Evaluación del ventrículo izquierdo por ecocardiografia tridimensional. Comparación con la Cardio-RM / Evaluation of the left ventricle with three-dimensional echocardiography: comparison with cardiac magnetic resonance

Objetivo. La implantación de la ecocardiografia tridimensional (E3D) en el ámbito clínico está experimentando importantes avances. Sin embargo, la calidad de imagen depende de la ventana acústica, y puede ser difícil la identificación de los bordes endocárdicos. El objetivo de este estudio fue comparar la E3D en la determinación de los volúmenes y la fracción de eyección del ventrículo izquierdo en pacientes no seleccionados, usando la resonancia magnética cardiaca (RMC) como patrón de referencia. Material y métodos. A 47 pacientes no seleccionados sometidos a un estudio de RMC, se les practicó también una E3D mediante la técnica de adquisición en tiempo real y análisis con detección semiautomática de los bordes. Resultados. Se excluyeron 4 pacientes (8,5%) por tener una ventana acústica extremadamente deficiente. En el resto (43 pacientes), incluyendo aquellos con una ventana subóptima, se obtuvo una correlación aceptable entre la E3D y la RMC: volumen telediastólico: 0,71; volumen telesistólico: 0,77; fracción de eyección: 0,74. Aunque hubo una infraestimación sistemática del volumen telediastólico, no se observaron diferencias significativas en la determinación de la fracción de eyección. Al excluir los 11 pacientes con ventana subóptima, se observó una infraestimación sistemática de los volúmenes telediastólico y telesistólico, lo que dio lugar paradójicamente a una mejoría de los coeficientes de correlación (0,79, 0,92, 0,84), resultando más exacta la fracción de eyección. Conclusiones. En comparación con la RMC, la E3D infraestima sistemáticamente los volúmenes ventriculares, pero permite la determinación adecuada de la fracción de eyección ventricular izquierda independientemente de la ventana acústica (AU)

Objective. Three-dimensional echocardiography (3DE) is becoming increasingly common in clinical environments. However, the quality of the images depends on the acoustic window, and it can be difficult to identify the endocardial borders. The objective of this study was to evaluate the performance of 3DE in determining the volumes and left ventricular ejection fraction in unselected patients against the gold standard, cardiac magnetic resonance (CMR). Material and methods. In 47 unselected patients who underwent CMR, we performed 3DE using a real-time acquisition technique and semiautomatic border detection. Results. We excluded 4 patients (8.5%) because they had an extremely deficient acoustic window. In the remaining 43 patients, including those with a suboptimal acoustic window, we obtained the following correlations between 3DE and CMR: end-diastolic volume, 0.71; end-systolic volume, 0.77; ejection fraction, 0.74. Although the end-diastolic volume was systematically underestimated, no significant differences were observed in the ejection fraction. When the 11 patients with suboptimal acoustic windows were excluded, we observed a systematic underestimation of the end-diastolic and end-systolic volumes, which paradoxically gave rise to improved correlation coefficients (0.79, 0.92, and 0.84, respectively) and a more accurate ejection fraction. Conclusions. Compared to CMR, 3DE systematically underestimates the ventricular volumes but enables adequate determination of the left ventricular ejection fraction regardless of the quality of the acoustic window (AU)

[Evaluation of the left ventricle with three-dimensional echocardiography: comparison with cardiac magnetic resonance]. / Evaluación del ventrículo izquierdo por ecocardiografia tridimensional. Comparación con la Cardio-RM.

OBJECTIVE: Three-dimensional echocardiography (3DE) is becoming increasingly common in clinical environments. However, the quality of the images depends on the acoustic window, and it can be difficult to identify the endocardial borders. The objective of this study was to evaluate the performance of 3DE in determining the volumes and left ventricular ejection fraction in unselected patients against the gold standard, cardiac magnetic resonance (CMR). MATERIAL AND METHODS: In 47 unselected patients who underwent CMR, we performed 3DE using a real-time acquisition technique and semiautomatic border detection. RESULTS: We excluded 4 patients (8.5%) because they had an extremely deficient acoustic window. In the remaining 43 patients, including those with a suboptimal acoustic window, we obtained the following correlations between 3DE and CMR: end-diastolic volume, 0.71; end-systolic volume, 0.77; ejection fraction, 0.74. Although the end-diastolic volume was systematically underestimated, no significant differences were observed in the ejection fraction. When the 11 patients with suboptimal acoustic windows were excluded, we observed a systematic underestimation of the end-diastolic and end-systolic volumes, which paradoxically gave rise to improved correlation coefficients (0.79, 0.92, and 0.84, respectively) and a more accurate ejection fraction. CONCLUSIONS: Compared to CMR, 3DE systematically underestimates the ventricular volumes but enables adequate determination of the left ventricular ejection fraction regardless of the quality of the acoustic window.

