Philips EPIQ Research Articles

Acute tricuspid valve annulus remodeling after transcatheter edge-to-edge repair with Triclip

Abstract Background Right ventricular (RV) adverse remodeling together with RV dysfunction, and not only tricuspid regurgitation (TR) severity, are independently associated with survival in patients with medically treated significant TR. Nevertheless, changes in RV dimensions and function after transcatheter tricuspid valve intervention and their association with outcomes remain largely unexplored, as well as tricuspid valve annulus (TVA) reverse remodeling. Aim of our study is to assess acute remodeling of TVA after tricuspid transcatheter edge-to-edge repair (T-TEER) with the TriClip device (Abbott Vascular, Santa Clara, CA, USA) using intraprocedural trans-esophageal echocardiography (TEE). Materials and methods This prospective, single-center study, conducted at Fondazione Policlinico Universitario Campus Bio-Medico of Rome, enrolled 60 consecutive symptomatic patients referred with the diagnosis of at least severe TR who underwent T-TEER from March 2021 to June 2024 with the TriClip System. Intraprocedural TEE was performed using Siemens Acuson SC2000 (Siemens Medical Systems, Pleasanton, CA, USA) at the beginning, and then using Philips EpiQ CVx (Philips Medical System, Andover, MA). A full-volume 3D echocardiographic data set was acquired during the procedure for each patient before and after the grasping. The following parameters were assessed using a multiplanar reconstruction analysis performed off-line using a 3D dataset: septal-lateral (SL) and antero-posterior (AP) annulus diameters; annulus area; annulus perimeter and eccentricity index. Results The mean age of the study cohort was 77,77 ± 6,18 years, and 77% were female. Twenty-eight patients (46,7%) had severe (3+), twenty-four patients (40%) massive (4+) and eight patients (13,3%) torrential (5+) tricuspid regurgitation. The majority of them had atrial functional tricuspid regurgitation, mostly due to annular dilatation. The acute procedural success was achieved in 82.22%. We observed an acute reduction in SL (from a median of 45 to 38 mm, p<0.0001), AP (from a median of 47.5 to 45.8 mm, p<0.0001), area (from a median of 18.4 to 16.2 cm2, p<0.0001), perimeter (from a median of 149 to 141 mm, p<0.0001) and eccentricity index (from 0.92 to 0.87, p <0.0001). The TV annulus was larger in patients with residual TR >2+. Analysis of the subgroups according to procedural success showed an acute inverse remodeling of the TV annulus independent of residual TR grade. We observed a significative reduction of TVA three-dimensional measurements immediately after the procedure. Conclusions In our study we observed that the reduction of TVA begins immediately after TriClip implantation, proving that T-TEER is effective in reducing TR and in inducing reverse remodeling of the TV apparatus. Concurrently, the baseline TV geometry influences the procedural results. Our data are gathered during T-TEER procedure, follow up data are needed for monitoring right ventricular performance. tva measures using mpr tr grade at baseline and after t-teer

Robotic acquisition of echocardiographic images, a proof of concept and safety study

Abstract Background/Introduction Though echocardiography remains the most utilized imaging modality in daily cardiology practice, a major challenge remains the physical strain and injury that can be induced in the echocardiographer. Purpose We developed a prototype robotic arm assisted echocardiography system which incorporates robotics with traditional echocardiography. We assessed the safety and feasibility of the system in 31 volunteers. Methods An ultrasound transducer was mounted upon a robotic arm (UR10 robotic arm, Universal Robots, Odense, Denmark). The transducer was connected to a Philips EPIQ 7C system. The position of the transducer was modified by the echocardiographer who could manipulate a remote stick controller in their hand whilst orientating its position in relation to the real-time images acquired upon the monitor of the echocardiography scanner. This enabled the sonographer to optimize the images and to initiate recordings of parasternal and apical 2D and 3D images. The maximal force on the robot arm was set to 5 Newtons (N) which was deemed to be both safe and to allow for adequate image quality. The force induced by the probe upon the chest wall was measured continuously. Acquired images were assessed for quality ranging from excellent to poor. Results 17 males and 14 females were scanned. The number of images acquired varied from a minimum of 16 and a maximum of 61. The mean time taken to scan an individual was 17.4 minutes with a standard deviation (SD) of 9.9 minutes. This equated to an average of 1.9 images per minute (SD 0.7). No statistical difference was noted between the number of images per minute obtained between male and female participants (mean (+/- SD) for males was 2.1(0.8) and for females 1.8 (0.7) P=0.27). The average force that was applied by the probe was 3.95+/-0.83 Newtons. None of the volunteers reported significant discomfort in the acquisition of the images. Of the 3D images obtained 5 of the participants had poor apical 3D datasets and 3 had poor parasternal datasets but the remaining images acquired were adequate for diagnostic quality. Conclusion(s) Our study demonstrates the feasibility and safety of acquiring 2D and 3D images using a prototype robotic arm assisted echocardiography system. Despite using a low force to the chest wall, the majority of images obtained were of diagnostic quality. Future studies will assess the techniques validity within a routine patient population compared to standard imaging performed by an experienced sonographer. Set up of robot-arm echocardioghy

Shear Wave Elastography for Carotid Artery Stiffness: Ready for Prime Time?

