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Search: L773:1525 2167 OR L773:1532 2114

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4.
  • Bajraktari, Gani, et al. (author)
  • Prolonged total isovolumic time predicts cardiac events following coronary artery bypass surgery
  • 2008
  • In: European Journal of Echocardiography. - : Oxford University Press. - 1525-2167 .- 1532-2114. ; 9:6, s. 779-783
  • Journal article (peer-reviewed)abstract
    • AIMS: Left ventricular (LV) systolic dysfunction may be associated with compromised stroke volume, which may be caused by asynchrony, reflected on the prolongation of isovolumic time (t-IVT). To assess the prognostic role of Doppler echocardiographic measurements in predicting cardiac events after coronary artery bypass grafting (CABG).METHODS AND RESULTS: The study included 74 patients undergoing routine CABG. A pre-CABG Doppler echocardiographic assessment of LV dimensions, filling and ejection was performed and t-IVT was determined as [60 - (total ejection time + total filling time)]. Follow-up period was 18 +/- 12 months. Of the 74 patients (age 65 +/- 16 years, 59 males), 29 underwent hospital admission for a cardiac event or died. There were no differences in age, gender, incidence of previous infarct or mitral regurgitation, LV-EDD (left ventricular end-diastolic dimension), left atrial or right ventricular size in patients with cardiac events compared with those without events. Left ventricular end-systolic dimension (LV-ESD) was greater (4.5 +/- 0.9 vs. 3.9 +/- 0.9 cm, P = 0.003), fractional shortening (FS) was lower (21 +/- 4 vs. 32 +/- 8%), E:A ratio and Tei index were higher (2.1 +/- 0.8 vs. 1.0 +/- 0.6 and 0.9 +/- 0.3 vs. 0.6 +/- 0.3, all P < 0.001), and t-IVT was longer (16 +/- 5 vs.10 +/- 4 s/min, P < 0.001) in patients with events. Multivariate predictors of post-CABG events (odds ratio 95% confidence interval) were low FS [0.66 (0.50-0.87), P < 0.001], high E:A ratio [l4.13 (1.17-14.60), P = 0.028], large LV-ESD [0.19 (0.05-0.84), P = 0.029], and long t-IVT [1.37 (1.02-1.84), P = 0.035].CONCLUSION: Despite satisfactory surgical revascularization, long t-IVT and systolic dysfunction suggest persistent ventricular dyssynchrony that contributes to post-CABG cardiac events. Early assessment of such patients for potential benefit from electrical resynchronization may optimize their cardiac performance and hence clinical outcome.
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  • Bech-Hanssen, Odd, 1956, et al. (author)
  • The relative contribution of prosthetic gradients, systemic arterial pressure, and pulse pressure to the left ventricular pressure in patients with aortic prosthetic valves.
  • 2011
  • In: European journal of echocardiography. - : Oxford University Press (OUP). - 1532-2114 .- 1525-2167. ; 12:1, s. 37-45
  • Journal article (peer-reviewed)abstract
    • AIMS: Aortic valve replacement (AVR) in patients with aortic stenosis reduces the left ventricular (LV) pressure and the LV mass. However, residual LV hypertrophy at follow-up is a common finding with negative prognostic impact. In the present study, we investigate the contribution of the prosthesis (size, type, and gradients) and the load opposed by the arterial system to the mean LV pressure (MLVP). METHODS AND RESULTS: Twenty-five patients with a bileaflet mechanical (n = 12, size 19-27) or stented biological (size 21-25) valve were included. After weaning from bypass, continuous Doppler recordings (transoesophageal transducer) and simultaneous LV and aortic pressure measurements were performed (high-fidelity catheters). The mean prosthesis gradients with catheter or Doppler were moderately correlated to MLVP (R(2) = 0.40 and 0.34, P = 0.002 and <0.0001). In a multiple regression model, the relationship between MLVP and prosthesis gradient, mean blood pressure, and pulse pressure was strong for both mechanical and biological valves. Using catheter prosthesis gradients, we could explain 97% of the variability in MLVP and when using Doppler gradients 91%. CONCLUSION: In the present study of patients with aortic prosthetic valves, we demonstrate the importance of the load opposed by the arterial system for the LV pressure. Our findings suggest that the MLVP can be estimated from easily obtainable Doppler data and blood pressure measurements. In analysing predictors of LV mass regression, morbidity, and mortality following AVR, the equations might be of interest.
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  • Bjällmark, Anna, et al. (author)
  • Ultrasonographic strain imaging is superior to conventional non-invasive measures of vascular stiffness in the detection of age-dependent differences in the mechanical properties of the common carotid artery
  • 2010
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 11:7, s. 630-636
  • Journal article (peer-reviewed)abstract
    • Aims: Elastic properties of large arteries have been shown to deteriorate with age and in the presence of atherosclerotic vascular disease. In this study, the performance of ultrasonographic strain measurements was compared to conventional measures of vascular stiffness in the detection of age-dependent differences in the elastic properties of the common carotid artery.Methods and results: In 10 younger (25-28 years, 4 women) and 10 older (50-59 years, 4 women) healthy individuals, global and regional circumferential and radial strain variables were measured in the short-axis view of the right common carotid artery using ultrasonographic two-dimensional (2D) strain imaging with recently introduced speckle tracking technique. Conventional elasticity variables, elastic modulus (Ep) and β stiffness index, were calculated using M-mode sonography and non-invasive blood pressure measurements. Global and regional circumferential systolic strain and strain rate values were significantly higher (p < 0.001, p < 0.01 for regional late systolic strain rate) in the younger individuals, whereas the values of conventional elasticity variables in the same group were lower (p < 0.05). Among all strain and conventional elasticity variables, principal component analysis and its regression extension identified only circumferential systolic strain variables as contributing significantly to the observed discrimination between the younger and older age groups.Conclusion: Ultrasonographic 2D-strain imaging is a sensitive method for the assessment of elastic properties in the common carotid artery, being in this respect superior to conventional measures of vascular elasticity. The method has potential to become a valuable non-invasive tool in the detection of early atherosclerotic vascular changes.
