| 1. |
- Lam, Yat-Yin, et al.
(author)
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Left ventricular and ascending aortic function after stenting of native coarctation of aorta.
- 2010
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In: American Journal of Cardiology. - : Elsevier BV. - 0002-9149 .- 1879-1913. ; 105:9, s. 1343-1347
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Journal article (peer-reviewed)abstract
- Patients with surgically corrected aortic coarctation have increased proximal aortic stiffness that might contribute to the known worse cardiovascular outcomes. We examined the effect of stenting on the mid-term ascending aortic elastic properties and its relation to cardiac structure and function in adults with native coarctation of the aorta. A total of 20 consecutive patients (13 men, age at stenting 30 + or - 8 years) were prospectively studied before and 14 + or - 2 months after coarctation stenting. The aortic stiffness index was calculated using the ascending aortic diameters and right arm blood pressure values. The ventricular long-axis function was assessed using pulsed-wave tissue Doppler imaging at the septal site. The results were compared to those from 31 normal controls. Statistically significant improvement was found in aortic narrowing (catheter-derived gradient 32 + or - 11 vs 10 + or - 6 mm Hg), left ventricular mass index (132.8 + or - 50.1 vs 114.7 + or - 47.7 g/m(2)), long-axis function, and left atrial volume index (26.5 + or - 5.3 vs 23.7 + or - 5.6 mm(3)/m(2)). The patients continued to have a thicker left ventricle, reduced long-axis function, and larger left atrium after intervention than did the controls. They also had impaired proximal aortic function with respect to the controls that remained unchanged after stenting (aortic stiffness index 10.7 + or - 4.5 to 10.1 + or - 3.0). The poststenting aortic stiffness index correlated modestly with the left ventricular mass index and reduced long-axis velocity. In conclusion, aortic stenting resulted in partial mid-term improvement in cardiac structure and function in adults with coarctation of aorta but the ascending aortic elastic properties remained abnormal. Such a degree of impairment was related to residual left ventricular hypertrophy and dysfunction. Early identification of such patients and optimum management might avoid these irreversible ventriculoaortic disturbances and their known consequences.
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| 2. |
- Henein, Mark, et al.
(author)
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Atrial interaction in the form of 'cross talk' in patients with ventricular outflow tract obstruction.
- 2011
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 17:147(3), s. 388-392
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Journal article (peer-reviewed)abstract
- BACKGROUND: The Bernheim 'a' wave in the jugular venous pulse of patients with left ventricular hypertrophy has been shown to reflect accentuated right atrial activity. OBJECTIVE: To study possible atrial interaction in patients with right and left ventricular outflow tract obstruction due to significant pulmonary (PS) and aortic valvular stenosis (AS) respectively. METHODS: We studied 41 PS patients (age 36+/-10 year) and 41 AS patients (age 35+/-12 year) and their results were compared with those of 27 controls (age 30+/-7 year). RV and LV filling were recorded by conventional PW Doppler. Biventricular segmental function was studied using the PW tissue Doppler imaging (TDI) and M-mode techniques. RESULTS: The 2 patient groups had similar degree of ventricular outflow tract obstruction. Long axis function was impaired while global systolic function was preserved in the pressure-overloaded ventricle. Patients had higher peak late filling (A wave) and TDI late diastolic (Aa) velocities recorded in the disease-free ventricles despite having similar peak early filling velocities (E wave), E wave deceleration time and E/Ea ratios were not different from controls (p>0.05 for all). Such accentuation of atrial activity (A wave) was moderately correlated with the degree of contralateral ventricular outflow tract obstruction (p<0.001 for both). CONCLUSIONS: Long axis function is more sensitive than global function in revealing myocardial dysfunction in the pressure-overloaded ventricles. The increased contralateral atrial systolic activity suggests an evidence for atrial interaction in the form of 'cross talk'.
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| 3. |
- Henein, Mark, et al.
(author)
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Disturbed left atrial mechanical function in paroxysmal atrial fibrillation : a speckle tracking study
- 2012
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 155:3, s. 437-441
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Journal article (peer-reviewed)abstract
- OBJECTIVE: We aimed to assess left atrial (LA) intrinsic myocardial function and its relationship to left ventricular (LV) filling pattern in a group of paroxysmal atrial fibrillation (PAF) patients. METHODS: Twenty-three PAF patients (age 68±7year, 10 males) were studied using speckle tracking echocardiography and compared with 18 age and sex matched controls. LA segmental longitudinal strain (S), strain rate (SR) and myocardial velocities during atrial systole were measured as were LA diameters. E/A and E/Em were also measured. RESULTS: LA longitudinal diameter was larger in patients (5.5±0.6 vs. 4.8±0.6cm, p<0.01) and global LA S (-9.2±4.3 vs. -12.9±4.6%, p=0.01) and SR (-1.1±0.5 vs. -1.6±0.7 1/s, p<0.01) were reduced and correlated with E/A (r=0.52, p=0.01 and r=0.43, p<0.05, respectively). LA lateral S and SR were uniformly reduced compared with controls (p<0.05 for all). Both septal and lateral wall SR correlated with E/A (p<0.05 for all), only septal S correlated with E/A (p<0.05). LA myocardial velocities were highest at the annular level and lowest at the rear in both patients and controls (p<0.01 for all). CONCLUSION: In PAF patients, LA systolic function is suppressed and is directly related to the pattern of LV filling which itself may suggest raised pressures. While intrinsic global and segmental function can reproducibly be studied by S and SR, myocardial velocities reflect only regional motion, thus less sensitive in demonstrating localize dysfunction.
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| 4. |
- Henein, Mark, et al.
(author)
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Suppressed left atrial function in PAF
- 2012
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 157:2, s. 272-272
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Journal article (peer-reviewed)
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| 5. |
- Henein, Michael Y., et al.
(author)
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Aortic valve
- 2012. - 2
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In: Clinical echocardiography. - London : Springer. - 9781848825215 - 9781848825208 ; , s. 33-62
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Book chapter (peer-reviewed)abstract
- The aortic valve is a passive valve made up of three leaflets which assume the shape of half moons (semi-lunar). Opposite to the mitral valve, there is no true aortic fibrous annulus but a complex root made up of the aortic wall sinuses, left ventricular myocardium, and interleafletfibrous triangles. The ostia of the coronary arteries are located within the aortic sinuses. The sinotubular junction is an important anatomic landmark for surgical procedures. It may be that the leaflets of the aortic valve are not passive as they are rich in different types of nerve endings. The function and role of these “nerves” remain obscure.
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| 6. |
- Henein, Michael Y., et al.
(author)
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Cardiac tumors
- 2012. - 2
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In: Clinical echocardiography. - London : Springer. - 9781848825215 - 9781848825208 ; , s. 239-250
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Book chapter (peer-reviewed)abstract
- Cardiac tumors are rarely suspected clinically but usually appear as unexpected fi ndings when patients are investigated for syncope, breathlessness, thromboembolism, or constitutional manifestations such as congestive heart failure or pulmonary hypertension [1]. Transthoracic echocardiography provides a great opportunity to identify tumors that are clinically silent [2], although extension to extra cardiac structures should be further investigated by transesophageal echocardiography [3], CT scanning, or CMR. Benign tumors form approximately 80% of all cardiac tumors, 70% of which are myxomas [4].