Carotid artery stiffness is associated with aging and atherosclerotic disease, leading to cerebrovascular events. Shear Wave Elastography (SWE) is a novel ultrasound technique offering a direct, quantitative assessment of the arterial wall elasticity. The aim of this study is to validate the technical feasibility of SWE in measuring carotid stiffness (CS). A literature search was performed across the PubMed and Scopus databases, with keywords including “carotid stiffness”, “Shear Wave Elastography”, “atherosclerosis”, and “vascular elasticity”. The findings reveal the potential of SWE in quantifying carotid Intima–Media Complex (IMC) stiffness, with implications for the early diagnosis of vascular disease, aiding in clinical decision making and prognostic assessment. Based on the findings of the literature search, a small pilot study was conducted involving 10 participants, using the Philips EPIQ Elite system for the SWE measurements. The technical analysis revealed optimizing the region of interest (ROI) size, probe positioning, and cine-loop analysis as crucial factors for obtaining accurate results. The results of the literature review and small pilot study demonstrate the potential of SWE as a non-invasive method for assessing carotid stiffness. Certain technical adjustments, such as smaller ROIs and careful probe placement, improved the accuracy and repeatability of carotid SWE measurements. Further studies are needed to assess and standardize carotid SWE across larger patient populations.

Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS cardio-oncology clinic

BackgroundFollowing the publication of international cardio-oncology (CO) imaging guidelines, standard echocardiographic monitoring parameters of left ventricular systolic function have been endorsed. Recommendations highlight that either two-dimensional (2D) or three-dimensional (3D) left ventricular ejection fraction (LVEF), alongside global longitudinal strain (GLS) should be routinely performed for surveillance of patients at risk of cancer therapy-related cardiac dysfunction (CTRCD). We studied the feasibility of 3D-LVEF, 2D-GLS and 2D-LVEF in a dedicated CO service.MethodsThis was a single-centre prospective analysis of consecutive all-comer patients (n = 105) referred to an NHS CO clinic. Using a dedicated Philips EPIQ CVx v7.0, with X5-1 3D-transducer and 3DQA software, we sought to acquire and analyse 2D- and 3D-LVEF and 2D-GLS, adhering to the British Society of Echocardiography (BSE) and British Cardio-Oncology Society (BCOS) transthoracic echocardiography protocol.ResultsA total of 105 patients were enrolled in the study; 5 were excluded due to carcinoid heart disease (n = 5). Calculation of 3D-LVEF was achieved in 40% (n = 40), 2D-GLS in 73% (n = 73), and 2D-LVEF in 81% (n = 81). LV quantification was not possible in 19% (n = 19) due to poor myocardial border definition. Strong correlation existed between 2D-LVEF and 3D-LVEF (r = 0.94, p < 0.0001). Bland–Altman plot demonstrated no statistical differences in that the mean deviation between 2D-LVEF and 3D-LVEF were consistent throughout a range of LVEF values. The most persistent obstacle to 3D-LVEF acquisition was insufficient myocardial border tracking (n = 30, 50%).ConclusionThis study demonstrates the high feasibility of 2D-GLS and 2D-LVEF, even in those with challenging echocardiographic windows. The lower feasibility of 3D-LVEF limits its real-world clinical application, even though only a small difference in agreement with 2D-LVEF calculation was found when successfully performed.

Comparison of Preoperative and Postoperative Conventional and Speckle Tracking Echocardiographic Parameters in Living Liver Donors.

