| 1. |
- Winter, Reidar, et al.
(författare)
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Feasibility of noninvasive transthoracic echocardiography/Doppler measurement of coronary flow reserve in left anterior descending coronary artery in patients with acute coronary syndrome: A new technique tested in clinical practice
- 2003
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Ingår i: Journal of the American Society of Echocardiography. - 1097-6795. ; 16:5, s. 464-468
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to test the feasibility and accuracy of transthoracic Doppler echocardiography measurement of coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD) territory in the clinical setting of the acute coronary syndrome. Methods: Transthoracic Doppler echocardiography measurements of CFR were made in 42 consecutive patients in the distal LAD before and during adenosine infusion. The results were validated by coronary angiography. A normal CFR was predefined as a more than 2-fold increase of flow velocity during adenosine infusion. Results. We were able to detect significant stenosis in the LAD territory with 92% sensitivity and 82% specificity if we considered a stenosis greater than or equal to 50% to be significant. Defining a stenosis of greater than or equal to 70% as significant increased the sensitivity and the negative-predictive value to 100%, with a specificity of 70%. Conclusion: Measuring CFR using transthoracic Doppler echocardiography is noninvasive, feasible, accurate, and relatively inexpensive. The excellent negative-predictive value of this technique makes it a useful tool for identifying patients who can avoid repeated angiography as a result of suspected subacute LAD restenosis after percutaneous coronary intervention.
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| 2. |
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| 3. |
- Bech-Hanssen, O., et al.
(författare)
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Net Pressure Gradients in Aortic Prosthetic Valves can be Estimated by Doppler
- 2003
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 16:8, s. 858-866
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Tidskriftsartikel (refereegranskat)abstract
- Background: In aortic prosthetic valves, both the Doppler-estimated gradients and orifice areas are misleading in the assessment of hemodynamic performance. The parameter of major interest is the net pressure gradient after pressure recovery (PR). We, therefore, investigated, in vitro, our ability to predict the net pressure gradient and applied the formulas in a representative patient population with 2 different valve designs. Methods: We studied the St Jude Medical (SJM) standard valve (size 19-27) and SJM Biocor (size 21-27) in an in vitro steady-flow model with simultaneous Doppler-estimated pressure and catheter pressure measurements. Using echocardiography, we also studied patients who received the SJM (n = 66) and SJM Biocor (n = 45). Results: In the SJM, we observed PR both within the prosthesis and aorta, whereas in the SJM Biocor, PR was only present in the aorta. We estimated the PR within the valve and within the aorta separately from echocardiographic in vitro data, combining a regression equation (valve) with an equation on the basis of fluid mechanics theory (aorta). The difference between estimated and catheter-obtained net gradients (mean ± SD) was 0.6 ± 1.6 mm Hg in the SJM and - 0.2 ± 1.9 mm Hg in the SJM Biocor. When these equations were applied in vivo, we found that PR had an overall value of 57 ± 7% of the peak Doppler gradient in the SJM and 33 ± 9% in the SJM Biocor. Conclusions: The in vitro results indicate that it is possible to predict the net pressure gradient by Doppler in bileaflet and stented biologic valves. Our data indicate that important PR is also present in stented biologic valves.
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| 4. |
- Castor, S, et al.
(författare)
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Assessment of fetal pulmonic stenosis by ultrasonography
- 1996
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Ingår i: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 9:6, s. 805-13
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Tidskriftsartikel (refereegranskat)
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| 5. |
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| 6. |
- Escobar Kvitting, John-Peder, 1976-, et al.
(författare)
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How accurate is visual assessment of synchronicity in myocardial motion? An in vitro study with computer-simulated regional delay in myocardial motion : clinical implications for rest and stress echocardiography studies
- 1999
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 12:9, s. 698-705
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Tidskriftsartikel (refereegranskat)abstract
- Asynchronicity in echocardiographic images is normally assessed visually. No prior quantitative studies have determined the limitations of this approach. To quantify visual recognition of myocardial asynchronicity in echocardiographic images, computer-simulated delay phantom loops were generated from a 3.3 MHz digital image data from a normal left ventricular short-axis heart cycle acquired at 55 frames per second. Six expert observers visually assessed 30 abnormal and 3 normal loops with differing computer-induced delay patterns on 3 occasions and in this optimally simulated environment could recognize only single delays of 89 ms or more. This was improved to 71 ms or more by use of side-by-side (normal versus abnormal) comparative review. Thus visual assessment of clinically important regional delay in rest or stress echo images is limited.
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| 7. |
- Flachskampf, Frank A, et al.
(författare)
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Overestimation of flow velocity through leaks in mechanical valve prostheses and through small orifices by continuous-wave Doppler.
- 1997
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 10:9, s. 904-914
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Tidskriftsartikel (refereegranskat)abstract
- The reliability of continuous-wave Doppler flow velocity measurements through small regurgitant lesions, such as in prosthetic leakage, has not been systematically analyzed. To evaluate the accuracy of continuous-wave Doppler in prosthetic valve leakage and small orifices in an in vitro, steady-flow model-flow velocities through the leaks of twelve intact mechanical prostheses and through six circular nozzles (area 0.5 to 20 mm2) were measured at pressure drops between 30 and 105 mm Hg. These results were compared with those predicted by the modified Bernoulli equation. Laser Doppler anemometry of flow velocities through the nozzles was also performed. Despite high correlation, there was substantial overestimation of Bernoulli predicted velocities by echo Doppler in the prosthetic leaks (mean +12.3% +/- 9.4%; range 90.3% to 143.4%). In the nozzles < or = 10 mm2, but not in the largest (20 mm2) nozzle, there was also overestimation of the Bernoulli predicted velocities (mean +6.2% +/- 2%). Laser Doppler anemometry of flow velocities through the nozzles showed slightly lower values than predicted by the Bernoulli equation. Thus, continuous-wave echo Doppler overestimates flow velocities through small orifices. This apparently is, at least in part, due to transit time effects and should be taken into account when using echo Doppler in small (< 10 mm2) orifices, such as in mild to moderate regurgitant lesions and prosthetic valve leakage.
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| 8. |
- Fyrenius, Anna, et al.