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  • Bukachi, Frederick, et al. (author)
  • Age dependency in the timing of mitral annular motion in relation to ventricular filling in healthy subjects : Umea General Population Heart Study
  • 2008
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 9:4, s. 522-529
  • Journal article (peer-reviewed)abstract
    • AIMS: Peak left ventricular (LV) relaxation normally precedes peak filling (E), which supports the hypothesis that LV suction contributes to early-diastolic filling. The significance of similar temporal discordance in late diastole has previously not been studied. We describe the time relationships between mitral annular motion and LV filling in early and late diastole and examine the effect of normal ageing on these time intervals. METHODS AND RESULTS: A total of 128 healthy subjects aged 25-88 years were studied. Transmitral and pulmonary venous flow reversals (Ar) were recorded by Doppler echocardiography. Mitral annular diastolic displacement-early (E(m)) and late (A(m))-were recorded by Doppler tissue imaging. With reference to electrocardiographic R and P-waves, the following measurements were made: R to peak E-wave (R-E) and E(m) (R-E(m)); onset P to peak A-wave (P-pA), A(m) (P-pA(m)), and Ar (P-pAr). The differences between [(R-E) and (R-E(m))] for early-diastolic temporal discordance (EDTD) and [(P-A) and (P-A(m))] for late-diastolic temporal discordance (LDTD) were calculated. Isovolumic relaxation time (IVRT) was also measured. Early-diastolic temporal discordance was approximately 26 ms in all age groups. Late-diastolic temporal discordance, however, was inversely related to age (r = -0.35, P < 0.001) and IVRT (r = -0.34, P < 0.001) and therefore decreased in the elderly vs. young (13 +/- 10 vs. 23 +/- 10 ms; P < 0.001). In multivariate analysis, age failed to predict LDTD in the presence of IVRT. A, A(m), and Ar were simultaneous at onset, and peak A(m) coincided with peak Ar in all age groups (r = 0.97, P < 0.001). No significant differences were noted in the RR intervals. CONCLUSIONS: Sequential prolongation of IVRT with ageing reduces LDTD, thus converging the peaks of A(m), A, and Ar (atrial mechanical alignment)-a potential novel method to identify subjects at increased dependency on atrial contraction for late-diastolic filling.
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  • Bukachi, Frederich, et al. (author)
  • Pulmonary venous flow reversal and its relationship to atrial mechanical function in normal subjects--Umeå General Population Heart Study.
  • 2005
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 6:2, s. 107-116
  • Journal article (peer-reviewed)abstract
    • AIMS: Although pulmonary venous flow reversal (Ar) is useful in the evaluation of left ventricular (LV) diastolic function, it is often difficult to study with transthoracic echocardiography (TTE). We determined the relationship between Ar and left atrial (LA) mechanical function and sought to define surrogate measurements for Ar. METHODS AND RESULTS: A total of 130 healthy subjects, mean age 54.3+/-18.3 years, 62 women, were studied and classified into three groups: [young (Y), 25-44 years; n=44], [middle-age (M), 45-64 years; n=43] and [elderly (E), > or =65 years; n=43]. Pulmonary venous flow and LV inflow studies were performed by TTE and LV basal free-wall motion was studied by Doppler tissue imaging (DTI). All images were acquired with a superimposed electrocardiogram. RR interval was similar in all groups while LA dimension and PR interval were increased in Group E vs. Y (P<0.001). LA contraction (A(m)) on DTI, transmitral A-wave (A) and Ar were simultaneous and started 84ms after onset of P wave and this interval increased with age (P=0.02). Similarly, the time intervals from the same landmark to peak A(m), A, and Ar were prolonged with age (all, P<0.001). Despite this prolongation, peak A(m) coincided with peak Ar in every age group (r=0.97, P<0.001) and Ar acceleration and deceleration times were consistently equal. CONCLUSION: The timing of A(m) obtained by DTI can be used to accurately estimate corresponding measurements of Ar recorded by TTE in subjects without cardiac disease.
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  • Evangelista, Arturo, et al. (author)
  • Echocardiography in aortic diseases : EAE recommendations for clinical practice
  • 2010
  • In: European Journal of Echocardiography. - : Oxford Journals. - 1525-2167 .- 1532-2114. ; 11:8, s. 645-658
  • Journal article (peer-reviewed)abstract
    • Echocardiography plays an important role in the diagnosis and follow-up of aortic diseases. Evaluation of the aorta is a routine part of the standard echocardiographic examination. Transthoracic echocardiography (TTE) permits adequate assessment of several aortic segments, particularly the aortic root and proximal ascending aorta. Transoesophageal echocardiography (TOE) overcomes the limitations of TTE in thoracic aorta assessment. TTE and TOE should be used in a complementary manner. Echocardiography is useful for assessing aortic size, biophysical properties, and atherosclerotic involvement of the thoracic aorta. Although TOE is the technique of choice in the diagnosis of aortic dissection, TTE may be used as the initial modality in the emergency setting. Intimal flap in proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. However, a negative TTE does not rule out aortic dissection and other imaging techniques must be considered. TOE should define entry tear location, mechanisms and severity of aortic regurgitation, and true lumen compression. In addition, echocardiography is essential in selecting and monitoring surgical and endovascular treatment and in detecting possible complications. Although other imaging techniques such as computed tomography and magnetic resonance have a greater field of view and may yield complementary information, echocardiography is portable, rapid, accurate, and cost-effective in the diagnosis and follow-up of most aortic diseases.
