Assessment of systolic and diastolic left ventricular and left atrial function using vector velocity imaging in Takotsubo cardiomyopathy.

Five adult patients with Takotsubo cardiomyopathy (TC) diagnosed by usual criteria were studied with velocity vector imaging (VVI) on admission and at follow-up, when their LV function had improved, as assessed by 2D TTE wall-motion score (WMS) index. Averaged peak segmental longitudinal strain (S) in systole, and velocity (V) and strain rate (SR) in both systole and diastole were measured from apical 4- (A4C) and 2-chamber views (A2C) in all patients. The data obtained by VVI were analyzed separately for involved and uninvolved segments, which were independently assessed by WMS. In the involved segments, systolic S, V, SR, and diastolic SR improved (P-value < 0.05) on follow-up. Diastolic V showed a trend toward improvement but did not reach statistical significance. In the uninvolved segments, none of the parameters improved significantly either during systole or diastole. In three of these five patients, left atrial (LA) walls were also studied by placing region of interest (ROI) points in the middle of each wall. Peak segmental LA systolic and diastolic V and SR as well as systolic S were obtained for both involved and uninvolved LA walls which were assessed independently using WMS similar to LV. In the involved LA walls, none of the atrial systolic and diastolic parameters changed significantly but all parameters with the exception of systolic V showed a tendency toward improvement during follow-up. Among the uninvolved LA walls, none changed significantly but atrial systolic SR and, diastolic V and SR tended to increase during follow-up. Our retrospective study using VVI demonstrates that TC patients also have LV systolic and diastolic longitudinal dysfunction, not just systolic radial dysfunction as assessed by traditional 2D TTE indices. Longitudinal LA dysfunction may also be present.

Live/real time three-dimensional transthoracic echocardiographic assessment of pulmonary regurgitation.

There is no gold standard for the measurement of pulmonary regurgitation (PR) severity. Two-dimensional (2D) transthoracic echocardiography is most commonly used to quantify PR severity using color Doppler criteria for aortic regurgitation. However, this method is limited by visualization of only one or two dimensions of the proximal PR jet or vena contracta (VC) precluding accurate assessment of its shape or size. This limitation would be expected to be obviated by three-dimensional (3D) transthoracic echocardiography, which could provide a more accurate quantitative assessment of PR severity. This study evaluated 82 adult patients with PR using 2D and 3D. PR VC area by 3D was obtained by planimetry by positioning the cropping plane exactly parallel to the VC, which was viewed en face by cropping of the 3D data set. Regurgitant volumes were calculated by 2D (assuming a circular VC) and by 3D as a product of the VC and velocity time integral obtained by color Doppler-guided conventional Doppler interrogation of the PR jet.The 3D VC area correlated with 2D jet width (JW)/right ventricular outflow tract (RVOT) width (r = 0.71) and 2D VC area (r = 0.79). 3D JW/RVOT width correlated with 2D JW/RVOT (r = 0.87). 3D regurgitant volumes also correlated with 2D regurgitant volumes (r = 0.76). The 3D VC values of <0.20, 0.20-0.45, 0.46-1.15, and >1.15 cm(2) and regurgitant volumes of <15 ml, 15-50 ml, 51-115 ml, and >115 ml were effective as cutoffs for grades 1, 2, 3, and 4 PR, respectively. In conclusion, quantification of 3D VC area and regurgitant volumes correlate reasonably well with the current 2D methods for measurement of PR. Since 3D visualizes PR VC in three dimensions, it would be expected to provide a more accurate and more quantitative assessment of PR severity as compared to 2D.