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| 7. |
- Henein, Michael Y., et al.
(author)
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Coronary artery disease
- 2012. - 2
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In: Clinical echocardiography. - London : Springer. - 9781848825215 - 9781848825208 ; , s. 115-147
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Book chapter (peer-reviewed)abstract
- Anomalous origin of the left coronary artery from the pulmonary trunk usually presents in early infancy with congestive cardiac failure due to ischemic myocardial dysfunction. The diagnosis can usually be made by parasternal short axis sections of the great arteries. The most characteristic finding is reversed flow in the left coronary artery demonstrated by color flow Doppler. Usually the anomalous coronary artery connects to the pulmonary trunk at one of the sinuses, but in some cases the connection may be to the more distal pulmonary arteries. A less common presentation of this condition is in late childhood or early adult life, usually with left ventricular dysfunction and mitral regurgitation. There is almost always reversed blood flow in the left coronary artery representing a left to right shunt from the right coronary artery into the pulmonary trunk.
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| 8. |
- Henein, Michael Y., et al.
(author)
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Mitral valve
- 2012. - 2
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In: Clinical echocardiography. - London : Springer. - 9781848825215 - 9781848825208 ; , s. 1-32
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Book chapter (peer-reviewed)abstract
- The mitral valve is composed of two leaflets, an annulus, chordae tendineae, and two papillary muscles. The anterior (aortic) leaflet is attached to the root of the aorta in direct continuity with the aortic valve and the membranous septum, and has a rectangular shape involving one-third of the circumference of the annulus. The posterior leaflet is continuous with the posterior wall of the left atrium and is longer than the anterior leaflet occupying two-thirds of the circumference of the mitral annulus.
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| 9. |
- Henein, Michael Y., et al.
(author)
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Pulmonary valve
- 2012. - 2
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In: Clinical echocardiography. - London : Springer. - 9781848825215 - 9781848825208 ; , s. 81-92
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Book chapter (peer-reviewed)abstract
- The pulmonary valve lies anterior and to the left of the aortic valve. The three pulmonary leafl ets assume the shape of half moons (semi-lunar) and are similar but usually not equal in size. The right and left coronary sinuses of the aorta always face the pulmonary valve. The leafl ets are thinner and more delicate than the aortic leafl ets. Unlike the aortic valve, the pulmonary valve sits on a complete muscular ring of the infundibulum and is not in direct continuity with the tricuspid valve. It is thickest along the closing edge. The delicate pocket-like leaflets are formed primarily of collagen, and they, therefore, open and close passively, with little elastic recoil. In the middle of the free edge of each leafl et is a fi brous mound, the nodule of Arrantius. Coaption of the three nodules ensures complete central closure of the valve orifi ce during ventricular diastole.
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| 10. |
- Henein, Michael Y., et al.
(author)
-
Tricuspid valve
- 2012. - 2
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In: Clinical echocardiography. - London : Springer. - 9781848825215 - 9781848825208 ; , s. 63-79
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Book chapter (peer-reviewed)abstract
- The morphologically right atrioventricular valve has three leaflets (tricuspid): septal, inferior (mural), and anterosuperior which are separated from each other by anteroseptal, superoinferior, and inferoseptal commissures, respectively. The inferior leaflet takes its origin exclusively from the diaphragmatic parietal wall of the ventricle and is often called the mural leaflet. Each commissure is usually supported by the corresponding papillary muscle. The most characteristic and distinguishing feature of the tricuspid valve is the direct attachment of the cords from the septal leaflet to the septum.
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| 11. |
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| 12. |
- Backman, Christer, et al.
(author)
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Unusual arrhythmogenic myocardial disease
- 2014
-
In: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:4, s. 195-196
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Journal article (peer-reviewed)
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| 13. |
- Bajraktari, Gani, et al.
(author)
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Combined electrical and global markers of dyssynchrony predict clinical response to Cardiac Resynchronization Therapy
- 2014
-
In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 48:5, s. 304-310
-
Journal article (peer-reviewed)abstract
- AIM: To assess potential additional value of global left ventricular (LV) dyssynchrony markers in predicting cardiac resynchronization therapy (CRT) response in heart failure (HF) patients. METHODS: We included 103 HF patients (mean age 67 +/- 12 years, 83% male) who fulfilled the guidelines criteria for CRT treatment. All patients had undergone full clinical assessment, NT-proBNP and echocardiographic examination. Global LV dyssynchrony was assessed using total isovolumic time (t-IVT) and Tei index. On the basis of reduction in the NYHA class after CRT, patients were divided into responders and non-responders. RESULTS: Prolonged t-IVT [0.878 (range, 0.802-0.962), p = 0.005], long QRS duration [0.978 (range, 0.960-0.996), p = 0.02] and high tricuspid regurgitation pressure drop [1.047 (range, 1.001-1.096), p = 0.046] independently predicted response to CRT. A t-IVT >= 11.6 s/min was 67% sensitive and 62% specifi c (AUC 0.69, p = 0.001) in predicting CRT response. Respective values for a QRS >= 151 ms were 66% and 62% (AUC 0.65, p = 0.01). Combining the two variables had higher specifi city (88%) in predicting CRT response. In atrial fibrillation (AF) patients, only prolonged t-IVT [0.690 (range, 0.509 -0.937), p = 0.03] independently predicted CRT response. CONCLUSION: Combining prolonged t-IVT and the conventionally used broad QRS duration has a significantly higher specifi city in identifying patients likely to respond to CRT. Moreover, in AF patients, only prolonged t-IVT independently predicted CRT response.
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| 14. |
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| 15. |
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| 16. |
- Bajraktari, Gani, et al.
(author)
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Gender related predictors of limited exercise capacity in heart failure
- 2013
-
In: IJC Heart & Vessels. - : Elsevier. - 2214-7632. ; 1, s. 11-16
-
Journal article (other academic/artistic)abstract
- Aim The aim of this study was to investigate the impact of gender on the prediction of limited exercise capacity in heart failure (HF) patients assessed by 6 minute walk test (6-MWT).Methods In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and a Doppler echocardiographic study were performed in the same day. Conventional cardiac measurements were obtained and global LV dyssynchrony was indirectly assessed using total isovolumic time − t-IVT [in s/min; calculated as: 60 − (total ejection time − total filling time)] and Tei index (t-IVT/ejection time). Patients were divided into two groups according to gender, which were again divided into two subgroups based on the 6-MWT distance (Group I: ≤ 300 m, and Group II: > 300 m).Results Female patients were younger (p = 0.02), and had higher left ventricular (LV) ejection fraction — EF (p = 0.007) but with similar 6-MWT distance to male patients (p = 68). Group I male patients had lower hemoglobin level (p = 0.02) and lower EF (p = 0.03), compared with Group II, but none of the clinical or echocardiographic variables differed between groups in female patients. In multivariate analysis, only t-IVT [0.699 (0.552–0.886), p = 0.003], and LV EF [0.908 (0.835–0.987), p = 0.02] in males, and NYHA functional class [4.439 (2.213–16.24), p = 0.02] in females independently predicted poor 6-MWT distance (< 300 m).Conclusion Despite similar limited exercise capacity, gender determines the pattern of underlying cardiac disturbances; ventricular dysfunction in males and subjective NYHA class in female heart failure patients.