Introduction We aimed toassess whether partial hepatectomy has an influence on conventional and speckle tracking parameters on echocardiography in living liver donors in the early postoperative period. Methods This study was a retrospective study to investigate the cardiac effects of liver donation after the transplant operation in a high-volume liver transplant center. Ninety living liver donors were included in the study. The echocardiographic images were obtained from 90 living liver donors before and five to seven days after the operation. The echocardiographic examinations were evaluated with a Philips Epiq 7 ultrasound system (Philips Ultrasound; Bothell, WA, USA) by experienced cardiologists in accordance with the recommendations of the American Society of Echocardiography. These included M-mode, two-dimensional imaging, tissue Doppler assessment at the septal and lateral mitral annulus, and strain imaging in all patients at rest in the left decubitus position. The changes in echocardiographic parameters in living liver donors were analyzed.Paired T-test was used to assess significant differences. Results The left ventricular (LV) global longitudinal strain (GLS), right ventricular (RV)GLS, and RV free wall LS, reservoir phase of left atrial strain (LAS-r), conduit phase of LAS (LAS-cd) did not show significant changes after the operation (for all, p>0.05). However, the absolute atrial contraction phase of LAS (LAS-ct) mean value increased significantly (14.2±8.8 vs 16.6±8.3, p=0.025) postoperatively. Among the conventional echo parameters, isovolumic relaxation time (IVRT) and the E/A ratio demonstrated notable postoperative alterations.The mean IVRT (87.3 ± 22.4 vs. 80.8 ± 18.1, p=0.014) and E/A ratio (1.5 ± 0.5 vs. 1.3 ± 0.3, p=0.012) exhibited a postoperative decline. Conclusions To the best of our knowledge, our study is the first to evaluate the effect of partial hepatectomy on cardiac functions by echocardiography in living liver donors, and there was no deterioration in the functions of both the ventricles and left atrium.

Ultrasound visualization and blood flow velocity measurements of the adrenal arteries in the fetus.

Detection and surveillance of fetal growth restriction (FGR) is well established, but there is still room for improvement. Animal studies indicate that compromised fetuses increase adrenal blood flow. Modern ultrasound equipment allows us to measure vascular impedance in the fetal adrenal arteries despite their modest size. However, extensive anatomical variance is a challenge to standardizing measurements. We set out to improve this. We included 75 low-risk pregnant women in a prospective cross-sectional study aiming to develop a reliable technique to visualize and measure flow velocity in human fetal adrenal arteries. We used commercially available ultrasound equipment: a GE Voluson 10 2019 with a C2-9 probe (GE Healthcare, Zipf, Austria), and a Philips Epiq Elite with a V9-2 probe (Philips Medical Systems International B.V., Best, The Netherlands), exploiting the modern sensitive power Doppler modes in both scanners to visualize small vessels. Among 72 fetuses, the inferior adrenal artery was the most consistently visualized and measured artery to the gland. Doppler velocimetry was achieved in 66 (92%) participants. We found the anatomical variation described previously but were able to develop visualization strategies to identify the common arteries and use a consistent Doppler technique for the second half of pregnancy. It is possible to visualize and measure flow velocity in the adrenal arteries of human fetuses. The success rate was highest for the inferior adrenal artery making this vessel a candidate for clinical studies.

Phrenic Nerve Sonography Alterations in Patients with ALS: Insight with Clinical and Neurophysiological Findings.

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder, and although the diagnosis is primarily based on clinical criteria, ENMG, as the "gold standard", does not always show detectable changes. Therefore, our study suggests that alterations in echogenicity and heterogeneity of the phrenic nerve (PN) may serve as potential additional diagnostic tools for ALS. Methods: Our study included 32 patients in the ALS group and 64 individuals in the control group. Each participant underwent an interview and completed questionnaires to collect clinical and demographic data, including age, gender, height, body mass index (BMI), hip and waist circumference, duration of illness, ALS-FRS-R score, comorbidities, and medication use. Ultrasound examinations of the PN were performed by two authors using a high-resolution "Philips EPIQ 7" ultrasound machine equipped with a linear 4-18 MHz transducer. The ALS group participants underwent PN sonography and conduction examinations, arterial blood gas (ABG) analysis, respiratory function tests (RFT), and electroneuromyography (ENMG). Results: The study demonstrated that the phrenic nerve is significantly smaller on both sides in patients with ALS compared to the control group (p < 0.01). Changes in the homogeneity and echogenicity of the PN were also observed on both sides. On the right side, 43.8% of the nerves showed heterogeneity, 40.6% were isoechoic, and 21.9% were hyperechoic. On the left side, 59.4% of the nerves exhibited heterogeneity, 34.4% were isoechoic, and 28.1% were hyperechoic. Moreover, sonography on both sides showed significant correlation with ALS-FRS-R, COMPASS-31, and ENMG results. Conclusions: Our study highlights the importance of phrenic nerve ultrasound as a promising supplementary diagnostic tool for ALS. The significant differences in phrenic nerve size, echogenicity, and homogeneity between patients with ALS and the control group demonstrate that ultrasound imaging can detect morphological changes in the phrenic nerve. Incorporating phrenic nerve ultrasound into routine diagnostic protocols could improve early detection, enhance disease monitoring, and offer a more comprehensive understanding of the neurodegenerative processes in ALS.

Effect of cross-platform variations on transthoracic echocardiography measurements and clinical diagnosis.

