Systolic longitudinal function of the left ventricle assessed by speckle tracking in heart failure patients with preserved ejection fraction

Background: Echocardiographic evaluations of the longitudinal axis of the left ventricular [LV] function have been used in the diagnosis and assessment of heart failure with normal ejection fraction [HFNEF]. The evaluation of the global and segmental peak systolic longitudinal strains [PSLSs] by two-dimensional speckle tracking echocardiography [STE] may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF

Methods: In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity [E]; late diastolic peak flow velocity [A]; E/A ratio; deceleration time of E; early diastolic myocardial velocity [e?]; late diastolic myocardial velocity [A?]; systolic myocardial velocity [S]; and global, basal, mid, and apical PSLSs. The correlations between these methods were assessed

Results: The mean age was 57.50 +/- 10.07 years in the HFNEF patients and 54.90 +/- 7.17 years in the control group. The HFNEF group comprised 69.8% males and 30.2% females, and the normal group consisted of 70% males and 30% females. The global, basal, mid, and apical PSLSs were significantly lower in the HFNEF group [p value < 0.001 for all]. There was a significant positive correlation between the global PSLS and the septal e' [p value < 0.001]. There was a negative correlation between the global PSLS and the E/e' ratio [p value = 0.001]. There was a significant negative correlation between the E/e' ratio and the mid PSLS [p value = 0.002] and the basal PSLS [p value = 0.001]. There was a weak positive correlation between the septal e' and the mid PSLS [p value = 0.001] and the basal PSLS [p value < 0.001]. There were also weak negative correlations between the isovolumic relaxation time and the global PSLS [p value = 0.022] and the mid PSLS [p value = 0.018] and also between the New York Heart Association functional class and the mid PSLS [p value = 0.041] and the basal PSLS [p value = 0.009]

Conclusion: Our HFNEF patients on conventional echocardiography had different STE findings compared to our normal subjects, which is indicative of diastolic dysfunction. The longitudinal systolic function of the LV, which was measured by STE, was reduced in all the segments, denoting some degree of subclinical systolic dysfunction in these patients

Mitral regurgitation after percutaneous balloon mitral valvotomy in patients with rheumatic mitral stenosis: a single-center study

Percutaneous balloon mitral valvotomy [BMV] is the gold standard treatment for rheumatic mitral stenosis [MS] in that it causes significant changes in mitral valve area [MVA] and improves leaflet mobility. Development of or increase in mitral regurgitation [MR] is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association [NYHA] functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient [MVPG and MVMG], left atrial [LA] pressure, pulmonary artery systolic pressure [PAPs], and MR severity before and after BMV, were evaluated. Totally, 105 patients [80% female] at a mean age of 45.81 +/- 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure [p value < 0.001] MVA significantly increased [mean area = 0.64 +/- 0.29 cm[2] before BMV vs. 1.90 +/- 0.22 cm2 after BMV; p value < 0.001] and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 [78.1 %] patients, but it increased in 18 [17.1%] and decreased in 5 [4.8%] patients. Patients with increased MR had a significantly higher calcification score [2.03 +/- 0.53 vs. 1.50 +/- 0.51; p value < 0.001] and lower MVA before BMV [0.81 +/- 0.23 vs. 0.94 +/- 0.18; p value = 0.010]. There were no major complications. In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV

association between epicardial adipose tissue and coronary artery disease: an echocardiographic cut-off point

EAT is an independent factor in coronary artery disease [CAD]. The objective of the current study was to define an echocardiographic cut-off point for EAT and to determine its diagnostic value in predicting the increase in CAD risk. Two hundred patients underwent coronary artery angiography for diagnosis of CAD and transthoracic echocardiography for measurement of EAT on the right ventricle [RV], RV apex and RV outlet tract. Sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of the EAT cut-off points in the three above-mentioned areas for predicting the severity of CAD were measured. The relation between the EAT and CAD risk factors was evaluated as well. EAT was independent from gender, height, hypertension, diabetes, HDL, total cholesterol, ejection fraction, acute coronary syndrome, and the location of the coronary artery stenosis in the coronary artery in all three anatomical areas. EAT on RV and RV apex had a significant relation with CAD [P /= 10 mm and RV apex EAT >/= 8 mm had sensitivity and PPV of more than 70% in predicting coronary stenosis >/= 50% and acute coronary syndrome [ACS] and RVOT EAT >/= 13 mm is of PPV=83.5% for predicting coronary stenosis >/= 50%. EAT thickness has an acceptable diagnostic value for predicting severe coronary artery stenosis and ACS. Therefore, non-invasive EAT thickness measurement could be of great assistance to clinicians for detecting the patients at risk and helping them to undergo supplementary evaluations with invasive approaches.