(författare)
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Pitfalls in Doppler evaluation of diastolic function : insights from 3-dimensional magnetic resonance imaging
- 1999
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Ingår i: Journal of the American Society of Echocardiography. - Amsterdam : Elsevier Science B.V.. - 0894-7317 .- 1097-6795. ; 12:10, s. 817-826
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Tidskriftsartikel (refereegranskat)abstract
- Ultrasound-Doppler assessment of diastolic function is subject to velocity errors caused by angle sensitivity and a fixed location of the sample volume. We used 3-dimensional phase contrast magnetic resonance imaging (MRI) to evaluate these errors in 10 patients with hypertension and in 10 healthy volunteers. The single (Doppler) and triple (MRI) component velocity was measured at early (E) and late (A) inflow along Doppler-like sample lines or 3-dimensional particle traces generated from the MRI data. Doppler measurements underestimated MRI velocities by 9.4% ± 8.6%; the effect on the E/A ratio was larger and more variable. Measuring early and late diastolic inflows from a single line demonstrated the error caused by their 3-dimensional spatial offset. Both errors were minimized by calculating the E/A ratio from maximal E and A values without constraint to a single line. Alignment and spatial offset are important sources of error in Doppler diastolic parameters. Improved accuracy may be achieved with the use of maximal E and A velocities from wherever they occur in the left ventricle.
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| 9. |
- Hedberg, Pär, et al.
(författare)
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Mitral annulus motion compared with wall motion scoring index in the assessment of left ventricular ejection fraction
- 2003
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 16:6, s. 622-629
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Tidskriftsartikel (refereegranskat)abstract
- The biplane disc summation method is the recommended echocardiographic procedure to determine left ventricular (LV) ejection fraction (EF). Assessment of mitral annulus motion (MAM) or wall motion scoring index (WMI) has been reported to be less dependent on image quality compared with the recommended method, and proposed as a surrogate to the disc summation method in calculation of LVEF. We aimed to compare MAM and WMI in the echocardiographic assessment of LVEF. In a randomly selected population-based sample of 75-year-old men and women in sinus rhythm (n = 409) MAM, as measured by M-mode, was compared with WMI, calculated as the mean value of wall motion scoring in 9 LV segments. LVEF, as measured by the biplane disc summation method was used as reference. The limits of agreement (mean difference ± 1.96 SD) between LVEF and corresponding MAM values were −18 to +13 LVEF%, and between LVEF and corresponding WMI values were −12 to +13 LVEF%. The areas under the receiver operating characteristic curves for MAM and WMI to predict a LVEF < 50% were 0.892 and 0.998, respectively (95% confidence interval of the difference 0.062-0.149). The corresponding areas for MAM and WMI to predict a LVEF < 40% were 0.955 and 0.998, respectively (95% confidence interval of the difference 0.017-0.069). In conclusion, the ability of WMI to estimate LVEF was more favorable than MAM in this population-based sample of 75-year-old participants. The findings suggest that the WMI is preferable to MAM in estimating LVEF.
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| 10. |
- Strotmann, Jörg M., et al.
(författare)
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Anatomic M-mode echocardiography : a new approach to assess regional myocardial function - A comparative in vivo and in vitro study of both fundamental and second harmonic imaging modes
- 1999
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 12:5, s. 300-307
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the accuracy of anatomic M-mode echocardiography (AMM).Methods: Eight phantoms were rotated on a device at different insonation depths (IDs) in a water beaker. They were insonated with different transducer frequencies in fundamental imaging (FI) and second harmonic imaging (SHI), and the diameters were assessed with conventional M-mode echocardiography (CMM) and AMM with the applied angle correction (AC) after rotation. In addition, left ventricular wall dimensions were measured with CMM and AMM in FI and SHI in 10 volunteers.Results: AC had the greatest effect on the measurement error in AMM followed by ID (AC: R2 = 0.295, ID: R2 = 0.268; P < .0001). SHI improved the accuracy, and a difference no longer existed between CMM and AMM with an AC up to 60 degrees. In vivo the limit of agreement between AMM and CMM was -1.7 to +1.8 mm in SHI.Conclusion: Within its limitations (AC < 60 degrees; ID < 20 cm), AMM could be a robust tool in clinical practice.
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| 11. |
- Sun, Y, et al.
(författare)
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Estimation of volume flow rate by surface integration of velocity vectors from color Doppler images.
- 1995
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795 .- 0735-1097 .- 1558-3597. ; 8:6, s. 904-914
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Tidskriftsartikel (refereegranskat)abstract
- A new Doppler echocardiographically based method has been developed to quantify volume flow rate by surface integration of velocity vectors (SIVV). Electrocardiographic-gated color Doppler images acquired in two orthogonal planes were used to estimate volume flow rate through a bowl-shaped surface at a given time and distance from the probe. To provide in vitro validation, the method was tested in a hydraulic model representing a pulsatile flow system with a restrictive orifice. Accurate estimates of stroke volume (+/- 10%) were obtained in a window between 1.2 and 1.6 cm proximal to the orifice, just before the region of prestenotic acceleration. By use of the Bernoulli's equation, the estimated flows were used to generate pressure gradient waveforms across the orifice, which agreed well with the measured flows. To demonstrate in vivo applicability, the SIVV method was applied retrospectively to the determination of stroke volume and subaortic flow from the apical three-chamber and five-chamber views in two patients. Stroke volume estimates along the left ventricular outflow tract showed a characteristic similar to that in the in vitro study and agreed well with those obtained by the Fick oxygen method. The region where accurate measurements can be obtained is affected by instrumental factors including Nyquist velocity limit, wall motion filter cutoff, and color flow sector angle. The SIVV principle should be useful for quantitative assessment of the severity of valvular abnormalities and noninvasive measurement of pulsatile volume flows in general.
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| 12. |
- Aburawi, Elhadi, et al.
(författare)
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Coronary Flow in Neonates with Impaired Intrauterine Growth.
