Double Chamber Right Ventricle with New-Onset Biventricular Failure in an Octogenarian.

• DCRV may be an incidental finding in asymptomatic adults. • DCRV may be unmasked by acquired cardiac conditions. • PS-type murmur with RVH on electrocardiogram should raise suspicion for DCRV.

Biatrial and right ventricular deformation imaging: Implications of the recent EACVI consensus document in the clinics and beyond.

In this review, right ventricular (RV), right atrial (RA), and left atrial (LA) strain in some selected clinical situations has been discussed in light of the current literature. To exemplify the significance of the use of multichamber strain, we have provided some illustrations of common cardiac problems. The recently published European Association of Cardiovascular Imaging (EACVI) consensus document for standardization of RV, RA, and LA strain, using the currently available software, has fulfilled the aspirations of investigators world over who have been studying atrial strain using a bailed-out algorithm designed principally to quantify left ventricular deformation.

Deformation imaging of the atria using 2D strain: A noninvasive modality to characterize operating compliance?

This viewpoint with two illustrated case summaries of biventricular and biatrial mechanical function/dysfunction emphasizes the importance of continued research in deformation imaging beyond the left ventricle, as there are no Cinderellas in the heart and we just cannot afford to be nonchalant toward the atria, particularly the right atrium.

Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction.

Aims: Deformation imaging, particularly of left-sided heart, is fast becoming an essential tool in clinical cardiology. However, data are scant regarding the value of biventricular and bi-atrial deformation in association with comorbidities in heart failure with reduced left ventricular ejection fraction (HFREF).

Methods And Results: Forty-nine subjects (72 ± 13 years; 28 male) with HFREF and 14 age-matched controls underwent deformation imaging including LV global longitudinal strain (LVGLS%), right ventricular strain (RVS%), and left atrial reservoir strain (LARS%).

3D and 4D Ultrasound: Current Progress and Future Perspectives.

Purpose Of Review: Three-dimensional (3D) echocardiography (3DE) and 4-dimensional echocardiography (4DE), also known as real-time (RT) 3DE (RT3DE), are rapidly emerging technologies which have made significant impact in the clinical arena over the years. This review will discuss the recent applications of 3DE in diagnosing and treating different types of cardiovascular disease.

Recent Findings: Recent studies using 3DE expanded on prior findings and introduced additional applications to different cardiac conditions.

Prevalence of Congenital Heart Disease and Pulmonary Hypertension in Down's Syndrome: An Echocardiographic Study.

Background: Down's syndrome (DS) is a genetic anomaly, which undergoes increased morbidity and mortality when associated with congenital heart disease (CHD). The aims of the study were to determine the prevalence of CHD and pulmonary hypertension (PH) in DS.

Methods: One hundred twenty-seven patients with DS living in Mexico City were evaluated by physical exam, electrocardiogram and echocardiogram.

Value of two-dimensional speckle tracking and real time three-dimensional echocardiography for the identification of subclinical left ventricular dysfunction in patients referred for routine echocardiography.

Background: While speckle tracking echocardiography (2DSTE) can be used to study longitudinal, circumferential, and radial function, real time 3D echocardiography (3DE) generates dynamic time-volume curves, offering a wide array of new parameters for characterizing mechanical and volumetric properties of the left ventricle (LV). Our aim was to investigate the merit of these new techniques to separate normal from abnormal echocardiograms as well as to identify subclinical disease in reportedly normal subjects.

Methods: Eighty-one patients (mean age 61 ± 16 years) underwent standard 2D echocardiography (2DE) enhanced by 2DSTE and 3DE.

Role of N-terminal pro-brain natriuretic peptide in ST-segment elevation myocardial infarction: experience from a tertiary centre in India.

Background: Role of biomarkers in ST-segment elevation myocardial infarction (STEMI) is paramount, as they aid in diagnosis and gauge prognosis of the disease. In this project, we sought to study the short-term outcome and clinical associates of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the setting of STEMI at a tertiary center in India.

Methods: In all, 173 STEMI patients (mean age: 57 ± 12 years, 38 women) had their NT-proBNP assayed in addition to troponins and high-sensitive C-reactive protein.

Principles and clinical applications of strain imaging.

