Short-axis Method Research Articles

Comparison of ante- and postmortem ventricular wall thickness using echocardiography and autopsy findings.

In autopsy practice, the thickness of ventricular walls is one of the parameters used to identify cardiac hypertrophy. The presented study aimed to compare ante- and postmortem measurements of ventricular wall thickness, (i) to determine a postmortem standardized localization and dissection method for ventricular wall measurements, and (ii) to determine the ability of postmortem measurements in recognition of antemortem hypertrophy. A single-center prospective study was conducted at the Institute of Legal Medicine in Hamburg, Germany. Sixty hearts were dissected alternating by the inflow-outflow or short-axis method, and the ventricular walls were measured at different locations and compared with the echocardiographic values of the end-diastolic phase during life of these individuals. The results showed measurement differences between the autoptic and echocardiographic values-for the left ventricle between 3.3 and 5.2mm, for the right ventricle between 0.2 and 1.1mm, and for the septum between 1.3 and 1.4mm. Diagnostic performance of recognizing antemortem hypertrophy with postmortem measurement was poor, except for measuring the right ventricle and septum with the short-axis method (area under the ROC curve of 0.72 and 0.82, respectively). According to the results, cardiac changes may occur postmortem and need to be considered when used for diagnosing cardiac pathology. The postmortem diagnosis of left or right ventricular hypertrophy should always be made in conjunction with other, particularly cardiac, autopsy findings. An autoptic diagnosis of hypertrophy solely by a ventricular wall thickness > 15mm or > 5mm alone is not sufficient.

Thyroid US-guided FNA techniques: A prospective,randomized controlled study

BackgroundThyroid nodules are common in the general population. Ultrasonography is the most efficient diagnostic approach to evaluate thyroid nodules. The US FNAC procedure can be performed using either the short axis (perpendicular), or a long axis (parallel) approach to visualize the needle as it is advanced toward the desired nodule. The main aim of this study was to compare the percentage of non-diagnostic results between the long and short axis approach. MethodsA prospective study that included a randomized controlled trial and was divided into two arms—the short axis and the long axis—was conducted. A total of 245 thyroid nodules were collected through the fine needle aspiration cytology, performed with ultrasound, from march 2021 to march 2022. The patient's demographic information were collected and also nodules characteristics. ResultsOf 245 nodules sampled, 122 were sampled with the long axis method, while 123 with the short axis method. There is not significantly less non diagnostic approach with either method compared to the other (11.5 % vs 16.3 % respectively). DiscussionPrevious studies came to the conclusion that the long axis method yields fewer non diagnostic samples. This study evaluated the two FNA approaches which were proceeded by the same physician who is expert in both techniques. ConclusionThe US FNAC performed in the long axis approach will not produce more conclusive results and less non diagnostic results (Bethesda category 1) than the short axis approach one.

Heart weight must not be measured before dissection during autopsies

During autopsies, weighing the heart is a standard procedure. In addition to myocardial pathologies, heart size, and ventricular wall thickness, heart weight is a common parameter to describe cardiac pathology and should be recorded as accurately as possible. To date, there exists no standard for recording heart weight at autopsy, although some authors recommend weighing the heart after dissection and removal of blood and blood clots. In the study presented, the hearts of 58 decedents were weighed after being dissected out of the pericardial sac (a), after dissection using the short-axis or inflow-outflow method with manual removal of blood and blood clots (b), and after rinsing and drying (c). Depending on the dissection method, the heart weight was 7.8% lower for the inflow-outflow method and 11.6% lower for the short-axis method after dissection compared to before and correspondingly 2.9% to 5% lower again after rinsing and drying respectively. Accordingly, the heart should be dissected, blood and blood clots removed, rinsed with water, and dried with a surgical towel after dissection, before weighing.