- 2012
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 1097-6795 .- 0894-7317. ; 25:3, s. 313-318
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subclinical myocardial injury has been reported in newborns with fetal weights < 2 SDs for gestational age. Intrauterine growth restriction might affect cardiac function and coronary flow (CF). METHODS: Seventeen newborns with intrauterine growth restriction and 15 age-matched healthy controls were enrolled in the study. Blood flow in the umbilical artery and maternal uterine artery was assessed using Doppler velocimetry. Cardiac function and left anterior descending coronary artery CF were measured using transthoracic Doppler echocardiography at 1 week of age. RESULTS: The mean growth deviation of the newborns from normal was -2.5 ± 0.2 SDs. Percentage left ventricular shortening fraction was 39 ± 4.3% in patients and 42 ± 4.1% in controls (P = .40), and the mean left ventricular mass index was 86.6 g/m(2) in patients and 73.7 g/m(2) in controls (P < .01). The mean left anterior descending coronary artery diameter was 0.99 ± 0.1 mm in patients and 0.8 ± 0.1 mm in controls (P = .002). The left anterior descending coronary artery flow velocity-time integral was correlated with left ventricular mass index (r = 0.31, P = .007) and with mitral peak E/A ratio (r = 0.74, P = .01). Intrauterine growth restriction was associated with increased peak flow velocity in diastole (34.5 ± 4 vs 19 ± 6 cm/sec in controls, P = .0001), as well as increased CF (37 ± 7.3 vs 8.2 ± 3.0 mL/min in controls, P = .001). CONCLUSIONS: CF is significantly increased in neonates with impaired intrauterine growth. Left ventricular mass index is increased, but systolic and diastolic function remains normal. The clinical significance of increased CF is unclear, but it might lead to decreased CF reserve.
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| 13. |
- Aburawi, Elhadi, et al.
(författare)
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Effects of Balloon Valvuloplasty on Coronary Blood Flow in Neonates With Critical Pulmonary Valve Stenosis Assessed With Transthoracic Doppler Echocardiography.
- 2009
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 1097-6795 .- 0894-7317. ; 22, s. 165-169
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treating pulmonary valve stenosis with balloon valvuloplasty (BV) is a good model to study the effect of right ventricular (RV) pressures on coronary flow. METHODS: Transthoracic Doppler echocardiography was used to register coronary flow in 10 age-matched healthy controls and 7 neonates before and 1 day after BV. RESULTS: Left ventricular fractional shortening and cardiac output increased significantly after BV. Right coronary artery diameter decreased from 1.2 +/- 0.2 to 1.1 +/- 0.1 mm (P < .02). Posterior descending coronary artery flow parameters decreased significantly, with blood flow decreasing from 8.4 to 5.7 +/- 1.9 mL/s (P < .003). RV end-diastolic pressure and RV systolic pressure explained almost totally the variation in coronary flow (r(2) = 0.87). CONCLUSIONS: RV end-diastolic pressure and RV systolic pressure determined coronary flow in neonates with critical pulmonary valve stenosis. Cardiac output and left ventricular fractional shortening increased after pulmonary valve BV.
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| 14. |
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| 15. |
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| 16. |
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| 17. |
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| 18. |
- Arnold, MF, et al.
(författare)
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Editorial: Does atrioventricular ring motion always distinguish constriction from restriction? A Doppler myocardial imaging study
- 2001
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 14:5, s. 391-395
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Constrictive pericarditis and restrictive cardiomyopathy can be difficult to differentiate on clinical examination. Cardiac ultrasonography is increasingly being used as the noninvasive method of choice for confirming the specific morphologic and hemodynamic abnormalities associated with either condition. Interrogation of atrioventricular valve plane motion by Doppler myocardial imaging (DMI) has been suggested as a valuable new approach that can help differentiate one from the other. We report the color DMI, pulsed DMI, and strain rate findings in 2 cases of constrictive pericarditis in which consideration of the annular motion pattern alone would not have allowed such differentiation.
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| 19. |
- Barclay, Susan A, et al.
(författare)
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The shape of the proximal isovelocity surface area varies with regurgitant orifice size and distance from orifice : computer simulation and model experiments with color M-mode technique.
- 1993
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 6:4, s. 433-445
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Tidskriftsartikel (refereegranskat)abstract
- The hemispheric proximal isovelocity surface area method for quantification of mitral regurgitant flow (i.e., Qc = 2 pi r2v), where 2 pi r2 is the surface area and v is the velocity at radius r, was investigated as distance from the orifice was increased. Computer simulations and steady flow model experiments were performed for orifices of 4, 6, and 8 mm. Flow rates derived from the centerline velocity and hemispheric assumption were compared with true flow rates. Proximal isovelocity surface area shape varied as distance from each orifice was increased and could only be approximated from the hemispheric equation when a certain distance was exceeded: > 7, > 10, and > 12 mm for the 4, 6, and 8 mm orifices, respectively. Prediction of relative error showed that the best radial zone at which to make measurements was 5 to 9, 6 to 14 and 7 to 17 mm for the 4, 6, and 8 mm orifices, respectively. Although effects of a nonhemispheric shape could be compensated for by use of a correction factor, a radius of 8 to 9 mm can be recommended without the use of a correction factor over all orifices studied if a deviation in calculated as compared with true flow of 15% is considered acceptable. These measurements therefore have implications for the technique in clinical practice.
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| 20. |
- Bech-Hanssen, O, et al.
(författare)
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Aortic prosthetic valve design and size : Relation to Doppler echocardiographic findings and pressure recovery - An in vitro study
- 2000
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 13:1, s. 39-50
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Tidskriftsartikel (refereegranskat)abstract
- The extent to which Doppler echocardiography information can be used in the assessment of prosthesis hemodynamic performance is still controversial. The goals of our study were to assess the importance of valve design and size both on Doppler echocardiography findings and on pressure recovery in a fluid mechanics model. We performed Doppler and catheter measurements in the different orifices of the bileaflet St Jude (central and side orifices), the monoleaflet Omnicarbon (major and minor orifices), and the stented Biocor porcine prosthesis. Net pressure gradients were predicted from Doppler flow velocities, assuming either independence or dependence of valve size. The peak Doppler estimated gradients (mean +/- SD for sizes 21 to 27) were 21 +/- 10.3 rum Hg for St Jude, 18 +/- 9.3 mm Hg for Omnicarbon, and 37 +/- 14.5 mm Hg for Biocor (P <.05 for St Jude and Omnicarbon vs Biocor). The pressure recovery (proportion of peak catheter pressure) was 53% +/- 8.6% for central-St Jude, 29% +/- 8.9% for side-St Jude, 20% +/- 5.6% for major-Omnicarbon, 23% +/- 7.4% for minor-Omnicarbon, and 18% +/- 3.6% for Biocor (P <.05 for central-St Jude and side-St Jude vs Omnicarbon and Biocor). Valve sizes (2) significantly influenced pressure recovery (y in percentage) (central-St Jude: y = 3.7x - 35.9, r = 0.88, P =.0001, major-Omnicarbon: y = 2.1x - 30.3, r = 0.85, P =.0001). By assuming dependence of valve size, Doppler was able to predict net pressure gradients in St Jude with a mean difference between net catheter and Doppler-predicted gradient of - 3.8 +/- 2.5 mm Hg. In conclusion, prosthetic value design and size influence the degree of pressure recovery, making Doppler gradients potentially misleading in both the assessment of hemodynamic performance and the comparison of one design with another. The preliminary results indicate that net gradient can be predicted from Doppler gradients,
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| 21. |
- Bech-Hanssen, Odd, 1956, et al.
