Contrast-Enhanced Echocardiographic Measurement of Left Ventricular Wall Thickness in Hypertrophic Cardiomyopathy: Comparison with Standard Echocardiography and Cardiac Magnetic Resonance.

BACKGROUND: Left ventricular wall thickness (LVWT) measurement is key in the diagnostic and prognostic assessment of hypertrophic cardiomyopathy (HCM). Recent investigations have highlighted discrepancies in LVWT by cardiac magnetic resonance (CMR) and standard echocardiography (S-Echo) in this condition. The aim of this study was to elucidate the role of contrast-enhanced echocardiography (C-Echo) to optimize LVWT measurement in patients with HCM. METHODS: Fifty patients with HCM were prospectively enrolled, undergoing S-Echo, C-Echo, and CMR. Blinded LVWT measurements were performed according to a 16-segment left ventricular model using all three imaging techniques. Agreement between both echocardiographic modalities and CMR (as the reference technique) at the segmental level was tested using Bland-Altman analyses. Reproducibility on segmental measurements by S-Echo and C-Echo was also investigated. RESULTS: Patients' mean age was 47 ± 21 years, and 35 (70%) were men. Maximal mean LVWT by S-Echo (20.1 ± 3.8 mm) was greater than the values derived using C-Echo (17.6 ± 4.0 mm, P < .01) and CMR (17.7 ± 4.5 mm, P < .01), with no statistically significant difference between the latter two. Segmental Bland-Altman models demonstrated globally smaller bias and narrower 95% limits of agreement for C-Echo compared with S-Echo. Across all left ventricular segments, LVWT by C-Echo was 2.4 mm lower (range, 1.0-2.5 mm) than that derived by S-Echo, which accounted for a 25% intertechnique difference. Regarding maximal LVWT, the mean absolute difference between C-Echo and S-Echo was 3.0 ± 1.9 mm (range, 0.0-7.9 mm), which represented a 15% intertechnique change. Data analyses demonstrated globally less intra- and interobserver variability in segmental LVWT derived from C-Echo compared with S-Echo. CONCLUSIONS: C-Echo rendered LVWT measurements closer to those derived by the reference technique (CMR) and improved reproducibility compared with S-Echo. C-Echo represents a suitable tool for LVWT measurement in patients with HCM as an alternative to CMR whenever this is not available or possible.

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)

[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)

[Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance and computed tomography]. / Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada.

This article contains a review of the most important contributions made by echocardiography, magnetic resonance imaging and computed tomography to the field of cardiology in 2009. During this period, we helped establish values for myocardial deformation parameters in a number of different clinical settings that have enabled us to achieve better understanding of systolic and diastolic function in both ventricles. Real-time three-dimensional echocardiography has provided new ways to improve the selection and monitoring of potential candidates for an increasing number of noncoronary interventions, such as percutaneous aortic valve implantation and percutaneous mitral valve repair. Magnetic resonance imaging has clearly become the technique of choice for studying a range of different conditions, such as myocarditis and various forms of cardiomyopathy, and is now established as the reference standard in clinical practice for determining the sizes of infarcts and myocardial areas at risk. The diagnostic potential of computed tomography for assessing heart disease has been confirmed in large multicenter trials.

Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada / Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance and computed tomography

En este artículo se realiza una revisión de las aportaciones más relevantes del ecocardiograma, la resonancia magnética y la tomografía computarizada a la cardiología que han sido publicadas durante 2009. En este periodo, hemos asistido a la consolidación, en distintos contextos clínicos, de parámetros de deformación miocárdica que nos han permitido comprender mejor tanto la función sistólica como la diastólica de ambos ventrículos. La ecocardiografía tridimensional en tiempo real ha abierto nuevas vías para seleccionar y monitorizar mejor a los candidatos a un creciente número de procedimientos intervencionistas no coronarios, tales como el implante percutáneo de prótesis valvulares aórticas o la reparación mitral percutánea. La resonancia magnética se ha convertido definitivamente en la técnica de elección para el estudio de entidades diferentes, como la miocarditis y varios tipos de miocardiopatías, y se ha asentado como el patrón de referencia en la práctica clínica para la determinación del tamaño del infarto y el área de miocardio en riesgo. Las posibilidades diagnósticas de la tomografía computarizada en el diagnóstico cardiológico se ven confirmadas en grandes ensayos multicéntricos (AU)

This article contains a review of the most important contributions made by echocardiography, magnetic resonance imaging and computed tomography to the field of cardiology in 2009. During this period, we helped establish values for myocardial deformation parameters in a number of different clinical settings that have enabled us to achieve better understanding of systolic and diastolic function in both ventricles. Real-time three-dimensional echocardiography has provided new ways to improve the selection and monitoring of potential candidates for an increasing number of no coronary interventions, such aspercutaneous aortic valve implantation and percutaneous mitral valve repair. Magnetic resonance imaging has clearly become the technique of choice for studying arange of different conditions, such as myocarditis and various forms of cardiomyopathy, and is now established as the reference standard in clinical practice for determining the sizes of infarcts and myocardial areas at risk. The diagnostic potential of computed tomography for assessing heart disease has been confirmed in large multicenter trials (AU)