Cardiac Imaging Update

Impact of Diastolic Dysfunction Grade on Left Atrial Mechanics Assessed by Two-Dimensional Speckle Tracking Echocardiography.

J Am Soc Echocardiogr. 2010 Jul 26;

Authors: Otani K, Takeuchi M, Kaku K, Haruki N, Yoshitani H, Tamura M, Abe H, Okazaki M, Ota T, Lang RM, Otsuji Y

BACKGROUND: Mitral inflow patterns reflect not only left ventricular diastolic function but also left atrial (LA) remodeling. The aim of this study was to determine the effects of left ventricular diastolic dysfunction on LA volumetric and functional parameters assessed using two-dimensional speckle-tracking echocardiography. METHODS: Two-dimensional speckle-tracking analysis of the LA wall in the apical four-chamber view was performed in 268 subjects. Subjects were classified according to diastolic dysfunction grade. Indexed maximum and minimum LA volumes and indexed LA volume before atrial contraction were measured from LA volume waveforms. Expansion, passive emptying, and active emptying indices were calculated. RESULTS: LA volumes increased progressively with advanced stages of diastolic dysfunction. The expansion index and passive emptying index showed progressive decreases according to the grade of diastolic dysfunction. The active emptying index increased until mild diastolic dysfunction and thereafter progressively decreased until reaching severe diastolic dysfunction. Significant correlations were noted between the active emptying index and A-wave velocity (r = 0.31, P < .01) and between the E/E' ratio and the expansion index (r = 0.56, P < .01). CONCLUSIONS: LA volumes and functional parameters derived from two-dimensional speckle-tracking echocardiography vary according to the level of diastolic dysfunction. These results suggest that left ventricular diastolic dysfunction also predicts the severity of LA remodeling.

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Echocardiography for Assessment of Right Ventricular Volumes Revisited: A Cardiac Magnetic Resonance Comparison Study in Adults with Repaired Tetralogy of Fallot.

J Am Soc Echocardiogr. 2010 Jul 26;

Authors: Greutmann M, Tobler D, Biaggi P, Mah ML, Crean A, Oechslin EN, Silversides CK

BACKGROUND: The aim of this study was to develop a mathematical model using two-dimensional echocardiographic parameters to estimate right ventricular end-diastolic volume (RVEDVi) in adults with repaired tetralogy of Fallot. METHODS: Linear regression equations were used to examine the relationship between two-dimensional echocardiographic and cardiac magnetic resonance (CMR) imaging measures of RVEDVi. Imaging studies in 101 adults were used to create and validate the model. The ability of the model to detect changes in CMR RVEDVi was tested in 57 adults with serial studies. RESULTS: The optimal model to quantitate CMR RVEDVi included two-dimensional echocardiographic right ventricular end-diastolic area measured in the apical four-chamber view, indexed to body surface area (AreaDi) (CMR RVEDVi = 11.5 + [7 x AreaDi]). The model reliably allowed the detection of stable and changing CMR RVEDVi (kappa = 0.84 and kappa = 0.82, respectively, P < .0001). CONCLUSION: Quantitative assessment of right-ventricular volumes by echocardiography is feasible and may be used for serial follow-up in patients with contraindications for CMR.

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Independent and incremental value of stress echocardiography over clinical and stress electrocardiographic parameters for the prediction of hard cardiac events in new-onset suspected angina with no history of coronary artery disease.

Eur J Echocardiogr. 2010 Jul 28;

Authors: Chelliah R, Anantharam B, Burden L, Alhajiri A, Senior R

AIMS: Recent data have shown that exercise electrocardiogram (ECG) has no incremental prognostic value over clinical and rest ECG parameters in chest pain patients without a history of coronary artery disease (CAD). The incremental prognostic value of stress echocardiography (SE) in this population is unknown. METHODS AND RESULTS: Accordingly, 547 consecutive patients (68 +/- 4.9 years) with chest pain but no previous history of CAD, referred for SE (exercise and dobutamine), were identified. Patients were followed up for death and acute myocardial infarction (AMI). At a median follow-up period of 28 months, there were a total of 35 hard cardiac events (5 deaths and 30 non-fatal AMI). Among the prognostic clinical, resting/stress ECG, and SE data, univariate predictors were the Framingham risk score (P = 0.025), diabetes (P = 0.06), hypercholesterolaemia (P = 0.06), stress ECG ischaemia (P = 0.044), stress heart rate (P = 0.019), and SE-determined ischaemic burden (stress-rest wall thickening score index; P < 0.001). In a multivariate model, ischaemic burden was the only independent predictor of events (P < 0.001). SE also showed incremental prognostic value over and above clinical (Framingham's risk score) and stress ECG changes in a global chi(2) model. This was true also for patients undergoing only exercise SE (n = 347). CONCLUSION: SE provides both independent and incremental prognostic value for the prediction of hard cardiac events in chest pain patients without a previous history of CAD-over and above clinical, ECG, and stress ECG data.

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Left ventricular longitudinal systolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a long-term follow-up study focused on speckle tracking echocardiography.

Eur J Echocardiogr. 2010 Jul 28;

Authors: Sommer A, Poulsen SH, Mogensen J, Thuesen L, Egeblad H

AIMS: To examine left ventricular (LV) longitudinal systolic myocardial function in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after transcoronary ablation of septal hypertrophy (TASH). METHODS AND RESULTS: Twenty-three of 39 consecutive patients with HOCM had serial two-dimensional (2D) echocardiograms available for speckle tracking analyses before and up to 36 months after TASH. Before TASH, overall LV myocardial longitudinal systolic 2D strain was decreased despite normal LV ejection fraction (EF). A significant reduction of LV mass and left ventricular outflow tract (LVOT) gradients occurred during long-term follow-up after TASH, but this was not accompanied by improvement of average LV longitudinal systolic strain. However, in the basal LV segments remote to the site of alcohol injection longitudinal systolic strain increased [baseline: -13.1 +/- 5.4%; 1 month: -16.0 +/- 5.5% (NS); 12 months: -16.5 +/- 4.9% (P < 0.05 vs. baseline); 36 months: -17.4 +/- 4.2% (P < 0.01 vs. baseline)]. In contrast, the alcohol-treated basal segments of the septum and adjacent myocardium showed unchanged strain over time. CONCLUSION: Average LV longitudinal myocardial systolic function is depressed in HOCM despite normal LV EF. TASH-induced reduction of the LVOT obstruction does not improve average LV longitudinal systolic 2D strain. This is in contrast to global improvement of longitudinal systolic function after valve replacement in aortic valve stenosis. The discrepancy may be caused by the fact that HOCM is a primary myocardial disease.

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Myocardial abscess: a rare complication of valvular endocarditis demonstrated by 3D contrast echocardiography.

Eur J Echocardiogr. 2010 Jul 28;

Authors: Walker N, Bhan A, Desai J, Monaghan MJ

Myocardial abscess is a rare and often fatal complication of valvular endocarditis. We present a case of a patient with aortic valve endocarditis whose post-operative course was complicated by a large left ventricular abscess. The spatial location of the defect was difficult to assess with 2D transthoracic echocardiography (TTE); however, real-time 3D contrast TTE allowed us to visualize the full extent of the defect and its precise anatomical location, prior to successful surgical resection.

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