Mitral valve navigator. A new diagnostic tool for effective regurgitant orifice quantification in mitral regurgitation.

INTRODUCTION: Mitral regurgitation severity assessment is usually carried out using qualitative, semiquantitative, and quantitative parameters. The mitral valve navigation (MVN) tool allows to measure the mitral effective regurgitant orifice (MERO) from 3D echo datasets. Our aim was to validate the MVN as a new tool to quantify MERO. A secondary aim was to assess the intra- and interobserver variability. METHODS: This is a retrospective study in which consecutive subjects undergoing a transoesophageal echocardiogram for more than mild mitral regurgitation evaluation were included. MERO measurement obtained by means of 3D color Doppler was used as the gold standard method for comparison. In every patient, MERO was also obtained using the MVN tool. RESULTS: Fifty-nine consecutive patients were analyzed (47.5% female; mean age 50.8 years). Mitral regurgitation was moderate in 23 (39%) and severe in 36 (61%) patients. Forty patients (67.8%) had a primary and 19 (32.2%) a secondary mitral regurgitation. The intraclass correlation coefficient (ICC) between 3D color Doppler and MVN was excellent (ICC: 0.95; 95% CI: 0.82 to 0.98; P < 0.001) in the total group and for patients with primary and secondary mitral regurgitation. Intra- and interobserver agreements were also good. CONCLUSIONS: Mitral valve navigator shows an excellent accuracy for measuring MERO when the transoesophageal 3D color Doppler is used as the reference method, either primary or secondary mitral regurgitation. Intraobserver reproducibility and interobserver reproducibility are also excellent. These findings make this software a good alternative method to measure mitral regurgitation severity.

Long term effects of fetal undernutrition on rat heart. Role of hypertension and oxidative stress.

BACKGROUND AND AIMS: Fetal undernutrition is a risk factor for heart disease in both genders, despite the protection of women against hypertension development. Using a rat model of maternal undernutrition (MUN) we aimed to assess possible sex differences in the development of cardiac alterations and the implication of hypertension and cardiac oxidative stress. METHODS: Male and female offspring from rats fed ad libitum (control) or with 50% of the normal daily intake during the second half of gestation (MUN) were used. Heart weight/body weight ratio (HW/BW), hemodynamic parameters (anaesthetized rats) and plasma brain natriuretic peptide (BNP, ELISA) were assessed in 21-day, 6-month and 22-month old rats. Plasma testosterone (ELISA) and cardiac protein expression of enzymes related to reactive oxygen species synthesis (p22phox, xanthine-oxidase) and degradation (catalase, Cu/Zn-SOD, Mn-SOD, Ec-SOD) were evaluated in 21-day and 6-month old rats (Western Blot). Heart structure and function was studied at the age of 22 months (echocardiography). RESULTS: At the age of 21 days MUN males exhibited significantly larger HW/BW and cardiac p22phox expression while females had reduced p22phox expression, compared to their respective sex-matched controls. At the age of 6-months, MUN males showed significantly larger blood pressure and cardiac xanthine-oxidase expression; MUN females were normotensive and had a lower cardiac expression of antioxidant enzymes, compared to their respective sex-matched controls. At the age of 22 months, both MUN males and females showed larger HW/BW and left ventricular mass and lower ejection fraction compared to sex-matched controls; only MUN males exhibited hypertension and a larger plasma BNP compared to aged male controls. CONCLUSIONS: 1) During perinatal life females exposed to fetal undernutrition are protected from cardiac alterations, but in ageing they exhibit ventricular hypertrophy and functional loss, like MUN males; 2) cardiac oxidative stress might be implicated in the observed heart alterations in both sexes and 3) the severity of cardiac damage might be greater in males due to hypertension.