Fragmented QRS complex in acute anterior myocardial infarction and coronary sinus blood flow: is there any relevance?

Patients with QRS fragmentation following myocardial infarction [MI] are at greater risk of cardiac death. Transthoracic echocardiography [TTE] can be used as a method for evaluating the coronary sinus blood flow [CSBF] and coronary sinus velocity time integral [CSVTI]. The present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases, half of them with fragmented QRS. Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50 patients were without fragmented QRS complex, while there was no difference in terms of LVEF in both groups of study. CSBF [303 +/- 126 ml/min vs. 258 +/- 121 ml/min; p-0.001] and CSVTI [14.45 +/- 2.85 ml vs. 10.85 +/- 2.69 ml; p=0.003] were significantly lower in the acute anterior MI patients with fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS. We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and these variables are reduced in acute anterior MI patients with fragmented QRS

role of transesophagesl echocardiography in diagnosis and treatment in a series of patients with chronic thromboembolic pulmonary hypertension

We describe 6 cases of chronic thromboembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy in our center. Transthoracic and transesophageal echocardiography provided valuable data on surgical accessibility of thrombus, its extension, chronicity and hemodunamic conse1uances on right ventricular transesophageal echocardiography as a rapid, bedside and easily available method has been a useful guide for diagnosis and guiding the treatment for these patients

Massive myocardial calcification in 19 years old man

We report a case of extensive myocardial calcification in a 19 years old male. This rare condition is associated with metastatic deposition, infarction or other endocrine disorders and in this patient, with childhood history of living in a farm may have been caused by some type of infection

Non invasive assessment of myocardial perfusion after first myocardial infarction with transthoracic echocardiography

Standard methods for the measurement of myocardial perfusion are invasive and require cardiac catheterization or the use of radioisotope dyes. The coronary sinus blood flow [CSBF] is an appropriate criterion for the efficacy of myocardial perfusion. This study sought to measure CSBF via transthoracic echocardiography [TTE] in patients with acute myocardial infarction [AMI] and to assess its relation with left ventricular ejection fraction [LVEF], wall motion scoring index [WMSI], and in-hospital mortality. This case-control study evaluated 20 patients [pts] with anterior AMI and 20 healthy individuals as controls over a 6-month period [in 2005] in Madani Heart Center in Tabriz [Iran]. All the patients received the same drugs for AMI treatment [e.g. fibrinolytic]. CSBF and WMSI, having been obtained via TTE, were compared between the two groups. Baseline variables were similar between the two groups [P>0.05]. CSBF in the AMI group was 287.8 +/- 128 ml/ min and in the control group was 415_127 ml/min [P=0.001]. There was a significant correlation between CSBF and LVEF [r=0.52, P=0.01], between CSBF and WMSI [r=-0.77, P=0.0001], and between CSBF and in-hospital mortality [r=0.58, P=0.03]. Our study demonstrated a good correlation between CSBF measured with 2D-doppler TTE and LVEF, WMSI, and in-hospital mortality

large mobile aortic arch mass

Mobile luminal mass of aortic arch is an unusual finding in patients with peripheral embolization. To search the source of these emboli, aortic arch mass should be considered. To our knowledge, transesophageal echocardiography [TEE] can be a useful modality to demonstrate the nature and exact location of the mass. This report is illustrative of a large mobile aortic arch mass, histologically thrombus, found by TEE in a 48- year-old woman with embolic symptoms