Assessment of Left Ventricular Systolic Function by Cardiovascular Magnetic Resonance Compressed Sensing Real-Time Cine Imaging Combined With Area-Length Method in Normal Sinus Rhythm and Atrial Fibrillation

BackgroundThe most-commonly used multi-slice Simpson's method employed with routine two-dimensional segmented cine images makes it difficult to evaluate left ventricular (LV) volume and function due to endocardial border blurring and beat-to-beat variation during atrial fibrillation (AF) status.ObjectivesTo assess the feasibility of compressed sensing real-time (CSRT) cine imaging combined with an area-length method for quantification of LV systolic function in normal sinus rhythm (NSR) and AF.MethodsThe CSRT cine sequence and routine segmented balanced Steady-State-Free-Precession cine sequence were performed in 71 patients with NSR (n = 36) or AF (n = 35). Image quality and edge sharpness for both sequences were assessed. The LV functional measurements in patients with NSR included end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), cardiac index (CI), and LV mass (LVM); all were assessed using segmented cine with Simpson's rule in short axis (SegSA_Simpson, as a reference standard) and area-length (AL) method in the two chamber (Seg2CH_AL) or four chamber (Seg4CH_AL) and CSRT cine with AL method in the two chamber (CSRT2CH_AL) or four chamber (CSRT4CH_AL). Finally, the mean, maximum, and minimum values of each LV functional parameter [EDV/ESV/SV/EF/CO/CI/LVM/heart rate (HR)] from 4~5 consecutive heartbeats were measured using CSRT2CH_AL in patients with AF.ResultsIn patients with NSR, measurements of EDV (p > 0.05), ESV (p > 0.05), SV (p > 0.05), EF (p > 0.05), and LVM (p > 0.05) assessed with CSRT2CH_AL did not differ significantly from those obtained with SegSA_Simpson. In patients with AF, CSRT image quality score (p < 0.001) and edge sharpness (p < 0.001) both were significantly higher than those obtained from segmented cine. The CSRT2CH_AL provided significantly different results among mean, maximum, and minimum values of each LV parameter from 4~5 consecutive heartbeats (all p < 0.001) with strong inter- and intra-observer agreement in AF.ConclusionsThe CSRT cine sequence combined with two chamber area-length analysis accurately assessed LV systolic function in NSR. This approach is expected to permit the assessment of multiple parameters in consecutive heartbeats with good inter- and intra-observer reproducibility for beat-to-beat analysis of LV function in AF.

Right ventricular strain and volume analyses through deep learning-based fully automatic segmentation based on radial long-axis reconstruction of short-axis cine magnetic resonance images.

We propose a deep learning-based fully automatic right ventricle (RV) segmentation technique that targets radially reconstructed long-axis (RLA) images of the center of the RV region in routine short axis (SA) cardiovascular magnetic resonance (CMR) images. Accordingly, the purpose of this study is to compare the accuracy of deep learning-based fully automatic segmentation of RLA images with the accuracy of conventional deep learning-based segmentation in SA orientation in terms of the measurements of RV strain parameters. We compared the accuracies of the above-mentioned methods in RV segmentations and in measuring RV strain parameters by Dice similarity coefficients (DSCs) and correlation coefficients. DSC of RV segmentation of the RLA method exhibited a higher value than those of the conventional SA methods (0.84 vs. 0.61). Correlation coefficient with respect to manual RV strain measurements in the fully automatic RLA were superior to those in SA measurements (0.5-0.7 vs. 0.1-0.2). Our proposed RLA realizes accurate fully automatic extraction of the entire RV region from an available CMR cine image without any additional imaging. Our findings overcome the complexity of image analysis in CMR without the limitations of the RV visualization in echocardiography.

Compare the Efficacy and Safety of Modified Combined Short and Long Axis Method versus Oblique Axis Method for Right Internal Jugular Vein Catheterization in Adult Patients (The MCSLOA Trial): Study Protocol of a Randomized Controlled Trial.

BackgroundUltrasound-guided internal jugular vein (IJV) catheterization has become a standard procedure as it yields a higher success rate and fewer mechanical complications compared with an anatomical landmark technique. There are several common methods for ultrasound guidance IJV catheterization, such as short-axis out-of-plane, long-axis in-plane and oblique axis in-plane, but these technologies are still developing. It is important to further study the application of different ultrasound-guided IJV puncture techniques and find an effective and safe ultrasound-guided puncture technique.MethodsA China randomized, open-label, parallel, single center, positive-controlled, non-inferiority clinical trial will evaluate 190 adult patients undergoing elective surgery and need right jugular vein catheterization. Study participants randomized in a 1:1 ratio into control and experimental groups. The control group will take the oblique axis in-plane method for IJV catheterization. The experimental group will take the Modified combined short and long axis method. The primary endpoint of the trial is the rate of one-time successful guidewire insertion without posterior wall puncture (PWP). Secondary endpoints are the number of needle insertion attempts, the total success rate, the procedure time, and mechanical complications.ConclusionThis randomized controlled trial will evaluate the effectiveness and safety of Modified combined short and long axis method and oblique axis in-plane method for right IJV catheterization in adult patients.

