10) vs. 163 (10-1653.10), P = 0.003] levels after ablation. The changes in LVEF (P = 0.370) and BNP (P = 0.772) were similar between the CB and RF ablation groups. Conclusion Our findings demonstrated that AF ablation using either CB or RF was associated with an improvement in LVEF and neurohormonal profile in AF patients with reduced LVEF.

Do diurnal changes in blood pressure affect myocardial work indices?

Do diurnal changes in blood pressure affect myocardial work indices?

Right ventricular improvement is associated with left ventricular diastolic function and size enhancement in PAH patients: an echocardiographic study

Abstract Background While pulmonary vasodilation therapy improves right ventricular (RV) function in pulmonary arterial hypertension (PAH), data regarding left ventricular (LV) function remain sparse. Purpose We aimed to investigate whether PAH therapy improve LV function in PAH patients. Methods Between 2002 and 2020, all incident PAH patients from one PH referral centers were included, treated and followed-up according to current ESC/ERS guidelines. All patients had comprehensive echocardiography both investigating right and left ventricular function before and after 1-year of vasodilation therapy. In addition to RV echocardiographic evaluation, we focused on LV ejection fraction from Modified Simpson method, LV diameters by M-mode, transmitral pulsed-wave E/A ratio, Flow to tissue Doppler imaging E/e' ratio, and left atrial size. Results 126 patients were included (63% female, 57±17 yo), mainly from connectivite tissue associated and idiopathic PAH (24% and 28% respectively) causes. Compared to baseline, 1-year NYHA functional class (p&amp;lt;0.01), NTproBNP plasma level (p&amp;lt;0.001), invasive mean pulmonary arterial pressure (p&amp;lt;0.01) and cardiac index (p&amp;lt;0.01) significantly improved. While LV ejection fraction (p=0.68), LV end-diastolic diameter (p=0.11) as well as LA area and volume (p=0.09) were not significantly enhanced under vasodilation therapy, LV diastolic function, assessed by mitral E wave (p&amp;lt;0.01), tissue doppler imaging mitral e' wave (p=0.04), and E/A ratio (p=0.045) were significantly improved at 1-year. There was a significant correlation between LV end-diastolic diameter (p&amp;lt;0.001) and RV end-diastolic area (p&amp;lt;0.001) owing to the normalization of right- to left ventricular interdependence, as well as between mitral E wave and TAPSE (p=0.045). Conclusion By improving RV function, PAH vasodilation therapy enhances LV size and diastolic function and normalizes the biventricular interdependence. Funding Acknowledgement Type of funding sources: None.

Model for Prediction of Left Ventricular Myocardial Hypertrophy in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is diagnosed in 25% of adults and associated with high fatal risks of cardiovascular complications. Left ventricular hypertrophy (LVH) is recognized as one of the markers of such risks. In this study, we attempted to create a mathematical model for predicting LVH among OAS patients with various levels of disease severity.Materials and methods. In a prospective cohort study, we included 368 patients (358 male; age 46.0 [42.0; 49.0] yr.) with diagnosed OSA, arterial hypertension, grade I-II obesity (WHO classification 1997). The severity of sleep apnea was verified during nighttime computed somnography (CSG) on WatchPAT-200 hardware (ItamarMedical, Israel) with original software zzzPATTMSW ver. 5.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics from 11.00 PM to 7:30 AM. Verification of LVH was performed in one- and two-dimensional modes in standard echocardiographic positions using Xario-200 ultrasound scanner (Toshiba, Japan) with 3.5 MHz transducer. Hemodynamic parameters of left ventricular (LV) systolic function (EF %, ESV, EDV) were determined by quantitative assessment of two-dimensional echocardiograms using the modified Simpson method. Evaluation of the systolic function of the right ventricle (RV) was performed in the «M»-mode by measuring the systolic excursion of the fibrous ring of the tricuspid valve (TAPSE).Results. ESS and TSat90% (AUC = 0.975; SD = 0.00741; CI 95% [0.953; 0.988]) should be considered the best predictors for predicting LVH in various degrees of OSA severity, allowing us to offer a predictive model with a sensitivity of 93.7% and specificity of 93.8%, after conducting a questionnaire screening and computer somnographic study.Conclusions. Our proposed model of clinical prediction of LVH among patients with various degrees of OAS is based on a carefully planned analysis of questionnaire and instrumental data, and is well applicable in real diagnostic procedures by a wide range of therapeutic practitioners.