Novedades en imagen cardiaca 2014 / Update on cardiac imaging techniques 2014

En este artículo se realiza una revisión de las aportaciones de las técnicas de imagen más relevantes a la cardiología que se han publicado durante este año. El ecocardiograma sigue siendo la piedra angular en el diagnóstico y el seguimiento de las valvulopatías, con un esfuerzo continuo para mejorar su cuantificación y obtener parámetros pronósticos de seguimiento. El estudio de la función miocárdica regional se afianza en el diagnóstico de la disfunción ventricular subclínica, y el ecocardiograma transesofágico tridimensional se ha convertido en el perfecto aliado del intervencionismo en las cardiopatías estructurales. La cardiorresonancia y la tomografía computarizada cardiaca acaparan la mayoría de las publicaciones en imagen cardiaca relativas a la cardiopatía isquémica, reflejo de unas técnicas más que consolidadas en la práctica clínica. La medicina nuclear destaca en el estudio de la viabilidad miocárdica tras el intervencionismo en el síndrome coronario agudo y refuerza su rendimiento en el diagnóstico de la cardiopatía isquémica (AU)

In this article, we review the contributions of the most important imaging techniques used in cardiology, reported in 2014. Echocardiography remains the cornerstone for diagnosing and monitoring valvular heart disease, and there has been a continuing effort to improve quantification of this condition and obtain prognostic parameters for follow-up. The study of regional myocardial function is anchored in the diagnosis of subclinical ventricular dysfunction, and 3-dimensional transesophageal echocardiography has become the perfect ally in interventional procedures for structural heart disease. Cardiac magnetic resonance imaging and cardiac computed tomography are the focus of most publications on cardiac imaging in ischemic heart disease, reflecting their consolidated use in clinical practice. Nuclear medicine excels in the study of myocardial viability after interventional treatment of acute coronary syndromes and its performance is validated in the diagnosis of ischemic heart disease (AU)

Update on cardiac imaging techniques 2014.

In this article, we review the contributions of the most important imaging techniques used in cardiology, reported in 2014. Echocardiography remains the cornerstone for diagnosing and monitoring valvular heart disease, and there has been a continuing effort to improve quantification of this condition and obtain prognostic parameters for follow-up. The study of regional myocardial function is anchored in the diagnosis of subclinical ventricular dysfunction, and 3-dimensional transesophageal echocardiography has become the perfect ally in interventional procedures for structural heart disease. Cardiac magnetic resonance imaging and cardiac computed tomography are the focus of most publications on cardiac imaging in ischemic heart disease, reflecting their consolidated use in clinical practice. Nuclear medicine excels in the study of myocardial viability after interventional treatment of acute coronary syndromes and its performance is validated in the diagnosis of ischemic heart disease.

Update on cardiac imaging techniques 2013.

Cardiac imaging is a cornerstone of diagnosis in heart conditions, and an essential tool for assessing prognosis and establishing treatment decisions. This year, echocardiography stands out as a guide in interventional procedures and in choosing the size of the prosthesis. It is also proving to be a valuable technique in low-flow, low-gradient aortic stenosis. Three-dimensional echocardiography is advancing our knowledge of cardiac anatomy and valvular measurements. The parameters indicating tissue deformation have predictive power in valve disease and in the follow-up of drug-induced cardiotoxicity. Single-photon emission computed tomography and positron emission tomography are proving useful in ischemic heart disease and in the diagnosis of cardiac inflammation and infections. The role of computed tomography has been strengthened in noninvasive coronary angiography, the emergency room management of chest pain, assessment of chronic occlusions, and morphologic study of coronary plaque. Cardiac magnetic resonance imaging remains the gold standard for tissue characterization in ischemic heart disease and cardiomyopathies, and is assuming a greater role in stress studies and in the assessment of myocardial viability.

