2-dimensional Transthoracic Echocardiography Research Articles

Thoracic Aortic Intima-Media Thickness in Preschool Children Born Small for Gestational Age

To assess thoracic aortic intima-media thickness (aIMT) as a marker of thoracic aortic remodeling in children born small for gestational age (SGA). We assessed thoracic aIMT, carotid intima-media thickness (cIMT), and pulse wave velocity (PWV) in 239 patients (117 SGA; 122 appropriate for gestational age controls) age 6-8years. Each SGA participant was matched 1:1 based on sex, gestational age, and birth date. Thoracic aIMT was determined by 2-dimensional transthoracic echocardiography. SGA children showed a significant increase in both aIMT (0.89mm [0.12] vs 0.79mm [0.11], P<.001) and cIMT (.50mm [0.05] vs 0.49mm [0.04], P<.001) compared with appropriate for gestational age controls, but the magnitude of the difference in aIMT was greater than that in cIMT (standardized difference of the means: +84% vs +27%). aIMT was linearly correlated with aortic arch PWV as measured by echocardiography (r=0.211, P<.001) but not with carotid-femoral PWV (r=0.113, P=.111). Born SGA was independently associated with increased aIMT after controlling for perinatal, anthropometric, and biochemical determinants in linear regression models. SGA children exhibit increased thoracic aIMT and aortic arch PWV in early childhood that may suggest the presence of structural changes in the thoracic aorta wall architecture. Measurement of ascending aIMT by transthoracic echocardiography is feasible and reproducible and may be a useful marker of vascular disease.

Abstract 16669: Left Atrial Function After Closure of Atrial Septal Defect in Adults: Comparison Between Transcatheter Closure and Surgical Closure

Introduction: Transcatheter closure is offered as an alternative to surgery for the majority of patients with secundum atrial septal defect (ASD). However, little is known about the effect of a mechanical device on left atrial (LA) function. Hypothesis: Transcatheter closure of secundum ASD preferably preserves LA function compared with surgical closure in adult patients. Methods: We examined adult patients who underwent transcatheter (n = 58) and surgical ASD closure (n = 17) and controls (n = 20). Patients with greater than mild mitral or tricuspid regurgitation and those with a history of atrial fibrillation were not included. All the devices employed were the Amplatzer TM Septal Occluders. LA volumes were measured by the biplane area-length method using 2-dimensional transthoracic echocardiography at the onset of mitral opening (Vmax), the beginning of LA systole (Va) and the onset of mitral closure (Vmin) before and 15 ± 11 months after ASD closure. LA reservoir, conduit and booster pump functions were assessed by (Vmax-Vmin)/Vmax, (Vmax-Va)/Vmax and (Va-Vmin)/Va, respectively. Left ventricular (LV) ejection fraction was obtained to estimate LV systolic function. For the estimation of LV diastolic function, the ratio of transmitral early to late flow velocity (E/A), deceleration time of early mitral flow velocity (DT) and the ratio of systolic to diastolic pulmonary venous flow velocity (S/D) were obtained by conventional Doppler echocardiography. Results: In transcatheter closure, employed device size indexed to body surface area was 12 ± 3 mm/m 2 . Before ASD closure, there was no significant difference in all the LA parameters between the 2 groups, whereas LV ejection fraction was significantly decreased in the surgical group as compared with the transcatheter group. After ASD closure, Vmax index was significantly increased in the surgical group. LV end-diastolic volume index were significantly increased both after transcatheter and surgical ASD closure. After ASD closure, the surgery group showed significantly decreased LA reservoir and conduit functions as compared with the transcatheter group and controls. Conclusions: The transcatheter group, not surgical group, showed preserved LA function at mid-term follow-up after ASD closure.

RF31 IS ISOLATED TYPE I VENTRICULAR SEPTAL DEFECT STILL RARE IN ITALIAN POPULATION COMPARED TO ASIAN?