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  • Feneck, Rob, et al. (author)
  • Recommendations for reporting perioperative transoesophageal echo studies
  • 2010
  • In: European Journal of Echocardiography. - : Oxford Journals. - 1525-2167 .- 1532-2114. ; 11:5, s. 387-393
  • Journal article (peer-reviewed)abstract
    • Every perioperative transoesophageal echo (TEE) study should generate a written report. A verbal report may be given at the time of the study. Important findings must be included in the written report. Where the perioperative TEE findings are new, or have led to a change in operative surgery, postoperative care or in prognosis, it is essential that this information should be reported in writing and available as soon as possible after surgery. The ultrasound technology and methodology used to assess valve pathology, ventricular performance and any other derived information should be included to support any conclusions. This is particularly important in the case of new or unexpected findings. Particular attention should be attached to the echo findings following the completion of surgery. Every written report should include a written conclusion, which should be comprehensible to physicians who are not experts in echocardiography.
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  • Flachskampf, Frank, 1957-, et al. (author)
  • Recommendations for transoesophageal echocardiography : update 2010
  • 2010
  • In: European Journal of Echocardiography. - : Oxford Journals. - 1525-2167 .- 1532-2114. ; 11:7, s. 557-576
  • Journal article (peer-reviewed)abstract
    • Transoesophageal echocardiography (TOE) is a standard and indispensable technique in clinical practice. The present recommendations represent an update and extension of the recommendations published in 2001 by the Working Group on Echocardiography of the European Society of Cardiology. New developments covered include technical advances such as 3D transoesophageal echo as well as developing applications such as transoesophageal echo in aortic valve repair and in valvular interventions, as well as a full section on perioperative TOE.
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  • Forsberg, Lena M, et al. (author)
  • Left and right ventricular function in aortic stenosis patients 8 weeks post-transcatheter aortic valve implantation or surgical aortic valve replacement
  • 2011
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 12:8, s. 603-611
  • Journal article (peer-reviewed)abstract
    • Aims Knowledge of longitudinal left and right ventricular (LV and RV) function after transcatheter aortic valve implantation (TAVI) is scarce. We hypothesized that the longitudinal systolic biventricular function in aortic stenosis (AS) patients is affected differently by TAVI and surgical aortic valve replacement (SAVR). less thanbrgreater than less thanbrgreater thanMethods and results Thirty-three AS patients (all-TAVI group, age 81 +/- 9 years, 18 female), with EuroSCORE 18 +/- 9%, were accepted for TAVI. Seventeen of these patients were matched (by gender, age, and LV function) to 17 patients undergoing SAVR. Conventional echocardiographic parameters, systolic atrioventricular plane displacement (AVPD) at standard sites and peak systolic velocity (PSV) by pulsed tissue Doppler at basal RV free wall, LV lateral wall, and septum were studied before and 8 weeks after the procedure. Procedural success was 100%, and 30-day mortality 9%. In all TAVI patients, AVPD(lateral), PSV(lateral), AVPD(septal), and PSV(septal) increased (P andlt; 0.001, 0.003, 0.006 and 0.002). When studying the matched patients postoperatively, both the SAVR and TAVI patients had increased PSV(lateral) and AVPD(lateral) (SAVR: P = 0.03 and P = 0.04, TAVI: P = 0.04 and P = 0.01). The PSV(RV) increased in the all-TAVI group (P = 0.007), while the AVPD(RV) was unchanged. SAVR patients had decreased AVPD(RV) (P = 0.001) and PSV(RV) (P = 0.004), while the matched TAVI patients had unchanged RV function parameters. less thanbrgreater than less thanbrgreater thanConclusion An improvement in regional longitudinal LV function in the septal and lateral wall could be seen after TAVI. Among the matched patients, both the TAVI and SAVR patients seemed to improve LV function in the lateral wall. RV systolic function increased in TAVI patients, but was impaired in the matched SAVR group at the 8-week follow-up.
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  • Fraser, AG, et al. (author)
  • Feasibility and reproducibility of off-line tissue Doppler measurement of regional myocardial function during dobutamine stress echocardiography
  • 2003
  • In: European Journal of Echocardiography. - 1525-2167 .- 1532-2114. ; 4:1, s. 43-53
  • Journal article (peer-reviewed)abstract
    • Aims: Off-line post-processing of colour tissue Doppler from digital loops may allow objective quantification of dobutamine stress echocardiography. We assessed the reproducibility of off-line measurements of regional myocardial velocities. Methods and Results: Nine observers analysed 10 studies, each making 2400 observations. Coefficients of variation in basal segments from apical windows, at rest and maximal stress, were 9-14% and 11-18% for peak systolic velocity, 16-18% and 17-19% for time-to-peak systolic velocity, 9-17% and 18-24% for systolic velocity time integral, and 18-23% and 21-27% for systolic acceleration. Coefficients of variation for diastolic velocities in basal segments at rest were 11-40%. Coefficients of variation for peak systolic velocity were 10-24% at rest and 14-28% at peak in mid segments, and 19-53% and 29-69% in apical segments. From parasternal windows coefficients of variation for peak systolic velocity were 14-16% in basal posterior, and 19-29% in mid-anterior segments. High variability makes measurement unreliable in apical and basal anterior septal segments. The feasibility of obtaining traces was tested in 92 subjects, and >90% in all basal and mid segments apart from the anterior septum. Conclusion: Quantification of myocardial functional reserve by off-line analysis of colour tissue Doppler acquired during dobutamine stress is feasible and reproducible in 11 segments of the left ventricle. The most reliable measurements are systolic velocities of longitudinal motion in basal segments.
