Two-dimensional Echocardiographic Signs Research Articles

Rapid atrial septal oscillation — A new two-dimensional echocardiographic sign in atrial flutter

Rapid atrial septal oscillation — A new two-dimensional echocardiographic sign in atrial flutter

Respirophasic two-dimensional echocardiographic signs are highly sensitive and specific for pericardial constriction

Respirophasic two-dimensional echocardiographic signs are highly sensitive and specific for pericardial constriction

Respirophasic Two-dimensional Echocardiographic Signs Are Highly Sensitive and Specific for Pericardial Constriction

Respirophasic Two-dimensional Echocardiographic Signs Are Highly Sensitive and Specific for Pericardial Constriction

Restrictive hemodynamic patterns after cardiac transplantation: Relationship to histologic signs of rejection

Hemodynamic and echocardiographic data from 33 consecutive patients undergoing cardiac transplantation were correlated with endomyocardial biopsy results to determine whether reversible restrictive hemodynamics accompany histologic evidence of transplant rejection. During the study period 251 biopsy specimens were obtained during periods of no histologic evidence of transplant rejection and 52 episodes of mild, 20 episodes of moderate, and one episode of severe rejection. Right atrial mean pressure increased significantly during episodes of moderate transplant rejection (9.9 ± 6.2 mm Hg, p < 0.001) compared with pressures obtained during periods when there was no evidence of rejection (4.6 ± 3.2 mm Hg), mild rejection (5.8 ± 3.9 mm Hg), or resolving rejection (4.3 ± 3.4 mm Hg). Y descent was elevated during moderate rejection (9.6 ± 4.2 mm Hg, p < 0.001) compared with pressures during episodes of no rejection (5.6 ± 2.5 mm Hg), mild rejection (6.6 ± 2.7 mm Hg), and resolving rejection (5.8 ± 3.1 mm Hg) and showed a wave morphology consistent with a restrictive hemodynamic pattern. Pulmonary capillary wedge pressure was increased during moderate rejection (14.4 ± 6.4 mm Hg) when compared with pressures obtained during episodes of no rejection (10.2 ± 5.8 mm Hg) or resolving rejection (10.2 ± 5.4 mm Hg) ( p < 0.02). Sensitivity for a right atrial mean pressure of 11 mm Hg indicating moderate rejection was 41% with a specificity of 96%. Sensitivity for Y descent (≥ 10 mm Hg) was 52% and specificity was 94%. In patients without rejection right atrial mean pressure and Y descent showed a decrease over the initial 8 week posttransplant period, but the significant increases in right atrial mean pressure and Y descent during moderate rejection remained. From 27 patients 148 echocardiograms were evaluated for chamber size and wall thickness and alteration of left ventricular systolic function. Fractional shortening and fractional area change were measured. Doppler echocardiograms from 20 patients were evaluated for pressure half-time, deceleration time, peak deceleration time, and peak diastolic velocity of the mitral valve. No two-dimensional or Doppler echocardiographic parameters correlated with transplant rejection status. Histologic evidence of moderate transplant rejection is associated with a reversible increase in right atrial mean pressure and Y descent indicating restrictive hemodynamics, with a high specificity but a low sensitivity. Transplanted hearts exhibit normal hemodynamics 9 weeks after transplantation. There are no two-dimensional echocardiographic signs that predict rejection status, and a single Doppler echocardiographic analysis does not differentiate between patients with or without transplant rejection.

Reliability of M-Mode, Two-Dimensional and Doppler Echocardiography in Diagnosing a Flail Mitral Valve Leaflet

The purpose of this study was to evaluate the M-mode, two-dimensional, and Doppler echocardiographic signs for a flail mitral valve leaflet. This was a retrospective evaluation of 54 patients who had (1) significant mitral regurgitation, (2) a technically adequate echocardiographic study, and (3) description of valve anatomy done at surgery or necropsy. The following M-mode signs were examined for their ability to detect a flail valve: (1) systolic flutter of the mitral valve closure line, sensitivity 29%, specificity 76%; (2) abnormal diastolic posterior leaflet motion, sensitivity 73%, specificity 71%; (3) abnormal diastolic anterior leaflet motion, sensitivity 67%, specificity 86%; (4) systolic atrial echoes, sensitivity 28%, specificity 68%; (5) multiple independent systolic closure lines, sensitivity 71%, specificity 52%. The two-dimensional echocardiographic signs evaluated were (1) diastolic inversion of the anterior leaflet toward the left atrium, sensitivity 29%, specificity 96%; (2) diastolic inversion of the posterior leaflet toward the left atrium, sensitivity 54%, specificity 93%, (3) systolic inversion of the anterior leaflet into the left atrium, sensitivity 57%, specificity 93%; (4) systolic inversion of the posterior leaflet into the left atrium, sensitivity 79%, specificity 86%; (5) systolic whipping of the mitral leaflets, sensitivity 73%, specificity 74%; (6) presence of floating apical chordae, sensitivity 30%, specificity 91%. Doppler echocardiographic signs evaluated were (1) presence of left atrial systolic antegrade flow, sensitivity 30%, specificity 91%; (2) vertical striations superimposed on the typical regurgitant flow pattern, sensitivity 75%, specificity 69%. When all the two-dimensional signs except systolic whipping and the M-mode signs for abnormal diastolic leaflet motion were combined, the sensitivity for detecting a flail mitral valve was maximized at 97%, but specificity was reduced to 64%. In conclusion, two-dimensional echocardiographic signs are more sensitive and specific than either M-mode or Doppler signs for detecting a flail mitral valve. The various M-mode, two-dimensional, and Doppler echocardiographic signs, however, are complementary to each other, and sensitivity is maximized when they are combined.

