Routine Echocardiographic Examination Research Articles

Two Types of Double Chambered Left Ventricle: a case series

Abstract Background Double Chambered Left Ventricle (DCLV) is a rare anatomical variant of the left ventricular structure characterized by the division of the left ventricle into two distinct chambers due to abnormal muscle bundles or septa. This anomaly typically results in primary and secondary chambers within the left ventricle. Due to the lack of conspicuous clinical symptoms, DCLV is often overlooked. Case Summary The first patient was a 69-year-old male experiencing intermittent chest tightness for several weeks. Transthoracic echocardiography indicated the presence of Type A DCLV, which was subsequently confirmed by 3D echocardiography and cardiac magnetic resonance imaging. A few months later, during a routine transthoracic echocardiographic examination of a 48-year-old male, we unexpectedly discovered Type B DCLV. His unique cardiac structure was clearly demonstrated through 3D echocardiography. Discussion DCLV is a rare structural heart malformation often overlooked due to atypical symptoms. This paper presents two cases of DCLV within a six-month period, illustrating two distinct classifications. Comprehensive understanding of the imaging manifestations of DCLV is imperative for accurate clinical diagnosis.

“Eclipsed mitral regurgitation” incidentally detected during routine echocardiographic examination: a case of a 70-year-old woman

“Eclipsed mitral regurgitation” incidentally detected during routine echocardiographic examination: a case of a 70-year-old woman

Echocardiographic Changes in Prevalent Hemodialysis Population Based on Cardiac Symptomatology

BACKGROUND: Despite the prevalence of cardiovascular complications in hemodialysis (HD) patients, routine screening for asymptomatic individuals remains underexplored in clinical practice, particularly beyond those assessed for kidney transplantation. This study aimed to investigate echocardiographic changes in prevalent HD patients, irrespective of symptomatic presentation. SUBJECTS AND METHODS: A prospective, single-center study spanning 36 months included 79 HD patients. Grouping was based on cardiac symptomatology assessed with the New York Heart Association (NYHA) classification: group 1 comprised 18 asymptomatic patients (NYHA class I), while group 2 included 61 patients with moderate cardiac symptoms (NYHA classes II and III). Routine laboratory analyses, miRNA 133, hydration, and nutritional parameters were assessed, with echocardiography performed a day post-HD. RESULTS: Demographic data, HD quality, blood pressure, therapy, and most echocardiographic indicators showed no significant differences. Asymptomatic patients exhibited noteworthy cardiac structural and functional abnormalities: 55.5% had left ventricular hypertrophy (LVH), and 72.2% had increased left atrial volume index (LAVi). Concentric hypertrophy was observed in 7/18 asymptomatic patients, while 15/61 symptomatic patients demonstrated concentric left ventricle remodeling. In comparison to group 2, group 1 displayed higher hemoglobin, uric acid, and miRNA 133 concentrations, along with better hydration control and higher lean tissue index. All these dependent variables show statistically significant relation to the NYHA: approximately 13% of the variance in Hb levels and 18% of the variance in miRNA can be explained by NYHA classification. CONCLUSION: This study advocates for routine echocardiographic and cardiac examinations for all HD patients from the treatment's onset, irrespective of symptoms. Maintaining optimal volume, nutrition, urate concentrations, and hemoglobin is crucial for comprehensive cardiac care in this population. Additionally, exploring whether interventions targeting these non-cardiac factors could alleviate symptoms and improve quality of life in symptomatic HD patients would be worthwhile.

Polistemi Vera ve Esansiyel Trombositemi Tanısı Alan Hastalarda Elektrokardiyografik ve Ekokardiyografik Bulgularının Değerlendirilmesi