Accurate cardiac chamber quantification is essential for clinical decisions and ideally should be consistent across different echocardiography systems. This study evaluates variations between the Philips EPIQ CVx (version 9.0.3) and Canon Aplio i900 (version 7.0) in measuring cardiac volumes, ventricular function, and valve structures. In this gender-balanced, single-centre study, 40 healthy volunteers (20 females and 20 males) aged 40 years and older (mean age 56.75 ± 11.57 years) were scanned alternately with both systems by the same sonographer using identical settings for both 2D and 4D acquisitions. We compared left ventricular (LV) and right ventricular (RV) volumes using paired t-tests, with significance set at P < 0.05. Correlation and Bland-Altman plots were used for quantities showing significant differences. Two board-certified cardiologists evaluated valve anatomy for each platform. The results showed no significant differences in LV end-systolic volume and LV ejection fraction between platforms. However, LV end-diastolic volume (LVEDV) differed significantly (biplane: P = 0.018; 4D: P = 0.028). Right ventricular (RV) measurements in 4D showed no significant differences, but there were notable disparities in 2D and 4D volumes within each platform (P < 0.01). Significant differences were also found in the LV systolic dyssynchrony index (P = 0.03), LV longitudinal strain (P = 0.04), LV twist (P = 0.004), and LV torsion (P = 0.005). Valve structure assessments varied, with more abnormalities noted on the Philips platform. Although LV and RV volumetric measurements are generally comparable, significant differences in LVEDV, LV strain metrics, and 2D vs. 4D measurements exist. These variations should be considered when using different platforms for patient follow-ups.

Repeatability of ultrasonographic measurement of cross‐sectional area of the multifidus muscle in the horse

SummaryBackgroundRecent studies have described techniques to acquire ultrasound measurements of the cross‐sectional area of the multifidus muscle to investigate back pain in horses and monitor the response to rehabilitation. These techniques have been extrapolated from human research but have not been clinically validated in the horse.ObjectiveThe objective of the study was to investigate whether measuring the cross‐sectional area of the multifidus muscle in horses using ultrasound is a repeatable technique.Study designCross‐sectional.MethodsUltrasound images of the articular process view and interspinous view of the multifidus muscle were acquired at T15, T18, L2 and L5 on the left and right sides. Three images were acquired at each location and each image was measured three times to give an average cross‐sectional area. Study 1 investigated the repeatability of acquiring images in a single session, and then on two separate days. Study 2 compared measurements of images acquired with a console (Philips EpiQ) and a portable (MyLab™Alpha) ultrasound machine. Study 3 investigated the repeatability of measuring the cross‐sectional area using external software, OsiriX. Intraclass correlation coefficients (ICC) were calculated for each study.ResultsRepeatability varied from good to excellent for images taken in a single session. The repeatability for measuring the images using external software was good to excellent. There was poor‐to‐moderate repeatability for images taken on two different days and poor‐to‐good repeatability when using the two different machines.Main limitationsPopulation size, study population limited to a single breed, only one operator.ConclusionsThe measurement of the multifidus muscle in horses has poor repeatability and may have limited application.

P248 Feasibility, accuracy and reproducibility of the ultrasound measurement of psoas muscle compared to bioelectrical impedance analysis for the evaluation of skeletal muscle mass in patients with IBD

Abstract Background Sarcopenia is characterized by the loss of muscle mass and it is a strong predictor of disability and poor outcomes in several chronic gastrointestinal diseases such as inflammatory bowel diseases (IBD). Therefore, it is useful to evaluate muscle mass in patients with chronic gastrointestinal diseases at risk for sarcopenia. Radiological evaluation of muscle mass is obtained with computed tomography (CT), magnetic resonance (MRI) and bioelectrical impedance (BIA). We aimed at assessing the feasibility, reproducibility and diagnostic accuracy of ultrasound (US) measurement of psoas muscle thickness adjusted for body mass index (BMI) compared to skeletal muscle mass (SMM) evaluated with BIA normalized to height2 in the quantification of muscle mass among patients with IBD. Methods We enrolled a total of 86 consecutive patients with IBD (males 68.6%, mean age 50.4 ± 17.6, 7.4% with Crohn’s disease) who underwent US evaluation of psoas muscle thickness and BIA during the same day. US measurement (Philips Epiq, Bothell, USA) was performed by two sonographers, blind to each other. BIA was performed with the Seca mBCA 525 (Hamburg, Germany). A cut-off of 6.68 and 8.97 of SMM normalized to height2 was considered as normal value for women and men respectively. Sensitivity, specificity, positive and negative predictive values(PPV and NPV), positive and negative likelihood ratios (LR+ andLR−) were calculated, all with the respective 95% confidence inter-vals (95% CI). The reproducibility between the US operators was evaluated by intra-class correlation coefficient(ICC) for the quantitative variables of psoas muscle. The study was approved by our local ethics committee and partially funded by the Italian Ministry of Health. Results US psoas muscle thickness measurement was feasible in all the 86 enrolled patients. There was a significant correlation between US measurement and BIA with a Pearson r coefficient of 0.54 (p= &amp;lt;0.0001). Among men a cut off of 108.18 cmxkg/m*2 showed a sensitivity of 93.5% and a specificity of 53,6% in the detection of low SMM at BIA (Figure 1). Among women a cut off of 66.9 cmxkg/m*2 showed a sensitivity of 78.5% and a specificity of 69.2% in the detection of low SMM at BIA (Figure 2). Reproducibility among the operators had an ICC of 0.95 (CI 0.93-0.96). Conclusion Sarcopenia is a prognostic factor of poor outcomes in IBD, therefore it is important to identify patients at risk for it. Nowadays, assessment of muscle mass and eventually sarcopenia relies on radiological techniques (CT/MRI and BIA). At this purpose we propose a simple, non-ionizing, fast and reproducible US technique that compared to BIA showed a high sensitivity and thus can be used in clinical ractice to screen for muscle mass reduction in IBD patients.

