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1.
Article in English | MEDLINE | ID: mdl-38060988

ABSTRACT

AIMS: Mechanisms underlying left ventricular dysfunction and arrhythmogenesis in bileaflet mitral valve prolapse (BMVP) patients are not well defined. Myocardial work index (MWI) is a noninvasive assessment that correlates with myocardial oxygen consumption. We aimed to compare global and regional MWI in BMVP patients with normal controls. METHODS AND RESULTS: In this retrospective study, we calculated MWI in BMVP patients and controls using GE EchoPAC (GE Healthcare, Chicago, IL) software. Of 147 BMVP patients (59% women, mean age 54 ± 15 years), 16 had a flail mitral leaflet. There was regional heterogeneity in MWIs, with increased posterolateral trident myocardial work (2099 ± 271 vs. 1895 ± 321 mm Hg%, P = .039), constructive work (2831 ± 366 vs. 2257 ± 338 mm Hg%, P < .001), wasted work (87 [52-194] vs. 71 [42-103] mm Hg%, P = .015), peak systolic strain (-23.0 ± 2.4 vs. -19 ± 3%, P < .001), and reduction in myocardial work efficiency (95.00 [93.50-97.75] vs. 96.75 (95.00-97.75) %, P = 0.020) in 100 BMVP patients compared with age- and sex-matched controls. BMVP patients' basal septal wall MWIs were lower than those of controls. The higher work indices in patients with BMVP were reduced in those who developed flail leaflets. No significant differences in work indices were seen between ventricular arrhythmia and non-arrhythmia BMVP patients. CONCLUSION: Regional differences in MWIs were noted in the BMVP patients compared with controls, with overall reduced myocardial efficiency in the posterolateral trident and basal septal regions. In cross-sectional analysis, MWIs were not different in patients with ventricular tachyarrhythmias. Impact of MWI in long-term prognosis needs to be determined.

2.
Vasc Med ; 28(5): 425-432, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37646458

ABSTRACT

BACKGROUND: Controversy regarding the definition of the upper limit of normal (ULN) for dilated mid-ascending aorta (mAA) stems from variation in criteria, based on several small-sized studies with small datasets of normal subjects (DONS). The present study was carried out to demonstrate this variation in the prevalence of mAA dilation and to identify the optimal definition by creating the largest DONS. METHODS: Echocardiographic studies of patients ≥ 15 years of age performed at a large tertiary care center over 4 years (n = 49,330) were retrospectively evaluated. The leading-edge-to-leading-edge technique was used to measure the mAA in diastole. The largest-to-date DONS (n = 2334) was created, including those who were normal on medical record review, did not have any of the 28 causes of dilated aorta, and had normal echocardiograms. Because age had the strongest correlation with mAA (multivariate adjusted R2 = 0.26), as compared with sex, height, and weight, we created a new ULN based on the DONS with narrow age stratification (10-year intervals). RESULTS: The prevalence of dilated mAA varied between 17% and 23% when absolute criteria were used with sex stratification, and it varied between 6% and 11% when relative criteria (relative to age, body surface area, and sex) were used. Based on new criteria from the DONS, it was 7.6%, with a ULN of 3.07-3.64 cm in women and 3.3-3.91 cm in men. CONCLUSIONS: These data demonstrate the undesirable variation in the prevalence of dilated mAA based on prior criteria and propose a new ULN for dilated mAA.


Subject(s)
Aorta, Thoracic , Aorta , Naphthalenesulfonates , Male , Humans , Female , Child, Preschool , Retrospective Studies , Prevalence , Aorta/diagnostic imaging , Cost of Illness
3.
J Am Soc Echocardiogr ; 36(11): 1140-1153, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37574150

ABSTRACT

Abnormal septal motion (ASM), which often is associated with myocardial ischemia, is also observed in other diseases. Owing to the position of the interventricular septum (IVS) in the heart, its movement not only relies on contractile properties but is also affected by the pressure gradient between the 2 ventricles and by the mode of electrical activation. Echocardiography allows the operator to focus on the motion of the IVS, analyzing its characteristics and thereby gaining information about the possible underlying pathophysiological mechanism. In this review, we focused on the main echocardiographic patterns of ASM that are not related to a failure of contractile properties of the septum (i.e., acute coronary syndrome and cardiomyopathies), showing their pathophysiological mechanisms and underlining their diagnostic usefulness in clinical practice.