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  • Galderisi, Maurizio, et al. (author)
  • Recommendations of the European Association of Echocardiography : how to use echo-Doppler in clinical trials
  • 2011
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 12:5, s. 339-353
  • Journal article (peer-reviewed)abstract
    • The European Association of Echocardiography (EAE) has developed the present recommendations to assist clinical researchers in the design, implementation, and conduction of echocardiographic protocols for clinical trials and to guarantee their quality. Clinical trials should be designed and conducted based on the knowledge of the pathophysiology of the clinical condition studied, the technical characteristics of the echo-Doppler modalities, and the variability of the tested parameters. These procedures are important to choose the most reliable and reproducible techniques and parameters. Quality assurance must be guaranteed by adequate training of peripheral site operators to obtain optimal echo-Doppler data and by using a core laboratory for accurate and reproducible data analysis.
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  • Govind, Satish C., et al. (author)
  • Quantification of low-dose dobutamine stress using speckle tracking echocardiography in coronary artery disease
  • 2009
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 10:5, s. 607-612
  • Journal article (peer-reviewed)abstract
    • Aims We sought to evaluate the utility of speckle tracking echocardiography (STE) for detecting left ventricular (LV) mechanical abnormalities during low-dose (20 mu g) dobutamine stress (DSE). Methods and results Twenty-nine patients (56 +/- 12 years) with a history of recent acute coronary events (ACE) underwent STE-DSE. Left ventricular images, sampled at frame rates 70-100 Hz, were analysed off-line (Echopac BT 6.0.0). Velocity, strain, and rotational imaging were performed. Twenty patients had LV ejection fraction (EF) >40% (Group 1) whereas nine patients had LVEF <40% (Group 2). Average heart and frame rates were identical during DSE in the two groups (P = ns). Global circumferential strain (%) was significantly lower in Group 2 compared with Group 1 (10.65 +/- 5.30 vs. 16.82 +/- 6.61; P < 0.05) at rest and during peak stress (14.72 +/- 6.51 vs. 21.13 +/- 7.2; P < 0.05). The global peak rotation rate (degree/s) was, however, higher at rest in Group 2 (70 +/- 97 vs. 19 +/- 67; P < 0.05) and 20 mu g stress. Peak systolic velocity increased in three of the four LV walls at 20 mu g ( in Groups 1 and 2). A global rotational rate increased significantly at 20 mu g during systole in both the groups, but was unchanged in Group 2 during diastole. Conclusions Speckle tracking echocardiography dobutamine stress appears to provide comprehensive information on LV mechanical status in the aftermath of ACE. The modality may help risk stratify such patients.
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  • Gustafsson, Ulf, 1976-, et al. (author)
  • Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function : an echocardiographic speckle-tracking study in healthy individuals
  • 2009
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; :10, s. 56-61
  • Journal article (peer-reviewed)abstract
    • AIM To elucidate the complexity of left ventricular motion throughout the cardiac cycle, we studied regional rotation in detail. METHODS AND RESULTS: Regional rotation in six subdivisions of the circumference at three levels was studied by using speckle-tracking echocardiography in 40 healthy subjects. At the basal level the inferoseptal segments rotated significantly more clockwise during systole than the opposing anterolateral segments. At the papillary level the inferoseptal segments differed significantly from the anterolateral segments, where the inferoseptal segments rotated clockwise and the anterolateral segments rotated counter-clockwise. The apical level showed significant difference in regional rotation only at aortic valve opening. In early systole, untwist before the main systolic twist was seen at the basal and apical levels; however, the duration of the basal untwist was much longer than that of the apical. The diastolic phases of rotation at the basal and apical levels matched the different filling phases. CONCLUSION: Large regional differences in rotation are present at the basal and papillary levels in healthy subjects. The diastolic untwist matches the phases of both the E-wave and A-wave and seems to be related with intraventricular pressure differences, indicating that untwist plays an important role in the filling of the ventricle.
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  • Lind, Britta, et al. (author)
  • Left ventricular isovolumic velocity and duration variables calculated from colour-coded myocardial velocity images in normal individuals
  • 2004
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 5:4, s. 284-293
  • Journal article (peer-reviewed)abstract
    • Aims: To describe the normal myocardial velocity profile during the isovolumic contraction and relaxation period at four different locations within left ventricular base and to establish normal age and gender related isovolumic time and velocity values. Methods and results: In 49 healthy individuals (26 women/23 men) in age groups 21-49 and 50-76 years, tissue velocity profiles and 2D-data were acquired at high temporal resolution (90-147 frames/s) for a subsequent off-line analysis using software enabling retrieval of myocardial Doppler velocity and 2D/anatomical M-mode information from different cardiac locations during the same cardiac cycle. The obtained velocity curves during the isovolumic contraction and relaxation period were usually biphasic and displayed clear regional differences in their respective positive and negative maximal velocities. Besides some gender related differences, mainly in the duration of the positive and negative velocity wave components during the isovolumic contraction period, a clear age-dependent increase in the duration of the isovolumic relaxation phase and its negative and positive velocity components was observed. Conclusion: Modern tissue Doppler imaging supplemented by anatomical M-mode images of the mitral and aortic valve movements allows a proper analysis of the rapid isovolumic myocardial movements. The presented normal isovolumic time and velocity values may prove useful for studies of myocardial function.
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25.