Background: Type I Ventricular Septal Defect (VSD) is less common in Western Countries (5-6% of all VSDs) than in Asia (30% of all VSDs) despite the incidence of VSD is similar (25-30% of all Congenital Heart Defects). In the last 2 years we operated on several isolated Type I VSDs. Methods: A retrospective study reviewing VSDs surgical repair from March 2016 to April 2018 was conducted. In total 14 patients received surgical correction of a isolated VSD. The diagnosis was made primarily on transthoracic 2-dimensional echocardiography,standard cardiac catherization. Patients with associated major cardiovascular anomalies were excluded. The classification of VSD type is according to the nomenclature for VSD reviewed by The Society of Thoracic Surgeons in 2000. Results: In 4 out of 14 patients Type I VSD was identified (28,5%),in 9 Type II (64,3%) and in 1 Type III (7,2%). Focusing on patients with Type I they were all female and surprisingly all Italian with no Asian relatives at all. Age at operation ranged from 2 to 13 months (mean 7,7 mo) and weight ranged from 3,8 to 10 kg (mean 6,8 kg). Surgical repair was done via transpulmonary arterial access. All patients are alive and well with no aortic nor pulmonary valve problems at 24 months of follow up. Conclusions: We are surprised to find out such a incidence of Type I VSD in Italian population. We are fully aware of the weak statistical power of our series so we look forward to propose an Italian multicenter study to verify the hypothesis of a changing incidence of Type I VSD in Italy.

Comparison of the two dimensional versus three dimensional transthoracic echocardiography in assessment of mitral regurgitation

Comparison of the two dimensional versus three dimensional transthoracic echocardiography in assessment of mitral regurgitation

Medida tridimensional del área del anillo tricúspide. Un nuevo criterio en la selección de candidatos a anuloplastia

Introduction and objectivesLate functional tricuspid regurgitation after rheumatic left-sided valve surgery is an important predictor of poor prognosis. This study investigated the usefulness and accuracy of 3-dimensional transthoracic echocardiography tricuspid area compared with conventional 2-dimensional diameter (2DD) for assessing significant tricuspid annulus dilatation, providing cutoff values that could be used in clinical practice to improve patient selection for surgery. MethodsWe prospectively included 109 patients with rheumatic heart disease in the absence of previous valve replacement. Tricuspid regurgitation was divided into 3 groups: mild, moderate, and severe. Optimal 3-dimensional area (3DA) and 2DD cutoff points for identification of significant tricuspid annulus dilatation were obtained and compared with current guideline thresholds. Predictive factors for 3DA dilatation were also assessed. ResultsOptimal cutoff points for both absolute and adjusted to body surface area (BSA) tricuspid annulus dilatation were identified (3DA: 10.4 cm2, 6.5 cm2/m2; 2DD: 35 mm, 21 mm/m2); 3DA/BSA had the best diagnostic performance (AUC=0.83). Three-dimensional transthoracic echocardiography tricuspid area helped to reclassify surgical indication in 14% of patients with mild tricuspid regurgitation (95%CI, 1%-15%; P=.03) and 37% with moderate tricuspid regurgitation (95%CI, 22%-37%; P<.0001), whereas 3DA/BSA changed surgery criteria in cases of mild tricuspid regurgitation (17%; 95%CI, 3%-17%; P=.01) compared with 2DD/BSA. On multivariable analysis, right and left atrial volumes and basal right ventricle diameter were independently correlated with 3DA. ConclusionsThe current 40 mm threshold underestimates tricuspid annulus dilatation. Although 21 mm/m2 seems to be a reasonable criterion, the combination with 3DA assessment improves patient selection for surgery.Full English text available from:www.revespcardiol.org/en

Electrocadiographic Scoring Helps Predict Left Ventricular Wall Motion Abnormality Commonly Observed after Subarachnoid Hemorrhage

Background: Cardiac wall motion abnormality (WMA) is a common complication in patients with subarachnoid hemorrhage (SAH) and is one determinant of their prognosis. The aim of this study was to examine whether the electrocardiography (ECG) findings at admission could predict WMA commonly observed after SAH. Materials and methods: We studied 161 SAH patients with SAH who were hospitalized in our institution between April 2007 and November 2010. We performed bedside 2-dimensional transthoracic echocardiography and 12-lead surface ECG within 24hours of SAH onset. Each of the following ECG changes was scored as having 1 point: ST elevation, ST depression and T wave inversion. We summed up the points in every patient and compared with WMA evaluated by echocardiography. Results: The study subjects were classified into 2 groups based on the presence of WMA. Multivariate analysis revealed that ST elevation, ST depression and T wave inversion were strong independent predictors of WMA. Receiver operating characteristic curve determined that the threshold value to predict WMA was 4 points (sensitivity 86.5%, specificity 83.1%, AUC 0.94, P < .0001). Conclusions: In conclusion, a novel ECG score may well predict WMA after SAH which may associate with an increased risk of mortality.

