Registro Español de Imagen Cardiaca. I Informe Oficial de la Sección de Imagen Cardiaca de la Sociedad Española de Cardiología (2017) / Spanish Cardiovascular Imaging Registry. First Official Report of the Spanish Society of Cardiology Working Group on Cardiovascular Imaging (2017)

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Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study.

AIMS: Reference values for Doppler parameters according to age and gender are recommended for the assessment of heart physiology, specifically for left ventricular (LV) diastolic function. In this study, we report normal reference ranges for Doppler parameters obtained in a large group of healthy volunteers. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following Doppler acquisition and measurement protocols approved by the European Association of Cardiovascular Imaging. METHODS AND RESULTS: A total of 449 (mean age: 45.8 ± 13.7 years) healthy volunteers (198 men and 251 women) were enrolled at the collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was obtained from all subjects following predefined protocols. The majority of the Doppler diastolic parameters (e', E/e') as well as right ventricle systolic s' wave velocity were similar in men and women. Left ventricle s' wave velocity was higher in men than in women. E wave and e' were higher in younger subjects and decreased progressively in the older ones. E/e' ratio increased with ageing. Septal e' <8 cm/s was present in 19.7% of the subjects in the 40-60 year group and in 55% of those in the ≥60 year group. However, the cut-off value of average E/e' or lateral E/e' remained <15 or 13, respectively, in the majority of patients. CONCLUSION: The NORRE study provides the reference values for the most useful Doppler parameters in the evaluation of heart physiology. These data highlight the need of using age-specific reference values especially for the diagnosis of LV systolic and diastolic dysfunction and for the estimation of LV filling pressures.

Influence of aortic regurgitation after TAVI on left ventricular filling pattern.

BACKGROUND: Paravalvular aortic regurgitation after transcatheter aortic valve implantation is associated with a hemodynamic deterioration and a poor outcome. We aim to determine the early hemodynamic effect of paravalvular aortic regurgitation in relation with the change in the left ventricle filling pattern and to assess their clinical outcome. MATERIAL AND METHODS: Eighty-two consecutive patients referred for transcatheter aortic valve implantation were included. Patients were classified according to the change in the left ventricular filling pattern, and significant paravalvular aortic regurgitation (grade ≥ 2) was reported. Follow-up and incidence of death and hospitalization for heart failure were reported. RESULTS: Sixteen patients (19·5%) presented a worsening of left ventricular filling pattern. The incidence of significant paravalvular aortic regurgitation was higher in the group with a worsening of left ventricular filling pattern (56·3% vs. 19·7%; P = 0·009). In the multivariate analysis, the only variable significantly associated with the worsening of left ventricular filling pattern was the significant paravalvular aortic regurgitation (OR 4·84; 95% CI 1·23 - 19·1; P = 0·024). During the follow-up (642·5 days), there was a higher incidence of the endpoint of death or hospitalization for heart failure in the group with a worsening of left ventricular filling pattern (62·5% vs. 31·8%; P = 0·042) and a lower event-free survival rate (long rank test = 0·013). CONCLUSIONS: The presence of a significant paravalvular aortic regurgitation is associated with a worsening in parameters of diastolic function. This finding should alert the cardiologist as patients with a worsening of left ventricular filling pattern present a higher incidence of paravalvular aortic regurgitation and a less favourable outcome.

Eco-Doppler de ejercicio en pacientes con miocardiopatía hipertrófica. Factores determinantes de la limitación funcional / Exercise eco-doppler in hypertrophic cardiomyopathy patients. Determinant factors of exercise intolerance

