Transthoracic Echocardiography Group Research Articles

Comparison of effectiveness between transthoracic echocardiography and X-ray guided closure of patent foramen ovale: A retrospective analysis.

To compare the effectiveness of transthoracic echocardiography (TTE) and X-ray guided closure of patent foramen ovale (PFO). In this retrospective study, clinical data from 90 patients who underwent PFO occlusion surgery in the First People's Hospital of Yongkang from January 2020 to December 2022 were retrospectively reviewed. Among them, 43 patients underwent X-ray guided PFO occlusion surgery (X-ray group) while 47 patients underwent TTE guided PFO occlusion surgery (TTE group). Perioperative, cardiac function related indicators were measured before and after treatment, along with right-to-left shunting status, and incidence of complications in both groups. There was no significant difference in the duration of surgery or hospitalization between the TTE group and the X-ray group (p>0.05). After treatment, the cardiac function indicators of both groups increased compared to before treatment (p<0.05), and there was no significant difference between the groups (p>0.05). After treatment, right-to-left shunting in the two groups improved compared to before treatment (p<0.05), with no significant difference between the groups (p>0.05). There was no significant difference in complications between the two groups (p>0.05). TTE guided PFO occlusion is as effective as X-ray guided PFO occlusion in the treatment of PFO. TTE surgery is clinically beneficial for reducing radiation damage with a good safety profile.

Comparison of clinical outcomes between transthoracic echocardiography- and X-ray-guided left bundle branch pacing for bradycardia: A randomized controlled trial.

Left bundle branch pacing (LBBP) is a physiological pacing modality. However, the long procedure and fluoroscopy time of LBBP is still a problem. This study aims to compare the clinical outcomes between transthoracic echocardiography (TTE)- and X-ray-guided LBBP. This is a single-center, prospective, randomized controlled study. Consecutive patients who underwent LBBP in our team from June 2022 to November 2022 were enrolled. Procedure and fluoroscopy time, pacing parameters, electrophysiological and echocardiographic characteristics, as well as complications were recorded at implantation and during follow-up. In this study, 60 patients were enrolled and divided into two groups: 30 patients were allocated to the X-ray group and the remaining 30 to the TTE group. There was no significant difference in the success rate between the two groups (86.7% vs. 76.7%, p = .317). The procedure time of TTE group was comparable to that of the X-ray group (9.0 vs. 12.0 min, p = .063). However, the fluoroscopy time in the TTE group was significantly lower than that of the X-ray group (2.5 vs. 5.0 min, p = .002). There were no statistically significant differences in pacing parameters, electrophysiological and echocardiographic characteristics, or complications between the two groups at implantation and during follow-up. TTE-guided LBBP is a feasible and safe method. Compared with X-ray, TTE showed a comparable success rate and procedure time, but it could significantly reduce the fluoroscopy time of LBBP.

Abstract 15167: The Use of Echocardiography in Patients With Advanced Peripheral Arterial Disease

Introduction: Patients with peripheral arterial disease (PAD) are at high risk of concomitant cardiac diseases. Transthoracic echocardiography (TTE) is a common imaging modality to assess cardiac function and is used as a screening tool, especially for patients with advanced PAD undergoing lower extremity revascularization (LER). The current study evaluates the incidental use of TTE in patients undergoing LER. Hypothesis: Patients with a perioperative TTE have improved outcomes compared to patients who do not undergo TTE. Methods: The electronic records of patients undergoing LER between 2013-2020 were reviewed. All TTE within 6 months of initial LER were captured. Patient characteristics and outcomes were compared between patients who underwent TTE and those who did not. Results: A total of 1,988 patients underwent LER, and 69.3% (N=1,377) had TTE. Patients in the TTE group were more likely to be African American and have diabetes mellitus, chronic kidney disease, and coronary artery disease. Patients with TTE were more likely to be on aspirin and undergo open/hybrid revascularization. There was no significant difference between the 2 groups in perioperative MI, major amputation, or mortality. Furthermore, patients with TTE had higher MALEs. (Table) However, there were no differences in MALE-free survival between the two groups (Figure 1) Conclusion: TTE was obtained in 69.3% of patients with advanced PAD undergoing LER but did not seem to be associated with outcomes in this institutional series. Further research is warranted to identify PAD patients that would benefit from TTE prior to LER.