Background/Aims: Polycythemia vera (PV) and essential thrombocythemia (ET) are chronic myeloproliferative diseases. Along with the increase in myeloproliferative cell lines, they can cause various clinical outcomes such as arterial and venous thrombosis, pulmonary hypertension, and myocardial infarction. This study was designed to evaluate the cardiac effects of these diseases via electrocardiography and echocardiography. Methods: A total of 50 patients with a diagnosis of PV, 50 patients with a diagnosis of ET, and 50 healthy individuals as a control group were included in this study. Data on patient demographics were recorded in all subjects. All patients and control subjects had electrocardiography (ECG) recordings and routine transthoracic echocardiographic examination. Pulse wave velocity (PWV) was assessed with a Holter blood pressure device. Results: In total, 50 PV patients, 50 ET patients, and 50 control group were included in the study. The demographic characteristics of the PV, ET and control groups were similar. The PR interval was significantly shorter in control subjects than in PV and ET patients (p:0.007, p:0.024). Although the measured values were within normal limits, diastolic posterior wall thickness was significantly lower in the control group compared to PV and ET patients (p:0.019, p:0.009). PWV was significantly higher in ET patients compared to the control group (p:0.012). Conclusion: In this study, evaluating the effects of PV and ET on electrocardiography and transthoracic echocardiography; ECG parameters used to predict ventricular arrhythmias (QT, QTc, Tp-Te, Tp-Te/QT) and Pulmonary Artery Pressure showed no significant change, in opposition to existing literature. Nonetheless, similar to previous publications, PV and ET were found to negatively affect the diastolic function parameters on transthoracic echocardiography. While the aortic stiffness was significantly higher in ET patients compared to the control group, no significant difference was noted between PV patients and control subjects in terms of aortic stiffness.

Prenatal Detection and Postnatal Outcome of Persistent Left Superior Vena Cava and Agenesis of Ductus Venosus Associated with Postnatal Bovine Aortic Arch.

Isolated agenesis of ductus venosus (ADV) is usually a benign condition, but it may be associated with cardiovascular defects, hydrops, growth restriction, and chromosomal abnormalities. Additionally, persistent left superior vena cava (PLSVC) and bovine aortic arch are relatively common fetal anomalies. To the author's knowledge, this is the first report of prenatal detection of DV agenesis and PLSVC associated with the postnatal bovine aortic arch with a hypoplastic transverse aortic arch. A 25-year-old, G2P1 woman was referred to our department at 31 weeks due to fetal growth restriction and short femur. On fetal echocardiography, DV could not be viewed via two-dimensional (2D) and Doppler ultrasound (US) imaging; there was also evidence of the co-occurrence of PLSVC and an aortic arch anomaly. We revealed the intrahepatic continuation of the umbilical vein. A weekly follow-up program was scheduled for the patient and the rest of the pregnancy was uneventful. Postnatal, thorax computer tomography and transthoracic echocardiography (TTE) demonstrated PLSVC and bovine aortic arch associated with hypoplastic transverse aortic arch. Routine echocardiographic examinations revealed that the blood flow of the aortic arch had increased gradually, and the male infant's aortic arch had significantly widened and reached the normal range until the baby was discharged from the hospital. DV agenesis and PLSVC are usually benign conditions but underlying serious heart diseases may accompany them. Therefore, in situations like ours, a prenatal aortic arch evaluation is of capital importance. Postnatal hemodynamic changes should be taken into consideration in the management of these cases. This is the first example in the literature that these abnormalities co-existed in one case.

Routine Abdominal Aortic Examination During Echocardiographic Studies Detects Significant Numbers of Abdominal Aortic Aneurysm and Should be a Part of Routine Echocardiographic Examinations.

Early detection and follow-up of abdominal aortic aneurysm (AAA) are important and can be lifesaving. The goal of this study was to evaluate if routine abdominal aorta screenings during echocardiograms can be helpful in detecting asymptomatic abdominal aortic aneurysm. We retrospective studied consecutive patients who were sent for outpatient routine echocardiograms for various clinical reasons in 2015-2017 until we reached a total of 1000 patients. Starting from the subcostal and then proceeding to the abdomen, a long-axis screening of the abdominal aorta was attempted on all of the patients after the echocardiogram was completed. No patient preparation was given. Imaging began from the subcostal view and proceeded caudally with images obtained every 1-2 cm. Measurement of the aortic diameter was performed from the longitudinal plane using the leading-edge-to-leading-edge method. The age range was 33-96 years with a median age of 72.4. A total of 273 (27.3%) patients did not have an appropriate window to evaluate AAA. Among the remaining 727 screenings, 18 (2.4%) had dilatation of abdominal aorta or AAA. The dilatation and aneurysms ranged between 2.5 and 4.5 cm in size. Abnormal aortic diameters were as follows: 5 (27.7%) were between 2.5 and 2.9 cm, 6 (33.3%) between 3 and 3.4 cm, 1 (5.5%) between 3.5 and 3.9, 5 (27.7%) between 4.0 and 4.4 cm, and 1 (5.5%) between 4.5 and 4.9 cm. Performing routine abdominal aortic examinations during routine echocardiographic exams can detect a significant amount of abdominal aortic aneurysm which can be lifesaving. We suggest adding abdominal aortic assessment to routine echocardiographic examination.