Comparison of pre-mortem 2D-3D ultrasound examination to post-mortem micro-CT of carotid arteries - first experiences.

<p>A prerequisite for the treatment of carotid atherosclerosis is the accurate measurement of the stenosis, that is most commonly evaluated by duplex ultrasonography. In this study, we aimed to verify the reliability of 2D and 3D ultrasonography, comparing the data to results of post-mortem micro-CT examination.</p>. <p>Neurological patients with any life-threatening, presumably fatal neurological disease were enrolled. Ultrasound examinations were performed with a Philips Epiq 5G machine, using a VL13-5 broadband linear volume array transducer. Plaque length, diameter and vessel area reduction (stenosis) were calculated using the 2D images. Finally, the stenosis was reassessed using automatized, 3D application as well. After the death of the patient, autopsy was performed, during which the previously examined carotid artery was removed. The samples were examined with micro-CT. Similar to the ultrasound examination, plaque length, diameter and vessel area reduction (stenosis) were determined.</p>. <p>Ten vessels of seven patients were eligible for complex comparison. Plaque diameter and length measured by CT did not correlate with the ultrasound data. CT-measured axial plaque and vessel areas showed no correlation with ultrasound results either. While determining the strength of correlation between stenoses measured by the different modalities, significant correlation was found between the results measured by ultrasound (2D) and CT (Pearson r: 0.902, P&lt;0.001).</p>. <p>Three-dimensional ultrasound analysis is a spectacular method for examining carotid plaques, as it can assist in a more detailed evaluation of the plaque morphology and composition, thereby identifying plaques with a particularly high risk of stroke. Micro-CT is an excellent tool for the exact determination of calcified plaque areas, but ultrasound images are not suitable yet for such a precise examination due to acoustic shadowing and artifacts.</p>.

Preoperative ultrasound elastography for postoperative pancreatic fistula prediction after pancreatoduodenectomy: A prospective study

BackgroundPostoperative pancreatic fistulas are the most frequent major complications after pancreatoduodenectomy. The soft pancreatic texture is a critical, independent risk factor for postoperative pancreatic fistulas after pancreatoduodenectomy. The current gold standard for postoperative pancreatic fistula risk evaluation consists of the surgeon's intraoperative palpation of the pancreatic texture and, thus, lacks objectivity. In this prospective study, we used ultrasound-based shear-wave elastography, image data analysis, and a fistula risk score calculator to correlate the stiffness of pancreatic tissue with the occurrence of clinically relevant postoperative pancreatic fistulas. MethodsWe included 100 patients with pancreatic pathologies (71% pancreatic ductal adenocarcinoma) and 100 healthy individuals who were preoperatively assessed via real-time tissue ultrasound-based shear-wave elastography on a Philips EPIQ 7 ultrasound device and had pancreatic parenchyma histologically evaluated with manually stained images. ResultsWe found a significant difference in the mean elasticity between the soft (1.22 m/s) and the hard pancreas group (2.10 m/s; P < .0001). The mean elasticity significantly correlated with the pancreatic fibrosis rate and the appearance of a postoperative pancreatic fistula after pancreatoduodenectomy. Low elasticity (≤1.2 m/s, mean) correlated with soft and high elasticity (>2.0 m/s, mean) with hard pancreatic parenchyma, as assessed by pathologic evaluation. Multivariate analysis revealed a mean elasticity of <1.3 m/s as a significant cut-off predictor for clinically relevant postoperative pancreatic fistulas (P = .003; Youden-Index = 0.6945). ConclusionPreoperative ultrasound-based shear-wave elastography is a feasible and objective clinical diagnostic modality in evaluating pancreatic tissue stiffness. A mean pancreatic elasticity of <1.3 m/s was a significant independent risk predictor of clinically relevant postoperative pancreatic fistulas after pancreatoduodenectomy.