Comparison of Success Rates of Different Methods of Ultrasound-Guided Radial Artery Cannulation (Short-Axis and Long-Axis Methods) Against the Traditional Palpatory Method: A Prospective Randomized Study.

ObjectiveRecent meta-analysis comparing the success rates of various methods of arterial cannulation in adult patients found heterogeneity in the available data. Hence, we did this study to evaluate and compare the success rate of palpatory method with that of ultrasound guided methods of radial artery cannulation. The aim is to compare the first-attempt success rate of the palpatory method with that of ultrasound-guided radial artery cannulation techniques, namely, the short-axis out-of-plane and the long-axis in-plane methods.MethodsThis is a prospective, randomized, parallel-arm study. Ninety patients aged from 18 to 50 years (presenting for various surgeries requiring radial artery cannulation for invasive blood pressure monitoring or frequent arterial blood gas analysis) were divided into 3 groups. Each group had one of the 3 techniques of radial arterial cannulation, namely palpatory, short-axis ultrasound method, and long-axis ultrasound method. The parameters analyzed were first-attempt success rate, number of attempts needed, cannulation time, need for crossover of technique, and incidence of complications. Multivariate analysis was done with one-way ANOVA, with Tukey's post hoc test. For categorical data, the chi-square test was used. The probability value of .05 was considered as a significant level.ResultsThe first-attempt success rate was 76.7% in the long-axis method, 86.7% in the short-axis method, and 56.7% in the palpatory method. The short-axis method has been shown to have a shorter cannulation time, fewer attempts needed for successful cannulation, and lower need for crossover of techniques when the first 2 attempts fail.Conclusions: We conclude that the ultrasound-guided short-axis method of radial artery cannulation is associated with higher first-attempt success rate compared to the traditional palpatory method.

HISTOMORPHOLOGICAL SPECTRUM OF VARIOUS CARDIAC CHANGES IN SUDDEN DEATH: AN AUTOPSYSTUDY

INTRODUCTION : Cardiovascular disease (including coronary artery disease, stroke and peripheral vascular disease) is no.1 cause of worldwide mortality, with about 80% of burden occurring in developing countries. Sudden cardiac death is dened as unexpected death from cardiac causes either without symptoms or within 1-24 hours of onset of symptoms(1). The common cause of sudden cardiac death is ischaemic heart disease. Non ischaemic sudden cardiac death occurs in hypertrophic obstructive cardiomyopathy and in severe left ventricular hypertrophy(2). The purpose of this study will be to determine the causes of sudden death and observe the spectrum of morphological and histopathological changes in heart after sudden death. MATERIALS AND METHODS: This autopsy study was conducted on 121 cases of sudden death over a period extending from January 2019 to August 2020 in autopsy section of Pathology department of BJGMC, Pune. In this autopsy study hearts of patients with a history of sudden death were evaluated for histological and morphological changes. Each heart was grossed adopting the inow outow method and short axis method. Staining solutions used were Solution A: Alum Hematoxylin and Solution B: 1% Eosin Y. OBSERVATIONS : 50 (41.32%) cases out of 121 cases had coronary artery disease along with myocardial infarction of which 43 cases were males and 7 cases were females. No cardiac aetiology was found in 23.96% cases. Coronary artery disease was independently seen in 14.87% cases. Left ventricular concentric hypertrophy was noted in 4.13% cases. Myocardial infarction independently was noted in 3.30%cases, Myocarditis in 2.47% cases, myocarditis with pericarditis in 1.65% cases, HOCM, lipoma, mitral stenosis, pericarditis, septic infarct, secondaries of adenocarcinoma, early vegetation and small vessel disease in 0.82% cases. Calcic aortic stenosis was demonstrated in 1 case. Brown atrophy was demonstrated in 1 case. DISCUSSION : Out of 69 cases of coronary artery disease calcication was commonly seen in 34(49.27%) cases. 47(82.45%) (M-39,l F-8) out of 57 cases of myocardial infarction demonstrated chronic or old infarct. Single vessel involvement was most common in which left anterior descending coronary artery was signicantly involved in 68.75 % cases. Posterior wall was most commonly involved by myocardial infarction which included posterior, posteroseptal, and posterolateral infarcts.