Coronary Slow Flow Phenomenon: The Role of New Echo cardiographic Indices

Abstract Background: The Coronary Slow Flow Phenomenon (CSFP) is defined as a delayed distal vessel contrast opacifi-cation in the absence of obstructive epicardial coronary artery disease during coronary angiography. There is conflicting data in medical literature regarding the effects of CSFP on the left ventricular functions assessed by conventional echocar-diography or tissue Doppler imaging. Aim of Study: To evaluate whether there is impairement of Global Longitudinal Strain (GLS) of the Left Ventricle (LV) obtained by Speckle Tracking Echocardiography (STE) in patients with CSFP and the role of GLS of the left ventricle in prediction of CSFP. Patients and Methods: Patients with chronic stable angina referred for coronary angiography from February 2015 to Augusts 2017 at the Department of Cardiology, Faculty of Medicine; Zagazig University Hospitals were examined. 31 patients with CSFP and 52 age and sex matched controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by TIMI Frame Count (TFC). GLS of LV was measured by two dimensional (2D) STE in addition to other conventional and tissue Doppler parameters to assess LV diastolic and systolic functions. Results: LV GLS was lower in CSFP group patients (–15 ±2.73) compared to control group (–17.19±2.54) (p=0.001). There was statistically significant negative correlation between mean TFC and LV GLS (r=–0.33, p=0.002). LVEF by modified Simpson method was lower in CSFP group (57.77±5.66%) compared to control group (59.29±3.32%) but with no statis-tical significance (p=0.18). Left atrial diameter, LAVI were larger in CSFP group compared to control group (p < 0.05). MV E/Ep and TV E/Ep was higher in CSFP group compared to control group (p < 0.001). Smoking was the only risk factors that showed statistical significance being more common in CSFP patients (p=0.003) with positive correlation between mean TFC and smoking index (r=0.28, p=0.002). Conclusion: CSFP impaires LV systolic and diastolic function, RV diastolic function. We found significant negative correlation between mean TFC and GLS of LV.

Current Awareness and Status of Transthoracic Echocardiography in Kumamoto Prefecture - A Report of the Kumamoto Cardiovascular Echocardiography Standardization Project.

Background: There are few reports on current awareness and status of transthoracic echocardiography (TTE), including the actual performance rate according to echocardiographic guidelines, in a specific area or region.Methods and Results: This cross-sectional survey study was conducted in Kumamoto Prefecture from October 2018 to March 2019. There are 366 medical institutions advocating cardiology in Kumamoto Prefecture. Of these, 259 (101 hospitals and 158 clinics) returned questionnaires regarding TTE. In all, 150,570 TTEs were performed in 2017. Of these, 132,771 (88%) were performed in hospitals and 17,799 (12%) were performed in clinics. Physicians performed only 5% of TTEs, whereas sonographers performed 86%. Although the modified Simpson method was performed in 90% of hospitals, 3-dimensional echocardiography was performed in only 2% of hospitals. In addition, the left atrial volume index was not examined in approximately 60% of hospitals, and the mean E/E′ ratio was not examined in 80% of hospitals. Multivariable logistic regression analysis revealed that having a Fellow of the Japan Society of Ultrasonic in Medicine was significantly and independently associated with guideline-oriented TTE (odds ratio 9.43; 95% confidence interval 1.22–72.71, P<0.05).Conclusions: The rate of echocardiographic measurements performed according to echocardiographic guidelines is exceptionally low in Kumamoto Prefecture. Sufficient dissemination of echocardiographic guidelines may be important in improving this rate.