Subject(s)
Coronary Artery Disease , Myocardial Ischemia , Humans , Heart Septum/diagnostic imaging , Echocardiography , Myocardial Ischemia/diagnostic imaging , Heart Ventricles
4.
Circ Cardiovasc Imaging ; 16(2): e014419, 2023 02.
Article in English | MEDLINE | ID: mdl-36734221

ABSTRACT

Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.


Subject(s)
Aortic Valve Stenosis , Ventricular Function, Left , Adult , Humans , Stroke Volume , Heart , Echocardiography
5.
Vascular ; : 17085381221140171, 2022 Nov 22.
Article in English | MEDLINE | ID: mdl-36412136

ABSTRACT

OBJECTIVES: The cutoff for dilated mid-ascending aorta (mAA) is controversial and has several definitions. The present study was carried out to determine the prevalence of mAA dilation based on published definitions and to identify the optimal cutoff. METHODS: Echocardiographic studies of patients >15 years of age performed at a large tertiary care center over 4 years, n = 49,330, were retrospectively evaluated. Leading-edge-to-leading-edge technique was used to measure the mAA in diastole. Several cutoff criteria were included. In addition, we defined normals in our database as those who, after 28 causes of dilated aorta were excluded, were normal both clinically and echocardiographically (n = 2334). RESULTS: The mean age was 64.2 ± 17.1 years, and 31.5% were men. The prevalence of dilated mAA based on absolute criteria with sex stratification varied between 17% and 23% and based on relative criteria (to age, body surface area, and sex) varied between 6% and 11%. It further decreased to 7.6% on the addition of narrow age stratification (10 year intervals) performed on normals in our database. The multivariate adjusted R2 (for variation in mAA diameter) was 0.25 for age, decreasing to 0.12 for weight and 0.07 for sex and height. CONCLUSIONS: The lowest prevalence of 7.6% probably represents the optimal cutoff for dilated mAA because it includes age, which explains most of the variation in mAA, in narrow (10 year) intervals only performed in our normals, which represents the largest sample size to date.

6.
Curr Cardiol Rep ; 24(11): 1587-1597, 2022 11.
Article in English | MEDLINE | ID: mdl-35984555

ABSTRACT

PURPOSE OF REVIEW: Echocardiography is a valuable tool for management of patients with a left ventricular assist device (LVAD). We present an updated review on the practical applications of the role of echocardiography for pre- and postoperative evaluation of patients selected. RECENT FINDINGS: The LVAD is a temporary or permanent option for patients with advanced heart failure who are unresponsive to other therapy. Use of the device has its own risks, and implantation remains a complex procedure. Transthoracic and transesophageal echocardiography are useful tools for patient evaluation and monitoring both peri- and postoperatively, as we previously presented. Assessment of left and right ventricular function, complications such as thrombus formation or intracardiac shunting, and valvular disease are all important in this assessment. This also aids in predicting postoperative complications. Placement of the device is confirmed intraoperatively, and subsequent ramp studies are used to determine optimal device settings. Right ventricular (RV) failure is the most common postoperative complication and preoperative evaluation of its function is crucial. Studies suggest that tricuspid annular plane systolic excursion, RV fractional area change, and RV global longitudinal strain are strong predictors of RV failure; LV ejection fraction, size, and end-diastolic diameter are also important markers. Aortic regurgitation and mitral stenosis must always be corrected prior to LVAD placement. However, direct visualization before and after implantation, especially to rule out potential contraindications such as thrombi, cannot be overemphasized. Ramp studies remain an integral part of device optimization and may result in greater myocardial recovery than previously realized.


Subject(s)
Heart-Assist Devices , Humans , Echocardiography
9.
J Cardiol ; 79(1): 90-97, 2022 01.
Article in English | MEDLINE | ID: mdl-34493420