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| 17. |
- Bajraktari, Gani, et al.
(author)
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Left ventricular asynchrony and raised filling pressure predict limited exercise performance assessed by 6 minute walk test
- 2011
-
In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 146:3, s. 385-389
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Six minute walking test (6-MWT) may serve as a reproducible test for assessing exercise capacity in heart failure (HF) patients and can be clinically predicted. We aimed in this study to ascertain if global markers of ventricular asynchrony can predict 6MWT distance in a group of patients with HF and left ventricular (LV) ejection fraction (EF) <45%.METHODS AND RESULTS: This study included 77 consecutive patients (60+/-12 years) with stable HF. LV end-diastolic and end-systolic dimensions, shortening fraction (SF), EF, myocardial velocities, t-IVT, and Tei index were measured, as well as 6-MWT distance. Patients with limited exercise performance (CONCLUSIONS: In heart failure patients, the higher the filling pressures and the more asynchronous the left ventricle, the poorer is the patient's exercise capacity. These findings highlight specific LV functional disturbances that should be targeted for better optimization of medical and/or electrical therapy.
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| 18. |
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| 19. |
- Bajraktari, Gani, 1964-, et al.
(author)
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Left ventricular global dyssynchrony is exaggerated with age
- 2013
-
In: International Cardiovascular Forum. - : Barcaray International Publishing. - 2410-2636. ; 1:1, s. 47-51
-
Journal article (peer-reviewed)abstract
- Background and Aim. Total isovolumic time (t-IVT) and Tei index both reflect global left ventricular (LV) dyssynchrony. They have been shown to be sensitive in responding to myocardial revascularization and in predicting clinical outcome in heart failure patients. Since most these patients are senior, determining the exact effect of age on such parameters remains mandatory. The aim of this study was to investigate the effect of age on LV t-IVT and Tei index compared with conventional systolic and diastolic parameters in normal individuals.Methods. We studied 47 healthy individuals, mean age 62±12 years (24 female), who were arbitrarily classified into three groups: M (middle age), S (seniors), and E (elderly), using spectral Doppler echocardiography and tissue-Doppler imaging. We studied the interrelation between age, LV systolic and diastolic function parameters as well as t-IVT [60 – (total ejection time + total filling time) in s/min], and Tei index (T-IVT/ejection time).Results. LV ejection fraction was 68±6%, E/A ratio 1±0.4, filling time 538±136ms, ejection time 313±26ms, t-IVT 7.7±2.6 s/min and Tei index 0.41±0.14. Age strongly correlated with t-IVT (r=0.8, p<0.001) and with Tei index (r=0.7, p<0.001) but not with QRS duration. Age also correlated with E/A ratio (r=-0.6, p<0.001), but not with global or segmental systolic function measurements. Mean values for t-IVT were 5.5 (95% CI, 4.6-6.3 s/min) for M, 6.9 (95% CI, 6.0-7.8 s/min) for S and 9.5 (95% CI, 8.4-10.6 s/min) for E groups. The corresponding upper limit of the t-IVT 95% normal CI (calculated as mean ±2SD) for the three groups was 8.3 s/min, 10.5 s/min and 14.5 s/min, respectively. The upper limit of normal t-IVT 95% CI was significantly shorter in the S compared with the E group (p=0.001). T-IVT correlated with A wave (r=0.66, p<0.001), E/A ratio (r=-0.56, p<0.001), septal e’ (r=-0.49, p=0.001) and septal a’ (r=0.4, p=0.006), but not with QRS.Conclusions. In normals, age is associated with exaggerated LV global dyssynchrony and diastolic function disturbances, but systolic function remains unaffected. The strong relationship between age and t-IVT supports its potential use as a marker of global LV dyssynchrony. In addition, variations in the upper limit of normal values, particularly in the elderly may have significant clinical applications in patients recommended for CRT treatment.
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| 20. |
- Bajraktari, Gani, et al.
(author)
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Left ventricular markers of global dyssynchrony predict limited exercise capacity in heart failure, but not in patients with preserved ejection fraction
- 2012
-
In: Cardiovascular Ultrasound. - : BioMed Central. - 1476-7120. ; 10, s. 36-
-
Journal article (peer-reviewed)abstract
- Background: The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional capacity assessed by 6 min walk test (6-MWT) in patients with heart failure (HF), irrespective of ejection fraction (EF).Methods: In 147 HF patients (mean age 61 +/- 11 years, 50.3% male), a 6-MWT and an echo-Doppler study were performed in the same day. Global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 - (total ejection time + total filling time)], and Tei index (t-IVT/ejection time). Patients were divided into two groups based on the 6-MWT distance (Group I: <= 300 m and Group II: > 300 m), and also in two groups according to EF (Group A: LVEF >= 45% and Group B: LVEF <45%).Results: In the cohort of patients as a whole, the 6-MWT correlated with t-IVT (r = -0.49, p < 0.001) and Tei index (r = -0.43, p < 0.001) but not with any of the other clinical or echocardiographic parameters. Group I had lower hemoglobin level (p = 0.02), lower EF (p = 0.003), larger left atrium (p = 0.02), thicker interventricular septum (p = 0.02), lower A wave (p = 0.01) and lateral wall late diastolic myocardial velocity a' (p = 0.047), longer isovolumic relaxation time (r = 0.003) and longer t-IVT (p = 0.03), compared with Group II. In the patients cohort as a whole, only t-IVT ratio [1.257 (1.071-1.476), p = 0.005], LV EF [0.947 (0.903-0.993), p = 0.02], and E/A ratio [0.553 (0.315-0.972), p = 0.04] independently predicted poor 6-MWT performance (< 300 m) in multivariate analysis. None of the echocardiographic measurements predicted exercise tolerance in HFpEF.Conclusion: In patients with HF, the limited exercise capacity, assessed by 6-MWT, is related mostly to severity of global LV dyssynchrony, more than EF or raised filling pressures. The lack of exercise predictors in HFpEF reflects its multifactorial pathophysiology.
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| 21. |
- Bajraktari, Gani, et al.