Abstract 14470: Right Ventricular Flow Visualization and Characterization via High Speed Volumetric Echo-PIV

Introduction: Although 4D echocardiography is used for many clinical applications, the evolving vortex flow in the right ventricle (RV) is relatively unknown and cannot be characterized with conventional echocardiography. An obstacle is that acquiring high frame rate (&gt;100fps) data in presence of contrast is challenging and has not yet reported. Hypothesis: High frame-rate 4D echocardiographic data in presence of contrast can elucidate RV vortex flow via volumetric Echo-PIV (V-Echo-PIV). Methods: We devised a new transthoracic echocardiography (TTE) protocol using a Philips EPIQ CV9 ultrasound system with a 3D matrix probe (X5-1c) to acquire high frame-rate 4D data for processing with V-Echo-PIV. Apical RV focused view was used for full-volume acquisition by limiting the sector width and imaging depth solely to the entire RV. Visualization of the RV flow and wall dynamics was achieved by IV administration of Optison™ and Normal Saline. VolDICOMs were processed with V-Echo-PIV to obtain RV blood flow velocity field during the full cardiac cycle. Results: We improve the frame rates' scan lines to +30Hz. A 100Hz is achieved by stitching 4 cycles. We show that 4D RV flow can be quantified and characterized at high temporal resolution using V-Echo-PIV. Fig. 1A shows cine blood velocity in a healthy subject with a 51bpm heart rate. For which, V-Echo-PIV acquired 117 three-dimensional vector fields in one cardiac cycle, given the setting of 100Hz acquisition rate. The figure features flow patterns from systole to diastole, from left to right. Fig. 1B depicts the iso-surface of transient tricuspid vortex during diastolic RV filling. Conclusions: Enabled by high speed acquition in presence of contrast, V-Echo-PIV can be used as a viable alternative to 4D Flow MRI to visualize and evaluate real-time intra-cardiac blood flow, as it requires only a very short acquisition time and can be used wherever an echocardiography machine with matrix probes is available.

Comparative assessment of echocardiographic parameters in persons without diagnosed chronic non-communicable diseases depending on body mass index

Aim: To compare the indicators of structural remodeling and intracardiac hemodynamics in people without previously diagnosed chronic non-communicable diseases, depending on body mass index (BMI).Material and Methods. We analyzed the data of 123 people aged 21 to 59 years who did not have chronic non-infectious diseases and did not take any drug therapy that affects the indicators of central and peripheral hemodynamics, as well as lipid, carbohydrate and fat metabolism. All the examined persons were divided depending on the BMI into 2 groups, comparable in sex, but with age differences. The first group consisted of 60 people (75% women) with a BMI &lt; 30 kg/m2, whose median age was 40 years (Q1–Q3: 35–48 years). The second group included 63 subjects (76.1% women) with BMI ≥ 30 kg/m2 at the age of 48.5 years (Q1–Q3: 38–54 years). Structural and functional parameters of the heart were assessed during transthoracic echocardiography, which was performed on the Philips EPIQ CVx 2D ultrasound machine by one specialist.Results. In the group of persons with increased BMI, the average values of the left ventricular relative wall thickness (RWT LV) were higher – 0.37 [0.34; 0.40] versus 0.41 [0.37; 0.47], p = 0.01; left ventricular mass index (LVMI) – 64.0 [53.0; 76.5] g/m2 and 27.0 [23.1; 30.9] g/m2,7 vs. 82.0 [70.0; 92.0] g/m2 and 38.1 [34.5; 46.5] g/m2,7, p = 0.01; epicardial fat (EF) – 5 [4; 6] mm vs. 8 [5; 10] mm, p = 0.01, left ventricular global longitudinal strain (LV GLS) –21.8 [–23.6…–19.7]% vs. –19.2 [–21.2…–18.2] %, p = 0.01. Statistically direct correlations of BMI with LVMI g/m2,7 (ρ = 0.746; p = 0.01), EF (ρ = 0.563; p = 0.01), LV GLS (ρ = 0.418; p = 0 .01), RWT (ρ = 0.438; p = 0.01). With an increase in BMI by 1 kg/m2, one should expect an increase in the thickness of EF by 0.172 mm, longitudinal deformation of the LV by 0.151%, RWT by 0.003, LVMI, g/m2 by 1.200, LVMI g/m2,7 by 1.116.Conclusion. The increase in BMI is associated with changes in structural remodeling and systolic function of the LV. In individuals with increased BMI, to determine structural remodeling and changes in the geometry of the heart chambers, it is necessary to use growth indexing, to determine indicators of GLS LV, to determine the thickness of EF in order to detect intracardiac hemodynamic disorders in the early stages and timely prevention of complications.