Correlation between myocardial fibrosis and the occurrence of atrial fibrillation in hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study.

Cardiac magnetic resonance imaging (CMR) in hypertrophic cardiomyopathy (HCM) often shows delayed contrast enhancement (DE) representing regions of focal myocardial fibrosis. Atrial fibrillation (AF) is a commonly reported complication of HCM. We determined the relationship between the presence of left ventricular myocardial fibrosis (LVMF) detected by DE-CMR and the occurrence AF in a series of patients with HCM. 67 patients with HCM (47 males; mean age 50.1+/-18.5 years) were studied by CMR measuring mass of LVMF, left ventricular mass, volume and function, and left atrial (LA) area. AF was present in 17 (25%) patients. LVMF was observed in 57% of patients. AF was significantly more frequent in patients who also showed LVMF, compared with the group without LVMF (42.1% vs. 3.4%, respectively; p<0.0001). LA size was larger in patients showing DE (LA area: 37.4+/-11.1 vs. 25.9+/-6.8 cm(2); respectively, p=0.0001). AF in HCM is related with myocardial fibrosis detected by DE-CMR and dilatation of the LA. This fact adds to the proven adverse prognostic value of myocardial fibrosis in HCM, thus, reinforcing the usefulness of this technique in the assessment of these patients.

Técnicas de imagen no invasivas del árbol coronario / Non-invasive imaging techniques of the coronary tree

El desarrollo tecnológico ha permitido soslayar demanera eficaz las dificultades que entrañaba elestudio no invasivo del árbol coronario, que son supequeño diámetro y su continuo movimiento. Lamejora en la resolución espacial y temporal dela cardio-tomografía computarizada conmultidetectores ha permitido incorporar estatécnica al arsenal diagnóstico de la enfermedadcoronaria con mejores resultados que las pruebasconvencionales. Su limitación principal es lanecesidad de emplear contraste y radiaciónionizante. La cardio-resonancia magnética permite,sin necesidad de contraste ni radiación, visualizarlos orígenes y los segmentos proximalescoronarios, lo que la convierte en la técnica dereferencia en centros experimentados ante lasospecha de una anomalía coronaria, incluso comotécnica de «chequeo» en poblaciones de riesgo dadasu inocuidad

The technological development has made it possibleto effectively evade the difficulties involved in thenon-invasive study of the coronary tree, which is itssmall diameter and continuous movement.Improvement in the spatial and temporal resolutionof the cardiac multidetector computed tomographyhas made it possible to incorporate this techniqueinto the diagnostic armamentarium of coronarydisease, with better results than the conventionaltests. Its principal limitation is the need to usecontrast and ionizing radiation. The cardiacmagnetic resonance makes it possible to visualizethe proximal coronary origins and segments withoutneeding to use contrast or radiation. This makes it areference technique in experienced sites when thereis suspicion of a coronary abnormality, even as a«verification» technique in at risk populations, giving that it is innocuous (AU)

[Non-invasive imaging techniques of the coronary tree]. / Técnicas de imagen no invasivas del árbol coronario.

The technological development has made it possible to effectively evade the difficulties involved in the non-invasive study of the coronary tree, which is its small diameter and continuous movement. Improvement in the spatial and temporal resolution of the cardiac multidetector computed tomography has made it possible to incorporate this technique into the diagnostic armamentarium of coronary disease, with better results than the conventional tests. Its principal limitation is the need to use contrast and ionizing radiation. The cardiac magnetic resonance makes it possible to visualize the proximal coronary origins and segments without needing to use contrast or radiation. This makes it a reference technique in experienced sites when there is suspicion of a coronary abnormality, even as a <> technique in at risk populations, giving that it is innocuous.

[Transthoracic echocardiography in stroke performed by neurologist: pilot study]. / Ecocardiografía transtorácica realizada por neurólogos en patología vascular: estudio piloto.