  • Lindqvist, Per, et al. (author)
  • Echocardiography based estimation of pulmonary vascular resistance in patients with pulmonary hypertension : a simultaneous Doppler echocardiography and cardiac catheterization study
  • 2011
  • In: European Journal of Echocardiography. - London : Saunders. - 1525-2167 .- 1532-2114. ; 12:12, s. 961-966
  • Journal article (peer-reviewed)abstract
    • Aims: Pulmonary vascular resistance (PVR) is an important measurement for the diagnosis of patients with pulmonary hypertension (PH) but needs accurate determination of mean pulmonary artery pressure (PAMP). We aimed to test the accuracy of a Doppler-derived measurement of PVR, using the conventional invasive equation in patients with PH.Methods and results: We investigated 30 patients undergoing right heart catheterization (RHC), mean age 62 ± 13 years, 21 females, with different diseases; idiopathic pulmonary arterial hypertension (PAH) (n= 5), associated PAH (n= 16), chronic thromboembolic PH (n= 6), interstitial lung disease (n= 2), and after closure of an atrial septal defect (n= 1). Patients with impaired left ventricular systolic function (EF < 50%) or elevated pulmonary capillary wedge pressure (PCWP >15 mmHg on RHC) were excluded. We used the formula: PAMP = PASPecho × 0.61 + 2 mmHg, where PASPecho is the peak tricuspid regurgitation pressure drop + 10 or 7 mmHg. Pulmonary vascular resistance was then calculated as PAMPecho− PCWP/cardiac output. Pulmonary capillary wedge pressure was estimated at 10 mmHg in all cases. The Doppler-derived estimation of PVRecho was achievable in 90% of patients, in whom accurate calculation of PAMP was obtainable. Pulmonary vascular resistance echo individual values strongly correlated with those from RHC (r= 0.85, P< 0.001 and r= 0.87, P< 0.001 for the two estimated values for right atrial pressure, respectively). The regression equation using this formula was PVRrhc = 0.95 × PVRecho− 0.29, and the regression line was close to identity. The Bland–Altman plot showed a good agreement between PVRecho and PVRrhc values, with a mean difference of −0.66 ± 2.1 Wood unit.Conclusion: The proposed Doppler-derived formula for estimating PVR based on the conventionally used invasive equation strongly correlates with invasive gold standard measures.
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26.
  • Lindqvist, Per, et al. (author)
  • Echocardiography in the assessment of right heart function
  • 2008
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 9:2, s. 225-234
  • Journal article (peer-reviewed)abstract
    • Assessment of right heart function remains difficult despite rapid technological echocardiographic developments. This review addresses the anatomical and physiological basis for assessment of right ven-tricutar function. It also addresses advantages and Limitations of individual echocardiographic techniques currently used in clinical and academic practice. The review concludes that volume calculation and estimation of ejection fraction is not ideal for clinical assessment of right ventricular function. Regional myocardial wall motion detection by M-mode and tissue Doppler velocities are probably the best useful methods in clinical practice. 1 D and 2D strain, velocity vector imaging and 4D echo-cardiography need further evaluation before considering them as routine investigations. A global interest needs to be given to a very important neglected entity, 'right ventricle', which has been shown to predict exercise toterance and outcome in a number of syndromes.
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  • Lindqvist, Per, et al. (author)
  • Right ventricular outflow-tract fractional shortening : an applicable measure of right ventricular systolic function.
  • 2003
  • In: European Journal of Echocardiography. - : Oxford University Press. - 1525-2167 .- 1532-2114. ; 4:1, s. 29-35
  • Journal article (peer-reviewed)abstract
    • AIMS: Assessment of right ventricular function is important. However, this is not easy to achieve due to the complex anatomy and geometry of the right ventricle, making the evaluation of its function limited. Therefore, a simple reliable and easy method is needed. This study was performed (1) to evaluate the use of right ventricular outflow tract fractional shortening obtained by M-mode echocardiography as a measure of right ventricular systolic function and (2) to determine the relationship between this parameter and other established measurements of right ventricular function such as long axis excursion.METHODS AND RESULTS: Ninety-two consecutive patients referred for echocardiographic assessment of left and right ventricular function, age mean+/-SD was 68+/-14 years, were investigated. Twenty healthy controls, age 46+/-12 years were also studied. M-mode echocardiography was used to measure right ventricular outflow tract fractional shortening and right ventricular long axis excursion. Doppler echocardiography was used for the estimation of right ventricular-right atrial pressure drop and pulmonary artery acceleration time. Right ventricular outflow tract fractional shortening (P<0.0001), right ventricular long axis excursion (P<0.0001) and pulmonary acceleration time (P<0.0001) were reduced in patients compared to controls. Right ventricular outflow tract fractional shortening correlated with long axis excursion (r=0.66 P<0.0001), pulmonary artery acceleration time (r=0.80 P<0.0001) and right ventricular-right atrial pressure drop (r=-0.53 P<0.0001). Right ventricular long axis excursion correlated with right ventricular-right atrial pressure drop though to a lesser significance (r=-0.27 P <0.001). Furthermore, right ventricular outflow tract fractional shortening was reduced in patients with pulmonary hypertension compared to patients without, this difference was not observed in the right ventricular systolic long axis excursion.CONCLUSION: Right ventricular outflow tract fractional shortening provides a simple and non-invasive measure of right ventricular systolic function. In combination with long axis excursion and Doppler velocities they should provide comprehensive assessment of right ventricular function.
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  • Lindqvist, Per, et al. (author)
  • Valve replacement for aortic stenosis normalizes subendocardial function in patients with normal ejection fraction.
  • 2010
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114.
  • Journal article (peer-reviewed)abstract
    • AIMS: Long-standing aortic stenosis (AS) causes various degrees of left ventricular (LV) dysfunction, which may improve after valve replacement. The aim of this study was to assess the nature of LV subendocardial abnormalities in AS and their response to valve replacement (AVR). METHODS AND RESULTS: We studied 41 consecutive symptomatic patients (age 64 +/- 13 years) with severe AS, normal LV ejection fraction (EF), but no obstructive coronary artery disease before, a week after AVR, and 6 months after AVR. LV subendocardial function was studied from recordings of long-axis M-mode (amplitude), tissue-Doppler (myocardial velocities) and speckle tracking (myocardial strain) echocardiographic techniques. Results were compared with those from 20 age- and gender-matched controls. In patients, LV dimensions and markers of asynchrony, total isovolumic time (t-IVT), and Tei index were not different from controls before AVR and remained unchanged afterwards. LV lateral long-axis amplitude, as well as lateral and septal systolic velocities and strain, were reduced (P < 0.001 for all) and E/E' was modestly raised. Lateral long-axis amplitude, systolic and diastolic velocities normalized within a week of AVR but strain lagged behind until 6 months later. The reduced septal long-axis amplitude remained permanently unchanged (NS) despite the early normalization of its systolic velocities (P < 0.001) and strain (P < 0.001). LV mass normalized at 6 months after AVR (P < 0.005). CONCLUSIONS: In patients with severe AS and maintained LV ejection fraction, subendocardial function is globally abnormal showing reduced amplitude of motion, velocities, and strain. The different response of its components suggests an evidence for differential reverse remodelling, irrespective of myocardial mass regression.