(författare)
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Doppler echocardiography can provide a comprehensive assessment of right ventricular afterload
- 2009
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 22:12, s. 1360-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of this study was to evaluate novel Doppler echocardiographic methods for a comprehensive assessment of right ventricular afterload, including pulmonary artery (PA) mean pressure (PAMP) and the PA pressure waveform. METHODS: The study comprised 109 patients who underwent right-heart catheterization simultaneously (group A, n = 31) with Doppler echocardiography on 35 occasions or nonsimultaneously (group B, n = 78) within 24 hours of Doppler echocardiography. Right ventricular afterload variables were obtained using pulsed Doppler in the PA and continuous Doppler of tricuspid regurgitation. The intervals from QRS to the opening and closing of the pulmonary valve and to the peak velocity of tricuspid regurgitation were measured. PA end-diastolic pressure, PA systolic pressure, and PA notch pressure were calculated. The Doppler-derived pressure curve was separated into 3 parts with fitted second-order curves. RESULTS: Catheter PAMP and Doppler PA systolic pressure in group A were strongly related (R = 0.85). The regression equation from group A (PAMP = 0.65 x Doppler PA systolic pressure - 1.2 mm Hg) was used to calculate PAMP in group B. There was no difference between catheter PAMP (mean, 39 +/- 18 mm Hg; range, 8-95 mm Hg) and Doppler PAMP (mean, 39 +/- 15 mm Hg; range, 12-83 mm Hg) (P = .85). The systolic areas under the curves for catheter and Doppler PAMP in group A were 20 +/- 4.7 and 20 +/- 4.0 mm Hg s, respectively (P = .52), and the diastolic areas were 21 +/- 5.7 and 22 +/- 6.3 mm Hg s, respectively (P = .21). CONCLUSION: A comprehensive assessment of right ventricular afterload that includes PAMP and the PA pressure waveform can be provided by Doppler echocardiography in patients with a wide range of PA pressures and different diagnoses.
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| 22. |
- Bech-Hanssen, Odd, 1956, et al.
(författare)
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Pulmonary Hypertension Phenotype Can Be Identified in Heart Failure With Reduced Ejection Fraction Using Echocardiographic Assessment of Pulmonary Artery Pressure With Supportive Use of Pressure Reflection Variables
- 2023
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 36:6, s. 604-614
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pulmonary hypertension (PH) is frequent in patients with heart failure and reduced ejection fraction (HFrEF) with 2 different phenotypes: isolated postcapillary PH (IpcPH) and, with the worst prognosis, combined pre- and postcapillary PH (CpcPH). The aims of the present echocardiography study were to investigate (1) the ability to identify PH phenotype in patients with HFrEF using the newly adopted definition of PH (mean pulmonary artery pressure >20 mm Hg) and (2) the relationship between PH phenotype and right ventricular (RV) function. Methods: One hundred twenty-four patients with HFrEF consecutively referred for heart transplant or heart failure workup were included with echocardiography and right heart catheterization within 48 hours. We estimated systolic pulmonary artery pressure (sPAPDoppler) and used a method to detect increased pulmonary vascular resistance (>3 Wood units) based on predefined thresholds of 3 pressure reflection (PRefl) variables (the acceleration time in the RV outflow tract [RVOT], the interval between peak RVOT and peak tricuspid regurgitant velocity, and the RV pressure augmentation following peak RVOT velocity). Results: Using receiver operator characteristic analysis in a derivation group (n = 62), we identified sPAPDoppler ≥35 mm Hg as a cutoff that in a test group (n = 62) increased the likelihood of PH 6.6-fold. The presence of sPAPDoppler >40 mm Hg and 2 or 3 positive PRefl variables increased the probability of CpcPH 6- to 8-fold. A 2-step approach with primarily assessment of sPAPDoppler and the supportive use of PRefl variables in patients with mild/moderate PH (sPAPDoppler 41-59 mm Hg) showed 76% observer agreement and a weighted kappa of 0.63. The steady-state (pulmonary vascular resistance) and pulsatile (compliance, elastance) vascular loading are increased in both IpcPH and CpcPH with a comparable degree of RV dysfunction. Conclusions: The PH phenotype can be identified in HFrEF using standard echocardiographic assessment of pulmonary artery pressure with supportive use of PRefl variables in patients with mild to moderate PH.
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| 23. |
- Bech-Hanssen, Odd, 1956, et al.
(författare)
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Pulsed-Wave Doppler Recordings in the Proximal Descending Aorta in Patients with Chronic Aortic Regurgitation: Insights from Cardiovascular Magnetic Resonance
- 2018
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 31:3
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Tidskriftsartikel (refereegranskat)abstract
- The pulsed-wave Doppler recording in the descending aorta (PWD DAO ) is one of the parameters used in grading aortic regurgitation (AR) severity. The aim of the present study was to investigate the assessment of chronic AR by PWD DAO with insights from cardiovascular magnetic resonance (CMR). Methods: This prospective study comprised 40 patients investigated with echocardiography and CMR within 4 hours either prior to valve surgery (n = 23) or as part of their follow-up (n = 17) due to moderate or severe AR. End-diastolic flow velocity (EDFV) and the diastolic velocity time integral (dVTI) were measured. The appearance of diastolic forward flow (DFF) was noted. Phase-contrast flow rate curves were obtained in the DAO. Results: Twenty-five patients had severe and eight had moderate AR by echocardiography (seven were indeterminate). The EDFV was below the recommended threshold ( > 20 cm/sec) in 13 patients (52%) with severe AR. Lowering the EDFV threshold ( > 13 cm/sec) and with a dVTI threshold > 13 cm showed negative likelihood ratios of 0.27 and 0.09, respectively. Detection of DFF with PWD DAO identified a nonuniform velocity profile by CMR with positive and negative likelihood ratios of 7.0 and 0.19, respectively. The relation between EDFV and DAO regurgitant volume (DAO-RVol CMR ) was strong in patients without (R = 0.88) and weak in patients with DFF (R = 0.49). The DAO-RVol CMR as a percent of the total RVol CMR decreased with increasing ascending aorta (AAO) size and increased with increasing AR severity. Conclusions: Our findings suggest that PWD DAO provides semiquantitative parameters useful to assess chronic AR severity. The limitations are related to nonuniform velocity contour and variable degree of lower body contribution, which depends on AR severity but also on the AAO size.