M-Mode echocardiography, 2-D grey scale imaging and standard Doppler that constitute conventional echocardiography has been used for over many decades now. Although these modalities form the backbone in routine clinical echocardiography, its inability to objectively quantify left ventricular function at regional and global levels as well as its loading and heart rate dependency make conventional echocardiography an incomplete tool in clinical situations. Tissue Doppler imaging (which includes myocardial velocity, displacement and strain) has been successfully used in a variety of clinical situations, from investigations of diastolic function to implantation of bi-ventricular pacing for cardiac resynchronization therapy and even in preclinical diagnosis of genetic diseases such as hypertrophic cardiomyopathy.

Quantification of low-dose dobutamine stress using speckle tracking echocardiography in coronary artery disease.

Aims: We sought to evaluate the utility of speckle tracking echocardiography (STE) for detecting left ventricular (LV) mechanical abnormalities during low-dose (20 microg) 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.

A right atrial hemangioma mimicking thrombus in a patient with atrial arrhythmias.

Cardiac hemangiomas are rare tumors, accounting for only 2.8% of all benign primary cardiac tumors and occur at any age. Clinical presentations vary depending on the tumor location (myocardial, endocardial or pericardial).

Relative importance of errors in left ventricular quantitation by two-dimensional echocardiography: insights from three-dimensional echocardiography and cardiac magnetic resonance imaging.

Background: The accuracy of left ventricular (LV) volumes and ejection fraction (EF) on two-dimensional echocardiography (2DE) is limited by image position (IP), geometric assumption (GA), and boundary tracing (BT) errors.

Methods: Real-time three-dimensional echocardiography (RT3DE) and cardiac magnetic resonance imaging (CMR) were used to determine the relative contribution of each error source in normal controls (n = 35) and patients with myocardial infarctions (MIs) (n = 34). LV volumes and EFs were calculated using (1) apical biplane disk summation on 2DE (IP + GA + BT errors), (2) biplane disk summation on RT3DE (GA + BT errors), (3) 4-multiplane to 8-multiplane surface approximation on RT3DE (GA + BT errors), (4) voxel-based surface approximation on RT3DE (BT error alone) and (5) CMR.

Normal values of right ventricular size and function by real-time 3-dimensional echocardiography: comparison with cardiac magnetic resonance imaging.

Background: Assessment of right ventricular function by 2-dimensional echocardiography (2DECHO) is difficult because of its complex shape. Real-time 3-dimensional echocardiography (RT3DECHO) may be superior.

Methods: End-diastolic volume, end-systolic volume, stroke volume, and ejection fraction obtained by 2DECHO, RT3DECHO short-axis disk summation (DS), and RT3DECHO apical rotation were compared with cardiac magnetic resonance imaging in 71 healthy individuals.

Evaluation of the electrocardiographic criteria for left ventricular hypertrophy with use of three-dimensional echocardiography.

Background: Left ventricular hypertrophy (LVH) is a common condition that carries an increased risk of cardiovascular events. Use of ECG in detection of LVH is limited because of the reported low sensitivity. Conventional echocardiographic techniques used as the standard for estimating left ventricular (LV) mass have limitations related to the position of the image plane and shape of the ventricle.

Intraoperative assessment of mitral regurgitation: role of phenylephrine challenge.

Objectives: We defined the effects of the operative (OP) state and phenylephrine challenge on the assessment of mitral regurgitation (MR) severity.

Methods: In all, 57 patients underwent transesophageal echocardiographic assessment of MR severity pre-OP (PREOP) and intra-OP. MR severity was assessed PREOP under conscious sedation and intra-OP with general anesthesia, before and after hemodynamic manipulation with vasoactive agents, to match intra-OP and PREOP transesophageal echocardiographic mean arterial blood pressures.

Primary large B-cell cardiac lymphoma.

Primary cardiac lymphomas are rare. They can be detected incidentally during echocardiography or cardiac operation. They can have various clinical manifestations.

Relationship of mitral annular remodeling to severity of chronic mitral regurgitation.

Hypotheses: (1) Mitral regurgitation (MR) severity is directly associated with mitral annular remodeling as evidenced by mitral annular enlargement. (2) Increasing severity of chronic MR will result in symmetric enlargement of the mitral annulus as measured by annular shape indices.

Background: Limited data exist on mitral annular remodeling for patients with MR.