Utilization of Transthoracic Echocardiography Is Associated with a Decreased 6-month Readmission Rate in Hospitalized Heart Failure: A Propensity Score-matched Analysis

Objective: Repeated hospitalization due to congestion is a characteristic of the whole course of heart failure. Echocardiography can be used to assess cardiac function and volume status. However, whether echocardiography can reduce the rehospitalization rate remains unclear. This study aimed to evaluate the impact of transthoracic echocardiography (TTE) use on readmission rates in hospitalized patients with heart failure. Methods: The study was based on the Zigong heart failure database, which contained information on 2,008 adult patients with heart failure admitted to the Zigong Fourth People’s Hospital (Sichuan Province, China) from December 2016 to June 2019. Patients were divided into 2 groups according to the usage of TTE on the day of hospital admission (TTE group (1,371 patients) and no TTE group (637 patients), respectively). The primary outcome was the 6-month readmission rate. The statistical approaches used included multivariate Cox regression, propensity score analysis, and an inverse probability weighting model to ensure the robustness of the findings. Results: A significant reduction in 6-month readmission rate was observed among the TTE group compared with the no TTE group (hazard ratio = 0.60, 95% confidence interval (CI) = 0.52–0.69, P &lt; 0.001). The frequencies of intravenous nitrates, diuretics, and inotropes during hospitalization were significantly higher in the TTE group compared with those in the no TTE group (10.9% vs. 8.3%, 88.5% vs. 86.2%, and 66.9% vs. 65.6%, respectively, all P &lt; 0.001). The proportion of patients returning to the emergency department within 6 months was significantly lower in the TTE group compared with the no TTE group (35.6% vs. 50.3%, P &lt; 0.001). Conclusions: Utilization of TEE on admission day was associated with a reduced 6-month readmission rate in hospitalized patients with heart failure.

Transthoracic echocardiography guidance of transcatheter tricuspid valve repair

Abstract Funding Acknowledgements Type of funding sources: None. Background Transcatheter edge-to-edge tricuspid valve repair (TTVR) for tricuspid regurgitation (TR) is an emerging treatment option in inoperable patients. TTVR is always guided by transesophageal echocardiography (TOE) and performed under general anesthesia. In patients with excellent acoustic window, transthoracic echocardiography (TTE) can also provide a comprehensive morphological understanding. Moreover, in TTVR there is no need for transseptal puncture. Purpose We investigated if TTVR can be successfully conducted by a novel TTE guiding approach, in conjunction with fluoroscopy, based on the concept of the 4 right-sided chamber views. Methods Thirty TTVR patients were assigned to a TTE (n=10) and a TOE group (n=20), depending on acoustic window and corresponding guidance. Multimodality imaging was paramount for procedural planning and included TTE, TOE and cardiac CT, from which the corresponding fluoroscopic angulations of the 4 right-sided chamber views were derived. Thus, interventionalists and cardiac imaging specialists were assessing the same chamber views from their respective imaging modality. TR severity and quality of life parameters were assessed at baseline and up to 12 months. Results Except for lower BMI (TTE 22.3±0.8 vs TOE 29.8±4.3, p&amp;lt;0.001), baseline characteristics were similar between groups e.g., age (81.7±3.9 vs 82.8±4.1, p = 0.483) or EuroSCORE II (11.9±10.3 vs 10.4±8, p = 0.692). Device success was achieved in all patients, with a total of 15 implanted clips in the TTE (clips / patient 1.5±0.7) vs 31 clips in the TOE group (1.5±0.6), and device times of 75±37.1 vs 65.7±31.3 minutes (p = 0.506). TR reduction was successful in all but one patient, in each group (90% vs 95%, p = 1.000). TR improvement was equal between-groups, with 2- or more grade reduction in 60% of cases, at 30 days. No device associated complications occurred. Nine patients in the TTE group and 17 in the TOE group completed one-year follow-up. Quality of life and functional capacity similarly improved in both groups, with NYHA class reduction in all survivals [100% (9/9) vs 95% (17/17), p = 1.000], and significant improvement in KCCQ score and 6-minute walk distance in each respective group (∆24.8±21.4 vs 20.1±13.6 points, p = 0.227; ∆93.5±100.4 vs 80.8±64 meters, p = 0.121). TR reduction impacted major organs e.g., liver and kidney. Thus, glomerular filtration rate (GFR) increased [TTE group 56.8±18.7 vs 64.6±14.9 ml/m2/1,73m2, p = 0.050; TOE group 50.7±19.9 vs 53.8±20.9, p = 0.347], while liver congestion parameters decreased e.g, aspartate aminotransferase (AST) [TTE group 28.6±7.5 vs 26.2±8.6 U/L, p = 0.274; TOE group 33.1±5.8 vs 23.6±9, p = 0.388]. Conclusions TTE guidance of TTVR is feasible in selected patients with excellent acoustic window and represents an alternative to TOE or, in combination, may facilitate transition to conscious sedation. Successful TTVR leads to improvement in quality of life, symptom control, and multiorgan function.

