Cardiac Imaging Update

Real-time three-dimensional transoesophageal echocardiography: a new intraoperative feasible and useful technology in cardiac surgery.

Int J Cardiovasc Imaging. 2010 Mar 30;

Authors: Gripari P, Tamborini G, Barbier P, Maltagliati AC, Galli CA, Muratori M, Salvi L, Sisillo E, Alamanni F, Pepi M

A new generation of transoesophageal echocardiographic probes with a novel matrix array technique has been recently introduced, allowing three-dimensional (3D) presentation of cardiac structures in real-time. This new tool may potentially provide fast and complete 3D information about cardiac structures improving spatial orientation and overcoming limitations of offline 3D technologies. The aim of this study was to demonstrate the feasibility and usefulness of real-time 3D transoesophageal echocardiography (TOE) for the intraoperative evaluation of cardiac surgery procedures. One-hundred patients underwent transoesophageal echocardiographic examination during cardiac surgery as a part of their routine clinical practice. In the intraoperative pre- and post-cardiopulmonary bypass periods complete 2D and 3D transoesophageal examinations were performed. Feasibility and duration of examinations, and immediate additional anatomical value of 3D versus 2D-TOE were annotated intraoperatively. Image quality, additional clinical value of 3D- compared to standard 2D-TOE and the accuracy in the description of mitral valve pathology by a surgeon and an echocardiographer were evaluated off-line. No complications related to transoesophageal examination occurred and successful intubation was achieved in all 100 patients. Therefore, 200 examinations were performed and analysed considering the pre- and post-cardiopulmonary bypass periods. The mean number of acquisitions per patient was 16 +/- 14, including 3D real-time, zoom, full-volume and colour full volume modalities. The duration of the 3D examination was 16 +/- 10 min and the mean image quality score 2.8 +/- 0.7 (in a scale 1-4). In 36 out of 100 cases (36%) 3D-TOE provided additional anatomical information. The surgeon evaluated 3D images easier and more accurately than 2D images (88% vs. 76% in the evaluation of mitral valve scallop). Real-time 3D TOE may be used routinely for the intraoperative evaluation of cardiac surgery. Imaging with this new probe facilitates intraoperative evaluation of several surgical procedures with an additional clinical value in selected cases.

20352342

See the rest here

Strain and strain rate echocardiography for evaluation of right ventricular dysfunction in patients with idiopathic pulmonary arterial hypertension.

Clin Res Cardiol. 2010 Mar 30;

Authors: Filusch A, Mereles D, Gruenig E, Buss S, Katus HA, Meyer FJ

Optimizing the non-invasive imaging of right ventricular (RV) function is of increasing interest for therapy monitoring and risk stratification in patients with idiopathic pulmonary hypertension (IPAH). Therefore, this study evaluated strain and strain rate echocardiography as a tool for comprehensive assessment of RV function and disease severity in IPAH patients. In 30 IPAH patients [WHO functional classes II-IV; mean pulmonary artery pressure (mPAP) 48.8 +/- 12.5 mmHg; pulmonary vascular resistance (PVR) 7.9 +/- 5.3 Wood units] and in 10 matched healthy control subjects’ two-dimensional echocardiography, 6-MWD and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were obtained. In IPAH patients when compared with controls, RV systolic strain (-18.8 +/- 4.3 vs. -34.5 +/- 3.8%, p = 0.0016) and strain rate (-1.6 +/- 0.6 vs. -2.7 +/- 0.5 s(-1), p = 0.018) were significantly altered and correlated significantly with elevated NT-proBNP levels (r = 0.73 and r = 0.62; p < 0.001, respectively) and reduced 6-MWD (r = -0.76 and r = -0.81; p < 0.001). In IPAH patients, reduced strain correlated with both mPAP (r = 0.61, p = 0.01 for strain; and r = 0.55, p = 0.04 for strain rate, respectively), and PVR (r = 0.84, p < 0.001 for strain; and r = 0.67, p < 0.001 for strain rate, respectively). This study gives first comprehensive evidence that strain echocardiography allows accurate non-invasive assessment of RV function and disease severity in patients with IPAH.