Septal Bounce, Vena Cava Plethora, and Pericardial Adhesion: Informative Two-Dimensional Echocardiographic Signs in the Diagnosis of Pericardial Constriction

To assess the diagnostic value of three different two-dimensional echocardiographic signs of pericardial constriction (early diastolic septal bounce, plethora of the inferior vena cava with blunted respiratory response, and pericardial adhesion), two independent observers retrospectively evaluated echocardiograms in 100 patients, 39 of whom had pericardial constriction, 15 had hemodynamically insignificant pericardial thickening, 16 had restrictive cardiomyopathy, and 30 had normal hearts. Causes of pericardial disease included cardiac surgery, malignancy, and uremia. Sensitivity and specificity of the three signs for constriction were 62% and 93% for septal bounce, 79% and 80% for vena cava plethora, and 79% and 90% for pericardial adhesion, respectively. The presence of either vena cava plethora or pericardial adhesion increased sensitivity, whereas the presence of both plethora and adhesion increased specificity. Between the two readers, septal bounce was the most consistent and pericardial adhesion the least consistent sign. False positive results included right ventricular pacing or left bundle branch block (septal bounce), postpericardiotomy (pericardial adhesion), and right heart failure (vena cava plethora). False negative results were often caused by technical problems with imaging. We conclude that these three two-dimensional echocardiographic signs are useful in differentiating pericardial constriction from hemodynamically insignificant pericardial thickening or restrictive cardiomyopathy.

Prevalence of Mitral Valve Prolapse in Presumably Healthy Young Saudi Men

ABSTRACT Echocardiographic and clinical data of 118 presumably healthy young Saudi medical students were analyzed to determine the prevalence of mitral valve prolapse (MVP). Eight subjects satisfie...

Isolated pulmonary valve prolapse: A sign of pulmonary hypertension

Isolated pulmonary valve prolapse may be a sign of pulmonary hypertension. Three patients with pulmonary hypertension as a result of left ventricular failure, chronic obstructive pulmonary disease, and primary pulmonary hypertension, respectively, are described in the case reports. It is likely that the morphological change of the pulmonary valve is due to exaggeration of the normal convexity of the elastic pulmonary leaflets as a result of a high pulmonary artery diastolic pressure. This two-dimensional echocardiographic sign may prove to be a useful qualitative hallmark for pulmonary hypertension. Present methods to detect pulmonary hypertension by two-dimensional echocardiography rely on remote findings of right heart abnormalities or changes in systolic time intervals. Pulmonic valve prolapse is the first direct sign of pulmonary hypertension found on two-dimensional echocardiography.

Sensitivity and specificity of two-dimensional echocardiographic signs of mitral valve prolapse

The sensitivity and specificity of previously described 2-dimensional echocardiographic signs of mitral valve prolapse (MVP) were assessed in 70 patients with MVP and in 100 normal control subjects. Specificity of individual signs was uniformly high, ranging from 88% for excessive motion of the posterior mitral ring to 100% for several signs including systolic arching in the parasternal long-axis view, excessive posterior coaptation and diastolic doming of the anterior mitral leaflet. Sensitivity of individual signs was low to moderate, ranging from 1% for whip-like motion of both mitral leaflets to 70% for excessive posterior coaptation of the mitral leaflets in the apical 4-chamber view. The highest sensitivity value (87%) was associated with the presence of systolic arching of 1 or both mitral leaflets in the parasternal long-axis view or systolic bowing of 1 or both mitral leaflets in the apical 4-chamber view or excessive posterior coaptation of the mitral leaflets or a combination. This increase in sensitivity was achieved without sacrificing specificity (97%). Thus, the individual 2-dimensional echocardiographic signs tested possess uniformly high specificity, but only low to moderate sensitivity; however, sensitivity can be markedly enhanced without sacrificing specificity by using selected combinations of echocardiographic signs.