Transthoracic echocardiography guidance of transcatheter edge-to-edge percutaneous tricuspid valve repair: the TTE-TTVR pilot study and methodology proposal

Abstract Background Transcatheter tricuspid valve repair (TTVR) is an emerging option for treating high-grade tricuspid regurgitation (TR) [1], mostly performed by edge-to-edge repair, and always guided by transesophageal echocardiography (TOE). In patients with excellent acoustic window, transthoracic echocardiography (TTE) can also provide a comprehensive understanding of tricuspid valve (TV) morphology [2]. Also, in TTVR there is no need for transseptal puncture. Purpose We sought to determine if TTVR can be successfully conducted by a novel TTE guiding approach, in conjunction with fluoroscopy [3]. Methods 30 consecutive patients, scheduled for TTVR, were assigned to a TTE group (n=10), in the presence of excellent acoustic window, and a TOE group (n=20). On top of fluoroscopy, TTVR was guided exclusively by TTE in the first group, with TOE result confirmation solely upon clip release, due to safety reasons. The second group underwent classical TOE guidance. Understanding the 4 right heart chamber views (Fig. 1) and their respective fluoroscopic angulations was paramount. TR severity, parameters of quality of life and functional capacity were assessed and compared between-groups, at baseline and 30 days. Results Except for lower BMI (TTE 22.3±0.8 vs TOE 29.8±4.3, p&amp;lt;0.001), other baseline characteristics were very similar between groups, e.g., age (81.7±3.9 vs 82.8±4.1, p=0.483) or EuroSCORE II (11.9±10.3 vs 10.4±8, p=0.692).Device success was achieved in all patients, with a total of 15 implanted clips in the TTE group (mean no. of clips / patient 1.5±0.7) and 31 clips in the TOE group (1.5±0.6). Device time (75±37.1 vs 65.7±31.3 minutes, p=0.506) and fluoroscopy duration (16.3±10.5 vs 14.4±7.2 minutes, p=0.564) were also close. TR reduction was successful in all but one patient, in each group (90% vs 95%, p=1.000). TR improvement was equal between-groups, with 2 or more grade reduction in 60% of each group, at 30 days. Thus, grade IV/V and V/V TR, present in 60% of all patients at baseline, dropped to 10% (9/10 vs 18/20, p=1.000) by procedure end and follow-up (Fig. 2). No device associated complications occurred. By 30 days, there was one non-cardiac death and one major bleeding. At follow-up, all but one patient had at least one grade reduction in NYHA class (10/10 vs 19/20, p=1.000). Kansas City Cardiomyopathy Questionnaire score and 6-minute walk distance similarly improved (Δ20.7±14.9 vs 15.5±7.9 points, p=0.227; Δ80.5±60.1 vs 46.6±30.6 meters, p=0.121). A statistical in-group difference was also noticed in renal function improvement by follow-up [glomerular filtration rate (GFR) TTE group 56.8±18.7 vs 64.8±12.5 ml/m2/1.73 m2, p=0.028; TOE group 50.7±19.9 vs 62.2±25.9, p=0.001]. Conclusion TTE guidance of TTVR is feasible in selected patients with excellent acoustic window and could offer an alternative in case of high anesthetic risk. Similar procedural success and clinical outcomes, as with TOE guidance, can be achieved. Funding Acknowledgement Type of funding sources: None.

The relationship between transthoracic echocardiography and mortality in adult patients with multiple organ dysfunction syndrome: analysis of the MIMIC-III database.