ABSTRACT

BACKGROUND: We aimed to determine predictors and the additive prognostic role of moderate to severe (MS) ischemic mitral regurgitation (MR) in myocardial infarction (MI). METHODS: Four hundred twenty-two patients with previous MI underwent cardiac magnetic resonance (CMR) imaging for the assessment of left ventricular (LV) ejection fraction (EF), end-diastolic (EDV) and end-systolic volume (ESV), sphericity index, wall motion score index (WMSI), and late gadolinium enhancement (LGE). Echocardiography was performed to assess MR. RESULTS: Thirty-eight had from moderate to severe MR (MS-MR group) and 384 did not (No MS-MR group). The S-MR group had higher LV volumes, sphericity index, WMSI, and LGE extent, and lower LVEF. At univariate logistic regression analysis, dilated volumes, SI >0.43, dyskinesia of inferolateral wall, papillary muscle (PM)-LGE, and LGE extent >16% were associated with MS-MR. At multivariate analysis, only SI (OR=5.7) and PM-LGE (OR=3) were independently associated with MS-MR. Considering only patients without LV dilatation, only dyskinesia in the inferolateral wall was a predictor of MS-MR (OR 34.8). Thirty cardiac events (cardiac death, appropriate implantable cardioverter-defibrillator firing, and resuscitated cardiac arrest) occurred during a median follow-up of 1,276 days. After adjusting the prognostic variables at univariate analysis by age (>65 years) and selecting those that were significant (EDV > 95 ml/m2, ESV >53 ml/m2, EF <30%, WMSI >1.65, LGE >12%, S-MR), only WMSI >1.65 and MS-MR remained an independent predictor of cardiac events. CONCLUSIONS: Increased WMSI and PM-LGE in the overall population and inferolateral dyskinesia in patients without ESV dilatation are predictors of MS-MR; MS-MR and elevated WMSI have independent negative prognostic value.


Subject(s)
Mitral Valve Insufficiency , Myocardial Infarction , Aged , Contrast Media , Gadolinium , Humans , Magnetic Resonance Imaging, Cine/methods , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Myocardial Infarction/etiology , Predictive Value of Tests , Prognosis , Stroke Volume
10.
J Cardiovasc Magn Reson ; 23(1): 121, 2021 11 01.
Article in English | MEDLINE | ID: mdl-34719402

ABSTRACT

BACKGROUND: Cardiovascular magnetic resonance permits assessment of irreversible myocardial fibrosis and contractile function in patients with previous myocardial infarction. We aimed to assess the prognostic value of myocardial fibrotic tissue with preserved/restored contractile activity. METHODS: In 730 consecutive myocardial infarction patients (64 ± 11 years), we quantified left ventricular (LV) end-diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (EF), regional wall motion (WM) (1 normal, 2 hypokinetic, 3 akinetic, 4 dyskinetic), and WM score index (WMSI), and measured the transmural (1-50 and 51-100) and global extent of the infarct scar by late gadolinium enhancement (LGE). Contractile fibrotic (CT-F) segments were identified as those showing WM-1 and WM-2 with LGE ≤ or ≥ 50%. RESULTS: During follow-up (median 2.5, range 1-4.7 years), cardiac events (cardiac death or appropriate implantable defibrillator shocks) occurred in 123 patients (17%). At univariate analysis, age, LVEDV, LVESV, LVEF, WMSI, extent of LGE, segments with transmural extent > 50%, and CT-F segments were associated with cardiac events. At multivariate analysis, age > 65 years, LVEF < 30%, WMSI > 1.7, and dilated LVEDV independently predicted cardiac events, while CT-F tissue was the only independent predictor of better outcome. After adjustment for LVEF < 30% and LVEDV dilatation, the presence of CT-F tissue was associated with good prognosis. CONCLUSIONS: In addition to CMR imaging parameters associated with adverse outcome (severe LV dysfunction, poor WM, and dilated EDV), the presence of fibrotic myocardium showing contractile activity in patients with previous myocardial infarction yields a beneficial effect on patient survival.


Subject(s)
Contrast Media , Myocardial Infarction , Aged , Gadolinium , Humans , Myocardial Infarction/diagnostic imaging , Myocardium , Predictive Value of Tests
11.
Echocardiography ; 38(10): 1711-1721, 2021 10.
Article in English | MEDLINE | ID: mdl-34510539