Evaluation and Comparison of Left Ventricular Functions by Cardiac MRI and 2D Transthoracic Echocardiography

It is important to measure left ventricular function (LVF) accurately in the diagnosis and follow-up of cardiovascular diseases. Different imaging algorithms and mathematical calculations have been developed for the evaluation of LVF in cardiac magnetic resonance imaging (MRI), and numerous studies are still being carried on this. In our study, LVF was calculated by two different measurement methods in MRI and were compared with transthoracic echocardiography (TTE) to assess the correlation and the consistency of these with TTE. In this study, 31 patients with left ventricular dysfunction due to different etiologies were evaluated with simultaneous TTE and MRI. In the Cine MR images, LVF parameters of ejection fraction, end-diastolic volume, end-systolic volume, and myocardial mass were measured using short axis images (short axis method) and short axis plus four chamber and two chamber images (combined method). The results were compared with the results from TTE. We found that the combined and the short axis-based calculations of ejection fraction, end-diastolic volume, end-systolic volume, and myocardial mass in cardiac MRI showed correlation and consistency with those calculated via echocardiography. We also determined that the short axis-based calculations in cardiac MRI showed better correlation with the echocardiography compared with the combined method. Because our results revealed that the cardiac MRI results obtained from the short axis method better correlate with the TTE, we recommend using short axis-based measurements in the evaluation left ventricular dysfunction.

A WIN for Safety and Efficacy: Evaluation of Developmental WINguide and Hybrid Guide for Wire-in-Needle Peripherally Inserted Central Line Catheter (PICC) Cannulation

Highlights Abstract Purpose/Design: This study was conducted to determine the efficacy of WINguide with the wire-in-needle (WIN) technique and the Hybrid Guide with hybrid technique (WT/HT) in effectively and safely achieving vein cannulation with a peripherally inserted central line catheter (PICC) guidewire on a simulation model. Methods: Two videos were watched. The first illustrates freehand modified Seldinger technique (MST) for PICC guidewire placement with ultrasound using a short axis (SA) puncture, rotating to long axis (LA) for placement into a Blue Phantom© manikin. The second uses the same SA and LA method using WT/HT. Randomized selection was performed to eliminate control bias; participants were recorded for data collection. Participants completed a survey on past proficiency and experience with the study devices. Results: Sixty-three of the 65 total participants’ hands were video recorded with the ultrasound screen during procedures and were included in data analysis. There were significantly fewer disappearances (the image of the vein on the ultrasound screen disappears) of LA view with devices (P = .002) and significantly fewer unique cases with disappearances of the LA view (P = .002). Survey results of all 65 participants are included in descriptive statistics. Of the total participants, 63.1% believe the procedure is faster with WT/HT. Of the inexperienced participants, 82.9% felt PICC guidewire placement is safer using WT/HT; 82.9% of inexperienced participants prefer WT/HT over freehand MST; and 90.8% of all participants would use WT/HT again. Limitations: Future research should be done with larger sample size. Conclusions: Using survey results, there seems to be a preference for using the WT/HT compared to MST for guidewire placement. In all metrics evaluated, the two techniques had either statistically similar results or the WT/HT had statistically significantly better results than MST.