(author)
-
Persistent Ventricular Asynchrony after Coronary Artery Bypass Surgery Predicts Cardiac Events
- 2010
-
In: Echocardiography. - : Wiley. - 0742-2822 .- 1540-8175. ; 27:1, s. 32-37
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Journal article (peer-reviewed)abstract
- Aim: The aim of this study was to identify echocardiographic LV systolic and diastolic measurements that predict clinical events post-coronary artery bypass graft (CABG) surgery. Methods: We collected data from 27 patients (age 70 +/- 7 years) who underwent elective CABG, before and within 6 weeks after surgery. LV systolic function was assessed by conventional echocardiographic parameters. A number of LV filling measurements were also made, which included total isovolumic time (t-IVT), Tei index, and restrictive filling pattern. Postoperative cardiac events were death or hospitalization for chest pain, breathlessness, or arrhythmia. Results: Patient's follow-up period was 17 +/- 10 months. Of the 27 patients (age 70 +/- 7 years, 22 male), 10 had postoperative cardiac events. LV ejection fraction (EF) and fractional shortening (FS) were lower (P = 0.01, and P = 0.007, respectively), t-IVT longer (P < 0.001), and Tei index was higher (P < 0.001) preoperatively in patients with events compared to those without. The same differences between groups remained after surgery; EF (P = 0.002), FS (P = 0.002), t-IVT (P < 0.001), and Tei index (P < 0.001). T-IVT was the only preoperative predictor of events (P = 0.038) but its postoperative value as well as that of FS predicted events (P = 0.034, and P = 0.042, respectively). T-IVT of 12.2 s/min and FS of 26% were 80% sensitive and 88% specific for predicting postoperative events. Conclusion: Despite successful surgical revascularization residual impairment of LV systolic function and persistent asynchrony in the form of prolonged t-IVT are associated with postoperative events. Since these abnormalities remained despite full medical therapy, they may thus suggest a need for electrical resynchronization therapy.
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| 22. |
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Batalli-Këpuska, Arbnora, et al.
(author)
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Abnormal systolic and diastolic myocardial function in obese asymptomatic adolescents
- 2013
-
In: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 168:3, s. 2347-2351
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Journal article (peer-reviewed)abstract
- Structural and functional cardiac changes are known in obese adults. We aimed to assess the relationship between body mass index (BMI) and cardiac function in overweight and obese asymptomatic adolescents. Ninety three healthy adolescents, aged 12.6±1.2years, received weight, height, BMI, waist, hips, waist/hips ratio assessment, hematology and biochemistry tests and an echocardiogram. Based on BMI, subjects were divided into: lean (L, n=32), overweight (Ov, n=33) and obese (Ob, n=32). Interventricular septal and LV posterior wall thickness were increased parallel to the BMI (L: 0.84±0.1cm, Ov: 0.88±0.1cm, Ob: 0.96±0.1cm, p<0.001, and L: 0.78±0.1cm, Ov: 0.8±0.1cm, Ob: 0.94±0.1cm, p<0.001, respectively) as were relative wall thickness (RWT) and mass index (LVMI) (L: 0.34±0.05, Ov: 0.34±0.05, Ob: 0.40±0.04, p<0.001, and L: 47.7±8.4g/m(2), Ov: 51.9±8.3g/m(2), Ob: 65.2±13.3g/m(2), p=0<001, respectively). LV early diastolic (E') lateral and septal velocities (L: 15.3±3.9cm/s, Ov: 13.6±4cm/s, Ob: 10.5±3.4cm/s, p<0.001, and L: 12.2±2.3cm/s, Ov: 11.1±2.4cm/s, Ob: 9.8±3.1cm/s, p=0.003, respectively), and systolic (S') velocities (L: 9.2±1.4cm/s, Ov: 9.3±2.3cm/s, Ob: 8.04±1.5cm/s, p=0.018, and L: 9.05±2.3cm/s, Ov: 9±2.4cm/s, Ob: 7.6±1.1cm/s, p=0.014, respectively) were all reduced, only in obese adolescents. LV lateral E' (r=-0.44, p<0.001) and S' (r=-0.29, p=0.005) correlated with BMI. In asymptomatic adolescents, LV wall is thicker and diastolic function impaired and correlate with BMI. These findings demonstrate early cardiac functional disturbances which might explain the known obesity risk for cardiac disease.
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| 27. |
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| 28. |
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| 29. |
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| 30. |
- Boles, Usama, et al.
(author)
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Coronary artery ectasia : remains a clinical dilemma.
- 2010
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In: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 21:5, s. 318-320
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Journal article (peer-reviewed)abstract
- Coronary artery ectasia (CAE) is defined as localized coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The incidence of CAE varies from 1.5 to 5% in most literature; however, it was reported as high as 10% in some nations. Although, the pathogenesis of CAE is not fully understood, atherosclerosis remains the main association with CAE, in the western world. Kawasaki disease is another common cause of acquired heart disease in children, causing CAE. Kawasaki disease prevalence is overstated by its geographical distribution. Current modalities of investigation looked at the anatomical distribution of the disease and its possible ischemic effects. Biomarkers were studied in depth to explain the active nature of CAE; however, the common association with atherosclerosis weakens its significance. Here we reviewed CAE, its prevalence, relationship to other systemic anomalies in the vascular bed, pathogenesis and diagnostic tools currently in use.
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| 31. |
- Boles, Usama, et al.
(author)
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Patterns of coronary artery ectasia and short-term outcome in acute myocardial infarction
- 2014
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In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 48:3, s. 161-166
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Journal article (peer-reviewed)abstract
- Objective. To assess the relationship between hematological inflammatory signs, cardiovascular risk (CV) factors and prognosis in patients presenting with acute myocardial infarction (AMI) and coronary artery ectasia (CAE). Design. We investigated 3321 AMI patients who required urgent primary percutaneous intervention in two centres in the United Kingdom between January 2009 and August 2012. Thirty patients with CAE were compared with 60 age-and gender-matched controls. Blood was collected within 2 h of the onset of chest pain. CV risk factors were assessed from the records. Major acute cardiac events and/or mortality (MACE) over 2 years were documented. Results. CAE occurred in 2.7% and more often affected the right (RCA) (p = 0.001) and left circumflex artery (LCx) (0.0001). Culprit lesions were more frequently related to atherosclerosis in non-CAE patients (p = 0.001). Yet, CV risk factors failed to differentiate between the groups, except diabetes, which was less frequent in CAE (p = 0.02). CRP was higher in CAE (p = 0.006), whereas total leucocyte, neutrophil counts and neutrophil/lymphocyte ratio (N/L ratio) were lower (p = 0.002, 0.002 and 0.032, respectively) than among non-CAE. This also was the case in diffuse versus localised CAE (p = 0.02, 0.008 and 0.03, respectively). The MACE incidence did not differ between CAE and non-CAE (p = 0.083) patients, and clinical management and MACE were unrelated to the inflammatory markers. Conclusion. In AMI, patients with CAE commonly have aneurysmal changes in RCA and LCx, and their inflammatory responses differ from those with non-CAE. These differences did not have prognostic relevance, and do not suggest different management.
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| 32. |
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| 33. |
- Bytyci, Ibadete, et al.