Hyperammonemia in patients with stable angina pectoris and nonalcoholic fatty liver disease at the steatosis stage

The aim. To assess the severity of hyperammoniemia in patients with non-alcoholic fatty liver disease at the steatosis stage in conditions of comorbidity with stable angina. Research materials and methods. During the clinical trial, three groups of patients with stable angina were formed. Group I (n = 43) consisted of patients with NAFLD at the stage of hepatic steatosis in combination with obesity and a stable form of CHD. Group II (n = 41) - patients with NAFLD at the stage of hepatic steatosis against the background of normal body weight and stable CHD. Group III (control) (n = 42) - patients with stable angina without NAFLD, with normal body weight. The results of laboratory examination (clinical and biochemical blood tests, lipidograms, insulin levels (calculated by HOMA-IR), glycosylated hemoglobin (HbAlc)) were evaluated; non-invasive markers for the diagnosis of liver injury. Hyperammonemia was evaluated by quantitative rapid ammonia analysis using a Pocket Chem TM BA PA-4140 analyzer. All patients underwent ultrasound of the liver using Philips Epiq 5 (USA). Results. In all patients with stable angina (group I and II), the diagnosis of non-alcoholic fatty liver disease, steatosis stage, was confirmed. The lipid profile of patients in Groups I and II showed more significant hypertriglyceridemia compared to those in the control group, with no statistical difference in Groups I and II. The mean ammonium level in patients with NAFLD in combination with stable CHD (group I, II) was above the threshold and was 87 (57-127.5) and 79 (57-97) μmol/L, respectively, and did not differ significantly (p &gt; 0.05). In patients of group III (without liver disease), the mean values of ammonia in the blood were in the target range. According to the results of correlation analysis, we established the relationship of ammonium with liver enzymes, calculated steatosis indices and basic metabolic indicators. Conclusion. Patients with non-alcoholic fatty liver disease in the steatosis stage with a combination of stable angina have more severe hyperammonemia compared to patients with stable CHD without concomitant liver injury.

Delivery of ultrasound cavitation therapy with a modified clinical scanner

Ultrasound-induced bioeffects from stable and inertial cavitation of microbubbles in tumors have been shown to enhance systemic drug delivery. However, the high pressures and long cycle lengths needed for cavitation treatment are not available on current clinical ultrasound scanners. Here, we implement acoustic conditions (1.6 MHz, 12-500 cycles, &amp;lt;3 MPa, 10-200 Hz PRF) suitable for cavitation treatments (USCTx) on the S5-1 probe of a Philips EPIQ scanner. Hydrophone measurements confirmed the acoustic conditions. Passive cavitation detection (PCD) in solutions and tissue mimicking phantoms containing microbubbles demonstrated the spatial and temporal extent of the produced cavitation with 20 consecutive pulses. Inertial cavitation was observed at peak negative pressures of ∼0.5 MPa and ∼0.9 MPa in the solutions and phantoms, respectively. At low PRFs (&amp;lt;100 Hz), inertial cavitation was only observed within the first 5-10 pulses for both media, suggesting USCTx may generate most bioeffects in the first few pulses. The higher PRFs sustained cavitation activity for a greater duration, consistent with gas diffusion of micron size bubbles after shell disruption with the first pulse. Having implemented USCTx with a clinical scanner and confirmed the produced cavitation in vitro, we plan to evaluate this technique in an upcoming mouse study.

Sonographic Phrenic Nerve Changes in Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects both the upper and lower motor neurons in the nervous system, causing muscle weakness and severe disability. The progressive course of the disease reduces the functional capacity of the affected patients, limits daily activities, and leads to complete dependence on caregivers, ultimately resulting in a fatal outcome. Respiratory dysfunction mostly occurs later in the disease and is associated with a worse prognosis. Forty-six participants were included in our study, with 23 patients in the ALS group and 23 individuals in the control group. The ultrasound examination of the phrenic nerve (PN) was performed by two authors using a high-resolution "Philips EPIQ 7" ultrasound machine with a linear 4-18 MHz transducer. Our study revealed that the phrenic nerve is significantly smaller on both sides in ALS patients compared to the control group (p < 0.001). Only one significant study on PN ultrasound in ALS, conducted in Japan, also showed significant results (p < 0.00001). These small studies are particularly promising, as they suggest that ultrasound findings could serve as an additional diagnostic tool for ALS.

Decrease of left ventricular function measured by speckle-tracking echocardiography based on systemic lupus erythematosus severity in children.