Preoperative echocardiography in patients with hip fracture: a prospective cohort study.

Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the present investigation was to assess whether preoperative echocardiography affects time to surgery, length of hospital stay (LOS), and in hospital mortality in high-risk patients who need surgery for a hip fracture. In the study entered 255 consecutive patients with hip fracture referred to a multidisciplinary hip fracture unit. Seven hundred seventeen patients referred before the implementation of routine echocardiographic examination were considered as control group. Echocardiography was performed in patients with systolic murmurs, unstable clinical conditions, recent decompensation of heart failure or hospital admission for coronary disease. Time to surgery, LOS, and in hospital mortality in patients who underwent preoperative echocardiography (high-risk group) were compared with patients who did not undergo echo (low-risk group) and with the control group. 122/255 patients underwent echocardiography. The two groups did not differ for age, sex, type or fracture, and notably time to surgery and LOS. Coronary heart disease, atrial fibrillation, and two or more comorbidities were more frequent in the echo group. Overall clinical characteristics were not different from group of patients referred before the implementation of the echocardiographic protocol but in these last patients time to surgery and LOS were significantly longer. As well in hospital mortality was not significantly different in the two groups (1.9 in echo vs. 1.7% in nonecho) but lower than in the control group (4.1% ). An echocardiographic guide may be useful in a high-risk group with a hip fracture to choose the proper anesthetic setting, referral for intensive care observation after surgery and, optimal medical treatment, including fluid management without delay in time to surgery.

Increased Left Atrial Stiffness is Significantly Associated with Paroxysmal Atrial Fibrillation in Diabetic Patients.

Atrial fibrillation (AF) and diabetes mellitus (DM) are common pathogenic diseases. Diabetes is an independent risk factor for AF, and coexisting AF is a risk factor for the diabetic pa-tient's progression. The purpose of this study was to see if two-dimensional-speckle tracking echocardiography (2D-STE) might provide valuable criteria for determining the risk of AF in diabetic patients. This retrospective study compared 30 adult diabetic patients with documented paroxysmal atrial fibrillation (PAF) with 30 age- and sex-matched diabetic patients without PAF. Inclusion criteria were: age ≥18 years, sinus rhythm, diabetes mellitus type 2, and the ability to sign the informed consent. Exclusion criteria included: moderate or severe valvular disease, previous myocardial infarction, left ventricular ejection fraction (LVEF) <50%, congenital heart disease, a history of cardiac surgery, paced atrial or ventricular rhythm, inadequate echocardiography imaging. The medical history, clinical, biochemical data and the results of the transthoracic cardiac ultrasound examination were registered during their evaluation at the outpatients cardiology clinics. The mean age of the patients was 62.5±1.7 years, 60% were men. Diabetic patients who experienced PAF episodes demonstrated significantly impaired left atrial (LA) deformation patterns, with decreased LA strains and increased LA stiffness (p < 0.05). The present study demonstrates that LA strains and LA stiffness are significantly associated with the occurrence of PAF in diabetic patients. As 2D-STE of the LA is more sensitive than routine echocardiographic examination, it should be performed in patients suspected of being suffering from PAF.

Benefits of 4-tiered classification of exercise-induced left ventricular hypertrophy in adolescent athletes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovation and Technology Ministry Hungary - National Research, Development and Innovation Office (Innovációs és Technológiai Minisztérium - Nemzeti Kutatási, Fejlesztési és Innovációs Hivatal Hungary. Introduction Exercise-induced left ventricular hypertrophy (LVH) is widely investigated in adolescent athletes characterized by 2-tiered classification (2TC). Though, the differentiation of normal adaptive changes from pathological LVH can be challenging. 4-tiered classification (4TC) may discriminate better different forms of exercise-induced LVH providing three-dimensional information of the left ventricle (LV). Purpose, methods The main objective of our study was to distinguish alterations between 2TC and 4TC examining 121 adolescent athletes with echocardiography. Moreover, these results were also compared to the matched LV parameters of 114 adult athletes. Results Examining the 4TC allocation representing parameters (LV mass, LV mass/BSA, LV end-diastolic volume/BSA, concentricity) of the adolescent and adult athletes we identified significant differences (p&amp;lt; 0,05) between the different LVH groups and normal geometry, suggesting that the applied classification provides proper group distinguishing power. There were no significant differences between the cumulative training times of the different LVH groups (p &amp;gt;0,05). Furthermore, the BSA corrected LV parameters did not show any correlation with training time. Totally 25 athletes (22%) were reclassified in 4TC into completely different groups, highlighted the 6 athletes (5%) reclassified from normal geometry to concentric LVH and the 11 adolescent (9%) reclassified from normal to eccentric LVH. The reclassifications rate showed similar pattern in adult athletes. Conclusion Based on all these data we assume that training time has no significant impact on the classification. Cardiac remodeling develops already in young age, and further training time has less impact on the adaptive changes. We prefer to apply 4TC in the routine echocardiographic examination of endurance athletes to specify a more sensitive and distinct screening method.