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| 24. |
- Bjällmark, Anna, et al.
(författare)
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Velocity tracking - a novel method for quantitative analysis of longitudinal myocardial function
- 2007
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier. - 0894-7317 .- 1097-6795. ; 20:7, s. 847-856
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Tidskriftsartikel (refereegranskat)abstract
- Doppler tissue imaging is a method for quantitative analysis of longitudinal myocardial velocity. Commercially available ultrasound systems can only present velocity information using a color Dopplerbased overlapping continuous color scale. The analysis is time-consuming and does not allow for simultaneous analysis in different projections. We have developed a new method, velocity tracking, using a stepwise color coding of the regional longitudinal myocardial velocity. The velocity data from 3 apical projections are presented as static and dynamic bull's-eye plots to give a 3-dimensional understanding of the function of the left ventricle. The static bull's-eye plot can display peak systolic velocity, late diastofic tissue velocity, or the sum of peak systolic velocity and early diastolic tissue velocity. Conversely, the dynamic bull's-eye plot displays how the myocardial velocities change over one heart cycle. Velocity tracking allows for a fast, simple, and hituitive visual analysis of the regional longitudinal contraction pattern of the left ventricle with a great potential to identify characteristic pathologic patterns.
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| 25. |
- Bolger, A F, et al.
(författare)
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Understanding continuous-wave Doppler signal intensity as a measure of regurgitant severity.
- 1997
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 10:6, s. 613-622
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Tidskriftsartikel (refereegranskat)abstract
- Continuous-wave Doppler signal intensity is commonly expected to reflect the severity of mitral regurgitation. Physical principles predict that alignment of the imaging beam, flow velocity, and turbulence can also be important or even dominant determinants of continuous-wave Doppler signal intensity. The reliability of tracking regurgitant severity with continuous-wave Doppler signal intensity was assessed in vitro with varying volume, velocity, turbulence, and beam alignment. The conditions wherein continuous-wave Doppler signal intensity increased with regurgitant volume were specific but poorly predictable combinations of orifice size, flow volume, and perfect beam alignment. Under other conditions flow velocity and turbulence effects dominated, and continuous-wave Doppler signal intensity did not reflect changing regurgitant volume. Continuous-wave Doppler signal intensity-based impressions of regurgitant severity may be unreliable and even misleading under some circumstances.
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| 26. |
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| 27. |
- Clemmensen, Tor Skibsted, et al.
(författare)
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Left Ventricular Pressure-Strain-Derived Myocardial Work at Rest and during Exercise in Patients with Cardiac Amyloidosis
- 2020
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Ingår i: Journal of the American Society of Echocardiography. - : MOSBY-ELSEVIER. - 0894-7317 .- 1097-6795. ; 33:5, s. 573-582
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Tidskriftsartikel (refereegranskat)abstract
- Background: Left ventricular pressure-strain-derived myocardial work index (LVMWI) is a novel, noninvasive method for left ventricular (LV) function evaluation in relation to LV pressure dynamics. LV global longitudinal strain (LVGLS) has proven benefit for diagnosis and risk stratification in patients with cardiac amyloidosis (CA), but LVGLS does not adjust for loading conditions. The aim of the present study was to characterize LVMWI at rest and during exercise in patients with CA. Methods: A total of 155 subjects were retrospectively included. These subjects comprised 100 patients with CA and 55 healthy control subjects. All patients had previously undergone comprehensive two-dimensional echocardiographic examinations at rest. Furthermore, a subgroup 27 patients with CA and 41 control subjects was examined using sennisu pine exercise stress echocardiography. Results: Patients with CA had significantly lower LVGLS, LVMWI, and LV myocardial work efficiency (LVMWE) than control subjects (P < .0001 for all). The reduction in LV myocardial performance was more pronounced in the basal segments, which led to significant alterations in the average apical-to-basal segmental ratios between patients with CA and control subjects (LVGLS, 2.6 [1.9 to 4.1] vs 1.3 [1.2 to 1.5]; LVMWI, 2.6 [1.7 to 3.8] vs 1.3 [1.1 to 1.5]; LVMWE, 1.1 [1.0 to 1.3] vs 1.0 [1.0 to 1.1]; P < .0001 for all). The average increase in LVMWI from rest to peak exercise was 1,974 mm Hg% (95% CI, 1,699 to 2,250 mm Hg%; P < .0001) in control subjects and 496 mm Hg% (95% CI, 156 to 835 mm Hg%; P < .01) in patients with CA. The absolute numeric LVGLS increase was 5.6% (95% CI, 3.9% to 7.3%; P < .0001) in control subjects and only 1.2% (95% CI, -0.9% to 3.3%; P = .26) in patients with CA (between groups, P < .0001) from rest to peak exercise. The LVMWI increase in patients with CA was mediated by improvement in the apical segments (P < .0001), whereas there was no significant LVMWI alterations in the midventricular or basal segments. LVMWE remained stable during exercise in control subjects (Delta -0.6%; 95% CI, -2.5% to 1.2%; P = .50) but decreased significantly in patients with CA (Delta -2.5%; 95% CI, -4.8% to -0.2%; P < .05). Conclusions: Patients with CA have significantly reduced magnitude of LVMWI compared with healthy control subjects. With exercise, the differences are even more pronounced. Even though LVMWI increased with exercise, LVMWE decreased, suggesting inefficient myocardial energy exploitation in patients with CA.
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| 28. |
- Dencker, Magnus, et al.
(författare)
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Bileaflet blood cysts on the mitral valve in an adult.