Left Ventricular Global Function Analysis by Multi-Detector CT Threshold Based Three Dimension Segmentation Method in Patients with Coronary Artery Disease: A Comparative Study with Two Dimensional Echocardiography

AbstractBackground: Evaluation of global left ventricular function in patients with Coronary Artery Disease (CAD) is important for clinical diagnosis, risk assessment, therapeutic decisions, and prognosis. Because MDCT is a noninvasive imaging modality frequently used for the assessment of coronary artery disease, its ability to assess the LV volumes and EF has to be evaluated and compared with Two Dimensional Standard Echocardiography (2DSE).Aim of Work: To evaluate the role of MDCT threshold based segmentation method in quantification of global left ventricular function in patients with coronary artery disease and compare MDCT data with 2D-echocardiography as the standard of reference.Patients and Methods: Sixty patients with suspected coronary artery disease underwent contrast enhanced MDCT using retrospective gating. Ten phases of cardiac cycle were processed to assess end-systolic and end-diastolic phase at LV short-axis view. 2DSE was performed within two weeks before MDCT. Left Ventricular Ejection Fraction (LVEF), Left Ventricular End-Diastolic Volume (LVDV) and Left Ventricular End-Systolic Volume (LVSV) were calculated using the three dimensional threshold based segmentation method (in MDCT) and modified Simpson method (in echocar-diography).Results: LVEF, LVDV and LVSV were 51.9±10.9, 182.5± 45.2 and 89.8±40.2 and 51.6±10.5, 175.4±32.3 and 87.2±30.6 on MDCT and echocardiography respectively with excellent correlation between the two modalities (p;0.001) using Pear-son's correlationcoefficient. A Bland-Altman analysis showed that MDCT had slightly higher LVEF, LVDV and LVSV values with mean value of differences of 0.6%, 7ml and 2.5ml respectively, MDCT segmentation method had an accuracy of 91.6%, 95% and 98.3% respectively.Conclusion: MDCT threshold based 3D segmentation method is an accurate method for quantitative evaluation of global left ventricular function compared to 2D echocardiog-raphy.

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&lt;0.05 was considered plausible. The obtained data demonstrate that relatively high levels (RH) of both galectin-3 (&gt;2.4 pg/ml) and aldosterone (&gt;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 -&gt;2.0 and ≤2.0 pg/ml and aldosterone level of - &gt;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.

Perioperative changes of the slope in the preload recruitable stroke work relationship by a single-beat technique after mitral valve surgery in functional mitral regurgitation with non-ischemic dilated cardiomyopathy.

The slope in the preload recruitable stroke work relationship is a highly linear, load-insensitive contractile parameter. However, the perioperative change of the slope has not been reported before. We examined the perioperative slope from a steady-state single beat in patients with functional mitral regurgitation and assessed the correlation with brain natriuretic peptide (BNP) levels. The study included 16 patients with non-ischemic dilated cardiomyopathy and refractory heart failure: 10 patients underwent mitral valve plasty and left ventricular plasty (MVP + LVP group) and 6 patients who underwent mitral valve replacement and papillary muscle tugging approximation (MVR + PMTA group). The left ventricular ejection fraction was assessed by the modified Simpson method; the slope was assessed by the single-beat technique using transthoracic echocardiography. BNP levels were measured by chemiluminescent immunoassay. The left ventricular ejection fraction and slope did not significantly change from pre- to early post-surgery in the MVP + LVP group. Both the left ventricular ejection fraction and slope significantly increased 6months after surgery in the MVR + PMTA group. Postoperative BNP level was low in the MVR + PMTA group. While the postoperative left ventricular ejection fraction did not correlate with BNP levels, the postoperative slope significantly correlated with BNP level after surgery in the MVP + LVP group and in the total functional mitral regurgitation group. The change of slope was dependent on surgical procedures. In functional mitral regurgitation, the slope may be a more sensitive parameter in reflecting the left ventricular contractile function than the left ventricular ejection fraction.

Effects of Sacubitril/Valsartan on biochemical indicators and on left ventricular structure in NYHA IV heart failure with reduced ejection fraction patients