P193 A MYXOMA IN THE LEFT ATRIUM ADHERENT TO THE INTERATRIAL SEPTUM

Abstract A 73–year–old woman came to our observation to perform a routine echocardiographic examination. The patient had arterial hypertension, dyslipidemia, hypothyroidism, and paroxysmal atrial fibrillation. She underwent a bilateral mastectomy for breast cancer about 5 years ago, and she was undergoing chemotherapy and radiation therapy for a stage IV lung adenocarcinoma. The clinical evaluation was normal, as was the electrocardiogram. The transthoracic echocardiographic evaluation showed the presence of a rounded formation with variable echogenicity, with an irregular surface (4 x 3 cm), adherent to the interatrial septum at the level of the fossa ovalis, which did not hinder the excursion of the mitral valve. No other significant cardiac abnormalities were detected.Transesophageal echocardiography confirmed the presence of atrial mass adhered to the oval fossa (panels A, B). of coarsely rounded shape, and variable echogenicity, in the absence of interference with the movement of the valve leaflets and of anomalies of the interatrial septum (panel C). Coronary angiography showed right–dominant coronary circulation (panel D) and mild stenosis of the mid–left anterior descending artery. Abundant arterial perfusion of the atrial mass, with several vessels originating from the circumflex artery, was also evident at the coronary angiography (panels E, F). The patient underwent cardiac surgery; the surgical exeresis of the left atrial mass was performed through right mini–thoracotomy (panels I and L). Because the neo–formation was adherent not only to the atrial septum but also to the left atrial roof, to obtain a radical excision, a large portion of the atrial wall and the septum were removed and totally reconstructed with the pericardium. The main artery supplied the mass–related vascular network was ligated. The postoperative course was uneventful, and the patient was discharged at home on day six. The pre–discharge echocardiography and the cardiac magnetic resonance ( panels G, H) showed the absence of any residual mass in the left atrium that appears anatomically reshaped, no shunt at the level of the interatrial septum, and preserved ventricular function of both ventricles. Histological analysis confirmed the diagnosis of atrial myxoma. At the six–month follow–up the patient was asymptomatic and the echocardiography was superimposable to discharge.

Echocardiography in acute stroke patients: a nationwide analysis in departments with certified stroke units in Germany

BackgroundEchocardiography is highly relevant in patients with ischemic stroke or TIA. Utilization of routine echocardiographic examinations [transthoracic (TTE) or transesophageal (TEE)] on stroke units remains however unknown. To representatively examine echocardiographic rates on stroke units in Germany and to evaluate structural factors that may influence the decision to conduct echocardiography.MethodsA nationwide analysis was performed by using certification audit data of all primary and comprehensive stroke centers (pSC and cSC) in Germany.ResultsStructural and organizational requirements of 310 departments (cSCs: 42.6%) were extracted. Median TTE rate was 63.3% (IQR 39.3–80.8), median TEE rate 21.3% (IQR 16.4–29.5). A cardiological department on site was present in 74.2%, and they were associated with higher TEE rates. TTE rates decreased with increasing numbers of patients (p = 0.026). Likewise, TEE rates decreased with increasing numbers of patients (p = 0.006), mediated by departments with cSCs (p = 0.008 for cSCs vs p = 0.230 for pSCs). TTE rates were far more inhomogeneously distributed than TEE rates and higher in pSCs (p = 0.011). Overall, 12.9% of centers did not perform any echocardiographic examination in at least 50% of all stroke patients.ConclusionMore detailed recommendations regarding echocardiography should be included in future guidelines. Moreover, evaluating the impact of echocardiographic examinations on long-term prognosis in stroke patients should be focus of further evaluations.

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery.