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32.
  • Manouras, Aristomenis, et al. (author)
  • Comparison between colour-coded and spectral tissue Doppler measurements of systolic and diastolic myocardial velocities : effect of temporal filtering and offline gain setting
  • 2009
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 10:3, s. 406-413
  • Journal article (peer-reviewed)abstract
    • Colour tissue Doppler (TD) has been reported to underestimate the longitudinal myocardial motion velocities measured with spectral TD. This study evaluates the effect of temporal smoothing and offline gain settings on the results of velocity measurements with these two methods and the difference between them. In 57 patients, 2D data and left ventricular velocity profiles were acquired using spectral and colour TD for a subsequent offline analysis. Longitudinal myocardial velocities were measured at unsaturated, 50%-saturated and fully saturated gain, and before and after temporal smoothing using 30, 50, and 70 ms filters, respectively. Gain level and filter width altered significantly the measured velocities. Peak systolic and early diastolic velocities were significantly higher (P < 0.001) and E/E' ratio was significantly lower (P < 0.001) with spectral TD than with colour TD, although there was a good correlation between the results of both TD modalities. The differences between the methods increased at increasing filter width and gain level. Despite good correlation of the results, spectral TD produces significantly higher myocardial velocity values and lower E/E' ratio than colour TD modality. Increasing gain and temporal smoothing alter significantly the results of velocity measurements and accentuate the difference between the two TD methods.
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33.
  • Mårtensson, Mattias, et al. (author)
  • Evaluation of tissue Doppler-based velocity and deformation imaging : a phantom study of ultrasound systems.
  • 2011
  • In: European Journal of Echocardiography. - : OXFORD UNIV PRESS. - 1525-2167 .- 1532-2114. ; 12:6, s. 467-476
  • Journal article (peer-reviewed)abstract
    • AIMS: The objective of this study was to test the accuracy and diagnostic interchangeability of tissue Doppler-based displacement, velocity, strain, and strain rate measurements in commercially used ultrasound (US) systems. METHODS AND RESULTS: Using an in-house made phantom, four different US scanner models were evaluated. Two different scanners of the same model were tested, and one scanner acquisition was tested twice with two generations of the same workstation giving six test results in total. The scanners were in active clinical use and are subject to regular maintenance checks. There were three displacement and four velocity results that stood out from the rest and could be regarded as accurate and interchangeable. Among the deformation measurements, three acceptable strain results were found while there were no acceptable strain rate results. Furthermore, the study showed that measurements from scanners of the same model, same acquisition post-processed on different workstations and repeated measurements from the same scanner, can yield disparate results. CONCLUSION: Measurements that are accurate and of interchangeable use can be found for displacement and velocity measurements, but are less likely to be found for strain and strain rate measurements. It is strongly recommended that the ability of each individual US scanner to measure displacement, velocity, strain, and strain rate is evaluated before it is introduced into clinical practice, and it must always be evaluated together with the workstation the scanner is intended to be used in conjunction with.
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34.
  • Mårtensson, Mattias, et al. (author)
  • High incidence of defective ultrasound transducers in use in routine clinical practice
  • 2009
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 10:3, s. 389-394
  • Journal article (peer-reviewed)abstract
    • The objective was to evaluate the function of ultrasound transducers in use in routine clinical practice and thereby estimating the incidence of defective transducers. The study comprised a one-time test of 676 transducers from 7 manufacturers which were in daily use in clinical departments at 32 hospitals. They were tested with the Sonora FirstCall Test System; 39.8% exhibited a transducer error. Delamination was detected in 26.5% and break in the cable was detected in 8.4% of the tested transducers. Errors originating from the piezoelectrical elements were unusual. Delamination and short circuit occurred without significant differences between transducers from all tested manufacturers, but the errors break in the cable, weak and dead element showed a statistically significant higher frequency in transducers from certain manufacturers. The high error frequency and the risk for incorrect medical decisions when using a defective transducer indicate an urgent need for increased testing of the transducers in clinical departments.
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35.
  • Mårtensson, Mattias, et al. (author)
  • Ultrasound transducer function : annual testing is not sufficient
  • 2010
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 11:9, s. 801-805
  • Journal article (peer-reviewed)abstract
    • The objective was to follow-up the study 'High incidence of defective ultrasound transducers in use in routine clinical practice' and evaluate if annual testing is good enough to reduce the incidence of defective ultrasound transducers in routine clinical practice to an acceptable level. A total of 299 transducers were tested in 13 clinics at five hospitals in the Stockholm area. Approximately 7000-15 000 ultrasound examinations are carried out at these clinics every year. The transducers tested in the study had been tested and classified as fully operational 1 year before and since then been in normal use in the routine clinical practice. The transducers were tested with the Sonora FirstCall Test System. There were 81 (27.1%) defective transducers found; giving a 95% confidence interval ranging from 22.1 to 32.1%. The most common transducer errors were 'delamination' of the ultrasound lens and 'break in the cable' which together constituted 82.7% of all transducer errors found. The highest error rate was found at the radiological clinics with a mean error rate of 36.0%. There was a significant difference in error rate between two observed ways the clinics handled the transducers. There was no significant difference in the error rates of the transducer brands or the transducers models. Annual testing is not sufficient to reduce the incidence of defective ultrasound transducers in routine clinical practice to an acceptable level and it is strongly advisable to create a user routine that minimizes the handling of the transducers.