Novedades en imagen cardiaca 2013 / Update on cardiac imaging techniques 2013

La imagen cardiaca es la piedra angular del diagnóstico en cardiología, así como un instrumento esencial en la valoración pronóstica y las decisiones terapéuticas. Este año, la ecocardiografía destaca como guía en el intervencionismo y en la elección del tamaño de las prótesis. Se consolida la entidad de la estenosis aórtica de bajo flujo y bajo gradiente. El método tridimensional avanza en el conocimiento anatómico y la cuantificación valvular. Los parámetros de deformación muestran su poder predictor en valvulopatías y en el seguimiento en la cardiotoxicidad inducida por fármacos. La tomografía computarizada por emisión monofotónica y la tomografía por emisión positrónica consolidan su utilidad en cardiopatía isquémica y destacan en el diagnóstico de inflamaciones e infecciones cardiacas. La tomografía computarizada cardiaca afianza su papel en la coronariografía no invasiva, el manejo del dolor torácico en urgencias, la valoración de las oclusiones crónicas y el estudio morfológico de la placa. La resonancia magnética cardiaca permanece como técnica de referencia en la caracterización tisular tanto en cardiopatía isquémica como en las miocardiopatías y afianza su papel en el estudio de estrés y la valoración de la viabilidad (AU)

Cardiac imaging is a cornerstone of diagnosis in heart conditions, and an essential tool for assessing prognosis and establishing treatment decisions. This year, echocardiography stands out as a guide in interventional procedures and in choosing the size of the prosthesis. It is also proving to be a valuable technique in low-flow, low-gradient aortic stenosis. Three-dimensional echocardiography is advancing our knowledge of cardiac anatomy and valvular measurements. The parameters indicating tissue deformation have predictive power in valve disease and in the follow-up of drug-induced cardiotoxicity. Single-photon emission computed tomography and positron emission tomography are proving useful in ischemic heart disease and in the diagnosis of cardiac inflammation and infections. The role of computed tomography has been strengthened in noninvasive coronary angiography, the emergency room management of chest pain, assessment of chronic occlusions, and morphologic study of coronary plaque. Cardiac magnetic resonance imaging remains the gold standard for tissue characterization in ischemic heart disease and cardiomyopathies, and is assuming a greater role in stress studies and in the assessment of myocardial viability (AU)

Novedades en imagen cardiaca 2012 / Update on cardiac imaging techniques 2012

La imagen cardiaca es uno de los pilares de la cardiología actual. La cantidad de situaciones en que las técnicas de imagen aportan información importante en clínica o investigación es sencillamente interminable, por lo que es imposible recoger en el formato reducido de un artículo todas las novedades importantes sobre imagen cardiaca que han aparecido en la literatura médica en el año 2012. Resumimos las publicaciones más importantes del año, entre las que destacan el desarrollo progresivo de las técnicas de deformación miocárdica y la ecocardiografía tridimensional y la incorporación creciente al trabajo clínico diario de la resonancia magnética y la tomografía computarizada (AU)

Cardiac imaging is one of the basic pillars of modern cardiology. The potential list of scenarios where cardiac imaging techniques can provide relevant information is simply endless so it is impossible to include all relevant new features of cardiac imaging published in the literature in 2012 in the limited format of a single article. We summarize the year's most relevant news on cardiac imaging, highlighting the ongoing development of myocardial deformation and 3-dimensional echocardiography techniques and the increasing use of magnetic resonance imaging and computed tomography in daily clinical practice (AU)

Update on cardiac imaging techniques 2012.

Cardiac imaging is one of the basic pillars of modern cardiology. The potential list of scenarios where cardiac imaging techniques can provide relevant information is simply endless so it is impossible to include all relevant new features of cardiac imaging published in the literature in 2012 in the limited format of a single article. We summarize the year's most relevant news on cardiac imaging, highlighting the ongoing development of myocardial deformation and 3-dimensional echocardiography techniques and the increasing use of magnetic resonance imaging and computed tomography in daily clinical practice.