Hepatic venous flow patterns reflect pressure changes in the right ventricle and are also markers of systemic venous congestion. Fluid management is crucial in patients undergoing cardiac surgery. Our goal was to determine which factors are associated with the increased congestion of the liver as measured by Doppler ultrasound in patients undergoing cardiac surgery. This prospective, observational study included 41 patients without preexisting liver disease who underwent cardiac surgery between 1 January 2021 and 30 September 2021 at a tertiary heart center. In addition to routine echocardiographic examination, we recorded the maximal velocity and velocity time integral (VTI) of the standard four waves seen in the common hepatic vein (flow profile) using Doppler ultrasound preoperatively and at the 20-24th hour of the postoperative period. The ratios of the retrograde and anterograde hepatic venous waves were calculated, and the waveforms were compared to the baseline value and expressed as a delta ratio. Demographic data, pre- and postoperative echocardiographic parameters, intraoperative variables (procedure, cardiopulmonary bypass time), postoperative factors (fluid balance, vasoactive medication requirement, ventilation time and parameters) and perioperative laboratory parameters (liver and kidney function tests, albumin) were used in the analysis. Of the 41 patients, 20 (48.7%) were males, and the median age of the patients was 65.9 years (IQR: 59.8-69.9 years). Retrograde VTI growth showed a correlation with positive fluid balance (0.89 (95% CI 0.785-0.995) c-index. After comparing the postoperative echocardiographic parameters of the two subgroups, right ventricular and atrial diameters were significantly greater in the "retrograde VTI growth" group. The ejection fraction and decrement in ejection fraction to preoperative parameters were significantly different between the two groups. (p = 0.001 and 0.003). Ventilation times were longer in the retrograde VTI group. The postoperative vs. baseline delta VTI ratio of the hepatic vein correlated with positive fluid balance, maximum central venous pressure, and ejection fraction. (B = -0.099, 95% CI = -0.022-0.002, p = 0.022, B = 0.011, 95% CI = 0.001-0.021, p = 0.022, B = 0.091, 95% CI = 0.052-0.213, p = 0.002, respectively.) Conclusion: The increase of the retrograde hepatic flow during the first 24 h following cardiac surgery was associated with positive fluid balance and the decrease of the right ventricular function. Measurement of venous congestion or venous abdominal insufficiency seems to be a useful tool in guiding fluid therapy and hemodynamic management.

Feasibility and Time Analysis of Three-Dimensional and Myocardial Deformation versus Conventional Two-Dimensional Echocardiography to Assess Cardiac Chambers

Currently, in most laboratories, speckle-tracking deformation imaging (strain) and three-dimensional echocardiography (3DE) analyses are not part of the routine echocardiographic examination. Although these techniques have been proven to be more accurate in the assessment of heart chamber geometry and function and provide additional prognostic value compared with conventional two-dimensional echocardiography (2DE), they are still perceived as being time-consuming. 1 Lang R.M. Badano L.P. Mor-Avi V. Afilalo J. Armstrong A. Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28: 1-39.e14 Abstract Full Text Full Text PDF PubMed Scopus (6784) Google Scholar , 2 Potter E. Marwick T.H. Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging. 2018; 11: 260-274 Crossref PubMed Scopus (282) Google Scholar , 3 Thomas L. Muraru D. Popescu B.A. Sitges M. Rosca M. Pedrizzetti G. et al. Evaluation of left atrial size and function: relevance for clinical practice. J Am Soc Echocardiogr. 2020; 33: 934-952 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar , 4 Gavazzoni M. Badano L.P. Vizzardi E. Raddino R. Genovese D. Taramasso M. et al. Prognostic value of right ventricular free wall longitudinal strain in a large cohort of outpatients with left-side heart disease. Eur Heart J Cardiovasc Imaging. 2020; 21: 1013-1021 Crossref PubMed Scopus (23) Google Scholar Recently, new automated on-cart tools have been demonstrated to perform accurate, fast, and reproducible strain and 3DE analyses of the heart chambers. 5 Narang A. Mor-Avi V. Prado A. Volpato V. Prater D. Tamborini G. et al. Machine learning based automated dynamic quantification of left heart chamber volumes. Eur Heart J Cardiovasc Imaging. 2019; 20: 541-549 Crossref PubMed Scopus (47) Google Scholar ,6 Genovese D. Rashedi N. Weinert L. Narang A. Addetia K. Patel A.R. et al. Machine learning–based three-dimensional echocardiographic quantification of right ventricular size and function: validation against cardiac magnetic resonance. J Am Soc Echocardiogr. 2019; 32: 969-977 Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar However, their time consumption compared with conventional 2DE remains to be demonstrated.