Three-dimensional Tricuspid Area. A New Criterion to Improve Patient Selection for Annuloplasty in Tricuspid Regurgitation.

Late functional tricuspid regurgitation after rheumatic left-sided valve surgery is an important predictor of poor prognosis. This study investigated the usefulness and accuracy of 3-dimensional transthoracic echocardiography tricuspid area compared with conventional 2-dimensional diameter (2DD) for assessing significant tricuspid annulus dilatation, providing cutoff values that could be used in clinical practice to improve patient selection for surgery. We prospectively included 109 patients with rheumatic heart disease in the absence of previous valve replacement. Tricuspid regurgitation was divided into 3 groups: mild, moderate, and severe. Optimal 3-dimensional area (3DA) and 2DD cutoff points for identification of significant tricuspid annulus dilatation were obtained and compared with current guideline thresholds. Predictive factors for 3DA dilatation were also assessed. Optimal cutoff points for both absolute and adjusted to body surface area (BSA) tricuspid annulus dilatation were identified (3DA: 10.4 cm2, 6.5 cm2/m2; 2DD: 35 mm, 21 mm/m2); 3DA/BSA had the best diagnostic performance (AUC=0.83). Three-dimensional transthoracic echocardiography tricuspid area helped to reclassify surgical indication in 14% of patients with mild tricuspid regurgitation (95%CI, 1%-15%; P=.03) and 37% with moderate tricuspid regurgitation (95%CI, 22%-37%; P<.0001), whereas 3DA/BSA changed surgery criteria in cases of mild tricuspid regurgitation (17%; 95%CI, 3%-17%; P=.01) compared with 2DD/BSA. On multivariable analysis, right and left atrial volumes and basal right ventricle diameter were independently correlated with 3DA. The current 40 mm threshold underestimates tricuspid annulus dilatation. Although 21 mm/m2 seems to be a reasonable criterion, the combination with 3DA assessment improves patient selection for surgery.

Speckle-tracking parameters as predictors of left ventricular systolic dysfunction in patients with myocarditis

Purpose. To evaluate the prognostic capabilities of speckle-tracking echocardiography for prediction of left ventricular systolic dysfunction persistence after 1-year follow-up of patients with myocarditis. Methods. We included 58 patients with acute diffuse myocarditis and left ventricular (LV) systolic dysfunction – LV ejection fraction (EF) ≤40 % who underwent examination 3 times: within the 1st month after the disease onset, at 6- and 12-month follow-up. Transthoracic 2-dimensional echocardiography (EchoCG) and speckle-tracking echocardiography (STE) were performed with the measurement ofLV end-diastolic volume index (LV EDVi) and LV EF, longitudinal global systolic strain (LGSS) and strain rate (LGSSr), circumferential global systolic strain (CGSS) and strain rate (CGSSr), radial global systolic strain (RGSS) and strain rate (RGSSr). For better clarity, parameters of longitudinal and circumferential strain were presented in absolute values. Results. After 12-month follow-up in comparison with the 1st month we observed improvement of LV EF 43.2 ± 3.1 % vs. 32.2 ± 2.7 % (P < 0.02), respectively, and decrease of LV EDVi 91.1 ± 6.6 ml/m 2 vs. 112.2 ± 7.2 ml/m 2 (P < 0.05), respectively. But statistically significant increase of STE parameters in comparison with their values in the 1st month was indicated after only 6-month follow-up: the absolute value of LGSS increased from 5.40 ± 0.41 % to 8.40 ± 0.63 % (P < 0.01) and the absolute value of CGSS – from 6.60 ± 0.73 to 10.40 ± 0.90 % (P < 0.01). By the 12th month there was a further increase in the absolute values of these indicators which corresponded to the statistically significant increase in LV EF and reduction in LV EDVi. By the use of binary regression analysis we defined cut-off values for STE parameters, measured within the 1st month of myocarditis onset, that with high sensitivity and specificity could predict LV systolic dysfunction persistence after 12 months: LGSS <8.6 %, LGSSr <0.61 s -1 and CGSS <8.3 %. Conclusions. On the basis of dynamic observation we detected STE parameters that within the 1 st month of myocarditis onset could be used for prognostication of LV systolic dysfunction persistence after 1-year follow-up: absolute values of LGSS <8.6 %, LGSSr <0.61 s -1 and CGSS <8.3 %.