BackgroundFor patients with multiple organ dysfunction syndrome (MODS), timely assessment of the condition and real-time adjustment of the treatment plan are of critical importance. To this end, transthoracic echocardiography (TTE) is widely used in clinical practice, but whether TTE can improve the short-term prognosis of MODS patients is currently unclear.MethodsWe extracted data of patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database and included cases according to inclusion and exclusion criteria. The primary endpoint was the mortality within 28 days after admission to the intensive care unit (ICU), and multi-variate regression analysis was conducted to infer the risk factors associated death within 28 days after ICU admission. Double robust analysis was conducted to investigate the correlation between TTE and the endpoint. A gradient-boosted model (GBM) was constructed to calculate the propensity score (PS) of patients received TTE, so as to reduce the difference of variates between these two groups.ResultsA total of 13,844 MODS cases were included and were divided into a TTE group and a non-TTE group. There were 5,022 cases (36.28%) in the TTE group, 2,416 (48.10%) of whom were female; and 8,822 (63.72%) in the non-TTE group, 4,129 of whom (46.80%) were female. The covariates that contributed significantly to PS included chronic heart failure (CHF), creatine kinase (CK), troponin, partial pressure of oxygen (PO2), and sequential organ failure assessment (SOFA) scores. Double robust analysis showed that within 28 days after ICU admission, the TTE group had lower risk of death when compared with the non-TTE group. The adjusted odds ratio (OR) value of TTE for 28 days death was 0.73 [95% confidence interval (CI): 0.65–0.82; P<0.001]. The other 3 models had similar results, suggesting that conduct TTE for patients with MODS in ICU was associated with lower risk of 28 days mortality.ConclusionsTTE can reduce the mortality of MODS patients in the ICU.

Value of early critical care transthoracic echocardiography for patients undergoing mechanical ventilation: a retrospective study

ObjectivesTo evaluate whether early intensive care transthoracic echocardiography (TTE) can improve the prognosis of patients with mechanical ventilation (MV).DesignA retrospective cohort study.SettingPatients undergoing MV for more than 48 hours, based...

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database.

Elderly patients in the intensive care unit (ICU) often suffer from cardiac function impairment. Real-time monitoring of cardiac function and structural changes has important clinical significance. Transthoracic echocardiography (TTE) is a convenient, intuitive, and non-invasive real-time examination of the heart, and it has been widely used for intensive care patients. This study aims to analyze the impact of TTE on the prognosis of elderly patients in ICU. Data from elderly patients in the ICU was obtained from the MIMIC-III 1.4 database, and they were divided into a TTE examination group and a non-TTE examination group. The baseline data of the two groups were compared, and multiple regression analysis, propensity score (PS), compatibility analysis, and other methods were used to analyze the influence of TTE on the prognosis of elderly patients in ICU. A total of 8,952 elderly cases were included, comprising 3,280 cases (36.6%) in the TTE group and 5,672 cases (63.4%) in the non-TTE group. The SAPS score (20.34±5.34 vs. 18.74±5.2, t=13.889, P<0.001) and SOFA score (5.10±3.38 vs. 3.82±2.81, t=19.250, P<0.001) of patients in the TTE group were higher than those of non-TTE group. The rate of patients in the TTE group receiving mechanical ventilation (52.10% vs. 34.80%) and vasoactive drugs (29.30% vs. 15.00%) was significantly higher than that in the non-TTE group. In the PS score compatibility cohort, the 28-day mortality rate of patients in the TTE group was 23.4%, and the 28-day mortality rate of patients in the non-TTE group was 28.7%. The adjusted odd ratio (OR) value was 0.76 (95% CI: 0.65-0.87, P<0.001). Analysis of secondary endpoints showed that patients in the TTE group did not use mechanical ventilation and hypertension drugs for a longer period of time than those in the non-TTE group, and the TTE group patients had significantly more fluid input in the first three days after admission to the ICU than in the non-TTE group. TTE examination can reduce the 28-day mortality risk of elderly critically ill patients.

Utilization of Echocardiography After Acute Kidney Injury Was Associated with Improved Outcomes in Patients in Intensive Care Unit.

