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| 2. |
- Achenbach, Stephan, et al.
(författare)
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CV Imaging : What Was New in 2012?
- 2013
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Ingår i: JACC Cardiovascular Imaging. - : Elsevier BV. - 1936-878X .- 1876-7591. ; 6:6, s. 714-734
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Tidskriftsartikel (refereegranskat)abstract
- Echocardiography, single-photon emission computed tomography (SPECT), positron emission tomography (PET), cardiac magnetic resonance, and cardiac computed tomography can be used for anatomic and functional imaging of the heart. All 4 methods are subject to continuous improvement. Echocardiography benefits from the more widespread availability of 3-dimensional imaging, strain and strain rate analysis, and contrast applications. SPECT imaging continues to provide very valuable prognostic data, and PET imaging, on the one hand, permits quantification of coronary flow reserve, a strong prognostic predictor, and, on the other hand, can be used for molecular imaging, allowing the analysis of extremely small-scale functional alterations in the heart. Magnetic resonance is gaining increasing importance as a stress test, mainly through perfusion imaging, and continues to provide very valuable prognostic information based on late gadolinium enhancement. Magnetic resonance coronary angiography does not substantially contribute to clinical cardiology at this point in time. Computed tomography imaging of the heart mainly concentrates on the imaging of coronary artery lumen and plaque and has made substantial progress regarding outcome data. In this review, the current status of the 5 imaging techniques is illustrated by reviewing pertinent publications of the year 2012.
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| 3. |
- Lauten, Juliane, et al.
(författare)
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Invasive Hemodynamic Characteristics of Low Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction
- 2013
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 61:17, s. 1799-1808
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The study sought to compare echocardiographic with invasive hemodynamic data in patients with "paradoxic" aortic stenosis and in patients with conventionally defined severe aortic stenosis. Background Controversy exists whether low gradient severe aortic stenosis despite preserved ejection fraction ("paradoxic" aortic stenosis; aortic valve area <1 cm(2), mean gradient <40 mm Hg, ejection fraction >50%), which has been mainly diagnosed by echocardiography (echo), may be largely due to mistakes in echocardiographic measurements. Methods We compared echocardiographic and invasive hemodynamic data from 58 patients (43% male, mean age 77 +/- 5 years) with "paradoxic" aortic stenosis. Data of 22 patients (45% male, mean age 73 +/- 7 years) with conventionally defined severe aortic stenosis area (aortic valve area <= 1 cm(2), mean gradient >40 mm Hg, ejection fraction >= 50%) were also analyzed. Results In patients with "paradoxic" aortic stenosis, orifice area by echo (0.80 +/- 0.15 cm(2)) and catheterization showed modest agreement, whether stroke volume was measured by oxymetry (0.69 +/- 0.16 cm(2), bias 0.14 +/- 0.17 cm(2)), or by thermodilution (0.85 +/- 0.19 cm(2), bias -0.03 +/- 0.19 cm(2)). Mean systolic gradients were very similar (32 +/- 7 mm Hg vs. 31 +/- 6 mm Hg; bias -0.08 +/- 7.8 mm Hg). In comparison, in patients with conventionally defined severe aortic stenosis, orifice area by echo was 0.72 +/- 0.17 cm(2) and by catheterization 0.51 +/- 0.15 cm(2) (oxymetry) and 0.68 +/- 0.21 cm(2) (thermodilution), respectively, and mean systolic gradient 51 +/- 10 mm Hg and 55 +/- 8 mm Hg, respectively. Ejection fractions did not differ significantly in both groups. Ascending aortic diameter was significantly smaller in the "paradoxic" aortic stenosis group than in patients with conventionally defined severe aortic stenosis (28 +/- 5 mm vs. 31 +/- 5 mm), and energy loss index was significantly larger (0.51 +/- 0.12 cm(2)/m(2) vs. 0.42 +/- 0.09 cm(2)/m(2), respectively). Heart rate and mean blood pressure during echo and catheterization were not significantly different. Conclusions Occurrence of low gradient severe aortic stenosis despite preserved ejection fraction was confirmed by invasive hemodynamics and was not the result of a systematic bias in the echo calculation of aortic orifice area.
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| 5. |
- Rost, Christian, et al.