Assessment of left ventricular size and function by 3-dimensional transthoracic echocardiography: Impact of the echocardiography platform and analysis software

BackgroundWhether echocardiography platform and analysis software impact left ventricular (LV) volumes, ejection fraction (EF), and stroke volume (SV) by transthoracic tridimensional echocardiography (3DE) has not yet been assessed. Hence, our aim was to compare 3DE LV end-diastolic and end-systolic volumes (EDV and ESV), LVEF, and SV obtained with echocardiography platform from 2 different manufacturers. Methods3DE was performed in 84 patients (65% of screened consecutive patients), with equipment from 2 different manufacturers, with subsequent off-line postprocessing to obtain parameters of LV function and size (Philips QLAB 3DQ and General Electric EchoPAC 4D autoLVQ). Twenty-five patients with clinical indication for cardiac magnetic resonance imaging served as a validation subgroup. ResultsLVEDV and LVESV from 2 vendors were highly correlated (r = 0.93), but compared with 4D autoLVQ, the use of Qlab 3DQ resulted in lower LVEDV and LVESV (bias: 11 mL, limits of agreement: −25 to +47 and bias: 6 mL, limits of agreement: −22 to +34, respectively). The agreement between LVEF values of each software was poor (intraclass correlation coefficient 0.62) despite no or minimal bias. SVs were also lower with Qlab 3DQ advanced compared with 4D autoLVQ, and both were poorly correlated (r = 0.66). Consistently, the underestimation of LVEDV, LVESV, and SV by 3DE compared with cardiac magnetic resonance imaging was more pronounced with Philips QLAB 3DQ advanced than with 4D autoLVQ. ConclusionsThe echocardiography platform and analysis software significantly affect the values of LV parameters obtained by 3DE. Intervendor standardization and improvements in 3DE modalities are needed to broaden the use of LV parameters obtained by 3DE in clinical practice.

Left atrial enlargement and clinical considerations in patients with or without a residual interatrial shunt after closure of the left atrial appendage with the WATCHMAN\u2122-device

BackgroundInterventional closure of the left atrial appendage (LAA) in patients with non-valvular atrial fibrillation, high thromboembolic and bleeding risk or bleeding history is an alternative therapeutic strategy to oral anticoagulation. It is not known if the exclusion of the LAA from the blood circulation affects the left atrial volume (LAV) and consequently its prognostic value or the circulatory performance of the heart in humans.MethodsWe aimed to prospectively assess potential changes in baseline LAV, left ventricular ejection fraction (LVEF), NT-proBNP-level and the covered distance in the 6-min walk-test 6 weeks and 6 months after LAA closure with the WATCHMAN™ device. We used serial 3-dimensional transthoracic and transesophageal echocardiography to assess LAV, residual interatrial shunt and device performance in 58 consecutive patients with successful LAA closure.ResultsAccurate 3D–echocardiographic data for LAV measurements were evaluable for 51 (91%) patients. Maximum LAV (LAVmax) at baseline was 102.8 ± 30.8 ml and increased significantly to 107.7 ± 32.8 ml after 6 weeks (p < 0.01) and 113.5 ± 34.2 ml after 6 months (p < 0.01). Minimal LAV (LAVmin) increased from 76.9 ± 29.5 ml at baseline to 81.8 ± 30.2 ml after 45 days (p < 0.01) and 82.1 ± 33.3 ml after 6 months (p < 0.01). Similarly, their indexes to BSA (LAVImax and LAVImin) increased significantly, as well. Patients without a residual left-to-right interatrial shunt showed a significantly higher increase in LAVmax or LAVmin. Baseline LVEF, NT-proBNP-level or the distance covered at the 6-min walk test did not significantly change 6 weeks or 6 months after LAA closure.ConclusionsLAVmax and LAVmin increase significantly after interventional LAA closure. LA enlargement does not correlate with clinical progression of heart failure. Persistent left-to-right interatrial shunt counteracts the LA enlargement. A reduced LA compliance after exclusion of the LAA from the blood circulation with consecutive increase in LA pressure may be a potential cause of LA enlargement and warrants further investigation.Trial registrationGerman Clinical Trials Register ID: DRKS00010768; Registration Date 07.07.2016.