Introducción y objetivos. En pacientes con miocardiopatía hipertrófica, los datos ecocardiográficos en reposo han mostrado una pobre correlación con la capacidad de ejercicio. Investigamos si la ecografía Doppler de esfuerzo podría explicar mejor la limitación funcional. Métodos. Estudiamos a 87 pacientes consecutivos, remitidos para test cardiopulmonar y ecografía de esfuerzo. Se realizó estudio basal y en el pico de ejercicio para evaluar el gradiente máximo, la regurgitación mitral y las velocidades diastólicas mitral y del Doppler tisular del anillo. Resultados. Desarrollaron obstrucción con el ejercicio 43 pacientes. Estos alcanzaron un menor consumo de oxígeno (21,3 ± 5,7 frente a 24,6 ± 6,1ml/kg/min; p = 0,012), presentaban mayor volumen auricular izquierdo (42,1 ± 14,5 frente a 31,1 ± 11,6ml/m2; p < 0,001) y desarrollaron más regurgitación mitral y mayor relación E/E’ con el ejercicio. Los datos de ejercicio mejoraron el poder predictivo de la capacidad funcional (R2 ajustada = 0,49 frente a R2 ajustada = 0,38 en reposo). La edad, el volumen auricular izquierdo, la relación E/E’ con el ejercicio y la obstrucción fueron los factores independientes asociados con la capacidad funcional. En los pacientes sin obstrucción, los volúmenes de las cavidades izquierdas fueron los factores determinantes. Conclusiones. En pacientes con miocardiopatía hipertrófica, la obstrucción con el esfuerzo y el volumen auricular izquierdo son los principales determinantes de la limitación funcional. Los parámetros diastólicos de esfuerzo mejoran la predicción de la capacidad funcional, aunque su poder predictivo no supera el 50%. En pacientes sin obstrucción, los volúmenes de las cavidades izquierdas son los factores determinantes (AU)

Introduction and objectives. At-rest echocardiography is a poor predictor of exercise capacity in patients with hypertrophic cardiomyopathy. We aimed to test the performance of treadmill exercise Doppler echocardiography in the prediction of functional limitations in these patients. Methods. Eighty-seven consecutive patients with hypertrophic cardiomyopathy underwent treadmill exercise echocardiography with direct measurement of oxygen consumption. Both at rest and at peak exercise, the mitral inflow, mitral regurgitation, left ventricular outflow tract obstruction and mitral annulus velocities were assessed. Results. Forty-three patients developed left ventricular outflow tract obstruction during exercise, which significantly decreased oxygen consumption (21.3 [5.7] mL/kg/min vs 24.6 [6.1] mL/kg/min; P=.012), and had greater left atrial volume (42.1 [14.5] mL/m2 vs 31.1 [11.6] mL/m2; P<.001) and a higher degree of mitral regurgitation and E/E’ ratio during exercise. Exercise variables improved the predictive value of functional capacity (adjusted R2 rose from 0.38 to 0.49). Independent predictors of oxygen consumption were age, left atrial volume, E/E’ ratio and the presence of left ventricular outflow tract obstruction. In a subset of patients without left ventricular outflow obstruction, only left ventricular and atrial volume indexes were independent predictors of exercise capacity. Conclusions. In patients with hypertrophic cardiomyopathy, left ventricular outflow tract obstruction and left atrial volume are the main predictors of exercise capacity. Exercise echocardiography is a better predictor of functional performance than at-rest echocardiography, although its predictive power is under 50%. In nonobstructed patients, left atrial and ventricular volumes were the independent factors (AU)

Exercise eco-Doppler in hypertrophic cardiomyopathy patients. Determinant factors of exercise intolerance.

INTRODUCTION AND OBJECTIVES: At-rest echocardiography is a poor predictor of exercise capacity in patients with hypertrophic cardiomyopathy. We aimed to test the performance of treadmill exercise Doppler echocardiography in the prediction of functional limitations in these patients. METHODS: Eighty-seven consecutive patients with hypertrophic cardiomyopathy underwent treadmill exercise echocardiography with direct measurement of oxygen consumption. Both at rest and at peak exercise, the mitral inflow, mitral regurgitation, left ventricular outflow tract obstruction and mitral annulus velocities were assessed. RESULTS: Forty-three patients developed left ventricular outflow tract obstruction during exercise, which significantly decreased oxygen consumption (21.3 [5.7] mL/kg/min vs 24.6 [6.1] mL/kg/min; P=.012), and had greater left atrial volume (42.1 [14.5] mL/m(2) vs 31.1 [11.6] mL/m(2); P<.001) and a higher degree of mitral regurgitation and E/E' ratio during exercise. Exercise variables improved the predictive value of functional capacity (adjusted R(2) rose from 0.38 to 0.49). Independent predictors of oxygen consumption were age, left atrial volume, E/E' ratio and the presence of left ventricular outflow tract obstruction. In a subset of patients without left ventricular outflow obstruction, only left ventricular and atrial volume indexes were independent predictors of exercise capacity. CONCLUSIONS: In patients with hypertrophic cardiomyopathy, left ventricular outflow tract obstruction and left atrial volume are the main predictors of exercise capacity. Exercise echocardiography is a better predictor of functional performance than at-rest echocardiography, although its predictive power is under 50%. In nonobstructed patients, left atrial and ventricular volumes were the independent factors.