Tricuspid Annular Abnormalities in Isolated Left Ventricular Non-compaction-Insights From the Three-dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study.

IntroductionProminent trabecular left ventricular (LV) meshwork and deep intertrabecular LV recesses are featuring LV non-compaction (LVNC). The aim of this study was to evaluate tricuspid annular (TA) morphological and functional abnormalities by three-dimensional speckle-tracking echocardiography (3DSTE) in patients with LVNC without right ventricular (RV) involvement.Materials and MethodsThis study consisted of 21 patients with isolated LVNC, from which 6 cases were excluded due to inferior image quality. The remaining patient group consisted of 15 subjects with a mean age of 52.1 ± 11.4 years (9 males). LVNC was defined according to the Jenni's criteria. Their results were compared to 21 age- and gender-matched healthy controls (mean age: 52.4 ± 3.9 years, 14 males). Complete routine 2-dimensional Doppler echocardiographic examination was performed in all the patients with isolated LVNC and healthy controls. End-systolic and end-diastolic TA dimensions were assessed on selected planes derived from full-volume 3D echocardiographic datasets during 3DSTE.ResultsPatients with isolated LVNC showed significantly dilated end-systolic and end-diastolic TA diameter and area, which were accompanied with preserved TA functional properties and associated with right atrial (RA) volumes. TA plane systolic excursion (TAPSE) showed mild correlations with TA fractional area change (TAFAC) and TA fractional shortening (TAFS). No correlations could be demonstrated between TAPSE and TA morphological features. Extent of LVNC did not correlate with any echocardiographic parameters.ConclusionTA is dilated with preserved sphincter-like function in patients with isolated LVNC. Longitudinal (TAPSE) and sphincter-like (TAFAC and TAFS) TA movements correlate with each other. TA dilation is associated with an increased RA volumes respecting cardiac cycle.

P106 A LEFT GIANT MYXOMA WITH A NOTABLE NEOVASCULARIZATION

Abstract A 73–year–old asymptomatic woman came to our observation to perform a routine echocardiographic examination. The patient suffered from arterial hypertension, dyslipidemia, hypothyroidism, paroxysmal atrial fibrillation. She underwent a bilateral mastectomy for breast cancer about 5 years ago, and she was undergoing chemotherapy and radiation therapy for a stage IV lung adenocarcinoma. The clinical evaluation was normal, as was the electrocardiogram. Transthoracic echocardiographic evaluation showed the presence of a rounded formation with variable echogenicity, with an irregular surface (4 x 3 cm), adherent to the interatrial septum at the level of the fossa ovalis, which did not hinder the excursion of the mitral valve. No other significant cardiac abnormalities were detected. Tansesophageal echocardiography confirmed the presence of atrial mass adhered to the oval fossa (panels A, B). of coarsely rounded shape, and variable echogenicity, in the absence of interference with the movement of the valve leaflets and of anomalies of the interatrial septum (panel C). Coronary angiography showed a right–dominant coronary circulation (panel D) and a mild stenosis of the mid left anterior descending artery. An abundant arterial perfusion of the atrial mass, with several vessels originating from the circumflex artery was also evident at the coronary angiography (panels E, F). The patient underwent cardiac surgery; the surgical exeresis of the left atrial mass was performed through right mini thoracotomy. Because the neo–formation was adherent not only to the atrial septum but also to the left atrial roof, to obtain a radical excision, a large portion of the atrial wall and the septum were removed and totally reconstructed with the pericardium. The main artery supplied the mass related vascular network was ligated. The post–operative course was uneventful, and the patient was discharged at home on day six. The pre–discharge echocardiography showed absence of any residual mass in left atrium that appear anatomically reshaped, no shunt at level of interatrial septum, preserved ventricular function of both ventricles. Histological analysis confirmed the diagnosis of atrial myxoma. At six–month follow–up the patient was asymptomatic and the echocardiography was superimposable to discharge.

Association between Preoperative Retrograde Hepatic Vein Flow and Acute Kidney Injury after Cardiac Surgery.