20352437

More here 

Screening Stress Myocardial Perfusion Imaging and Eligibility for Liver Transplantation.

Am J Cardiol. 2010 Apr 1;105(7):1010-1013

Authors: Bradley SM, Soine LA, Caldwell JH, Goldberg SL

Screening for coronary artery disease is common practice in the evaluation of liver transplantation candidates. However, it is unclear whether coronary screening influences transplantation eligibility. We sought to determine the association between screening stress myocardial perfusion imaging (MPI) results and the eligibility for liver transplantation. Within a retrospective cohort of liver transplantation candidates referred for screening stress MPI at a single institution from April 1998 to February 2004, we obtained the baseline characteristics, stress MPI results, transplantation eligibility, and transplantation denial criteria by chart review. Of 294 patients (39%) denied transplantation, the denial criteria were multifactorial for 91 (31%) of the candidates. Compared to candidates with low-risk stress MPI results, the odds of being denied transplantation were the same for candidates with intermediate-risk MPI results (odds ratio 0.93, 95% confidence interval 0.45 to 1.82) or high-risk MPI results (odds ratio 1.42, 95% confidence interval 0.54 to 3.73). This lack of association persisted in our analysis with additional stratification of stress MPI results into negative, positive-low-risk, positive-intermediate-risk, and positive-high-risk. In conclusion, the screening stress MPI results were not associated with liver transplantation eligibility. The large number of competing factors considered before transplantation listing and the low proportion of positive stress MPI results suggests that targeting screening to patients deemed otherwise acceptable for transplantation might increase the influence of stress MPI findings on transplantation eligibility.

20346322

Read the original post

Contractile Reserve Assessed Using Dobutamine Echocardiography Predicts Left Ventricular Reverse Remodeling after Cardiac Resynchronization Therapy: Prospective Validation in Patients with Left Ventricular Dyssynchrony.

Echocardiography. 2010 Mar 25;

Authors: S

Comparison of Tissue Doppler Dynamics with Doppler Flow in Evaluating Left Atrial Appendage Function by Transesophageal Echocardiography in Prehypertensive and Hypertensive Patients.

Echocardiography. 2010 Mar 25;

Authors: Tenekecioğlu E, Karabulut A, Yılmaz M

Increased blood pressure (BP) is associated with an increase in cardiovascular mortality and morbidity. We aimed to analyze the effect of increased BP onto the function of left atrial appendage (LAA) in early stages of hypertension. Transesophageal echocardiography (TEE) was prospectively performed to assess LAA functions in 120 patients with increased BP, and in 58 normotensive subjects without cardiovascular disease. Patients with increased BP were divided according to Joint National Committee VII (JNC VII) report: prehypertensive,stage-1 hypertensive and stage-2 hypertensive patients. During TEE, LAA late-emptying velocities (LAAEV) were significantly reduced only in stage-2 hypertensives as compared with control group (P < 0.001). In contrast, LAA late-contracting velocity (LAA TDI-D2) was significantly reduced in prehypertensive,stage-1 hypertensive and stage-2 hypertensive patients, when compared with control group (P < 0.05, P < 0.001, and P < 0.001, respectively). The LAA maximal areas were increased significantly only in stage-2 hypertensive patients when compared with control group (P < 0.05). During TEE, left atrial spontaneous echocardiographic contrast was found in 2 of 36 patients in prehypertension group, in 7 of 40 patients in stage-1 hypertension group, and in 10 of 44 patients in stage-2 hypertension group. Left atrial thrombi were observed in 3 (6.8%) patients of stage-2 hypertension group. In conclusion, in patients with untreated prehypertension and hypertension, elevation of afterload imposed on left atrium involved both left atrium and LAA, resulting in impairment of the LAA function. Tissue Doppler imaging (TDI) enables the detection of this functional impairment in early stages of hypertension, even in prehypertensive phase, when compared with conventional Doppler flow measurement of the LAA. Even in prehypertensive phase, BP should be decreased to normal levels to prevent the LAA dysfunction. (Echocardiography ****;**:1-10).

20345441

Originally posted here