ABSTRACT

OBJECTIVE: This study sought to determine the contractile reserve (CR) response to exercise stress echocardiography (ESE) quantified by the novel parameter, non-invasive myocardial work (MW), in subjects with angiographically proven coronary artery disease (CAD). METHODS: CR was measured by the relative change in ejection fraction (EF), global longitudinal strain (GLS) and MW indices from rest to peak exercise in 304 patients referred for clinically indicated ESE. Positive ESE patients proceeded to coronary angiography and further risk stratified based on either percutaneous or surgical intervention. RESULTS: CRGLS and global work index (CRGWI ) significantly decreased with exercise induced ischemia and angiographically proven significant CAD (CRGLS -1.6±3.5%; CRGWI -8.6±511 mm Hg% decrement, p < 0.001) compared to non-ischemic patients (CRGLS 1.4±2.2%; CRGWI 398±404 mm Hg% improvement). Global constructive work (CRGCW ) was significantly higher (p < 0.0001) in non-ischemic (818±457 mm Hg%) and blunted in ischemic patients (208±550 mm Hg%). CRGCW (AUC .81; 95%CI:.75-.86) demonstrated the most association for inducible ischemia followed by CRGLS (AUC .75; 95%CI:.69-.80), CRGWI (AUC .73, 95%CI:.67-.79) and CREF (AUC .71; 95%CI:.65-.77, p < 0.001). Subgroup analysis showed patients requiring surgical revascularization demonstrated a significantly lower CRGWE (-11.5±7.6%, p < 0.05) as a result of reduced CRGCW (281±573 mm Hg%, p < 0.05) and increased global wasted work (CRGWW , 289±151 mm Hg%, p = 0.09). CONCLUSION: Multivessel disease requiring surgical revascularization have the greatest reduction in CR. MW may potentially improve detection of ischemia and further risk stratification during ESE to maximize the benefits of revascularization.


Subject(s)
Echocardiography, Stress , Ventricular Function, Left , Echocardiography , Heart Ventricles , Humans , Stroke Volume
12.
Am J Cardiovasc Dis ; 11(3): 316-329, 2021.
Article in English | MEDLINE | ID: mdl-34322302

ABSTRACT

Patent foramen ovale (PFO) is present in about one-quarter of the population and should be considered an anatomical variant rather than a malformation. The association of PFO with cryptogenic stroke, migraine, peripheral embolism and other pathologies is still controversial. The evaluation of anatomical complexity, and particularly the long-tunnel morphology, is crucial for the assessment of the risk profile and for a targeted therapeutic management. Long-tunnel PFOs seem to be more prone to clot formation and complications related to percutaneous closure procedures. Echocardiography is the most useful method to investigate anatomical complexity, confirm and reinforce the indication to treatment, select the appropriate device and guide the PFO closure towards a successful procedure.

13.
JACC Case Rep ; 3(1): 125-127, 2021 Jan.
Article in English | MEDLINE | ID: mdl-34317484

ABSTRACT

We report a rare and complex case of cardiac sarcoidosis in a patient presenting with ventricular tachycardia. Multimodality imaging, along with clinical and histological examination, was essential in establishing the diagnosis of cardiac sarcoidosis. (Level of Difficulty: Beginner.).

16.
J Patient Cent Res Rev ; 8(2): 151-153, 2021.
Article in English | MEDLINE | ID: mdl-33898649

ABSTRACT

The COVID-19 pandemic led to a nationwide shutdown of elective medical procedures. Upon resumption of services, preprocedure nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was introduced for all patients requiring surgical or other aerosol-generating procedures. We investigated preprocedure COVID-19 testing in one of the largest U.S. health systems. Patients included in this retrospective, observational study were asymptomatic and scheduled for a procedure or surgery. All patients underwent a nasopharyngeal swab test for SARS-CoV-2 performed 24-72 hours prior to a planned procedure. Clinical demographics, type of procedure, test results, and subsequent procedure status were evaluated. Of 38,608 total patients, there were 277 COVID-19-positive patients (positivity rate: 0.72%). Of those 277, 244 (88%) had procedural delays or cancellations. Of the COVID-19-negative patients, 50 (0.13%) required later hospitalization for COVID-19. Median time from preprocedure negative test to admission was 46.3 ± 27.2 days. In the largest series published on preprocedure COVID-19 testing in the early phase of the pandemic, preprocedure COVID-19 positivity was low. Preprocedure COVID-19 testing had a significant impact on clinical management. Rate of COVID-19 cases requiring hospitalization in the months following the procedure was negligible, suggesting health system policies adequately protected patient safety.