ASD device closure in pediatrics: 3-Dimensional transthoracic echocardiography perspective

ObjectiveReal-time three-dimensional echocardiography, using both reconstruction methods and RT3D, has been used as an extra helping tool in several forms of congenital heart diseases. Our aim was to understand the relation of the ASD device to all surrounding structures by 3-dimensional echocardiography (3D). MethodsThis prospective study included 37 patients diagnosed as ASD secundum by transthoracic (TTE) and transesophageal echocardiography (TEE) referred for transcatheter closure from October 2013 to July 2016. Follow-up for 1 year using 2D and 3D-echocardiography was performed to assess the relations of the device to the surrounding structures. ResultsTranscatheter ASD closure and echocardiographic examinations were successfully performed for all patients. By 3D echocardiography, 16 patients (43.24%) had their ASD device close to the aortico-mitral continuity plane without apparent regurgitation, while the rest of our patients (56.75%) the devices were away from this plane. The following variables were significantly different between the two groups; body surface area, atrioventricular rim (AV), device size, left disc size and ratio of left disc to interatrial septum. A cut-off AV rim length not less than 8 mm was found optimal to avoid device encroachment on the sensitive surrounding structures. New Formula was constructed to aid in device choice. ConclusionUse of 3D before and after ASD closure is of value to determine the device relation to the surrounding structures. AV rim by TEE is an important rim to avoid eventual encroachment on the mitral valve and aorta.

Quantitative assessment of mitral apparatus in patients with acute myocardial infarction after percutaneous coronary intervention by real-time three-dimensional transthoracic echocardiography

Objective To assess the changes of structure and function of the moderate mitral valvular regurgitation before and after percutaneous coronary intervention (PCI) by real-time 3-dimensional transthoracic echocardiography(RT 3D-TTE). Methods Thirty-two patients with acute myocardial infarction(AMI) and moderate mitral regurgitation were enrolled in the study, while 30 healthy subjects were selected as the control group. All patients accepted RT 3D-TTE, the imaging was analyzed offline with TomTec 4D MV-Assessment software. The mitral valve structure and function parameters were measured. All AMI patients were performed RT 3D-TTE at 12 hours before PCI, 1 week and 3 months after PCI. According to whether improved at 3 months after PCI, patients with moderate mitral regurgitation were divided into two groups: improvement group and no improvement group. Results ①Compared with the control group, anterior-posterior(AP) diameter, anterolateral-posteromedial(AL-PM) diameter, annular circumference(AC), commissural diameter(CD), three-dimensional annular area(AA3D), tenting volume(TV), tenting height(TH), nonplanarity angle(NPA)of mitral regurgitation group were larger(P<0.05), annular height(AH)and maximum annular displacement(ADMax), and maximum annular displacement velocity(ADVMax) of mitral regurgitation group were smaller(P<0.05). ②At three months after PCI, 20 patients with moderate mitral regurgitation were improved(effective regurgitant orific area<0.2 cm2), twelve patients with moderate mitral regurgitation were not improved. Compared with mitral valve parameters before PCI and at one week after PCI, AP, AL-PM, AC, CD, AA3D, and TV in improvement group were discreased at three months after PCI(P<0.05), AH was increased (P<0.05). Compared with mitral valve parameters before PCI, mitral valve structure and function parameters after PCI were not improved, compared with those in no improvement group, AP, AL-PM, AC, CD, and AA3D in improvement group were smaller(P<0.05). ③By analysis of ROC curves AP, AL-PM, AC, and CD for diagnosing mitral regurgitation had good test effectiveness. Conclusions In patients with acute myocardial infarction and moderate mitral regurgitation, the mitral annular is not only presented as the size enlargement but also the flattening of its geometric shape and the decrease of its dynamic, while structure and function parameters of the mitral valve before PCI can predict improvement of mitral regurgitation and provide a reference for the development of clinical programs. Key words: Echocardiography, real-time three-dimensional; Myocardial infarction; Mitral valve insufficiency