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36.
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37.
  • Pepi, Mauro, et al. (author)
  • Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism
  • 2010
  • In: European Journal of Echocardiography. - : Oxford Journals. - 1525-2167 .- 1532-2114. ; 11:6, s. 461-476
  • Journal article (peer-reviewed)abstract
    • Embolism of cardiac origin accounts for around 15–30% of ischaemic strokes. Strokes due to cardioembolism are generally severe and early and long-term recurrence and mortality are high. The diagnosis of a cardioembolic source of stroke is frequently uncertain and relies on the identification of a potential cardiac source of embolism in the absence of significant autochthone cerebrovascular occlusive disease. In this respect, echocardiography (both transthoracic and/or transoesophageal) serves as a cornerstone in the evaluation, diagnosis, and management of these patients. A clear understanding of the various types of cardiac conditions associated with cardioembolic stroke and their intrinsic risk is therefore very important. This article reviews potential cardiac sources of embolism and discusses the role of echocardiography in clinical practice. Recommendations for the use of echocardiography in the diagnosis of cardiac sources of embolism are given including major and minor conditions associated with the risk of embolism.
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38.
  • Popescu, Bogdan A, et al. (author)
  • European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography
  • 2009
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 10:8, s. 893-905
  • Journal article (peer-reviewed)abstract
    • The main mission statement of the European Association of Echocardiography (EAE) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound in Europe'. As competence and quality control issues are increasingly recognized by patients, physicians, and payers, the EAE has established recommendations for training, competence, and quality improvement in echocardiography. The purpose of this document is to provide the requirements for training and competence in echocardiography, to outline the principles of quality measurement, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice in Europe.
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39.
  • Quintana, M, et al. (author)
  • The effects of heart rate on myocardial velocity and atrio-ventricular displacement during exercise with and without beta-blockade : a tissue Doppler echocardiographic study
  • 2005
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 6:2, s. 127-133
  • Journal article (peer-reviewed)abstract
    • BACKGROUND:Colour tissue Doppler echocardiography (TDE) allows an objective assessment of regional myocardial function. Peak systolic velocity (PSV) and A-V plane displacement (AVPD) obtained from colour TDE correlate well with changes in cardiac wall motion and can discriminate ischemic areas during stress echocardiography. During exercise, the relationship between PSV and AVPD depends on several factors besides ischemia and should be considered when performing exercise stress echocardiography.AIMS:To investigate the relation between PSV, AVPD and heart rate (HR) during semi-upright exercise with and without beta-blockade.SUBJECTS AND METHODS:Twelve healthy men underwent semi-upright exercise stress echocardiography with and without beta-blockade on two separate occasions. Standard echocardiographic projections were used for the stress echocardiography. Grey-scale echocardiographic pictures containing colour TDE information were obtained at rest and during a two-stage exercise test, and the images were analyzed off-line. The PSV and AVPD were measured at four points at the base of the left ventricle at the septum and lateral, inferior and anterior walls.RESULTS:PSV, AVPD and HR gradually increased during exercise. The increases in PSV and AVPD were linearly correlated with the increase in HR. The increases in PSV were significantly lower during exercise with beta-blockade than without beta-blockade (P<0.05). This was not observed in AVPD, as increments were not affected by beta-blockade.CONCLUSION:These data showing a relationship between HR and PSV, and a significantly lower PSV with beta-blockade at a given HR, suggest that PSV is influenced by HR and myocardial contractility, both of which are augmented by physical exercise-induced sympathetic stimulation.
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40.
  • Rost, Christian, et al. (author)
  • Sequential changes in myocardial function after valve replacement for aortic stenosis by speckle tracking echocardiography
  • 2010
  • In: European Journal of Echocardiography. - : Oxford Journals. - 1525-2167 .- 1532-2114. ; 11:7, s. 584-589
  • Journal article (peer-reviewed)abstract
    • Aims Regional myocardial function may change differently in different pathology. Speckle tracking echocardiography (STE) was applied to evaluate longitudinal, radial, and circumferential function in patients with aortic stenosis (AS) before, within 1 week, and 6 months after aortic valve replacement (AVR). Methods and results In 40 consecutive patients with severe AS, we acquired apical four-, three-, and two-chamber views and standard short-axis view pre- and post-AVR and after 6 months. Longitudinal, radial, and circumferential (LS, RS, and CS) were calculated by commercial STE software. Further, we analysed diastolic myocardial function by measuring E/e′ ratio. With AVR, valve area increased and remained stable at 6 months follow-up. Left ventricular mass was unchanged 1 week after AVR (270 ± 58 g vs. 267 ± 58 g, n.s.) but decreased significantly during the next 6 months (219 ± 50 g, P < 0.05). Left ventricular ejection fraction remained unchanged. Strain values did not change significantly within 1 week after AVR but increased significantly after 6 months (LS by 16%, RS by 21%, and CS by 28% of baseline values). E/e′ ratio was highly augmented before AVR (26.1 ± 12.5) and decreased significantly 6 months after AVR (15.9 ± 5.9). Conclusion Myocardial function significantly recovers after replacing the stenosed aortic valve. However, there is a considerable difference between the response of longitudinal, radial, and circumferential function. Our data suggest that echocardiographic assessment of regional function is feasible and of potential clinical importance.
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41.
  • Saha, Samir, et al. (author)
  • Functional diagnosis of coronary stenosis using tissue tracking provides best sensitivity and specificity for left circumflex disease : experience from the MYDISE (myocardial Doppler in stress echocardiography) study.