INTRODUCTION: The aim of this study is to assess concordance between transthoracic echocardiography (TTE) performed by neurologists and cardiologists for the screening of cardioembolic sources in patients with ischemic stroke. METHODS: We examined prospectively 27 consecutive patients with ischemic stroke. A potential source of embolism in all of the patients was sought by means of a TTE study. This study was performed by one neurologist after one-month full-time training on the technique and independently by one cardiologist whose results were considered as the reference standard. Regarding the risk of cardioembolism, findings from TTE studies were considered as normal, or indicative of either moderate or high risk, according to the TOAST criteria. Agreement between the two observers on the diagnosis of cardioembolic source was analyzed with the Cohen's Kappa Test (K). A K > 0,6 was considered as good agreement. RESULTS: The 27 patients studied had a mean age of 68,7 +/- 10,2 years and 70 % were men. A cardioembolic source was detected in 9 patients by the cardiologist and 8 of these were also identified by the neurologist: in 1 patient a mitral annulus calcification was not detected in the examination performed by the neurologist. In 2 patients with poor echocardiographic window, the neurologist underestimated the left ventricular function. Diagnostic agreement between both examinations was 88,9 % (K: 0,77; p = 0,001). CONCLUSION: Compared with cardiologists, trained neurologists show a fairly high degree of accuracy in the TTE screening of patients with stroke. Those cases with poor echocardiographic window or with abnormal findings should be confirmed by the cardiologists.

Ecocardiografía transtorácica realizada por neurólogos en patología vascular: estudio piloto / Transthoracic echocardiopraphy in stroke performed by neurologist: pilot study

El objetivo de nuestro estudio es comparar la concordancia entre la ecocardiografía transtorácica (ETT) realizada por neurólogos y cardiólogos en el cribado de fuentes cardioembólicas en pacientes con isquemia cerebral. Métodos. Evaluamos de forma prospectiva y consecutiva 27 pacientes con isquemia cerebral. A todos se les realizó una ETT por un neurólogo que había sido entrenado previamente durante un mes en la técnica, e independientemente, por un cardiólogo cuyos resultados fueron considerados como la referencia estándar. Según el riesgo de cardioembolismo, los hallazgos en la ETT fueron clasificados como normales, de moderado o alto riesgo según los criterios TOAST. La concordancia en el diagnóstico de fuente cardioembólica entre ambos exploradores fue evaluado con el test Kappa de Cohen (K). Una K>0,6 se consideró como buena concordancia. Resultados. De 27 pacientes con isquemia cerebral, la edad media fue de 68,7 ± 10,2 años y 70 % fueron hombres. En 9 pacientes el cardiólogo detectó una fuente cardioembólica, y de ellos, 8 pacientes también por el neurólogo (1 paciente con calcificación del anillo mitral no fue detectado). En 2 pacientes con mala ventana ecocardiográfica, el neurólogo infraestimó la función ventricular. El diagnóstico fue concordante entre ambas exploraciones en un 88,9 % de los pacientes (K: 0,77; p = 0,001). Conclusiones. Comparado con el cardiólogo, un neurólogo entrenado realiza la ETT con una buena fiabilidad. En los casos con mala ventana ecocardiográfica o con hallazgos patológicos, éstos deberían ser confirmados por el cardiólogo (AU)

Introduction. The aim of this study is to assess concordance between transthoracic echocardiography (TTE) performed by neurologists and cardiologists for the screening of cardioembolic sources in patients with ischemic stroke. Methods. We examined prospectively 27 consecutive patients with ischemic stroke. A potential source of embolism in all of the patients was sought by means of a TTE study. This study was performed by one neurologist after one-month full-time training on the technique and independently by one cardiologist whose results were considered as the reference standard. Regarding the risk of cardioembolism, findings from TTE studies were considered as normal, or indicative of either moderate or high risk, according to the TOAST criteria. Agreement between the two observers on the diagnosis of cardioembolic source was analyzed with the Cohen's Kappa Test (K). A K > 0,6 was considered as good agreement. Results. The 27 patients studied had a mean age of 68,7 ± 10,2 years and 70 % were men. A cardioembolic source was detected in 9 patients by the cardiologist and 8 of these were also identified by the neurologist: in 1 patient a mitral annulus calcification was not detected in the examination performed by the neurologist. In 2 patients with poor echocardiographic window, the neurologist underestimated the left ventricular function. Diagnostic agreement between both examinations was 88,9 % (K: 0,77; p = 0,001). Conclusion. Compared with cardiologists, trained neurologists show a fairly high degree of accuracy in the TTE screening of patients with stroke. Those cases with poor echocardiographic window or with abnormal findings should be confirmed by the cardiologists (AU)