3-Dimensional Echocardiographic Analysis of the Tricuspid Annulus Provides New Insights Into Tricuspid Valve Geometry and Dynamics

ObjectivesThe authors used transthoracic 3-dimensional transthoracic echocardiography (3DE) to characterize tricuspid annulus (TA) geometry and dynamics in healthy volunteers. BackgroundAccurate sizing of the TA is essential for planning tricuspid annuloplasty and for implantation of new percutaneous tricuspid devices. Methods3DE of the TA from 209 healthy volunteers was analyzed using custom software to measure TA area, perimeter, circularity, and dimensions at end diastole (equals tricuspid valve closure), mid-systole, end systole, and late diastole. TA intercommissural distances were measured at mid-systole. For comparison, TA diameters were measured at the same time points on multiplanar reconstruction of the 3DE datasets and on 2-dimensional transthoracic echocardiography (2DE) apical 4-chamber and right ventricular focused views. In 13 subjects with both 3DE and computed tomography, TA parameters were compared. Results3DE TA area, perimeter, and dimensions were largest in late diastole and smallest at mid-systole/end systole. Normal tricuspid valve parameters in end diastole were 8.6 ± 2.0 cm2 for area; 10.5 ± 1.2 cm for perimeter; 36 ± 4 mm and 30 ± 4 mm for longest and shortest dimensions, respectively; and 0.83 ± 0.10 for circularity. There were no age-related changes in TA parameters. Women had larger indexed TA perimeter and longer long-axis dimensions compared with men. The longest 3DE TA dimension was significantly longer than diameters measured from both 2DE and 3D multiplanar reconstruction. 3DE TA area, perimeter, and dimensions correlated with both right atrial and right ventricular volumes, suggesting that both chambers may be determinants of TA size. TA fractional area change was 35 ± 10%. Fractional changes in both perimeter and dimensions were ≥20%. When compared with computed tomography, 3DE systematically underestimated TA parameters. ConclusionsGender and body size should be taken into account to identify the reference values of TA dimensions. 2DE underestimates TA dimensions.

The impact of left ventricular deformation and dyssynchrony on improvement of left ventricular ejection fraction following radiofrequency catheter ablation in Wolff-Parkinson-White syndrome: A comprehensive study by speckle tracking echocardiography.

The purpose of this study was to evaluate left ventricular (LV) deformation and LV dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome and to identify the factors that affect the efficacy of radiofrequency catheter ablation (RFCA). Thirty patients (26 men, mean age 40±12years) with WPW syndrome were prospectively recruited for this study. They underwent 2-dimensional transthoracic echocardiography with speckle tracking analysis before RFCA and again within 48hours after RFCA. Control group consisted of 15 age and sex-matched healthy volunteers. The patients had significantly lower LV ejection fraction (LVEF), global longitudinal strain (Sl ), and global circumferential strain (Sc ) compared with healthy controls (64%±8% vs 68%±5%, P=.049; -17.6%±3.2% vs -19.9%±3.3%, P=.037, -15.2%±2.5% vs -19.4%±2.5%, P<.0001, respectively). Patients had a significantly higher dyssynchrony index relative to healthy controls (58.4±49.0ms vs 36.4±31.1ms, P=.031). After RFCA, there was a significant increase in LVEF and global Sc (68%±8% vs 64%±8%, P=.005; -17.3%±2.0% vs -15.2%±2.5%, P<.0001, respectively), along with a significant decrease in the dyssynchrony index (36.9±36.3ms vs 58.4±ms, P<.001) relative to the baseline values. Logistic regression revealed that the baseline dyssynchrony index was a predictor of LVEF improvement after RFCA (odds ratio: 1.060, P=.038). In WPW syndrome, impaired LV circumferential deformation can be restored by RFCA with concomitant improvement in LV dyssynchrony and LVEF.