Key questions: Is there a predictive value of hepatic venous flow patterns for postoperative acute kidney injury (AKI) after cardiac surgery? Key findings: In patients who underwent cardiac surgery, retrograde hepatic venous waves (A, V) and their respective ratio to anterograde waves showed a strong association with postoperative AKI, defined as the percentage change of the highest postoperative serum creatinine from the baseline preoperative concentration (%ΔCr). The velocity time integral (VTI) of the retrograde A wave and the ratio of the retrograde and anterograde waves’ VTI were independently associated with AKI after adjustment for disease severity. Take-home message: A higher ratio of retrograde/antegrade waves in hepatic venous retrograde waves, which are related to hepatic stasis, may predict AKI after cardiac surgery. Introduction: Hepatic venous flow patterns reflect pressure changes in the right ventricle and are also markers of systemic venous congestion. Pulsatility of the inferior caval vein was used to predict the risk of acute kidney injury (AKI) after cardiac surgery. Aims: Our objective was to evaluate the association between preoperative hepatic venous flow patterns and the risk of AKI in patients after cardiac surgery. Methods: This prospective, observational study included 98 patients without preexisting liver disease who underwent cardiac surgery between 1 January 2018, and 31 March 2020, at a tertiary heart center. In addition to a routine echocardiographic examination, we recorded the maximal velocity and velocity time integral (VTI) of the standard four waves in the common hepatic vein with Doppler ultrasound. Our primary outcome measure was postoperative AKI, defined as the percentage change of the highest postoperative serum creatinine from the baseline preoperative concentration (%ΔCr). The secondary outcome was AKI, defined by KDIGO (Kidney Disease Improving Global Outcomes) criteria. Results: The median age of the patients was 69.8 years (interquartile range [IQR 25–75] 13 years). Seventeen patients (17.3%) developed postoperative AKI based on the KDIGO. The VTI of the retrograde A waves in the hepatic veins showed a strong correlation (B: 0.714; p = 0.0001) with an increase in creatinine levels after cardiac surgery. The velocity time integral (VTI) of the A wave (B = 0.038, 95% CI = 0.025–0.051, p < 0.001) and the ratio of VTI of the retrograde and anterograde waves (B = 0.233, 95% CI = 0.112–0.356, p < 0.001) were independently associated with an increase in creatinine levels. Conclusions: The severity of hepatic venous regurgitation can be a sign of venous congestion and seems to be related to the development of AKI.

Measures of left atrial function predict incident heart failure in a low-risk general population: the Copenhagen City Heart Study.

This study investigated left atrial (LA) parameters as measured on transthoracic echocardiography as predictors of incident heart failure (HF) in a community cohort. In a large general population study (n=2221), participants underwent a health examination with echocardiography. The maximum and minimum LA volumes indexed to body surface area (LAVImax and LAVImin) were measured and the LA emptying fraction (LAEF) and LA expansion index (LAEI) were calculated. Among 1951 participants without atrial fibrillation or significant valve disease, the mean age was 59 ± 16 years and 58% were women. At baseline, 1% (n=16) had a left ventricular ejection fraction of <50%, 44% had hypertension, and 10% had diabetes. During follow-up (median 15.8 years, interquartile range: 11.3-16.2 years), 187 (10%) participants were diagnosed with incident HF. Participants who were diagnosed with HF during follow-up had a larger LAVImax and LAVImin and a lower LAEF and LAEI compared to participants without HF. In unadjusted analysis, LAVImax, LAVImin, LAEF and LAEI were predictors of incident HF. After multivariable adjustment for clinical and echocardiographic parameters, only LAVImin remained an independent predictor of incident HF (hazard ratio per 1 standard deviation increase: 1.22 [95% confidence interval 1.01-1.47], p=0.038). In the general population, LAVImin is an independent predictor of incident HF. LAVImax, currently the only LA measure in a routine echocardiographic examination, was not an independent predictor of incident HF.

Focus on normal structures and normal variants easily missed on routine echocardiographic examination

超音波検査のルーチン検査では，施設間で多少の違いはあるものの描出すべき断面とそこで見るべき構造物が決まっている．心エコー図検査業務に慣れ一通りの異常所見を経験すると，ルーチン画像を描出することに集中するあまり，しばしば描出している断面における心血管とその周囲にある臓器との空間的な位置関係を考えずに検査を行うことがある．これでは，何気なく見えている正常所見を認識できておらず，予想外の構造物や血流等に遭遇した際，正常と異常との鑑別が困難になることを経験する．本稿では，心エコー図検査で見逃しやすい正常構造物（所見）および健常者にも見られる正常亜型と考えられる所見について概説する．

The Use of Two Dimensional Speckle Tracking Echocardiography in Veterinary Cardiology