Situacion actual: lo nuevo en tecnicas de imagen cardiaca / State of the art: new developments in cardiac imaging

La imagen cardiaca sigue desentrañando aspectos anatómicos y funcionales relacionados con la enfermedad de la víscera. La ecocardiografía desarrolla y optimiza la visualización tridimensional tanto transesofagica como transtoracica, consolida el valor de técnicas que permiten entender mejor la mecánica cardiaca y la función ventricular, y al tiempo la industria saca al mercado nuevos equipos más manejables aunque limitados e incompletos para un estudio estándar. La tomografía mantiene e incrementa su valor diagnostico y predictivo en el campo de la enfermedad coronaria a coste radiactivo cada vez menor. La cardiorresonancia permite valorar exquisitamente el daño y la recuperación miocárdica en cardiopatía isquémica y tras el síndrome coronario agudo. La aparición de nuevas tomogamma cámaras exclusivas para cardiología nuclear mejora la calidad del estudio y reduce la radiación. Las imágenes hibridas o de fusión entre diferentes tecnologías, como las nucleares y la tomografía, son prometedoras e ilusionantes (AU)

Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiacmechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restricttheir use for routine assessment. Tomography’s diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future (AU)

Liver growth factor treatment restores cell-extracellular matrix balance in resistance arteries and improves left ventricular hypertrophy in SHR.

Liver growth factor (LGF) is an endogenous albumin-bilirubin complex with antihypertensive effects in spontaneously hypertensive rats (SHR). We assessed the actions of LGF treatment on SHR mesenteric resistance and intramyocardial arteries (MRA and IMA, respectively), heart, and vascular smooth muscle cells (VSMC). SHR and Wistar-Kyoto (WKY) rats treated with vehicle or LGF (4.5 µg LGF/rat, 4 ip injections over 12 days) were used. Intra-arterial blood pressure was measured in anesthetized rats. The heart was weighted and paraffin-embedded. Proliferation, ploidy, and fibronectin deposition were studied in carotid artery-derived VSMC by immunocytochemistry. In MRA, we assessed: 1) geometry and mechanics by pressure myography; 2) function by wire myography; 3) collagen by sirius red staining and polarized light microscopy, and 4) elastin, cell density, nitric oxide (NO), and superoxide anion by confocal microscopy. Heart sections were used to assess cell density and collagen content in IMA. Left ventricular hypertrophy (LVH) regression was assessed by echocardiography. LGF reduced blood pressure only in SHR. LGF in vitro or as treatment normalized the alterations in proliferation and fibronectin in SHR-derived VSMC with no effect on WKY cells. In MRA, LGF treatment normalized collagen, elastin, and VSMC content and passive mechanical properties. In addition, it improved NO availability through reduction of superoxide anion. In IMA, LGF treatment normalized perivascular collagen and VSMC density, improving the wall-to-lumen ratio. Paired experiments demonstrated a partial regression of SHR LVH by LGF treatment. The effective cardiovascular antifibrotic and regenerative actions of LGF support its potential in the treatment of hypertension and its complications.

[Progress on cardiac imaging techniques]. / Novedades en técnicas de imagen cardiaca.

The development of a noninvasive diagnostic test follows a typical timeline: description, enthusiasm, clinical assessment and application, and epidemiological study. However, for techniques such as echocardiography that are widely available, have no harmful effects and are inexpensive, clinical applications may become widespread before they have been evaluated. Real progress is being made with the use of new methodologies, such as myocardial deformation echocardiography and three-dimensional echocardiography. Three-dimensional transesophageal echocardiography has returned echocardiography to its place at the center of modern cardiac diagnosis after it had been displaced in recent years by cardiac multislice CT and cardiac magnetic resonance. However, the new radiological techniques that have helped to reduce radiation exposure to patients and that have improved image acquisition could restore CT to the heart of general cardiac diagnosis. At the moment, it is not possible to displace the echocardiography from its central role in cardiac imaging. This article contains a review of the most important publications on echocardiography, magnetic resonance imaging and cardiac CT that have appeared recently in cardiology journals, mainly during 2010.