- 2009
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 1097-6795 .- 0894-7317. ; 22:9, s. 5-1085
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Tidskriftsartikel (refereegranskat)abstract
- Blood cysts within the heart are very rare entities in adults. The authors present possibly the first ever case in which blood cysts were found on both mitral valve leaflets. A 65-year-old woman was referred for transthoracic echocardiography because of vague chest discomfort. Transthoracic echocardiography displayed echo-free cysts on the tips of both mitral valve leaflets. Subsequent transesophageal echocardiography confirmed this finding. The blood cysts were successfully surgically removed.
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| 29. |
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| 30. |
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| 31. |
- Eidenvall, Lars, et al.
(författare)
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Two-dimensional color Doppler flow velocity profiles can be time corrected with an external ECG-delay device.
- 1992
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317 .- 1097-6795. ; 5:4, s. 405-413
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Tidskriftsartikel (refereegranskat)abstract
- Although two-dimensional ultrasound color flow imaging is often considered to be a real-time technique, the acquisition time for two-dimensional color images may be up to 200 msec. Time correction is therefore necessary to obtain correct flow velocity profiles. We have developed a time-correction method in which a specially designed unit detects the QRS complex from the patient and creates a trig pulse that is delayed incrementally in relation to the QRS complex. This trig pulse controls the acquisition of the ultrasound images. A number of consecutively delayed images, with known incremental delay between the sweeps, can thus be stored in the memory of the echocardiograph and transferred digitally to a computer. The time-corrected flow velocity profile is obtained by interpolation of data from the time-delayed profiles. The system was evaluated in a Doppler string phantom test. With this technique it is possible to study time-corrected flow velocity profiles without the need to alter existing ultrasound Doppler equipment.
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| 32. |
- Emilsson, Kent, 1968-, et al.
(författare)
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Mitral annulus motion versus long-axis fractional shortening
- 2006
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Ingår i: Experimental & clinical cardiology. - : Elsevier BV. - 1918-1515. ; 11:4, s. 302-304
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In most echocardiographic studies concerning mitral annulus motion (MAM) in the assessment of left ventricular (LV) systolic function, comparisons have been performed between MAM, which represents a distance, and ejection fraction (EF), which represents a ratio between volumes. However, in theory, it is probably more suitable to compare the long-axis fractional shortening (FS(L)) (the ratio between the change in length [ie, MAM] and the end-diastolic length of the left ventricle) with EF. OBJECTIVES: To compare EF with MAM and EF with FS(L) in the assessment of LV systolic function. METHODS: Thirty healthy subjects were investigated using echo-cardiography, and the linear correlations between EF and MAM, and EF and FS(L) were calculated. RESULTS: The linear correlation (r) was found to be higher between EF and FS(L) (r=0.65; P<0.001) than between EF and MAM (r=0.49; P<0.01). CONCLUSIONS: The higher correlation between EF and FS(L) than between EF and MAM suggests that FS(L), which includes a correction for ventricular length, may be a more suitable index of LV systolic function than MAM per se.
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| 33. |
- Emilsson, Kent, 1963-, et al.
(författare)
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The relation between mitral annulus motion and ejection fraction : a nonlinear function.
- 2000
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 13:10, s. 896-901
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Tidskriftsartikel (refereegranskat)abstract
- In previous studies of the relation between mitral annulus motion (MAM) and left ventricular ejection fraction (EF), a linear relationship has been suggested. In this meta-analysis of 434 patients, we show that the relation is nonlinear and that a linear regression model overestimates EF in the lower range of MAM. The relation is better described by an S function and is influenced by age and heart size.
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| 34. |
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| 35. |
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| 36. |
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| 37. |
- Gao, Sinsia, 1966, et al.
(författare)
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Evaluation of the Integrative Algorithm for Grading Chronic Aortic and Mitral Regurgitation Severity Using the Current American Society of Echocardiography Recommendations: To Discriminate Severe from Moderate Regurgitation.
- 2018
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Ingår i: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. - : Elsevier BV. - 1097-6795. ; 31:9
-
Tidskriftsartikel (refereegranskat)abstract
- The recently published integrative algorithms for echocardiographic grading of native aortic regurgitation (AR) and mitral regurgitation (MR) by the American Society of Echocardiography are consensus based and have not been evaluated. Thus, the aims of the present study were to investigate the feasibility of individual parameters and to evaluate the ability of the algorithms to discriminate severe from moderate regurgitation.This prospective study comprised 93 patients with chronic AR (n=45) and MR (n=48). All patients underwent echocardiography and cardiovascular magnetic resonance within 4hours. The algorithms were evaluated using two different definitions for severe regurgitation: (1) a cardiovascular magnetic resonance standard indicating future need for valve surgery and (2) a clinical standard using patients who underwent valve surgery with proven postoperative left ventricular reverse remodeling and improved functional class (AR/MR, n = 26/26).The feasibility of the criteria in the first step of the algorithm was higher (AR/MR, 95%/91%) compared with the second step using quantitative Doppler parameters (74%/57%). For the AR algorithm, sensitivity was 95% and specificity 44%, whereas for the MR algorithm, sensitivity was 73% and specificity 92%. Among patients with benefit of surgery, the algorithms correctly identified 77%, misclassified 8%, and were inconclusive in 15% of the patients with AR; the corresponding figures were 73%, 15%, and 12% in the patients with MR.Using cardiovascular magnetic resonance as reference, the recommended algorithms for grading of regurgitation have the ability to rule out severe AR and rule in severe MR. The quantitative Doppler methods are hampered by feasibility issues, and our findings suggest that the decision regarding surgical intervention in symptomatic patients with discordant or inconclusive echocardiographic grading should be based on a consolidated assessment of clinical and multimodality findings.
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| 38. |
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| 39. |
- Gunnes, S., et al.
(författare)
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Analysis of the effect of temporal filtering in myocardial tissue velocity imaging
- 2004
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Ingår i: Journal of the American Society of Echocardiography. - : Mosby Inc. - 0894-7317 .- 1097-6795. ; 17:11, s. 1138-1145
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Tidskriftsartikel (refereegranskat)abstract
- Signal filtering to reduce random noise may compromise the reliability of tissue velocity measurements. This study evaluates the influence of temporal filters on time and velocity variables derived from myocardial tissue velocity images acquired in 15 healthy individuals at a high frame rate (142-184 Hz). Different time and velocity variables from the basal septum were analyzed offline before and after temporal filtering from 20 to 60 milliseconds in 10-millisecond steps using software enabling retrieval of myocardial Doppler velocity and 2-dimensional information from different cardiac locations during the same cardiac cycle. Filtering affected the results by increasing variability of time and by underestimation of velocity variables, the rapid isovolumic events being particularly filter sensitive. In addition, at a certain range of sampling rate, ambiguity of filtering effect was observed. This ought to be considered if an optimal, high-fidelity tissue Doppler velocity signal is to be obtained.