BackgroundWe aimed to investigate the association between usage of transthoracic echocardiography (TTE) within 24 hours after acute kidney injury (AKI) and the prognosis of patients in intensive care unit (ICU).MethodsThe Medical Information Mart for Intensive Care III (MIMIC-III) database was used to identify AKI patients with and without TTE administration. The primary outcome was 28-day mortality. Multivariable regression was used to clarify the association between TTE and clinical outcomes and propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized to validate our findings.ResultsAmong 23,945 eligible AKI patients, 3361 patients who received TTE and 3361 who did not conduct TTE had similar propensity scores which were included in this study. After matching, the TTE group had a significantly lower 28-day mortality (OR 0.80, 95% CI 0.72–0.88, P<0.001). Patients in the TTE group received more fluid on day 1 and day 2 and had a more urine volume on day 1 and day 3, and the reduction in serum creatinine was greater than that in the no TTE group. The mediating effect of creatinine reduction was remarkable for the whole cohort (P=0.02 for the average causal mediation effect).ConclusionTTE utilization was associated with decreased risk-adjusted 28-day mortality for AKI patients in ICU and was proportionally mediated through creatinine reduction.

Transcatheter Closure of Patent Ductus Arteriosus under Echocardiography Guidance: A Randomized Controlled Noninferiority Trial.

Background Percutaneous occlusion under fluoroscopy guidance has become the preferred method for the treatment of patent ductus arteriosus (PDA). To avoid radiation exposure and contrast agent use, PDA occlusion under transthoracic echocardiography (TTE) guidance was conducted. Objectives We assessed the hypothesis that the success rate of percutaneous PDA occlusion under TTE was noninferior to that under fluoroscopy guidance. Methods In this single-center trial, 100 patients were randomly assigned in a 1 : 1 ratio to the TTE group (n = 50) or to the fluoroscopy group (n = 50). The primary endpoint was the success rate of occlusion, with the noninferiority margin set at 8% for the between-group difference in intention-to-treat analysis. Secondary endpoints were hospitalization duration, cost, procedure time, and rate of adverse events including occluder migration, hemolysis, peripheral vascular complications, and residual shunt at 1-month and 12-month follow-up. Results Patient, defect, and device characteristics were similarly distributed between groups. The success rate of occlusion was 98% for the TTE group and 100% for the fluoroscopy group (absolute difference: −2%; 95% confidence interval: −5.9% to 1.9%). Cost and procedure duration were significantly lower in the TTE group, without adverse events in either group at a median of 12.0 months (range, 10.0–15.5 months) of follow-up. Conclusion Percutaneous PDA occlusion can be performed via TTE guidance safely and effectively, and the success rate of the TTE-guided procedure was noninferior to that under fluoroscopy guidance, with reduced cost and procedure time. The trial is registered with http://www.chictr.org.cn (ChiCTR-ICR-15006334).

Personalized Three-Dimensional Printing and Echoguided Procedure Facilitate Single Device Closure for Multiple Atrial Septal Defects.

Background To evaluate the feasibility of using a single device to close multiple atrial septal defects (ASDs) under the guidance of transthoracic echocardiography (TTE) and with the aid of three-dimensional (3D) printing models. Methods Sixty-two patients with multiple ASDs were retrospectively analyzed. Thirty of these patients underwent TTE-guided closure (3D printing and TTE group) after a simulation of occlusion in 3D printing models. The remaining 32 patients underwent ASD closure under fluoroscopic guidance (conventional group). Closure status was assessed immediately and at 6 months after device closure. Results Successful transcatheter closure with a single device was achieved in 26 patients in the 3D printing and TTE group and 27 patients in the conventional group. Gender, age [18.8 ± 15.9 (3–51) years in the 3D printing and TTE group; 14.0 ± 11.6 (3–50) years in the conventional group], mean maximum distance between defects, prevalence of 3 atrial defects and large defect distance (defined as distance ≥7 mm), and occluder size used were similarly distributed between groups. However, the 3D printing and TTE group had lower frequency of occluder replacement (3.8% vs 59.3%, p < 0.0001), prevalence of mild residual shunts (defined as <5 mm) immediately (19.2% vs 44.4%, p < 0.05) and at 6 months (7.7% vs 29.6%, p < 0.05) after the procedure, and cost (32960.8 ± 2018.7 CNY vs 41019.9 ± 13758.2 CNY, p < 0.01). Conclusion The combination of the 3D printing technology and ultrasound-guided interventional procedure provides a reliable new therapeutic approach for multiple ASDs, especially for challenging cases with large defect distance.

Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database.

While the use of transthoracic echocardiography (TTE) in the ICU is rapidly expanding, the contribution of TTE to altering patient outcomes among ICU patients with sepsis has not been examined. This study was designed to examine the association of TTE with 28-day mortality specifically in that population. The MIMIC-III database was employed to identify patients with sepsis who had and had not received TTE. The statistical approaches utilized included multivariate regression, propensity score analysis, doubly robust estimation, the gradient boosted model, and an inverse probability-weighting model to ensure the robustness of our findings. Significant benefit in terms of 28-day mortality was observed among the TTE patients compared to the control (no TTE) group (odds ratio = 0.78, 95% CI 0.68-0.90, p < 0.001). The amount of fluid administered (2.5 vs. 2.1L on day 1, p < 0.001), use of dobutamine (2% vs. 1%, p = 0.007), and the maximum dose of norepinephrine (1.4 vs. 1mg/min, p = 0.001) were significantly higher for the TTE patients. Importantly, the TTE patients were weaned off vasopressors more quickly than those in the no TTE group (vasopressor-free days on day 28 of 21 vs. 19, p = 0.004). In a general population of critically ill patients with sepsis, use of TTE is associated with an improvement in 28-day mortality.

Impact of echocardiography on one-month and one-year mortality of intertrochanteric fracture patients

ObjectiveThe aim of this study was to analyze the effects of preoperative echocardiography on patient survival, timing of surgery in length of hospital stay in patients who will undergo hip nailing for an intertrochanteric fracture. MethodsThe clinical records of the patients who were admitted to a tertiary university hospital with an intertrochanteric femur fracture were retrospectively analyzed. The age, gender, American Society of Anesthesiologists (ASA) score, days to surgery, total hospital stay, cardiac drug prescription/modification, cardiac intervention and presence of an echocardiography assessment including detailed findings were reviewed. Mortality data were accessed from the national civil registration system. Results181 (110 women and 71 men; mean age 81 (44–98)) cases were studied whom 65 underwent pre-operative echocardiography. Time to surgery and total hospital stay was 2 days longer at transthoracic echocardiography (TTE) group (p < 0.001). At one month control group survival rate was 93.1% on contrary it was 75.4% at TTE group. One-year survival rates were 77.3% and 55.1% respectively. Likewise mean expected survival time was 21.6 ± 1.03 months for control group and 15.12 ± 1.64 months for TTE group (p < 0.001). Only increased left ventricular end diastolic diameter (LVEDD) was showed to be associated with increasing one-year mortality with a hazard ratio of 10.78 (2.572–45.19) at multivariate model. ConclusionCardiac findings and requisite for preoperative TTE and increased LVEDD is a strong predictor for mortality. TTE significantly lengthens the time to surgery. Also LVEDD measurement can be easily performed in the bedside which we believe would save time and reduce mortality. Level of evidenceLevel III Diagnostic study.

A propensity score-matching analysis of transthoracic echocardiography and abdominal ultrasonography for the detection of abdominal aortic aneurysms.

INTRODUCTIONWe previously reported that the prevalence of abdominal aortic aneurysms (AAAs) was higher in patients undergoing scheduled transthoracic echocardiography (TTE) than in patients undergoing abdominal ultrasonography (AUS); however, intergroup patient backgrounds differed significantly in that report.PURPOSEWe tested the hypothesis that TTE could detect AAA as effectively as AUS.DESIGNA propensity score-matching analysis of a cross-sectional study was adopted as the design for this study.METHODSWe enrolled 7,619 and 15,433 patients scheduled to undergo TTE with additional evaluation of abdominal aorta at the end of the routine study and AUS, respectively, from 2009 to 2010 in our hospital, as reported. A propensity score for profiles of patients who underwent TTE or AUS was developed to adjust for potential confounding bias. Consequently, 4,388 patients in each group were matched for analyses.RESULTSIn propensity-matched patients, AAA was detected in 59 patients of the TTE group and in 48 patients of the AUS group; the prevalence of AAA detection did not differ significantly between TTE and AUS groups (P = 0.331). Positive associations were observed between AAA detection and male sex (adjusted odds ratio [OR]: 3.25; 95% confidence interval [CI], 2.05–5.15; P < 0.001), older age (adjusted OR: 1.029; 95% CI: 1.01–1.04; P < 0.001), and the presence of ischemic heart disease (adjusted OR: 1.78; 95% CI: 1.04–3.03; P = 0.033) and hypertension (adjusted OR: 2.16; 95% CI: 1.38–3.37; P = 001).CONCLUSIONTTE detected AAA with comparable efficacy as AUS in propensity-matched groups who underwent scheduled TTE and AUS.