Objective To investigate the effects of Sacubitril/Valsartan on amino-terminal pro-brain natriuretic peptide(NT-proBNP), high sensitivity C-reactive protein(hs-CRP), soluble suppression of tumorigenicity 2(sST2)levels and on left ventricular(LV)structure in NYHA Ⅳ heart failure with reduced ejection fraction(HFrEF)patients. Methods A total of 67 HFrEF patients with NYHA Ⅳ were randomly divided into the control group(n=30)receiving conventional medical treatment, and the observation group(n=32)receiving Sacubitril/Valsartan instead of ACEI(or ARB if ACEI induced cough)in conventional medical treatment.NT-proBNP levels were determined by fluorescer-enhanced chemiluminescence.hs-CRP levels were detected by latex-enhanced immunoturbidimetric assay.sST2 levels were determined by enzyme-linked immunosorbent assay(ELISA). The modified Simpson method was used to detect left ventricular end-diastolic diameter(LVEDD), LV posterior wall(LVPW)and LV ejection fraction(LVEF). Two groups of patients were treated and followed-up for 6 months. Results Clinical efficacy was better in the observation group than in the control group(effective rate, 20 cases or 61.3% vs.8 cases or 26.7%, P<0.05). As compared with the control group, the observation group of patients had an increased LVEF[(46.7±9.2)% vs.(41.8±8.0)%, P<0.05]and a decreased LVEDD[(52.6±6.7)mm vs.(58.8±7.5)mm, P<0.05]. After vs.before treatment, NT-proBNP, hs-CRP and sST2 levels were decreased in both control and observation groups[(1 427±219)μg/L vs.(2 615±273)μg/L, (1.14±1.02)mg/L vs.(1.55±1.38)mg/L, (0.30±0.12)μg/L vs.(0.41±0.10)μg/L, all P<0.05], and the decrements were much more in the observation group than in the control group(P<0.05). The annual accumulated frequence and duration of hospitalization were less in the observation group than in the control group[(0.8±0.6)times vs.(1.8±1.0)times, (10.2±5.8)d vs.(16.5±7.2)d, P<0.05]. The maintenance dose of tolasemide was lower in the observation group than in the control group[(15.2±8.4)mg vs.(20.6±10.8)mg, P<0.05]. Conclusions Sacubitril/valsartan therapy is safe and effective and it can reduce hs-CRP and sST2 levels and improve the ventricular remodeling in HFrEF patients of HYHA Ⅳ. Key words: Sacubitril/valsartan; Heart failure; N-terminal pro-brain natriuretic peptide; Hypersensitive C-reactive protein; Soluble ST2

Coronary Endarterectomy Improve Left Ventricle Ejection Fraction After Coronary Artery Bypass Grafting Surgery

The diffusely diseased coronary artery is a challenge for cardiac surgeons, although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel. It may assures complete revascularization of myocardium in case of diffusely diseased vessels and prevent residual ischemia but it has not been widely used. recently cardiac surgeons are performing and increasing number of coronary artery endarterectomy and it has evolved as an important adjuvant procedure in coronary artery bypass grafting surgery. we reviewed the early clinical and hemodynamic out comes with echocardiography of 22 patients undergoing coronary artery endarterectomy of left anterior descending artery (LAD) diagonal branches (D1 or D2) and right coronary artery and posterior descending artery (RCA and PDA) with patch plasty method using left internal mammary artery (LIMA) and saphenous vein graft (SVG) between January 2017 and June 2018. mean follow up of all patients were 3-6 months postoperatively, Left internal mammary artery (LIMA) anastomosed to left anterior descending artery (LAD) with endarterectomy and artery patch plasty in 12 (54, 5%) patients, saphenous vein graft (SVG) anastomosed to left anterior descending artery (LAD) with endarterectomy and vein patch plasty in 2 (9%) patients, and saphenous vein graft (SVG) to Right coronary artery (RCA) Diagonal (D1) and posterior descending artery (PDA) with endarterectomy and vein patch plasty in 9 (40.9%) patients. Postoperative mortality was 0% and echocardiographic assessment done by modified Simpson method on outpatient department (OPD) basis, 7 patients had left ventricle ejection fraction of (50-55%) preoperatively with no changes on postoperative period and 7 patients had improvement of left ventricle ejection fraction from (30-35%) preoperatively to (40-45%) in postoperative period. principle goal in coronary artery bypass grafting surgery (CABG) is to achieve complete revascularization of diseased coronary arteries, in particular the left anterior descending artery (LAD) is very important vessel because incomplete revascularization of the LAD has been proven to be a predictor of worse mortality after coronary artery bypass grafting surgery (CABG). Recent publications have revealed that coronary endarterectomy is a safe procedure and demonstrated favorable long term out comes. In our experience coronary endarterectomy has been performed with good clinical and hemodynamic out comes with echocardiography.

Assessment of left ventricular volume and function in healthy dogs by use of one-, two-, and three-dimensional echocardiography versus multidetector computed tomography.