Two-dimensional echocardiographic recognition of an aortic intimai flap prolapsing into the left ventricular outflow tract

A 59 year old man presented with dyspnea and a new murmur of aortic regurgitation. Two-dimensional echocardiography demonstrated a to and fro motion of the intimal flap as it prolapsed into the left ventricle and was thrust into the aorta during diastole and systole, respectively. At surgery, the echocardiographic and angiographic findings were confirmed and a proximal aortic dissection was identified. Prolapse of an intimal flap from the aorta into the left ventricular outflow tract represents a new two-dimensional echocardiographic sign of aortic dissection.

Left ventricular pseudotumor: a two-dimensional echocardiographic sign of aortic insufficiency.

A left ventricular, mass-like echocardiographic density (a pseudotumor), present only during diastole and not attached to any intracardiac structure, was present in 77 of 1,820 consecutive 2-dimensional echocardiograms performed with a rotating-head transducer. Evaluation of the patients with a pseudotumor demonstrated that aortic insufficiency of mild to moderate degree was the most commonly associated lesion. Of the 61 patients with aortic insufficiency in our series, 69% had a left ventricular pseudotumor. Of the cases with a pseudotumor and aortic insufficiency, none had severe aortic insufficiency. Of the 1,759 patients without aortic insufficiency, a left ventricular pseudotumor was present in 2%. In our series, the sensitivity of left ventricular pseudotumor for aortic insufficiency was 69% and the specificity was 98%.

Malapposition of the Mitral Valve: A Two-Dimensional Echocardiographic Sign of Left Ventricular Dysfunction

A pattern of mitral valve closure (malapposition) was observed in 75 of 1,267 patients examined with two-dimensional echocardiography. Criteria defining malapposition are: (a) the mitral valve leaflets exhibit a reduced area of coaptation during systole, (b) the angle at the point of coaptation of the anterior and posterior mitral valve leaflets becomes progressively more obtuse, approaching 180 degrees, and (c) the atrioventricular groove, the coaptation point, and the basal portion of the aortic root lie along the same vertical line. Malapposition appears to be the common denominator of previously described M-mode abnormalities seen in altered left ventricular hemodynamics and dysfunction.

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The purpose of this study was to evaluate the M-mode, two-dimensional, and Doppler echocardiographic signs for a flail mitral valve leaflet. This was a retrospective evaluation of 54 patients who had (1) significant mitral regurgitation, (2) a technically adequate echocardiographic study, and (3) description of valve anatomy done at surgery or necropsy. The following M-mode signs were examined for their ability to detect a flail valve: (1) systolic flutter of the mitral valve closure line, sensitivity 29%, specificity 76%; (2) abnormal diastolic posterior leaflet motion, sensitivity 73%, specificity 71%; (3) abnormal diastolic anterior leaflet motion, sensitivity 67%, specificity 86%; (4) systolic atrial echoes, sensitivity 28%, specificity 68%; (5) multiple independent systolic closure lines, sensitivity 71%, specificity 52%. The two-dimensional echocardiographic signs evaluated were (1) diastolic inversion of the anterior leaflet toward the left atrium, sensitivity 29%, specificity 96%; (2) diastolic inversion of the posterior leaflet toward the left atrium, sensitivity 54%, specificity 93%, (3) systolic inversion of the anterior leaflet into the left atrium, sensitivity 57%, specificity 93%; (4) systolic inversion of the posterior leaflet into the left atrium, sensitivity 79%, specificity 86%; (5) systolic whipping of the mitral leaflets, sensitivity 73%, specificity 74%; (6) presence of floating apical chordae, sensitivity 30%, specificity 91%. Doppler echocardiographic signs evaluated were (1) presence of left atrial systolic antegrade flow, sensitivity 30%, specificity 91%; (2) vertical striations superimposed on the typical regurgitant flow pattern, sensitivity 75%, specificity 69%. When all the two-dimensional signs except systolic whipping and the M-mode signs for abnormal diastolic leaflet motion were combined, the sensitivity for detecting a flail mitral valve was maximized at 97%, but specificity was reduced to 64%. In conclusion, two-dimensional echocardiographic signs are more sensitive and specific than either M-mode or Doppler signs for detecting a flail mitral valve. The various M-mode, two-dimensional, and Doppler echocardiographic signs, however, are complementary to each other, and sensitivity is maximized when they are combined.