Stimulation of ganglionated plexus attenuates cardiac neural remodeling and heart failure progression in a canine model of acute heart failure post-myocardial infarction.

Heart failure (HF) is associated with autonomic dysfunction. Vagus nerve stimulation has been shown to improve cardiac function both in HF patients and animal models of HF. The purpose of this present study is to investigate the effects of ganglionated plexus stimulation (GPS) on HF progression and autonomic remodeling in a canine model of acute HF post-myocardial infarction. Eighteen adult mongrel male dogs were randomized into the control (n=8) and GPS (n=10) groups. All dogs underwent left anterior descending artery ligation followed by 6-hour high-rate (180-220bpm) ventricular pacing to induce acute HF. Transthoracic 2-dimensional echocardiography was performed at different time points. The plasma levels of norepinephrine, B-type natriuretic peptide (BNP) and Ang-II were measured using ELISA kits. C-fos and nerve growth factor (NGF) proteins expressed in the left stellate ganglion as well as GAP43 and TH proteins expressed in the peri-infarct zone were measured using western blot. After 6h of GPS, the left ventricular end-diastolic volume, end-systolic volume and ejection fraction showed no significant differences between the 2 groups, but the interventricular septal thickness at end-systole in the GPS group was significantly higher than that in the control group. The plasma levels of norepinephrine, BNP, Ang-II were increased 1h after myocardial infarction while the increase was attenuated by GPS. The expression of c-fos and NGF proteins in the left stellate ganglion as well as GAP43 and TH proteins in cardiac peri-infarct zone in GPS group were significantly lower than that in control group. GPS inhibits cardiac sympathetic remodeling and attenuates HF progression in canines with acute HF induced by myocardial infarction and ventricular pacing.

Initial study of transthoracic echocardiography guided three-dimensional printing on the application of assessment of structural heart disease

Objective: To investigate the feasibility and diagnostic value of preoperative transthoracic echocardiography guided three dimensional printing model (TTE Guided 3DPM) on the assessment of structural heart disease (SHD). Methods: From February 2016 to October 2016, 44 patients underwent cardiac surgery in Tianjin Chest Hospital, forty-four patients were assessed preoperatively using TTE Guided 3DPM, including 25 males and 19 females, aged 3-75 years, with an average of (44±22) years. compared to conventional three dimensional transthoracic echocardiography (3D-TTE), and took direct intraoperative findings as "Golden Standard" simultaneously. There are twelve patients with SHD, including four cases with mitral prolapse, two cases with partial endocardial cushion defect, two cases with secondary atrial septal defect, two cases with rheumatic mitral stenosis, one case with tetralogy of Fallot, one case with ventricular septal defect (VSD), thirty-two patients without SHD were designed as negative control. Results: The sensitivity and specificity of TTE Guided 3DPM were greater than or equal to 3D-TTE, P value of McNemar test of 3D-TTE was greater than 0.05, the difference was not statistically significant, kappa=0.745, P<0.01, indicated that the results of 3DTTE and the gold standard were generally consistent.P value of McNemar test of TTE Guided 3DPM was greater than 0.05, the difference was not statistically significant, kappa=0.955, P<0.01, indicated that the results of TTE Guided 3DPM and gold standards were consistent. Compared with 3D-TTE and TTE Guided 3DPM, P value was greater than 0.05, the difference was not statistically significant, kappa=0.879, P<0.01, indicated that the results of 3D-TTE and TTE Guided 3DPM were consistent. TTE Guided 3DPM displayed the three-dimensional structure of SHD cardiac lesions clearly, which were consistent with intraoperative findings. Conclusion: TTE Guided 3DPM provides essential information for the preoperative evaluation and decision of SHD.

Relationship Between Myocardial Function, Body Mass Index, and Outcome After ST-Segment-Elevation Myocardial Infarction.