OBJECTIVE To compare left ventricle (LV) volume and function variables obtained by use of 1-D, 2-D, and real-time 3-D echocardiography versus ECG-gated multidetector row CT (MDCT) angiography, which was considered the criterion-referenced standard. ANIMALS 6 healthy, purpose-bred dogs. PROCEDURES Dogs were anesthetized and administered a constant rate infusion of esmolol, and 1-D, 2-D, and 3-D echocardiography and ECG-gated, contrast-enhanced MDCT were performed. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume, and ejection fraction (EF) were calculated by use of the Teichholz method for 1-D echocardiography, single-plane and biplane modified Simpson method of disks (MOD) and area-length method for 2-D echocardiography, and real-time biplane echocardiography (RTBPE) and real-time 3-D echocardiography (RT3DE) for 3-D echocardiography. Volumes were indexed to body surface area and body weight. Median values, correlations, and limits of agreement were compared between echocardiographic modalities and MDCT. RESULTS EDV and ESV measured by use of RTBPE and RT3DE had the strongest correlations with results for MDCT. Values obtained for EDV, ESV, stroke volume, and EF did not differ significantly between echocardiographic methods and MDCT. Use of RT3DE and RTBPE slightly underestimated EDV, ESV, and EF, compared with values for MDCT, as determined with Bland-Altman analysis. CONCLUSIONS AND CLINICAL RELEVANCE Values for EDV and ESV obtained by use of 3-D echocardiography, including RTBPE and RT3DE, had the highest correlation with slight underestimation, compared with values obtained by use of MDCT. This was similar to results for 3-D echocardiography in human medicine.

Comparison of four echocardiographic methods to determine left atrial size in dogs

ObjectivesTo compare a linear and three volume-based two-dimensional echocardiographic methods for measuring LA size: left atrium to aorta ratio (LA/Ao ratio), biplane area-length, biplane modified Simpson and monoplane area-length. AnimalsOne hundred seventy-six client-owned dogs of different breeds, 88 healthy dogs and 88 dogs with myxomatous mitral valve disease of different disease severity. MethodsThe left apical four- and two-chamber views were used to measure LA volumes. The right parasternal short-axis view at the level of the heart base was used to measure the LA/Ao ratio. ResultsThe biplane area-length method yielded 2.8% larger values than those of the biplane modified Simpson method, consistent across the full range of LA volumes. The monoplane area-length method derived on average 5.8% larger values of LA volume than the biplane area-length method. The difference between these two methods was most pronounced at larger LA volumes. The relation between the LA/Ao ratio and LA volume was curvilinear and with increasing LA size these two methods derived very dissimilar values. ConclusionsAll methods showed good feasibility and reproducibility, with the volume-based methods having the most favourable intra- and inter-observer variabilities.The LA/Ao ratio underestimates at higher values of LA size compared to the biplane area-length method. LA volume methods may be superior to the LA/Ao ratio in quantification of LA size. The biplane area-length method and biplane modified Simpson method can be used interchangeably. The monoplane area-length measurement may be used as a quick and reliable method for assessment of LA size in clinical practice.

Prognostic Value of Area Flow Index in Patients with Acute st Elevation Myocardial Infarction: Clinical and Echocardiographic Outcomes

Background: Early restoration of patency of infarct related artery is a universally accepted goal in the treatment of acute myocardial infarction. These could be achieved by Primary PCI or fibrinolysis. Primary PCI is preferred reperfusion strategy over fibrinolysis. Identifying initial area at risk in patients with acute myocardial infarction had been shown to have a direct impact on patients adverse clinical outcomes as well as prediction of systolic dysfunction. Area flow index (AFI) calculation in patients with acute myocardial infarction may predict initial area at risk during primary PCI. Aim: To investigate the clinical utility of Area flow index to predict systolic dysfunction and adverse clinical outcomes in patients with acute anterior ST elevation myocardial infarction Patients: 250 consecutive patients with acute anterior ST elevation myocardial infarction treated with primary PCI presenting to Alexandria main university hospital and ICC hospital from June 2013 till December 2014. Methods: Echocardiographic assessment of LV systolic function 5-7 days after myocardial infarction by calculation of ejection fraction using modified simpson method. Area flow index was calculated by dividing culprit segment cross sectional area to total coronary cross sectional area. Where DC is the culprit segment diameter, D1 left anterior descending diameter, D2 left circumflex diameter, D3 right coronary diameter. All patients were followed one month for the occurrence of MACE. Results: Patients were grouped according to their ejection fraction following myocardial infarction into 3 groups: -Group I: severe LV systolic dysfunction EF 45% There was a significant negative correlation between AFI and LVEF (r=-0. 58, P 28.4% had a 75.6% sensitivity and 78.1% specificity in predicting severe LV systolic dysfunction. Also the composite one month MACE was higher in the group with AFI>28.4% (p<0. 001). Conclusion: Area flow index calculated from coronary angiography at time of primary PCI is a new strong independent predictor of LV systolic dysfunction and 1month MACE in patients with acute anterior myocardial infarction.