(author)
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Left atrial emptying fraction predicts limited exercise performance in heart failure patients
- 2014
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In: IJC Heart and Vessels. - : Elsevier. - 2214-7632. ; 4, s. 203-207
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Journal article (peer-reviewed)abstract
- Aim: We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF). Methods: This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s′, e′ and a′), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination. Results: Patients with limited exercise performance (≤ 300 m) were older (p = 0.01), had higher NYHA functional class (p = 0.004), higher LV mass index (p = 0.003), larger LA (p = 0.002), lower LV EF (p = 0.009), larger LV end-systolic dimension (p = 0.007), higher E/A ratio (p = 0.03), reduced septal MAPSE (p < 0.001), larger LA end-systolic volume (p = 0.03), larger LA end-diastolic volume (p = 0.005) and lower LA emptying fraction (p < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898–0.993), p = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, p < 0.001) in predicting poor exercise performance. Conclusion: In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.
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| 34. |
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| 35. |
- Calcutteea, Avin, et al.
(author)
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Global and regional right ventricular dysfunction in pulmonary hypertension
- 2014
-
In: Echocardiography. - : Wiley. - 0742-2822 .- 1540-8175. ; 31:2, s. 164-171
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Pulmonary hypertension (PH) is known to affect the right ventricular (RV) function.AIMS: To assess the extent of global and regional RV dysfunction in PH patients.METHODS: We performed a cross-sectional study on 20 controls (age 62 ± 15 years, 7 males) and 35 patients (age 67 ± 12 years, 13 males) with PH of mixed etiologies and assessed RV inflow and outflow tracts (OTs) function, using speckle tracking echocardiography (STE) based myocardial deformation and its time relations. RV inlet and OT dimensions (2D), inlet myocardial velocities (TDI), myocardial strain and strain rate (SR), TAPSE (M-mode), ejection and filling times (pulsed-wave [PW] Doppler), and pulmonary artery acceleration (PAc) were measured.RESULTS: RV inlet and OT were dilated (P < 0.001 for both) and TAPSE (P < 0.001), inlet velocities (P < 0.001), basal and mid-cavity strain, SR and longitudinal displacement reduced (P < 0.001 for all). The time to peak systolic SR at basal, mid-cavity (P < 0.001 for both), and RVOT (P = 0.007) was short as was that to peak displacement (P < 0.001 for all). The time to peak pulmonary ejection correlated with time to peak SR at RVOT (r = 0.7, P < 0.001) in controls, but with that of the mid-cavity in patients (r = 0.71, P < 0.001). PAc was faster (P = 0.001) and RV filling time shorter in patients (P = 0.03) with respect to controls.CONCLUSIONS: PH has drastic effects on RV structure and intrinsic myocardial function, significantly disturbing its ejection time relations and overall pump performance. Increased RV afterload results in RV configuration changes with the inflow tract determining peak ejection rather than OT.
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| 36. |
- Calcutteea, Avin, 1978-
(author)
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New insights in the assessment of right ventricular function : an echocardiographic study
- 2013
-
Doctoral thesis (other academic/artistic)abstract
- Background: The right ventricle (RV) is multi-compartmental in orientation with a complex structural geometry. However, assessment of this part of the heart has remained an elusive clinical challenge. As a matter of fact, its importance has been underestimated in the past, especially its role as a determinant of cardiac symptoms, exercise capacity in chronic heart failure and survival in patients with valvular disease of the left heart. Evidence also exists that pulmonary hypertension (PH) affects primarily the right ventricular function. On the other hand, previous literature suggested that severe aortic stenosis (AS) affects left ventricular (LV) structure and function which partially recover after aortic valve replacement (AVR). However, the impact of that on RV global and segmental function remains undetermined. Objectives: We sought to gain more insight into the RV physiology using 3D technology, Speckle tracking as well as already applicable echocardiographic measures. Our first aim was to assess the normal differential function of the RV inflow tract (IT), apical and outflow tract (OT) compartments, also their interrelations and the response to pulmonary hypertension. We also investigated the extent of RV dysfunction in severe AS and its response to AVR. Lastly, we studied the extent of global and regional right ventricular dysfunction in patients with pulmonary hypertension of different aetiologies and normal LV function.Methods: The studies were performed on three different groups; (1) left sided heart failure with (Group 1) and without (Group 2) secondary pulmonary hypertension, (2) severe aortic stenosis and six months post AVR and (3) pulmonary hypertension of different aetiologies and normal left ventricular function. We used 3D, speckle tracking echocardiography and conventionally available Doppler echocardiographic transthoracic techniques including M-mode, 2D and myocardial tissue Doppler. All patients’ measurements were compared with healthy subjects (controls). Statistics were performed using a commercially available SPSS software.Results:1- Our RV 3D tripartite model was validated with 2D measures and eventually showed strong correlations between RV inflow diameter (2D) and end diastolic volume (3D) (r=0.69, p<0.001) and between tricuspid annular systolic excursion (TAPSE) and RV ejection fraction (3D) (r=0.71, p<0.001). In patients (group 1 & 2) we found that the apical ejection fraction (EF) was less than the inflow and outflow (controls: p<0.01 & p<0.01, Group 1: p<0.05 & p<0.01 and Group 2: p<0.05 & p<0.01, respectively). Ejection fraction (EF) was reduced in both patient groups (p<0.05 for all compartments). Whilst in controls, the inflow compartment reached the minimum volume 20 ms before the outflow and apex, in Group 2 it was virtually simultaneous. Both patient groups showed prolonged isovolumic contraction (IVC) and relaxation (IVR) times (p<0.05 for all). Also, in controls, the outflow tract was the only compartment where the rate of volume fall correlated with the time to peak RV ejection (r = 0.62, p = 0.03). In Group 1, this relationship was lost and became with the inflow compartment (r = 0.61, p = 0.01). In Group 2, the highest correlation was with the apex (r=0.60, p<0.05), but not with the outflow tract.2- In patients with severe aortic stenosis, time to peak RV ejection correlated with the basal cavity segment (r = 0.72, p<0.001) but not with the RVOT. The same pattern of disturbance remained after 6 months of AVR (r = 0.71, p<0.001). In contrast to the pre-operative and post-operative patients, time to RV peak ejection correlated with the time to peak outflow tract strain rate (r = 0.7, p<0.001), but not with basal cavity function. Finally in patients, RVOT strain rate (SR) did not change after AVR but basal cavity SR fell (p=0.04).3- In patients with pulmonary hypertension of different aetiologies and normal LV function, RV inflow and outflow tracts were dilated (p<0.001 for both). Furthermore, TAPSE (p<0.001), inflow velocities (p<0.001), basal and mid-cavity strain rate (SR) and longitudinal displacement (p<0.001 for all) were all reduced. The time to peak systolic SR at basal, mid-cavity (p<0.001 for both) and RVOT (p=0.007) was short as was that to peak displacement (p<0.001 for all). The time to peak pulmonary ejection correlated with time to peak SR at RVOT (r=0.7, p<0.001) in controls, but with that of the mid cavity in patients (r=0.71, p<0.001). Finally, pulmonary ejection acceleration (PAc) was faster (p=0.001) and RV filling time shorter in patients (p=0.03) with respect to controls.Conclusion: RV has distinct features for the inflow, apical and outflow tract compartments, with different extent of contribution to the overall systolic function. In PH, RV becomes one dyssynchronous compartment which itself may have perpetual effect on overall cardiac dysfunction. In addition, critical aortic stenosis results in RV configuration changes with the inflow tract, rather than outflow tract, determining peak ejection. This pattern of disturbance remains six month after valve replacement, which confirms that once RV physiology is disturbed it does not fully recover. The findings of this study suggest an organised RV remodelling which might explain the known limited exercise capacity in such patients. Furthermore, in patients with PH of different aetiologies and normal LV function, there is a similar pattern of RV disturbance. Therefore, we can conclude that early identification of such changes might help in identifying patients who need more aggressive therapy early on in the disease process.