(författare)
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Relation of Functional Echocardiographic Parameters to Infarct Scar Transmurality by Magnetic Resonance Imaging
- 2014
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 27:7, s. 767-774
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Tidskriftsartikel (refereegranskat)abstract
- Background: Identification of viable but dysfunctional myocardium after myocardial infarction is important for management, including the decision for revascularization. Assessment of infarct transmurality (TRM) by late contrast enhancement on magnetic resonance imaging (MRI) is frequently used for this task but has several limitations, particularly its availability. The goal of this study was to compare the value of several simple echocardiographic parameters measured at rest at the bedside for the identification of three degrees of infarct TRM, with contrast-enhanced MRI as the gold standard. Methods: In a prospective, single-center study, 41 patients (33 men; mean age, 62 +/- 10 years; 32 with ST-segment elevation infarctions) underwent resting echocardiography and contrast-enhanced MRI < 5 days after infarction. Wall motion score, preejection velocity by tissue Doppler, and longitudinal, circumferential, and radial peak systolic strain by speckle-tracking-based strain imaging were assessed, and the findings were compared with infarct TRM stratified by contrast-enhanced MRI (no scar, 0% TRM; nontransmural scar, 1%-50% TRM; and transmural scar, 51%-100% TRM). Results: Four hundred segments showed no scar, 125 showed nontransmural scar, and 213 showed transmural scar on contrast-enhanced MRI. The sensitivity and specificity of visual wall motion scoring to detect any scar versus no scar were 71% and 81%, respectively, similar to values for circumferential strain (sensitivity and specificity both 81% with a cutoff of -14.5%). Longitudinal and radial strain performed less well, and the presence of preejection velocity performed distinctly worse (45% and 90%, respectively). The sensitivity and specificity for identifying nontransmural versus transmural infarction was better for circumferential strain (78% and 75%, respectively, with a cutoff of -10.5%) than for the other strain types, preejection velocity (52% and 67%, respectively), or visual wall motion scoring (50% and 81%, respectively, for a score > 2). Conclusion: Visual wall motion analysis alone is able to detect infarcted myocardium but cannot differentiate sufficiently between transmural and nontransmural infarction. This is best achieved at the bedside using speckle-tracking-based circumferential strain.
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| 6. |
- Beyer, R., et al.
(författare)
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Combined aortic and mitral regurgitation : A scenario difficult to manage
- 2012
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Ingår i: Journal of Cardiovascular Echography. - : Medknow. - 2211-4122. ; 22:4, s. 140-145
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Forskningsöversikt (refereegranskat)abstract
- Objectives: The simultaneous presence of substantial regurgitation of both the aortic and the mitral valve imposes a massive volume load and, due to the aortic regurgitation, a pressure load on the left ventricle. This condition usually is caused by primary aortic regurgitation and concomitant functional mitral regurgitation due to left ventricular enlargement, but lesions can also be primary in both valves, as in endocarditis, carcinoid disease, or due to the cardiotoxicity of appetite-depressant drugs. Because dilatation of the left ventricle caused by chronic aortic regurgitation mostly is not fully reversible by aortic valve surgery, it is unlikely that severe or moderate mitral regurgitation will regress significantly after aortic valve surgery alone. In such cases, simultaneous repair of a severely regurgitant mitral valve is recommended by the guidelines, but the recommendation should probably be extended to moderate mitral regurgitation too. Conclusion: In treating combined aortic and mitral regurgitation, the incomplete reversibility of left ventricular dilatation due to aortic regurgitation should be kept in mind. If indications for aortic valve replacement are fulfilled, concomitant mitral valve repair should be strongly considered.
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| 7. |
- Farkhooy, Amir, et al.
(författare)
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The most important publications of the past year in echocardiography
- 2013
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Ingår i: Herz. - : Springer Science and Business Media LLC. - 0340-9937 .- 1615-6692. ; 38:1, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- We review the published literature on clinical echocardiography of the past year. Key topics were valvular heart disease, in particular aortic stenosis, and the imaging requirements for transcatheter aortic valve implantation. Three-dimensional echocardiography and deformation imaging have yielded important new insights in valvular heart disease. Other key fields have been assessment of heart failure, in particular heart failure with preserved ejection fraction, and the relationship of this condition with diastolic dysfunction and left atrial function. Functional imaging of cardiomyopathies was also an important topic.
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| 8. |
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| 9. |
- Flachskampf, Frank A., et al.
(författare)
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Aortic Stenosis New Classification : Reply
- 2012
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 59:23, s. 2123-2124
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Tidskriftsartikel (refereegranskat)
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| 10. |
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