Novedades en técnicas de imagen cardiaca / Progress on cardiac imaging techniques

Las pruebas diagnósticas no invasivas siguen una cronología típica: descripción, entusiasmo, evaluación y aplicabilidad clínica y epidemiológica. La ecocardiografía es una técnica sin efectos lesivos, altamente disponible y barata, por lo que su aplicabilidad clínica se difunde antes que su asentamiento y su evaluación. Los avances se están desarrollando con nuevas herramientas para el estudio de la deformación miocárdica y las aplicaciones clínicas del ecocardiograma tridimensional. La ecocardiografía transesofágica tridimensional ha vuelto a situar al ecocardiograma en el centro del diagnóstico cardiaco moderno que durante los últimos años había sido desplazado por la tomografía computarizada y la resonancia magnética. No obstante, nuevas tecnologías radiológicas que contribuyan a disminuir la irradiación de los pacientes y mejorar la adquisición de imágenes pueden llevar a la tomografía al eje capital del diagnóstico cardiológico global. Actualmente no podemos desplazar a la ecocardiografía como principal área de interés en imagen cardiaca. En este artículo revisamos las publicaciones más relevantes en las revistas de cardiología aparecidas principalmente durante 2010 en ecocardiografía, resonancia magnética y tomografía computarizada cardiaca (AU)

The development of a noninvasive diagnostic test follows a typical timeline: description, enthusiasm, clinical assessment and application, and epidemiological study. However, for techniques such as echocardiography that are widely available, have no harmful effects and are inexpensive, clinical applications may become widespread before they have been evaluated. Real progress is being made with the use of new methodologies, such as myocardial deformation echocardiography and three-dimensional echocardiography. Three-dimensional transesophageal echocardiography has returned echocardiography to its place at the center of modern cardiac diagnosis after it had been displaced in recent years by (..) (AU)

Utility of real-time three-dimensional transesophageal echocardiography in evaluating the success of percutaneous transcatheter closure of mitral paravalvular leaks.

BACKGROUND: The percutaneous closure of mitral paravalvular leaks has been reported in patients who are poor operative candidates. Unsuccessful percutaneous closure of leaks may be related to morphologic characteristics of the defects. METHODS: Ten patients were selected from a database for mitral dehiscence closure, in whom two-dimensional transesophageal echocardiography revealed inadequate leak closure. Another 4 patients with optimal results were also selected. Real-time three-dimensional transesophageal echocardiography (3DTEE) was performed in all of them. RESULTS: Real-time 3DTEE enabled the determination of the locations and number of the leaks, as well as their shapes, lengths, widths, areas, and extent. We were also able to observe the position of the device (or devices) implanted during percutaneous closure. CONCLUSION: According to this preliminary study, 3DTEE can improve understanding of the causes underlying failure of these techniques to reduce regurgitation secondary to a defect. This could improve patient selection and procedure results, but further studies are needed.

[Prognosis of heart transplant candidates stabilized on medical therapy]. / Pronóstico de una población inicialmente candidata a trasplante cardíaco controlada con tratamiento médico.

INTRODUCTION AND OBJECTIVES: A significant percentage of patients selected as candidates for heart transplantation can be stabilized by medical treatment, thereby enabling indefinite postponement of inclusion on the operation list. The aim of this study was to investigate the prognosis of these patients. PATIENTS AND METHOD: We studied retrospectively 118 patients with severe left ventricular systolic dysfunction (ejection fraction < or = 35%) who were consecutively evaluated for cardiac transplantation but who did not undergo transplantation because they became clinically stable on medical treatment. The mean follow-up period was 2.14 (2.19) years. Kaplan-Meier survival analysis, and univariate and multivariate Cox proportional risk analyses of factors predicting survival were performed. RESULTS: There were 18 deaths (15.2%): 12 were sudden (66.7%), 5 were due to heart failure (27.8%), and 1, to a non-cardiac cause (5.5%). The survival rate was 88% in the first year and 82% in the following 2 years. Univariate analysis showed that the parameters associated with mortality (P< or =.05) were pulmonary artery and capillary wedge pressures, diuretic treatment, and the absence of beta-blocker therapy. In the multivariate analysis, only the absence of beta-blocker therapy remained statistically significant (P=.003; RR = 0.13; 95%CI, 0.03-0.50). CONCLUSIONS: In a population of patients with severe left ventricular systolic dysfunction who were candidates for heart transplantation but who were stabilized by medical therapy, mortality during the first year of follow-up was 12%. Beta-blocker therapy was the only variable associated with better survival.