17.
J Patient Cent Res Rev ; 8(2): 146-150, 2021.
Article in English | MEDLINE | ID: mdl-33898648

ABSTRACT

PURPOSE: Transesophageal echocardiography is an aerosol-generating procedure, and exercise stress testing is a potentially aerosol-generating activity. Concern has been raised about heightened risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among health care personnel participating in these procedures. We aimed to investigate the prevalence of past coronavirus disease 2019 (COVID-19) infection in echocardiography and stress laboratory staff. METHODS: All staff who worked in the echocardiography and stress laboratories of one high-traffic urban hospital from March 15, 2020, to June 15, 2020, were asked to voluntarily participate. Those willing to participate were consented, and past COVID-19 infection was confirmed by a SARS-CoV-2 IgG antibody test (ARCHITECT, Abbott Laboratories) from June 15, 2020, to July 3, 2020. Clinical data were collected from the electronic medical record, and self-reported symptoms were documented with a participant survey. RESULTS: A total of 43 staff members (86.0% of 50 total laboratory staff) participated. A majority of participants were less than 40 years old (69.8%), were White (86.0%), and were women (79.1%); mean body mass index was 24.9 ± 4.7 kg/m2. Of the 43 staff members tested for past COVID-19 infection, 3 (7.0%) had a positive SARS-CoV-2 IgG antibody result. There were no unique features in the 3 SARS-CoV-2 antibody-positive subjects; of these, 2 had known prior COVID-19 infection and 1 was asymptomatic. CONCLUSIONS: This study provides clinical data on the seroprevalence of SARS-CoV-2 antibody in echocardiography and stress laboratory staff who regularly participate in a variety of procedures that are or may be aerosol-generating.

18.
J Am Soc Echocardiogr ; 34(8): 807-818, 2021 08.
Article in English | MEDLINE | ID: mdl-33895250

ABSTRACT

Myocardial work (MW) is a novel technique used in the advanced assessment of left ventricular function. In the past few years, this invasive measure has evolved to become a more attainable noninvasive technique. MW has benefits over left ventricular ejection fraction and global longitudinal strain by speckle-tracking echocardiography, as it includes the afterload-dependent limitation and dynamic myocardial contraction in relationship to various loading conditions. In this article, the authors provide a summary overview and discuss the additive value noninvasive MW provides to left ventricular systolic function assessment. The authors explore the evolution of invasive to noninvasive MW, examine how to acquire and measure, discuss normal reference values, examine its role in a multitude of cardiac conditions that have been investigated in current research, review a variety of clinical applications, and discuss potential limitations. The goal is to allow the reader to see the benefits of this rapidly emerging application and be able to incorporate it into everyday practice.


Subject(s)
Ventricular Dysfunction, Left , Ventricular Function, Left , Echocardiography , Humans , Myocardial Contraction , Myocardium , Stroke Volume , Ventricular Dysfunction, Left/diagnostic imaging
19.
Int J Cardiovasc Imaging ; 37(8): 2409-2417, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33721155

ABSTRACT

Sensitivity and specificity of ESE to determine hemodynamically significant coronary artery disease (CAD) is limited by subjective qualitative interpretation resulting in false-positive results. The objective of this study was to determine whether resting myocardial work estimated from non-invasive left ventricular pressure-strain loops can help improve the interpretation of exercise stress echocardiography (ESE). Resting global myocardial work was performed on 288 patients referred for clinically indicated ESE with no resting regional wall motion abnormalities and normal ejection fraction (≥ 55%). Coronary angiography was used to validate the presence of significant CAD in those with a positive ESE. Resting global myocardial work index (GWI) was significantly reduced (p < 0.001) in patients with true-positive (1544 ± 354 mmHg%) compared to negative (1819 ± 317 mmHg%) and false-positive (1857 ± 344 mmHg%) ESE. A GWI of ≤ 1391 mmHg (AUC 0.73; sensitivity 94%; specificity 73%) predicted true-positive ESE. Predictors of a true-positive ESE were (1) lower myocardial work efficiency (odds ratio 0.731, 95% CI 0.58-0.92, p = 0.007), (2) lower GWI (odds ratio 0.997, 95% CI 0.996-0.999, p = 0.006) (3) male gender (odds ratio 5.47, 95% CI 1.84-16.31, p = 0.002) and (4) E/e' ratio (odds ratio 1.15, CI 1.01-1.31, p = 0.032). Myocardial work is a potentially valuable quantitative parameter that provides incremental value over qualitative ESE interpretation and improves appropriate patient selection for coronary angiography.


Subject(s)
Coronary Artery Disease , Echocardiography, Stress , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Exercise Test , Humans , Male , Predictive Value of Tests , Sensitivity and Specificity
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