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| 40. |
- Guron, Cecilia Wallentin, 1965, et al.
(författare)
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Timing of regional left ventricular lengthening by pulsed tissue Doppler
- 2004
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Ingår i: J Am Soc Echocardiogr. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 17:4, s. 307-12
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Tidskriftsartikel (refereegranskat)abstract
- Pulsed tissue Doppler can measure myocardial velocities with high temporal resolution. Our aim was to determine the onset timing of the regional left ventricular longitudinal early lengthening (e) in relation to the mitral inflow (E) in acute coronary syndromes. We applied pulsed tissue Doppler to the septal, lateral, inferior, and anterior left ventricular basal walls of 160 patients with acute coronary syndromes and 60 control subjects. Maximum systolic and early diastolic velocities were lower for patient than for control walls (6.1 +/- 1.7 vs 7.9 +/- 1.4 cm/s, P <.0001, and 6.9 +/- 2.3 vs 10.0 +/- 2.3 cm/s, P <.0001, respectively) and e started later than E (12 +/- 30 vs 2 +/- 19 milliseconds later, P <.0001). All 3 variables related to the degree of visual left ventricular wall pathology. The intraindividual time range for all 4 e starts was wider for patients (43 +/- 27 vs 30 +/- 18 milliseconds, P <.0001). Our results show that pulsed tissue Doppler can identify a delayed and asynchronous initial wall lengthening in acute coronary syndromes.
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| 41. |
- Gustafsson, Ulf, 1976-, et al.
(författare)
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Apical circumferential motion of the right and the left ventricles in healthy subjects described with speckle tracking
- 2008
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 21:12, s. 1326-1330
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of this study was to determine whether right ventricular (RV) apical rotation could be of importance in RV function and compare this with left ventricular (LV) apical rotation. Methods Short-axis images at the apical level of both ventricles were simultaneously recorded in 14 healthy subjects (mean age, 62 ± 11 years). Results There was a significant difference in mean rotation between the two ventricles in the time interval between 50% of ejection and aortic valve closure (P < .05). At aortic valve closure, LV rotation was 10.9 ± 4.8° counterclockwise, and RV rotation was 1.1 ± 5.8° clockwise. The anterior and inferior parts of the right ventricle rotated in opposite directions toward the septum. The septal segments of both ventricles rotated inferiorly, thus likely reducing interventricular stress. Conclusion This study showed clear differences in apical rotation between the two ventricles. Whereas the left ventricle displayed uniform rotation, the right ventricle showed heterogeneous rotation, resulting overall in almost no rotation but in a “tightening belt” motion.
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| 42. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Analysis of mitral annulus motion measurements derived from M-mode, anatomic M-mode, tissue Doppler displacement, and 2-dimensional strain imaging
- 2006
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 19:9, s. 1092-1101
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Left ventricular longitudinal shortening plays an important role in cardiac contraction and can be measured by the mitral annulus motion (MAM) toward the cardiac apex. MAM can be evaluated by conventional M-mode, anatomic M-mode (AM-mode), tissue Doppler displacement (TDD), and 2-dimensional strain imaging (2DSI). Objective: The aim of the study was to compare these 4 different methods for measuring MAM. Methods: MAM was evaluated in 25 patients by M-mode, AM-mode, TDD, and 2DSI. Two walls (septal and lateral) in apical 4-chamber view were analyzed. Results. The angle correction between M-mode and AM-mode was significantly higher in the lateral wall (septum 2.2+/-1.6 vs lateral 4.1+/-1.6 degrees, P<0.01). However, with angle correction up to 8 degrees, the measurements obtained were not significantly different from those obtained by M-mode. No significant differences were found among 2DSI. M-mode, and AM-mode either, although all of them were significantly higher in comparison with TDD measurements in both septal (M-mode [11.0 +/- 2.4 nun], AM-mode [11.8 +/- 2.4 mm], 2DSI [11.0 +/- 3.4 mm] vs TDD [9.2 +/- 3.3 mm], P<.01) and lateral (M-mode [11.9 +/- 2.3 min], AM-mode [12.4 +/- 2.8 mm], 2DSI [10.4 +/- 3.9 mm] vs TDD [8.9 +/- 3.0 mm], P<.05) walls. The +/- 2SD variation from the mean difference in septal and lateral walls were, respectively, between: M-mode and TDD, -2.4 to 5.9 and -2.2 to 8.2 mm; M-mode and 2DSI, -5.7 to 5.7 and -5.8 to 8.7; AM-mode and TDD, -2.5 to 5.6 and -2.7 to 9.6; AM-mode and 2DSI, -5.7 to 5.87 and -5.9 to 9.8 and TDD and 2DSI, -3.2 to 6.6 and -5.3 to 8.4. Conclusions: AM-mode and M-mode measurements did not differ significantly. Despite the good correlation among all methods they were not interchangeable. TDD measurements were significantly lower than M-mode, AM-mode, and 2DSI measurements. M-mode and AM-mode are angle dependent and can, therefore, underestimate or overestimate MAM. The new method of 2DSI is promising because it tracks natural acoustic markers and is not angle dependent and, therefore, measures the true local tissue motion.
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| 43. |
- Hedberg, P., et al.
(författare)
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Mitral annulus motion as a predictor of mortality in a community-based sample of 75-year-old men and women
- 2006
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 19:1, s. 88-94
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Tidskriftsartikel (refereegranskat)abstract
- Mitral annulus motion (MAM) is a predictor of mortality in selected patient groups, but its prognostic value in less selected populations is not known. In a community-based random sample of 75-year-old men and women (n = 408), left ventricular function was measured as: (1) maximum amplitude of MAM; and (2) wall-motion index. During a median follow-up of 7.2 years, 83 persons died (26 from cardiac causes). Left ventricular function as measured by MAM predicted the risk of all-cause and cardiac mortality independently of other potential risk factors in this community-based sample. Regarding cardiac mortality, the predictive ability of MAM was also independent of left ventricular systolic function measured as wall-motion index. MAM may prove to be a valuable complement to other echocardiographic methods in the assessment of prognosis in less selected populations.