Better survival for overweight and obese patients after ST-segment-elevation myocardial infarction (STEMI) has been demonstrated. The association between body mass index (BMI), outcome, and left ventricular (LV) structure and function after STEMI, including LV longitudinal strain (global longitudinal strain), was evaluated. First patients with STEMI undergoing primary percutaneous coronary intervention (n=1604; mean age, 61±12 years; 75% men) had BMI measured on admission, and 2-dimensional transthoracic echocardiography performed within 48 hours. Patients were categorized based on standard criteria (normal/underweight, BMI<25 kg/m2 [n=486]; overweight, 25≤BMI<30 kg/m2 [n=820]; obese, BMI≥30 kg/m2 [n=298]). LV global longitudinal strain was measured using speckle-tracking analysis. Primary outcome measure was all-cause mortality. Compared with normal/underweight patients, obese patients were younger and more likely to have diabetes mellitus, hypertension, and hyperlipidemia and have higher discharge blood pressures. Despite no significant differences in infarct size, obese patients had significantly more impaired LV global longitudinal strain (-13.7±3.8 versus -15.0±4.2% and -15.0±4.1%; P<0.001) compared with normal/underweight and overweight patients, respectively. Although normal/underweight patients had the worst overall survival (log-rank P=0.04) after STEMI during a median follow-up of 5.2 (3.6, 6.9) years on Kaplan-Meier analysis, a significant nonlinear association between BMI and all-cause mortality across the range of BMI was seen, persisting after adjustment for age and sex. Obese patients demonstrate greater adverse LV remodeling and more impaired LV deformation after STEMI compared with those with normal BMI, amid similar infarct characteristics. Normal weight patients continue to demonstrate the worst survival, suggesting that the potential nonadverse effect of higher BMI in this population is independent of LV function.

Cystic tumour of the atrioventricular node: treatment dilemma

An asymptomatic 18-year-old black woman was found to have an incidental finding of third-degree atrioventricular (AV) block on a routine ECG. 2-Dimensional transthoracic echocardiography showed a heterogeneous mass in the...

Chiari Network in Right Atrium of Heart

Chiari network is an embryonic remnant of right valve of sinus venosus due to its incomplete resorption. It is a fenestrated net-like membranous structure mostly seen in the right atrium near the opening of Inferior vena cava and Coronary sinus. It is rare, often diagnosed incidentally and is usually of no clinical significance. However, there are reports of its association with atrial fibrillation, arrhythmias, right atrial thrombus entanglement, paradoxical embolism and catheter entrapment during percutaneous interventions. Here we present a case of Chiari network in a 45 years old female diagnosed by two dimensional trans-thoracic echocardiography (2D-TTE). Our aim is to highlight clinical significance of this rare but possible congenital cardiac remnant which is often silent.

Aortic valve prolapse misdiagnosed as aortic sinus aneurysm in patients with ventricular septal defect. Analysis of the echocardiographic findings.

Objectives:To retrospectively analyzed the preoperative echocardiographic findings of 9 patients with doubly committed ventricular septal defect (VSD) associated with aortic valve prolapse and to summarize the reasons for misdiagnosis.Methods:This retrospective study was conducted in Yijishan Hospital, Wannan, Anhui, China between June 2005 and May 2015. Using transthoracic echocardiography (TTE), 92 patients were diagnosed with doubly committed VSD associated with rupture of an aortic sinus aneurysm. The operative findings proved to be in accordance with the echocardiographic findings in 83 patients. Nine patients were confirmed as showing doubly committed VSD associated with perforation of a prolapsed aortic valve. We primarily discussed the 9 patients who were misdiagnosed by TTE.Results:Aneurysm-like protrusions could be detected by 2-dimensional TTE in the right ventricular outflow tract (RVOT) in 9 patients. All of the aneurysm-like protrusions were confirmed by surgery as over-enlarged right coronary leaflets bulging into the RVOT.Conclusion:Occasionally, in patients with doubly committed VSD, aortic valve prolapse can be misdiagnosed as an aortic sinus aneurysm. To reduce the misdiagnosis rate and to provide a more precise preoperative diagnosis, multi-section, and multi-angle observation of these diseases should be performed.