Significant Differences in PostMortem Heart Weight Before and After Dissection Using the Short‐Axis Dissecting Method

Correctly assessing heart weight can be critical at postmortem examination. The current international guidelines advocate using the short-axis method in dissecting the heart and the heart weighed when the blood is emptied. However, it did not specify at what point the heart should be weighed or how the blood should be emptied. This study compared heart weights at three different time points during the heart examination (immediately after dissecting out of the pericardial sac with blood still in chambers, blood washed/removed from heart chambers without the heart opened, and the heart completely opened, blood emptied, and pad dried). This was to illustrate the variation in measurement and potential errors when the heart is weighed at different time of dissection. The results show that there were statistical and clinical significant differences between the heart weights at each weighing points. We recommend the heart to be completely dissected with any blood and residual washing/rinsing water emptied before being weighed. Although performed in this study, the effect of pad drying the heart on heart weight was not explored and was a limitation in this study.

Intra-study and inter-technique validation of cardiovascular magnetic resonance imaging derived left atrial ejection fraction as a prognostic biomarker in heart failure with preserved ejection fraction

The aim of this study was to assess the agreements of both biplane and short-axis Simpson’s (SAX) methods for left atrial ejection fraction (LAEF) calculation utilising cardiovascular magnetic resonance imaging (CMR) in heart failure with preserved ejection fraction (HFpEF) and evaluate their relation to clinical outcomes. One hundred and thirty six subjects (HFpEF n = 97, controls n = 39) underwent CMR, six-minute walk tests and blood sampling in our prospective, observational, single-centre study. Overall, LAEF (%) was lower in HFpEF patients compared to controls (SAX 34 ± 13 vs 47 ± 8, biplane 34 ± 16 vs 51 ± 11; p < 0.0001 for both). Atrial fibrillation (AF) was present in 24% of HFpEF and was associated with higher LA volumes and lower LAEF compared to sinus rhythm (p < 0.0001) with both methods. Biplane LAEF correlated strongly with SAX measurements (overall Pearson’s r = 0.851, sinus rhythm r = 0.651, AF r = 0.882; p < 0.0001). Biplane LAEF did not differ significantly compared to SAX LAEF (overall 34 ± 16 vs 34 ± 13%; p = 0.307) except in AF subjects in whom biplane LAEF was lower (mean difference 2 ± 4%, p = 0.013). There were 44 composite events (25 deaths, 19 HF hospitalizations) in HFpEF during median follow-up of 1429 days. LAEF below the median was associated with increased risk of composite endpoints (Log-Rank biplane p < 0.0001; SAX p = 0.009). In multivariable Cox proportional hazards regression analysis, both biplane LAEF (hazard ratio [HR] 0.604; 95% confidence interval [CI] (0.406–0.900); p = 0.013) and SAX LAEF (HR 0.636; CI 0.441–0.918; p = 0.016) remained independent predictors along with indexed extracellular volume. CMR LAEF, derived from either the short-axis or biplane method is lower in HFpEF compared to healthy controls and remains a strong marker of prognosis.

Impact of Basal Plane Selection on the Evaluation of Cardiac Performance Parameters with Cardiac Magnetic Resonance Imaging in Patients with Corrected Tetralogy of Fallot: A Systematic Approach

Background: Assessment of cardiac performance parameters in patients with corrected tetralogy of Fallot with cardiac MRI short axis method compromises critical elements including papillary muscles, determination of end-diastolic and end-systolic cardiac phase, and furthermore, selection of the basal plane. Objectives: The study purpose was to evaluate the impact of basal plane selection on resulting cardiac performance parameters in cardiac MRI. Patients and Methods: Cardiac MRI examinations of 26 patients (mean-age: 20.7 years ± 7.8) with corrected tetralogy of Fallot were analyzed retrospectively. In post-processing, selection of end-diastolic and end-systolic phase was performed manually by visual determination of largest/smallest ventricular cavities. End-diastolic volume, end-systolic volume, and stroke volume were then calculated for both ventricles. Afterward, initially selected basal planes were systematically varied by one slice, and resulting volumes were compared. This retrospective study was conducted under approval of the institutional review board without patient informed consent. Results: Variations of the basal plane caused significant changes (P < 0.005) of end-diastolic and end-systolic volumes. Differences were as large as 15.2% ± 5.8 regarding the left ventricle and up to 17.4% ± 6.1 for the right ventricle. Consequently, calculated stroke volume changed up to 19.2% ± 6.3 for the left and 22.7% ± 7.2 for the right ventricle. Ejection fractions of both ventricles varied significantly (P < 0.005). These differences were up to 19.1% ± 8.2. Conclusion: Variation of the basal plane by just one slice in cardiac MRI short axis method led to significant changes in the resulting cardiac performance parameters of both ventricles in patients with corrected tetralogy of Fallot.