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| 44. |
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| 45. |
- Helin Forsberg,, Lena, et al.
(författare)
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Preoperative Longitudinal Left Ventricular Function by Tissue Doppler Echocardiography at Rest and During Exercise Is Valuable in Timing of Aortic Valve Surgery in Male Aortic Regurgitation Patients
- 2010
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier Science B.V. Amsterdam. - 0894-7317 .- 1097-6795. ; 23:4, s. 387-395
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to evaluate if left ventricular (LV) systolic function by tissue Doppler echocardiography at rest and during exercise preoperatively could predict postoperative LV function and thereby be useful in the timing of aortic valve surgery in patients with severe aortic regurgitation. Methods: In 29 patients (median age, 59 years; interquartile range, 39-64 years), echocardiography, tissue Doppler echocardiography, and radionuclide ventriculography were performed preoperatively and postoperatively at rest and during supine bicycle exercise. Results: Preoperative ejection fraction (EF) was 62%. Patients formed two groups, with basal LV peak systolic velocity (PSV) 5.9 cm/s preoperatively as the cutoff value between low and high PSV. Preoperatively, patients with low PSV had lower PSV during exercise (Pandlt;.005), EF during exercise (Pandlt;.05), and atrioventricular plane displacement (AVPD) at rest (Pandlt;.005) and during exercise (P andlt;.05) than those with high PSV. Postoperatively, patients with low PSV had smaller AVPD at rest (P andlt;.05), AVPD during exercise (Pandlt;.01), and PSV during exercise (Pandlt;.01). Conclusion: In patients with chronic aortic regurgitation with EFs and LV dimensions not fulfilling criteria for surgery according to guidelines, preoperative PSV and AVPD at rest and during exercise detected postoperative LV dysfunction.
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| 46. |
- Ingvarsson, Annika, et al.
(författare)
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Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation
- 2018
-
Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 31:3, s. 349-360
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients. Methods: The study enrolled 124 healthy HTx patients examined prospectively. Patients underwent comprehensive two-dimensional echocardiographic examinations according to contemporary guidelines. Results were compared with recognized reference values for healthy subjects. Results: Compared with guidelines, larger atrial dimensions were seen in HTx patients. Left ventricular (LV) diastolic volume was smaller, and LV wall thickness was increased. With respect to LV function, both ejection fraction (62 ± 7%, P < .01) and global longitudinal strain (-16.5 ± 3.3%, P < .0001) were lower. All measures of right ventricular (RV) size were greater than reference values (P < .0001), and all measures of RV function were reduced (tricuspid annular plane systolic excursion 15 ± 4 mm [. P < .0001], RV systolic tissue Doppler velocity 10 ± 6 cm/sec [. P < .0001], fractional area change 40 ± 8% [. P < .0001], and RV free wall strain -16.9 ± 4.2% [. P < .0001]). Ejection fraction and LV global longitudinal strain were significantly lower in patients with previous rejection. Conclusion: The findings of this study indicate that the distribution of routinely used echocardiographic measures differs between stable HTx patients and healthy subjects. In particular, markedly larger RV and atrial volumes and mild reductions in both LV and RV longitudinal strain were evident. The observed differences could be clinically relevant in the assessment of HTx patients, and specific reference values should be applied in this context.
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| 47. |
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| 48. |
- Johansson, Magnus C, 1954, et al.
(författare)
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Leftward Bulging of Atrial Septum Is Provoked by Nitroglycerin and by Sustained Valsalva Strain
- 2014
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 27:10, s. 1120-1127
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Tidskriftsartikel (refereegranskat)abstract
- Background: The motion of the interatrial septum primum (septum) is dependent on the interatrial pressure relation, normally with slightly higher pressure in the left atrium and the septum bulging toward the right atrium. The aim of this study was to explore the physiologic mechanisms that reverse interatrial pressures and provoke leftward bulging of septum (LBA). The hypothesis was that both left ventricular unloading with nitroglycerin and sustained Valsalva strain would independently provoke LBA and that their combination would further intensify the effect. Methods: Prospectively collected transesophageal echocardiography recordings from 13 patients with obstructive sleep apnea were retrospectively analyzed for the presence or absence of LBA during resting respiration and during Valsalva strain. In each condition, LBA beats were counted at time points before and after nitroglycerin spray had been administered, which enabled a comparison of the independent effects and the combined effect of the nitroglycerin and the Valsalva maneuver. An LBA beat was defined as a heartbeat displaying any LBA during the cardiac cycle. Results: Nitroglycerin increased the proportion of LBA beats significantly during resting respiration, from 21 +/- 27% to 54 +/- 43% (P = .008). During Valsalva strain, the proportion increased with nitroglycerin spray from 48 +/- 21% to 80 +/- 17% (P = .001). After nitroglycerin administration, LBA occurred in at least three beats during strain in all Valsalva periods. Conclusions: Unloading of the left ventricle by nitroglycerin administration and by sustained Valsalva strain independently provoked LBA. The combination of these two interventions further intensified the effect.
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| 49. |
- Johansson, Magnus C, 1954, et al.
(författare)
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Pitfalls in diagnosing PFO: characteristics of false-negative contrast injections during transesophageal echocardiography in patients with patent foramen ovales
- 2010
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Ingår i: Journal of the American Society of Echocardiography. - 0894-7317. ; 23:11, s. 1136-1142
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Contrast injections during transesophageal echocardiography for patent foramen ovale (PFO) detection may be false negative. The characteristics of false-negative injections were studied retrospectively. METHODS: Contrast transesophageal echocardiography was analyzed for the presence or absence of two characteristics: leftward bulging of the interatrial septum and dense contrast filling of the region of the right atrium adjacent to the interatrial septum. RESULTS: Two hundred forty-seven injections were administered to 14 patients with PFOs, and 130 (53%) were false negative. The absence of either characteristic during a single injection resulted in low sensitivity for PFO detection of 7%. When the two characteristics were present at the same time, the sensitivity for PFO detection after a single injection was as high as 95%. CONCLUSIONS: The simultaneous presence of both leftward bulging of the interatrial septum and dense contrast filling of the region in the right atrium, adjacent to the interatrial septum, is a prerequisite for PFO detection, and if either characteristic is missing, the injection is inconclusive.
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| 50. |
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