Systemic lupus erythematosus in children generally manifests more severely with a more aggressive disease course. Cardiac involvement in systemic lupus erythematosus often does not show specific signs and symptoms, but speckle-tracking echocardiography can detect cardiac dysfunction. This study aimed to determine the differences in left ventricular function as measured by speckle-tracking echocardiography in children with various severity of systemic lupus erythematosus activity. A cross-sectional study of 49 children diagnosed with systemic lupus erythematosus are currently undergoing outpatient or inpatient care at Dr Hasan Sadikin General Hospital, Bandung, from May 2023 to June 2023. Disease activity was assessed by Mexican Version of the Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) with a score of 2-5 classified as mild activity, 6-9 as moderate, and ≥10 as severe. Each subject underwent conventional echocardiography and speckle-tracking echocardiography with a Philips EPIQ machine performed by a Pediatric Cardiologist Consultant 10 days after inclusion. Fifteen (30.6%) subjects had mild disease activity, and 34 (69.4%) subjects had moderate disease activity. Most subjects (81.96%) were female with an average age of 15 years. The mean ejection fraction and fractional shortening as well as the median E/A ratio in the mild and moderate disease activity groups were not significantly different (65.76 versus 67.38%, 35.73 versus 37.11%, 1.6 versus 1.5%, respectively, p > 0.005). The global longitudinal strain in the moderate activity group was reduced more significantly than in the mild activity group (-16.58 versus -19.65, p = 0.008). Left ventricular function as measured by speckle-tracking echocardiography was lower in children with moderate systemic lupus erythematosus activity than those with mild disease activity.

Right ventricular dysfunction as a predictor of complicated course in left heart surgery

Aim. To analyze the right ventricular (RV) functionality in a cohort of heterogeneous cardiac surgical patients with left-sided valvular heart disease and determine the contribution of RV dysfunction in the complicated postoperative period according to echocardiography.Material and methods. A single-center prospective study of patients with left heart defects operated on in 2022 was conducted. Age ranged was 20-81 years, with a median age of 58 years. The study was conducted on a PHILIPS EPIQ CVx system using an X5-1 probe.Results. To estimate the risk of a complicated postoperative period depending on various indicators of RV systolic function assessment, ROC-analysis was performed. The ROC curve of the RV free wall longitudinal strain (RV FW LS) was characterized by the highest AUC value among other RV functional measures, equal to 0,81±0,06 (95% confidence interval (CI): 0,68-0,93), p&lt;0,001. A value of 20% was selected as the cut-off point of RV FW LS for predicting a complicated postoperative period. The RV FW LS &lt;20% was 19,2 times more likely to develop a complicated course (95% CI: 5,64 to 65,50), compared with the RV FW LS group ≥20%; p&lt;0,05. The odds of heart failure (HF) in the RV FW LS &lt;20% group were 22,78 times higher (95% CI: 5,90 to 88,04), compared with the RV FW LS ≥20% group; p&lt;0,05.Conclusion. The RV FW LS &lt;20% can be considered an independent predictor of complicated postoperative period with a multiple increase in the risk of complications, mainly the risk of heart failure. The assessment of RV FW LS can significantly help in risk stratification, being the reason for the reclassification of a number of patients in the high-risk group with a possible modification of surgical strategy.

Evaluation of the electrocardiogram RV5 /V6 criteria in the diagnosis of left ventricular hypertrophy in marathon runners.

To assess the value of electrocardiogram (ECG) RV5/V6 criteria for diagnosing left ventricular hypertrophy (LVH) in marathons. A total of 112 marathon runners who met the requirements for "Class A1" events certified by the Chinese Athletics Association in Changzhou City were selected, and their general clinical information was collected. ECG examinations were performed using a Fukuda FX7402 Cardimax Comprehensive Electrocardiograph Automatic Analyser, whereas routine cardiac ultrasound examinations were performed using a Philips EPIQ 7C echocardiography system. Real-time 3-dimensional echocardiography (RT-3DE) was performed to acquire 3-dimensional images of the left ventricle and to calculate the left ventricular mass index (LVMI). According to the LVMI criteria of the American Society of Echocardiography for the diagnosis of LVH, the participants were divided into an LVMI normal group (n=96) and an LVH group (n=16). The correlation between the ECG RV5/V6 criteria and LVH in marathon runners was analysed using multiple linear regression stratified by sex and compared with the Cornell (SV3+RaVL), modified Cornell (SD+RaVL), Sokolow-Lyon (SV1+RV5/V6), Peguero-Lo Presti (SD+SV4), SV1, SV3, SV4, and SD criteria. In marathon runners, the ECG parameters SV3+RaVL, SD+RaVL, SV1+RV5/V6, SD+SV4, SV3, SD, and RV5/V6 were able to identify LVH (all p<.05). When stratified by sex, linear regression analysis revealed that a significantly higher number of ECG RV5/V6 criteria were evident in the LVH group than in the LVMI normal group (p<.05), both with no adjustment and after initial adjustment (including age and body mass index), as well as after full adjustment (including age, body mass index, interventricular septal thickness, left ventricular end-diastolic diameter, left ventricular posterior wall thickness, and history of hypertension). Additionally, curve fitting showed that the ECG RV5/V6 values increased with increasing LVMI in marathon runners, exhibiting a nearly linear positive correlation. In conclusions, the ECG RV5/V6 criteria were correlated with LVH in marathon runners.