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| 37. |
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| 38. |
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| 39. |
-
Clinical echocardiography
- 2012. - 2
-
Editorial collection (peer-reviewed)abstract
- The main target of clinical and academic cardiology activities is to optimize the patient’s management and ultimately their welfare. Professionals manage patients according to their own understanding of disease process; clinicians concentrate on alleviating the symptoms and echocardiographers on identifying the disease. This book helps to ‘cross the barrier’ and describes the common ground between physiologic disturbances and their management which should ideally form the shared basis for understanding and managing all cardiac problems. A practical review of the many uses of echocardiography in clinical practice, Clinical Echocardiography is designed to integrate and refine the investigation of cardiac disorders within the framework of the pathologic, physiologic and surgical appearances of heart disease. It has been common to consider echocardiographic findings separately from the more physical aspects of heart disease. However, with the development of new imaging modalities such as three- and four-dimensional echocardiography, it has become necessary to consider this imaging as a window on the heart. This book aids the cardiologist, cardiac surgeon and echocardiographer to integrate their knowledge within the overall management of cardiac disease in a clinically relevant manner.
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| 40. |
- Ding, Wen-Hong, et al.
(author)
-
Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis.
- 2010
-
In: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 141:1, s. 24-31
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the predictors for mortality following aortic valve replacement (AVR) in elderly patients with aortic stenosis (AS).METHODS: 112 consecutive elderly AS patients (aged 77+/-2 years) with AVR between 1998 and 2003 were studied. Clinical and echocardiographic data of LV function were recorded before and 46 months after AVR. Results were compared with 72 younger patients (aged 60+/-1 years). Outcome measures were 30-day and long-term all cause mortalities.RESULTS: Elderly patients had higher NYHA class, more frequent atrial fibrillation, coronary artery disease, emergency operation and use of bioprosthetic valves. They also had shorter E-wave deceleration time (DT) and larger left atria (p<0.05 for all). 30-day mortality was 12% vs 4% (Log Rank x(2)=3.02, p=0.08) and long term mortality was 18% vs 7% (Log Rank x(2)=4.38, p=0.04) in two groups respectively. Age was not related to mortality after adjustment for other variables. Among all variables, anemia (OR 4.20, CI: 1.02-6.86, p=0.04), cardiopulmonary bypass (CPB) time (OR 1.02, CI 1.01-1.04, p<0.01), significant prosthesis patient mismatch (PPM) (OR 5.43, CI 1.04-18.40, p<0.05) were associated with 30-day mortality in elderly patients. Their long-term mortality was related to CBP time (OR 1.02, CI 1.00-1.05, p=0.04), PPM (OR 4.64, CI 1.33-16.11, p=0.02) and raised left atrial pressure: DT (OR 0.94, CI 0.84-0.99, p=0.03) and pulmonary arterial systolic pressure (OR 1.12, CI 1.03-1.19, p<0.001).CONCLUSION: Peri-operative AVR survival is encouraging. While pre-operative anemia and a longer CBP time determine early mortality, long term mortality is related to PPM, LV diastolic dysfunction and secondary pulmonary hypertension.
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| 41. |
- Ding, Wenhong, 1968-
(author)
-
Survival and functional recovery following valve replacement in patients with severe aortic stenosis
- 2013
-
Doctoral thesis (other academic/artistic)abstract
- Background: Aortic stenosis (AS) is the most common heart valve disease in Europe and North America. Age-related calcification of the valve is the commonest cause of acquired AS, especially in patients older than 70 years.Conventional surgical aortic valve replacement (SAVR) and the novel, minimally invasive transcatheter aortic valve implantation (TAVI), effectively preserve left ventricular (LV) function, relieve symptoms and improve survival in patients with severe symptomatic AS. However, patients with impaired LV function may carry significant operative risk, and long recovery time. In addition, such patients might have other comorbidities, and hence adding another challenge. Thus evaluation of ventricular function before and after AVR, as well as critical evaluation of TAVI patients should contribute to better clinical outcome.Methods: We studied LV function by conventional echocardiography before and after SAVR in the following groups; (I) 86 patients (aged 71±10 years) with severe AS and LV dysfunction; (II) 112 consecutive elderly AS patients (aged 77±2 years) and compared them with 72 younger patients (aged 60±1 years); (III)66 patients (age 70±2 years, 53 male) who underwent AVR for severe AS with concurrent LV dysfunction; (IV) 89 consecutive patients with symptomatic severeAS who underwent successful TAVI, 45 of whom received trans-apical TAVI (TA)(age 80.8±4.9 year, 26 male) and 44 trans-femoral TAVI (TF) (age 82.9±5.8 year,22 male).The conventional echocardiographic measurements were made according to the guidelines. Severe AS was identified by aortic valve mean pressure gradient >40mmHg or valve area <1.0 cm2. LV systolic dysfunction was identified as ejection fraction (EF) <50%. LV long-axis function was presented by mitral annular plane systolic excursion ( MAPSE ) at lateral wall and septal wall, which were measured from apical four-chamber view. Also from the same view, LV septal and lateral wall deformation using STE as well as global longitudinal systolic strain. The LV systolic twist as the net difference between apical rotation and basal rotation was measured from the parasternal apical and basal short-axis views in the TAVI patients.Results: Study I: In the low flow and high gradient group, operative (30-day) mortality was 10%, and peri-operative mortality was associated with lower mean LVEF, higher mitral E:A ratio, peak systolic pulmonary artery pressure (PSPAP), and higher serum creatinine (all p<0.001), NYHA class III–IV, concomitant coronary artery bypass graft (CABG), urgent surgery, and longer bypass-time (all p< 0.05). Mortality at 4 years was 17%. Univariate predictors of 4-year mortality were: lower EF (p<0.001), presence of restrictive LV filling (p<0.001), raised PSPAP (p<0.001) and CABG (p=0.037). However, only EF<40 % (p=0.03), the presence of restrictive LV filling (p=0.033) and raised PSPAP (p<0.01)independently predicted mortality in this group.Study II: Elderly patients had higher NYHA class, more frequent atrial fibrillation (AF), coronary artery disease (CAD), emergency operation and use of bioprosthetic valves. They also had shorter E-wave deceleration time (DT) and larger left atria (LA) (p<0.05 for all). 