  • 2005
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 6:1, s. 54-63
  • Journal article (peer-reviewed)abstract
    • AIMS: To evaluate the diagnostic capacity of quantitative analysis of segmental longitudinal myocardial displacement images (tissue tracking, TT) during dobutamine stress echocardiography for the detection of patients with coronary artery disease (CAD). METHODS AND RESULTS: TT-generated colour-coded maps of systolic segmental longitudinal displacement were obtained by post-processing of echocardiographic data from 105 patients with CAD and 90 low risk individuals selected from MYDISE database. Quantitative analysis of the distribution pattern of segmental displacement during dobutamine stress was most successful when a ratio of basal (high amplitude) to apical (low amplitude) colour-coded displacement bands (B/A ratio) was employed. Applied in four different left ventricular sectors, the B/A ratio provided a significant discrimination of patients with CAD (p<0.05 in the anterior and p<0.001 in the inferior wall) as assessed by receiver operating characteristic analysis. The procedure was most sensitive when applied in inferior wall for the detection of left circumflex coronary artery disease, the B/A ratio of 0.8 giving the best combination of sensitivity (77+/-8%) and specificity (77+/-5%) values. CONCLUSION: Quantification of dobutamine stress echocardiography using TT is an efficient diagnostic approach and a valuable additional modality in functional cardiac imaging for the initial identification of patients suspected for CAD.
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42.
  • Storaa, Camilla, et al. (author)
  • Tissue motion imaging of the left ventricle--quantification of myocardial strain, velocity, acceleration and displacement in a single image
  • 2004
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 5:5, s. 375-385
  • Journal article (peer-reviewed)abstract
    • AIMS: Several methods of parametric imaging of left ventricular function including tissue velocity imaging (TVI) and strain rate imaging (SRI) have previously been presented, however, they have the limitation that they can, respectively, portray only one physiological myocardial parameter. The aims of this pilot study were to implement and validate tissue motion imaging (TMI) for the first time, a visualization technique which permits acceleration, velocity, displacement and strain to be interpreted quantitatively or semi-quantitatively in a single image. METHODS AND RESULTS: TMI is achieved by the color coding of temporal tissue velocity integrals. The principles behind this technique are validated, and case examples demonstrating its use in the clinical setting are provided. Limitations of the method as well as future applications and improvements are discussed. CONCLUSION: As this method allows representation of a multitude of variables and is visually attractive, it may facilitate more widespread use of myocardial quantitation in everyday practice.
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43.
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44.
  • Strotmann, J.M., et al. (author)
  • Doppler myocardial imaging in the assessment of regional myocardial function in longitudinal direction pre- and post-PTCA
  • 2001
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 2:3, s. 178-186
  • Journal article (peer-reviewed)abstract
    • Aims: Doppler myocardial imaging is potentially a sensitive tool to assess regional myocardial velocities pre- and post-percutaneous transluminal coronary angioplasty (PTCA) as a marker of contractility to evaluate short- to medium-term information on functional myocardial recovery following the release of ischaemia. Methods: Thirty patients with single vessel disease were studied to assess regional myocardial peak systolic velocity, systolic velocity time integral and mitral valve plane excursion in longitudinal direction one day pre-, one day post- and 3 months post-PTCA. The patients were assigned to group A with coronary stenoses >70% and group B with stenoses <70%. Results: In group A pre-PTCA the ischaemic segments showed a significantly lower peak systolic velocity and velocity time integral compared with the values one day after PTCA (5.8 ± 1.4 vs 7.7 ± 1.4 cm.s-1, 1.06 ± 0.22 vs 1.23 ± 0.28 cm, P< 0.03). In contrast, mitral valve plane excursion in this group remained unchanged after PTCA for both the ischaemic and non-ischaemic left ventricular wall. In group B no changes of these parameters and no differences in mitral valve plane excursion of the ischaemic and the non-ischaemic left ventricular wall could be seen. Conclusion: With Doppler myocardial imaging it was possible to quantify a number of indices which changed due to the successful release of ischaemia.© 2001 The European Society of Cardiology.
  •  
45.
  • Strotmann, J. M., et al. (author)
  • The effect of pacing-induced heart rate variation on longitudinal and circumferential regional myocardial function after acute beta-blockade a cardiac ultrasound study
  • 2000
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 1:3, s. 184-195
  • Journal article (peer-reviewed)abstract
    • Aims: To evaluate the effect of acute beta-blockade in combination with differing heart rates on longitudinal and circumferential regional myocardial function using Doppler myocardial imaging and two-dimensional-echocardiography. Methods and Results: In seven pigs the following echocardiographic indices were measured at baseline, after beta-blockade both without and with atrial pacing: wall thickening fraction, fractional shortening, myocardial peak systolic velocity, transmyocardial velocity gradient and systolic velocity time integral of the posterolateral wall in short-axis view; mitral valve plane excursion, myocardial peak systolic velocity and systolic velocity time integral of the posterolateral wall in an apical five-chamber view. Peak systolic velocities and velocity gradients decreased significantly following acute beta-blockade but no further decay occurred at high heart rate due to pacing. The velocity time integrals and mitral valve plane excursion showed a tendency to decrease following beta-blockade but only after pacing were they significantly reduced. The wall thickening fraction and fractional shortening showed a significant reduction after beta-blockade but no further decay after pacing. Conclusions: Changes in systolic velocities and velocity gradients were independent of heart rate reduction under high dosage beta-blockade, whereas wall thickening fraction, mitral valve plane excursion and velocity time integrals changed due to pacing.
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46.
  • Zhao, Ying, et al. (author)
  • PDA with Eisenmenger complicated by pulmonary artery dissection.
  • 2010
  • In: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114.
  • Journal article (peer-reviewed)abstract
    • A 49-year-old lady, known to have Eisenmenger PDA, careful transthoracic echocardiogram, showed clear evidence for pulmonary trunk dissection with a flap across the pulmonary trunk and this finding was confirmed by a CT scan.
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