Left Ventricular Ejection Time Derived From the Common Carotid Artery Doppler Waveform: Association With Left Ventricular Ejection Fraction and Prediction of Heart Failure.

Left ventricular ejection time (LVET) is measured from blood pressure tracings as the interval from end diastole to the dicrotic notch and shows associations with left ventricular ejection fraction (LVEF) and heart failure. LVET can be measured on common carotid artery Doppler waveforms. We therefore studied the possible associations of common carotid artery LVET with LVEF measured by echocardiography and heart failure. We performed a retrospective study of 110 patients who had transthoracic echocardiography and carotid Doppler evaluations within 1 day of each other. LVEF was determined by the biplane modified Simpson method. LVET was measured from left common carotid artery Doppler tracings. Linear regression was used to evaluate associations between LVET and LVEF. We also used logistic regression with LVEF of less than 40% as a cut point for heart failure to generate a receiver operating characteristic curve, estimate the area under the curve, and calculate sensitivity and specificity. LVET was associated with LVEF (P < .0001). The area under the curve of LVET for heart failure was 0.81 (95% confidence interval [CI], 0.72-0.87), and the sensitivity and specificity were 76.9% (95% CI, 65.4%-88.4%) and 65.5% (95% CI, 53.4%-77.8%), respectively, for LVET of 321 milliseconds. LVET measured on common carotid artery Doppler tracings decreases with LVEF and is strongly associated with prevalent heart failure. Based on what is known of blood pressure-measured LVET, common carotid artery Doppler waveform-derived LVET could be used to serially monitor cardiac function.

The effect of long term continuous positive airway pressure treatment on systolic and diastolic function in patients with obstructive sleep apnoea syndrome: A five year observational study

Evaluation of the long-term effects of continuous positive airway presure (CPAP) on mean heart rate and left ventricular systolic and diastolic parameters in obstructive sleep apnea syndrome (OSAS) using conventional and tissue Doppler techniques. This prospective cohort study is designed to evaluate the long-term effects of CPAP treatments in normotensive OSAS patients. Initially 40 patients aged from eighteen to fifty five with documented OSAS syndrome were evaluated within one month of CPAP treatment. All had high self-reported compliance with treatment. From the latter, 21 patients with uninterrupted CPAP therapy (for at least 5 years, 5 hours per day) were included in the study and further evaluated with treatment. The left ventricular systolic function was assessed on apical four- chamber view using modified Simpson method and diastolic function was evaluated with classic transmitral pulsed and tissue Doppler techniques. Paired t test and Wilcoxon signed rank test had been used to compare the clinical and echocardiography data before and after treatment period. A comparison of values assessed after one month and after 5 years of CPAP therapy, revealed a significant increase in the acceleration time(AT) Em/Am ratio and ejection time (ET) (AT: p=0.04; Em/Am ratio p=0.03 ET: p=0.04) while a significant decrease was observed on deceleration time (DT), isovolumetric relaxation time (IRT), myocardial performance index (MPI), mitral regurgitation (MR) and 24 hour mean heart rate (HR) in all subjects (DT: p=0.02; IVRT: p=0,04; MPI: p=0,01; MR: p≤0.001; HR: p=0.004). We observed a significant improvement in the left ventricular systolic and diastolic function and a significant decrease of 24-hour heart rate and mitral regurgitation with unchanged ejection fraction of the left ventricle with long-term CPAP treatment similar to short-term treatment studies. The long-term maintenance of the beneficial effect of CPAP throughout the 5 year long-term treatment can be one of the pathophysiologic mechanisms that may explain the decrease of cardiovascular mortality observed with long-term CPAP therapy in OSAS patients.