30-day mortality was 12% vs 4 % (Log Rank x2=3.02, p=0.08) and long term mortality was 18% vs 7% (Log Rank x2=4.38,p=0.04) in the two groups, respectively. Age was not related to mortality after adjustment for other variables. Among all variables, anemia (OR 4.20, CI:1.02–6.86, p=0.04), cardiopulmonary bypass (CPB) time (OR 1.02, CI 1.01–1.04,p<0.01), significant patient prosthesis mismatch (PPM) (OR 5.43, CI 1.04–18.40,p<0.05) were associated with 30-day mortality in elderly patients. Their long-term mortality was related to CBP time (OR 1.02, CI 1.00–1.05, p=0.04),PPM (OR 4.64, CI 1.33–16.11, p=0.02) and raised LA pressure: DT (OR 0.94, CI0.84–0.99, p=0.03) and pulmonary artery systolic pressure (PASP) (OR 1.12, CI1.03–1.19, p<0.001).STUDY III: Following SAVR peak aortic pressure gradient (AOPG) decreased and indexed valve area increased (64±3 to 19±1 mmHg and 0.30±0.01 to 0.89±0.03 cm2/m2, p<0.001 for both). LVEF increased (from 45±1 to 54±2%;p<0.001), LV end diastolic and end-systolic dimensions fell (LVEDD index: from 33±1 to 30±1 mm/m2; and LVESD index: from 27±1 to 20±1 mm/m2; (p<0.01 forboth). LV diastolic dysfunction improved as evidenced by the fall in E/A ratio (from 2.6±0.2 to 1.9±0.4) and prolongation of total filling time; (from 29.2±0.6 to31.4±0.5 s/min, p=0.01 for both). Among all echocardiographic variables, LV dimensions (LVEDD index, OR 0.70, CI 0.52–0.97, p<0.05; LVESD index, OR 0.57, CI 0.40–0.85, p=0.005) were the two independent predictors of post-operative LV functional recovery on multivariate analysis. A cut-off value ofpre-operative LVESD index<=27.5 mm/m2 was 85% sensitive and 72% specific inpredicting intermediate-term recovery of LV function after AVR (AUC, 0.72, p=0.002). STUDY IV: Before TAVI, there was no difference between the two patient groups in gender, age, body surface area (BSA) and baseline LV function. However, left ventricular mass index (LVMi), left atrial volume index (LAVi) and tricuspid regurgitation pressure drop (TRPdrop) were increased in the TA group (p<0.05).One week after TAVI, aortic pressure gradient (AOPG) markedly dropped in thetwo groups (both p<0.001), LVEDD index and LVESD index fell but EF andmyocardial strain remained unchanged. Overall cavity twist reduced (p<0.048).Significant LVESD index reduction was only seen in TF group (p=0.02) with a slight increase in LVEF (p=0.04). Lateral MAPSE increased only in the TF group(p=0.02). LV longitudinal systolic strain remained unchanged in TA patients while apical lateral strain increased in TF group. LV apical rotation fell in the two groups but basal rotation increased only in the TA patients (p=0.02). LAVi reduced in bothgroups and to a greater extent in TF TAVI (p=0.006), as did TRPdrop (p<0.001).Conclusion: SAVR and TAVI are two effective treatments for severe AS patients.The severity of pre-operative systolic and diastolic LV dysfunction is the major predictor of mortality following SAVR for low-flow and high gradient AS.Peri-operative AVR survival is encouraging in the elderly. Long term mortality in the elderly is related to PPM, LV diastolic dysfunction and secondary pulmonary hypertension. LV functional recovery was evident in most patients with LV dysfunction after SAVR. A lower prevalence of LV functional recovery in patients with large pre-operative LVESD index might signify the loss of contractile reserveand thus predict post-operative functional recovery. TAVI results in significant early improvement of segmental and overall ventricular function, particularly in patients receiving the trans-femoral approach. The delayed recovery of the trans-apical TAVI group, we studied, might reflect worse pre-procedural diastolic cavity function.
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| 42. |
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| 43. |
- El-Maasarany, Shirley H, et al.
(author)
-
A-V nodal artery anatomy and relations to the posterior septal space and its contents
- 2010
-
In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 141:1, s. 92-98
-
Journal article (peer-reviewed)abstract
- BACKGROUND AND AIM: Radiofrequency catheter ablation treats resistant nodal re-entrant tachycardia but carries a risk to AV conduction system and its vessels. We aimed to study the origin of the A-V nodal artery (AVNA) and its course within the posterior septal space (PSS). METHODS: Twenty embalmed human hearts of both sexes (16 males) age, 25-60 years, were dissected to study the PPS and its arteries down to their destination. RESULTS: The PSS is a four sided pyramidal space, at the crux of the heart, with its base made of the pericardium. It is made of four; right upper and lower and left upper and lower walls corresponding to the right atrium and ventricle and left atrium and ventricle, respectively. The right coronary artery (RCA) crossed the base from the right to the left angle, to lie inferior and adherent to the terminal part of the coronary sinus (CS). The posterior interventricular artery, the ventricular branches of the RCA, the middle cardiac vein and the ventricular veins, all crossed the base of the space to their final destination. AVNA originated from either the RCA itself or one of its branches. Double AVNA was encountered in 14 specimens with the upper artery larger and passed between the right and left atria and the lower artery smaller and crossed the space adjacent to the right ventricle. CONCLUSIONS: These findings highlight the importance of the PSS and its structural relations, in particular to the AVNA, that should be considered during various interventional procedures.
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| 44. |
- Elfigih, Iqbal A., et al.
(author)
-
Non-invasive imaging in detecting myocardial viability : myocardial function versus perfusion
- 2014
-
In: IJC Heart & Vasculature. - : Elsevier. - 2352-9067. ; 5, s. 51-56
-
Research review (peer-reviewed)abstract
- Coronary artery disease (CAD) is the most prevalent and single most common cause of morbidity and mortality [1] with the resulting left ventricular (LV) dysfunction an important complication. The distinction between viable and non-viable myocardium in patients with LV dysfunction is a clinically important issue among possible candidates for myocardial revascularization. Several available non-invasive techniques are used to detect and assess ischemia and myocardial viability. These techniques include echocardiography, radionuclide images, cardiac magnetic resonance imaging and recently myocardial computed tomography perfusion imaging. This review aims to distinguish between the available non-invasive imaging techniques in detecting signs of functional and perfusion viability and identify those which have the most clinical relevance in detecting myocardial viability in patients with CAD and chronic ischemic LV dysfunction. The most current available studies showed that both myocardial perfusion and function based on non-invasive imaging have high sensitivity with however wide range of specificity for detecting myocardial viability. Both perfusion and function imaging modalities provide complementary information about myocardial viability and no optimum single imaging technique exists that can provide very accurate diagnostic and prognostic viability assessment. The weight of the body of evidence suggested that non-invasive imaging can help in guiding therapeutic decision making in patients with LV dysfunction.
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| 45. |
- Galderisi, Maurizio, et al.
(author)
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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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| 46. |
- Grönlund, Christer, 1975-, et al.