Comparison of lumbar plexus block using the short\xa0axis in-plane method at the plane of the transverse process and at the articular process: a randomized controlled trial

BackgroundAlthough the safety and effectiveness of the short-axis in-plane method has been confirmed for lumbar plexus block, the operation is difficult and has a high rate of epidural spread at the plane of the articular process. Therefore, we developed a new in-plane technique, called the beach chair method, which displays images from the transverse process. We compared the operative difficulty and incidence of epidural spread of the beach chair method with those of the control method (at the plane of the articular process) in this randomized controlled clinical trial.MethodsSixty patients, aged 18 to 75 years, scheduled for unilateral arthroscopic knee surgery were randomized to receive double-guided lumbar plexus block by the beach chair method (n = 30) or the control method (n = 30) with 30 ml 0.5% ropivacaine hydrochloride; all patients received a sciatic nerve block with 10 ml 1% lidocaine hydrochloride and 10 ml 0.5% ropivacaine hydrochloride.ResultsThe incidence of epidural spread after lumbar plexus block was significantly lower in the beach chair group than that in the control group [1 case (3.3%) vs. 9 (30.0%), P = 0.006]. Moreover, the imaging time (34.2 ± 16.7 s vs. 48.9 ± 16.8 s, P = 0.001), needling time (85.0 ± 45.3 s vs. 131.4 ± 88.2 s, P = 0.013) and number of needle punctures (2.7 ± 1.3 vs. 4.5 ± 2.1, P = 0.000) were significantly lower in the beach chair group than those in the control group; the ultrasound visibility score of the beach chair group was better than that of the control group. There were no significant differences in the remaining indicators.ConclusionsThe beach chair method was easier and was associated with a lower incidence of epidural spread than the control method. Therefore, the beach chair method (at the plane of the transverse process) provides another promising option for lumbar plexus block for the non-obese population.Trial registrationChinese Clinical Trial Registry (ChiCTR), Registration number:ChiCTR-INR-15007505, registered on November 06, 2015.

Reference value of left and right atrial size and phasic function by SSFP CMR at 3.0\u2009T in healthy Chinese adults

The size and function of the left atrium (LA) and right atrium (RA) are related closely with the prognosis of cardiovascular diseases. However, their normal reference values, as measured by cardiac magnetic resonance (CMR), are not well established in Chinese populations. Healthy Chinese subjects (n = 135, 66 males, age 23–83 years) without cardiovascular risk factors were recruited. We imaged the LA and RA of all subjects using short axis and long axis slices by steady-state free precession (SSFP) sequences using a 3.0T scanner. The size and functional parameters were measured. Age and gender differences in LA were further explored. The normal reference values of atrial dimensions, volumes, and empty fractions (EFs) were provided by short axis (SAX) and area-length methods. Volumes and EFs derived by the area-length method showed correlated well with those derived by the by SAX method, but significantly underestimated the volumes (all P < 0.001) and overestimated the LA EFs (all P < 0.001). Atrial dimensions and volumes were generally larger in males. Conduit EFs and total EFs showed gender differences. Most atrial parameters correlated with age. In general, our results showed that gender and age have considerable impact on LA and RA size and function.

Analgesic effect of premedication with meperidine in patients undergoing colonoscopy without sedation