The aim of this study is to present short-axis radial and circumferential strain and strain rate measurements by speckle tracking echocardiography technique in healthy cats and dogs. The study was performed at Small Animal Training and Research Hospital, Ankara University. Retrospective data from cats (n=5) and dogs (n=5), which are applied to the animal hospital for cardiological examination, were analyzed. Two-dimensional speckle tracking echocardiography was performed without sedation, and patients were manually restrained in the right and left lateral positions. Peak systolic radial strain, radial strain rate, circumferential strain, circumferential strain rate means were 24.47 ± 1.22%, 0.29 ± 0.20 s-1, -15.33 ± 2.56%, 0.05 ± 0.27 s-1 respectively for cats and were 39.33 ± 14.02%,-0.47s -1 ± 0.55 s-1, -23.13 ± 1.53%, -0.63 s-1± 0.18 s-1 respectively for dogs. It is thought that speckle tracking echocardiography can be included in routine echocardiographic examinations because this technique provides detailed information for determining the systolic potential of the left ventricle and the examination time is not much different compared to conventional echocardiographic examinations.

Tricuspid annular abnormalities in isolated left ventricular noncompaction – a three-dimensional speckle-tracking echocardiographic study

Abstract Introduction Left ventricular (LV) noncompaction (LVNC) is a rare cardiomyopathy due to arrest of the normal maturation process of the myocardium. It is characterized by prominent LV trabecularization with deep intratrabecular recesses. In most of cases LVNC is isolated, but biventricular forms are also known. The tricuspid valve is a complex anatomical structure which incorporates the three-dimensional (3D) saddle-shaped fibrosus annulus (TA). 3D speckle-tracking echocardiography (STE) is a novel non-invasive imaging method with capability of not only measuring volumetric, strain and rotational parameters of heart chambers, but with finding optimal valvular planes in the 3D space evaluation of TA dimensions respecting cardiac cycle is allowed. The present study was designed to assess TA morphological and functional abnormalities by 3DSTE in LVNC patients without right ventricular (RV) involvement. Methods The present study consisted of 15 patients with LVNC (mean age: 52.1±11.4 years, 9 males). LVNC was defined according to the Jenni's criteria. Their results were compared to 21 age- and gender-matched healthy controls (mean age: 52.4±3.9 years, 14 males). Complete routine 2-dimensional Doppler echocardiographic examination with 3DSTE was performed in all LVNC patients and healthy controls. Results Enlarged left atrial and LV dimensions with reduced LV ejection fraction could be seen in LVNC patients. The mean number of noncompacted segments proved to be 6.9±2.0. Grade 1 and 2 mitral regurgitation (MR) could be demonstratred in 5 and 5 LVNC patients, respectively. Higher grade of MR could not be found. Grade 1 and 2 tricuspid regurgitation (TR) could be demonstrated in 4 and 1 LVNC patients, respectively. Only one LVNC patient has grade 4 TR. Tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RV-FAC) proved to be 13.9±3.9 mm and 34.1±2.7%, respectively. LVNC patients showed significantly dilated end-diastolic and end-systolic TA diameter (2.6±0.3 cm vs. 2.2±0.3 cm, p&amp;lt;0.05 and 2.2±0.2 cm vs. 1.8±0.3 cm, p&amp;lt;0.05, respectively), area (8.4±1.7 cm2 vs. 7.0±1.5 cm2, p&amp;lt;0.05 and 6.5±1.7 cm2 vs. 5.3±1.4 cm2, p&amp;lt;0.05, respectively) and tendentiously larger perimeter (11.2±1.4 cm vs. 10.5±1.2 cm, p=ns and 9.8±1.5 cm vs. 8.9±1.0 cm, p=ns, respectively), which was accompanied with tendentiously lower TA functional properties represented by TA fractional area change (TAFAC, 22.2±12.3% vs. 23.7±11.7%, p=ns) and TA fractional shortening (TAFS, 15.9±5.6% vs. 18.8±8.0%, p=ns). TAPSE and RV-FAC showed mild correlations with TAFAC (r=0.39, p=0.05; r=0.36, p=0.05, respectively) and TAFS (r=0.37, p=0.05; r=0.38, p=0.05). Extent of LV noncompaction did not correlate with any echocardiographic parameters. Conclusions TA is dilated in LVNC patients without obvious RV involvement. Longitudinal (TAPSE) and sphincter-like (TAFAC, TAFS) TA motions correlate with each other. Funding Acknowledgement Type of funding sources: None.