Abstract 18096: Screening of Abdominal Aortic Aneurysm during Transthoracic Echocardiography

Introduction: We previously reported that the prevalence of abdominal aortic aneurysm (AAA) in patients who underwent scheduled transthoracic echocardiography (TTE) was higher than that of AAA in patients who underwent abdominal ultrasonography (AUS). However, the patient backgrounds differed significantly between the two groups. Hypothesis: We hypothesized TTE detected AAA as similarly as AUS, one of standard methods for the screening of AAA. Methods: A total of 7,619 patients who were scheduled for TTE from 2009 to 2010 in our hospital were prospectively included. The abdominal aorta was evaluated at the end of the routine protocol. All patients who received scheduled abdominal ultrasonography (AUS) during the same period, a total of 15,433 patients, were included. The patients with known AAA and those without consent were excluded. In order to compare the TTE group to AUS group, we developed a propensity score for profiles of patients who received TTE or AUS for potential confounding bias. Specifically, a multivariate logistic regression model was fit with TTE or AUS as a dependent variable, which included age, sex, numbers of comorbidities, and the presence of each comorbidity. Consequently, 4,388 patients in each group were matched for analyses. Results: In propensity-matched patients, AAA was detected in 59 patients of TTE group and 48 patients of AUS group and the prevalence of the detection of AAA was not different between TTE and AUS (p=0.331). Positive associations were observed between AAA detected and male sex (adjusted odds ratio [OR], 3.25; 95% CI, 2.05-5.15; P&lt;.001), older age (adjusted OR, 1.029; 95% CI, 1.01-1.046; P&lt;.001), having ischemic heart disease (adjusted OR, 1.78; 95% CI, 1.04-3.03; P=0.033), and having hypertension (adjusted OR, 2.16; 95% CI, 1.38-3.38; P=001). Conclusions: TTE detected AAA as similarly as AUS. This result suggested that additional examination of the abdominal aorta during scheduled TTE was efficient for the screening of AAA.

Transthoracic Echocardiography Is Still Useful in the Initial Evaluation of Patients With Suspected Infective Endocarditis: Evaluation of a Large Cohort at a Tertiary Referral Center

ObjectivesTo examine the sensitivity of contemporary transthoracic echocardiography (TTE) for the detection of vegetation, abscess cavity, or prosthetic valve dehiscence (Vg) in patients with suspected infective endocarditis (IE) and to identify whether a relatively normal initial TTE finding can be effectively used as a rule out test, obviating the need for transesophageal echocardiography (TEE). Patients and MethodsWe evaluated clinical, microbiological, and echocardiographic data for all patients with suspected IE referred for both TTE and TEE between January 1, 2005, and December 31, 2010. Patients were stratified into 3 groups by baseline TTE findings: negative TTE (native valves with less than or equal to mild regurgitation and no Vg), equivocal TTE (no Vg but prosthetic valve or greater than mild native valvular regurgitation), and positive TTE (Vg detected). ResultsWe studied 622 consecutive patients (68% male; mean ± SD age, 62±17 years), including 256 with Staphylococcus aureus bacteremia (SAB). The presence of Vg was confirmed by TEE in 141 patients (23%). The TTE had low sensitivity for the detection of Vg (58%). A total of 271 patients (44%) had an initial negative TTE. Of these, TEE demonstrated Vg in only 8 patients (negative predictive value [NPV] of negative TTE, 97%). The negative TTE group included 132 patients with SAB, only 6 of whom had Vg (NPV, 95%). Of 265 patients with equivocal TTE, Vg was demonstrated in 51 (19%). ConclusionIn a hospital population with clinically suspected IE, TTE had low sensitivity for the detection of Vg; however, a negative initial TTE was a common finding, with a high NPV, even in the setting of SAB. A TEE may be avoided in many patients with suspected IE.