Summary Background Colonoscopy is a standard and useful examination in the diagnosis of colorectal diseases; however, it usually causes pain to patients. Some patients receive narcotic drugs, e.g., meperidine, for pain relief if a colonoscopy is carried out without sedation. Whether the administration of such analgesic drugs to patients without sedation facilitates the performance of the colonoscopy or reduces pain remains to be elucidated. The aim of this study was to evaluate the analgesic effect of meperidine as premedication for patients undergoing a colonoscopy without sedation. Patients and Methods A total of 217 patients (109 men, 108 women) undergoing a diagnostic colonoscopy without sedation were analyzed prospectively. The procedures were carried out by three experienced endoscopists in a medical center. The patients could opt to receive analgesic drugs, with 25 mg of meperidine being given intramuscularly prior to the procedure if requested by either the doctor or patient. The colonoscopic examination was performed by one person using the short-axis method. Questionnaires to evaluate abdominal pain during or after colonoscopy without sedation were collected and analyzed for patients who used meperidine as premedication (Group A) and for those who did not receive meperidine (Group B). Abdominal pain was evaluated using a visual analog scale from 0 to 10. The cecal intubation rate, total insertion time, and the patient's willingness to receive another colonoscopy in the future if needed were also analyzed. Results In both groups, the cecal intubation rate was more than 99% with no significant difference between groups. The mean ± standard deviation insertion time was 7.14 ± 5.45 minutes in Group A and 6.24 ± 4.24 minutes in Group B ( p = 0.309). The visual analog pain score was 3.54 ± 3.13 in Group A and 2.46 ± 2.75 in Group B ( p = 0.009). After adjusting for age and sex, the pain score was 3.51 ± 3.21 in Group A ( p = 0.055). Multivariate analysis showed that female sex and the individual endoscopist performing the colonoscopy were associated with abdominal pain during the examination. Conclusion In our study, premedication with meperidine or no premedication was not associated with a reduction in abdominal pain during colonoscopy without sedation. The insertion time and cecal intubation rate showed no difference between patients with or without additional analgesic drugs prior to the procedure. However, as self-selection bias could not be ruled out, further randomized, placebo-controlled trials are needed to confirm our findings.

Assessment of Left Atrial Volume by Magnetic Resonance in Patients with Permanent Atrial Fibrillation. The Short-axis Method vs. the Single Plane Area-length Method

Background: Atrial fibrillation (AF) is associated with enlargement of the left atrium (LA). The LA volume can be assessed by cardiac magnetic resonance (CMR). The standard CMR method for measuring the LA volume is the short- axis (SA) method, which is time consuming, hence little useful in the clinical setting. For this reason more simplified methods have been developed to assess the LA volume. Objective: To compare the standard SA method and the simplified single plane area-length (AL) method for measurements of the LA volume in patients with permanent AF. Methods and Results: CMR was performed in 34 patients with permanent AF. CMR was conducted with the steady-state free precession (SSFP) technique TrueFISP. LA volumes were measured using the single plane AL method and the SA method. A good and statistically significant correlation was found between the two methods. The Pearson's correlation coefficients for LA maximal volume (LAmax) and LA minimal volume (LAmin) were 0.92, p<0.0001 and 0.91, p<0.0001, respectively. The single plane AL method underestimated LA volumes compared to the SA method (LAmax: 143 ± 35 ml vs. 149 ml ± 38, p=0.046, LAmin: 124 ml ± 30 vs. 130 ml ± 34, p=0.014). Intra- and interobserver agreement was inferior for the single plane AL method. Conclusion: Measurements of LA volumes by the SA method and the single plane AL methods correlate closely in patients with permanent AF. However, the single plane AL method underestimates the LA volume and the reproducibility is inferior compared to the SA method.

Guidewire malposition during central venous catheterization despite the use of ultrasound guidance

Guidewire malposition during central venous catheterization despite the use of ultrasound guidance

Left atrial volume measurement with magnetic resonance imaging: a comparison of biplane, short axis and long axis methods

Left atrial (LA) dilation is an important index in cardiovascular disease. The CMR volumetric short axis method is the reference imaging standard but has limited ability to define the mitral valve plane accurately. The biplane method is simpler and frequently employed in clinical settings. We hypothesized that long axis two chamber (2ch) imaging might better define left atrial boundaries.

1083 Reproducibility of right atrial volume and ejection fraction in healthy subjects and patients with right heart failure using the standard short axis and area-length method

Background Measurements of atrial volumes and ejection fraction (EF) are superior to diameters for both accurate determination of the atrial size and follow up studies. Changes of right atrial volume and EF might have a prognostic impact in patients with right heart failure. We therefore sought to evaluate the reproducibility of right atrial volumes and EF in healthy subjects and patients using the standard short axis method (SA) and the rapid area-length method (ALM).