(author)
-
Significant beat-to-beat variability of E/e’ irrespective of respiration
- 2013
-
In: International cardiovascular forum. - : Barcaray Publishing. - 2409-3424 .- 2410-2636. ; 1:2, s. 88-89
-
Journal article (peer-reviewed)abstract
- The E/e’ ratio is commonly used in Doppler echocardiographic examinations to estimate the pulmonary capillary wedge pressure. The rationale of using this ratio is to combine left ventricular (LV) filling (E) and relaxation (e’) velocities to indirectly assess left atrial pressure. However, the accuracy of this index has recently been questioned, particularly in patients with controlled heart failure. Likewise, the potential beat-to-beat variability of such measurements remains undetermined. The cardiovascular system is subject to several oscillations with the potential of influencing LV function and its intra-cavitary pressures, hence measurements of its filling and relaxation velocities. The aim of this pilot study was to assess the beat-to-beat variability of the E/e’ ratio in one minute long examination in healthy subjects, and patients with various severity of amyloid heart disease. The results show that despite critical application of the standard echocardiographic recording recommendations, E/e’ beat-to-beat variability was 36 % (22 to 50%) in healthy subjects and 17 % (11-26%) in patients, and where the most severe amyloid heart disease had the least variability. Thus, clinical use of a single or few cardiac beats might not necessarily reflect an accurate ratio between the two velocities, and hence casts doubt over their diagnostic value.
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| 47. |
- Grönlund, Christer, et al.
(author)
-
Simultaneous quantification of myocardial and blood flow velocities based on duplex mode ultrasound imaging
- 2013
-
In: Biomedical engineering online. - : BioMed Central (BMC). - 1475-925X. ; 12
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Ultrasound imaging of the heart is a commonly used clinical tool to assess cardiac function. The basis for this analysis is the quantification of cardiac blood flow and myocardial velocities. These are typically measured using different imaging modes and on different cardiac cycles. However, due to beat-to-beat variations such as irregular heart rhythm and transient events, simultaneous acquisition is preferred. There exists specialized ultrasound systems for this purpose; however, it would be beneficial if this could be achieved using conventional ultrasound systems due to their wide availability. The conventional Duplex mode ultrasound allows simultaneous acquisition, however at a highly reduced spatial and temporal resolution.METHODS: The aim of this work was to present and evaluate the performance of a novel method to recover myocardial tissue velocity using conventional Duplex ultrasound imaging, and to demonstrate its feasibility for the assessment of simultaneous blood flow and myocardial velocity in-vivo. The essence of the method was the estimation of the axial phase shift of robust echogenic structures between subsequent image frames. The performance of the method was evaluated on synthetic tissue mimicking B-mode image sequences at different frame rates (20--60 Hz) and tissue velocities (peak velocities 5-15cm/s), using cardiac deformation and displacement characteristics. The performance was also compared to a standard 2-D speckle tracking technique.RESULTS: The method had an overall high performance at frame rates above 25 Hz, with less than 15% error of the peak diastolic velocity, and less than 10 ms peak timing error. The method showed superior performance compared to the 2-D tracking technique at frame rates below 50 Hz. The in-vivo quantification of simultaneous blood flow and myocardial tissue velocities verified the echocardiographic patterns and features of healthy subjects and the specific patient group.CONCLUSIONS: A novel myocardial velocity quantification method was presented and high performance at frame rates above 25Hz was shown. In-vivo quantification of simultaneous myocardial and blood flow velocities was feasible using the proposed method and conventional Duplex mode imaging. We propose that the methodology is suitable for retrospective as well as prospective studies on the mechanics and hemodynamics of the heart.
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| 48. |
- Gustafsson, Sandra, et al.
(author)
-
Amyloid Fibril Composition as a Predictor of Development of Cardiomyopathy After Liver Transplantation for Hereditary Transthyretin Amyloidosis
- 2012
-
In: Transplantation. - 0041-1337 .- 1534-6080. ; 93:10, s. 1017-1023
-
Journal article (peer-reviewed)abstract
- Background. Liver transplantation (LTx) is an accepted treatment for hereditary transthyretin (TTR) amyloidosis (ATTR). However, unforeseen heart complications, especially a rapid development of cardiomyopathy after LTx has affected mortality and morbidity. Recently, a relationship between ATTR-fibril composition and cardiomyopathy has been noted. The aim of this study was to investigate whether development of cardiomyopathy and heart failure in LTx ATTR amyloid patients is related to amyloid fibril composition.Methods. Twenty-four patients with hereditary ATTR amyloidosis who had undergone LTx and have had their amyloid fibril type tested were available for the study. They had been examined by echocardiography including tissue Doppler and speckle tracking echocardiography before and after LTx. Patients were divided into two groups according to fibril composition, 10 patients with type A fibrils (a mixture of truncated and full-length TTR) and 14 patients with type B fibrils (full-length TTR fibrils only). There was no difference in time to the follow-up echocardiography between the two groups.Results. After LTx, the group consisting of type A patients developed symptoms of heart failure and with reduced systolic and diastolic ventricular function as shown by echocardiography, whereas no similar deterioration was noted for the group of patients with type B fibrils.Conclusion. Patients with type A fibrils deteriorate an already existing cardiomyopathy and heart failure after LTx, in contrast to patients with type B fibrils. These results might have significant clinical implications in optimizing best patients selection criteria for LTx.
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| 49. |
- Hamoudi, Zainab, et al.
(author)
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Comparative assessment of non-invasive imaging in detecting coronary artery disease
- 2014
-
In: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:5, s. 218-225
-
Research review (peer-reviewed)abstract
- Coronary artery disease (CAD) has an important impact on the morbidity and mortality in the West and health service resources worldwide. It is therefore crucial to accurately diagnose CAD early, in an attempt to limit its burden on patients and society, potentially by optimum risk stratification, accurate diagnosis and management. Invasive coronary angiography (ICA) is the conventional gold standard imaging investigation for the coronary circulation and assessment of disease severity. However, it is an invasive procedure and is associated with risks, although rare. In addition, it detects luminal stenosis but not the functional importance of those anatomical lesions. Therefore, a wide variety of non-invasive imaging developed to evaluate the presence and severity of CAD, including anatomical techniques e.g. coronary CT that assesses coronary stenosis, and quantifies coronary calcium, hence the burden of atherosclerotic plaques and functional imaging e.g. stress echocardiography, nuclear imaging by SPECT and PET and stress CMR. Selection of the most appropriate imaging, therefore, is challenging and requires knowledge of patients' pre-test probability and prevalence of disease, their advantages and limitations, cost and availability. This review attempts to provide an overview of the current supporting evidence of the role of non-invasive imaging in diagnosing CAD, in addition to its prognostic value, limitations and advantages.
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| 50. |
- Hellström, Monica, et al.
(author)
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Innocent left ventricular outflow tract membrane.
- 2011
-
In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 15:150(2), s. e65-e66
-
Journal article (peer-reviewed)abstract
- Innocent left ventricular outflow tract membranes are rare finding, and may have no significant haemodynamic effect. Thanks to the high resolution of the recent echocardiographs these membranes can be seen in detail. Various shapes and forms of such membranes need to be adequately studied and documented.
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