Clinical comparison of transthoracic echocardiography with angiography guided transcatheter occlusion in patent ductus arteriosus

Objective To investigate the feasibility and superiority of transthoracic echocardiography(TTE) guided transcatheter occlusion for patent ductus arteriosus(PDA). Methods Totally 58 patients with simple funnel shape(Type A)PDA were studied retrospectively, and they were divided into angiography group(n=21) and echocardiography group(n=37). The angiography group received traditional transcatheter occlusion technique, and the echocardiography group received TTE guided transcatheter occlusion of PDA.An observation for the effect was taken post operatively, as well as for the comparison between the 2 groups in the aspects of the operation duration, the time of X-ray exposure, the radiation dose, the length of hospital stay and the expense of medication. Results Successful occlusion was performed in all patients.Both of the TTE and angiogram group showed good position of the occlusion devices.Moreover, the velocities of blood flow in left pulmonary artery and the descending aorta were in a normal range.Compared with angiography group, echocardiography group experienced shorter operation duration(P<0.05), shorter X-ray exposure time(P<0.05), lower radiation dose, fewer days of hospital stay(P<0.05) and less expense of the medication(P<0.05). Conclusions TTE-guided transcatheter occlusion for simple funnel shape PDA(Type A) is a simplified occlusion method, which is effective and preferential treatment to the method of traditional angiography guidance in clinical trials. Key words: Transcatheter occlusion of patent ductus arteriosus; Transthoracic echocardiography; Angiography; Funnel shape

The Utility of Pulsed Tissue Doppler Parameters for the Diagnosis of Advanced Left Ventricular Diastolic Dysfunction

The evaluation of diagnostic value of pulsed tissue Doppler (TD) parameters (calculated from six points of mitral annulus and separately measured in the lateral part of mitral annulus) for the detection of pseudonormal mitral inflow pattern. Among 200 persons examined by transthoracic echocardiography group with E/A value between 1 and 2 was selected and divided to normal (54 subjects, early wave deceleration time, Edt > or = 150 msec) and pseudonormal (23 patients, Edt < 150 msec together with prolonged difference between duration of atrial reversal flow in pulmonary vein and mitral flow in atrial phase, delta Ar > or = 20 msec) inflow. Wide spectrum of TD parameters was compared between the selected groups. In normal inflow, average peak velocities of early and atrial phase of diastolic mitral annulus motion were significantly higher: 11.0 +/- 2.6 versus 8.9 +/- 3.5 cm/sec; (P = 0.005) and 12.0 +/- 2.2 versus 10.0 +/- 3.0 cm/sec; (P = 0.002), respectively. Ratio of peak early mitral wave velocity to peak velocity of annulus motion in early phase (Ev/E'v avr) was higher in the pseudonormal pattern: 9.8 +/- 3.7 versus 7.0 +/- 2.0, respectively (P < 0.001). For the value of Ev/E'v avr > 10.2, 70% accuracy for the diagnosis of pseudonormalization was detected. For the parameters measured in the lateral part of mitral annulus similar relationships in the early filling phase were detected but did not reach statistical significance in the atrial phase. Pulsed TD offers good accuracy for the diagnosis of pseudonormalization with increased ratio of peak early mitral wave velocity to peak velocity of mitral annulus being the optimal predictor of advanced diastolic dysfunction.

Using Transthoracic Two‐Dimensional Echocardiography to Guide the Placement of Coronary Sinus Catheters: A Randomized Study

To assess the value of transthoracic echocardiography (TTE) as an image guide in placing a coronary sinus catheter into the coronary sinus. Sixty consecutive patients undergoing electrophysiologic study were randomized to TTE (30 patients, "TTE group") or x-ray fluoroscopy (30 patients, "x-ray group") as an image guide to assist in the placement of a coronary sinus catheter. The success rate of placing the coronary sinus catheter was 96.7% in TTE group and 100% in x-ray group (P > 0.05). The procedure duration was 5.8 +/- 5.7 minutes in TTE group and 5.9 +/- 3.3 minutes in x-ray group (P > 0.05), The x-ray exposure time was 0.15 +/- 0 minute in TTE group and 4.2 +/- 2.8 minutes in x-ray group (P < 0.0001). Using TTE as an image guide, coronary sinus cannulation is feasible and as rapid as standard x-ray fluoroscopy, without the radiation risk.