Two-dimensional transthoracic measure of mitral annulus in mitral valve prolapse and moderate to severe regurgitation: a method comparison analysis with three-dimensional transesophageal echocardiography.

Background: Mitral annulus (MA) area is derived during transthoracic echocardiography (TTE) assuming of a circular shape using the MA diameter from the apical 4 chamber (A4c) view. Since the MA is not a circular structure, we hypothesized that an elliptical model using parasternal long-axis (PLAX) and apical 2 chamber (A2c) view measured MA diameters would have better agreement with 3-dimensional transesophageal echocardiography (3D TEE) measured MA in degenerative mitral valve disease (DMVD).

Methods: Seventy-six patients with moderate-to-severe DMVD had 2D TTE and 3D TEE performed.

Left atrial and ventricular systolic and diastolic myocardial mechanics in patients with end-stage renal disease.

Background: Diastolic cardiac dysfunction is an important complication of end-stage renal disease (ESRD), but quantification remains a challenge. Given that diastolic dysfunction is reflected in both left atrial (LA) and ventricular (LV) function, we aimed to identify abnormalities in LV and LA volume and function using measures of myocardial mechanics.

Methods: We retrospectively studied 53 incident ESRD patients (46±16 y/o 44% male) and compared them to 85 normal controls.

Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy.

Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined. Aim.

Quantitative Modeling of the Mitral Valve by Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Mitral Valve Repair: Correlation with Intraoperative Surgical Technique.

Background: Mitral valve (MV) repair is the procedure of choice for patients with degenerative MV disease (DMVD) with severe mitral regurgitation. The aim of this study was to identify specific quantitative MV parameters from preoperative three-dimensional (3D) transesophageal echocardiography that are associated with the length of the mitral annuloplasty band implanted and the performance of leaflet resection in patients with DMVD undergoing MV repair.

Methods: Ninety-four patients (mean age, 60 ± 11 years; 68% men) referred for MV surgery with adequate-quality preoperative 3D transesophageal echocardiographic studies were retrospectively identified.

Automated quantitative 3-dimensional modeling of the aortic valve and root by 3-dimensional transesophageal echocardiography in normals, aortic regurgitation, and aortic stenosis: comparison to computed tomography in normals and clinical implications.

Background: We tested the ability of a novel automated 3-dimensional (3D) algorithm to model and quantify the aortic root from 3D transesophageal echocardiography (TEE) and computed tomographic (CT) data.

Methods And Results: We compared the quantitative parameters obtained by automated modeling from 3D TEE (n=20) and CT data (n=20) to those made by 2D TEE and targeted 2D from 3D TEE and CT in patients without valve disease (normals). We also compared the automated 3D TEE measurements in severe aortic stenosis (n=14), dilated root without aortic regurgitation (n=15), and dilated root with aortic regurgitation (n=20).

Feasibility, accuracy, and reproducibility of real-time full-volume 3D transthoracic echocardiography to measure LV volumes and systolic function: a fully automated endocardial contouring algorithm in sinus rhythm and atrial fibrillation.

Objectives: To assess the feasibility, accuracy, and reproducibility of real-time full-volume 3-dimensional transthoracic echocardiography (3D RT-VTTE) to measure left ventricular (LV) volumes and ejection fraction (EF) using a fully automated endocardial contouring algorithm and to identify and automatically correct the contours to obtain accurate LV volumes in sinus rhythm and atrial fibrillation (AF).

Background: 3D transthoracic echocardiography is not used routinely to quantify LV volumes and EF. A fully automated workflow using RT-VTTE may improve clinical adoption.

The left ventricle responds to acute graded elevation of right ventricular afterload by augmentation of twist magnitude and untwist rate.

Background: The right and left ventricles share the interventricular septum, which mechanically transmits pressure gradients. The aim of this study was to investigate how acute mild or moderate right ventricular (RV) afterload affects left ventricular (LV) function.

Methods: In 14 open-chest pigs (mean weight, 43 ± 4 kg) with preserved pericardium, acute mild (>35 and ≤50 mm Hg) and moderate (>50 and ≤60 mm Hg) RV pressure loading conditions were induced by constriction of the pulmonary artery.

Impact of pericardial adhesions on diastolic function as assessed by vortex formation time, a parameter of transmitral flow efficiency.

Background: Pericardial adhesions are a pathophysiological marker of constrictive pericarditis (CP), which impairs cardiac filling by limiting the total cardiac volume compliance and diastolic filling function. We studied diastolic transmitral flow efficiency as a new parameter of filling function in a pericardial adhesion animal model. We hypothesized that vortex formation time (VFT), an index of optimal efficient diastolic transmitral flow, is altered by patchy pericardial-epicardial adhesions.

Multimodality imaging showing complete cardiovascular involvement by Erdheim-Chester disease.

Erdheim-Chester disease (ECD) is a multisystem non-Langerhans form of cell histiocytosis. Histiocytic infiltration leads to xanthogranulomatous infiltrates of multiple organ systems. Erdheim-Chester disease was first reported in 1930, only 320 cases reported in the literature.

Cardiac risk in patients aged >75 years with asymptomatic, severe aortic stenosis undergoing noncardiac surgery.

Severe aortic stenosis (AS) is a known predictor of cardiac risk during noncardiac surgery. However, for patients with asymptomatic AS, it is unclear whether aortic valve surgery should precede noncardiac surgery. We studied 30 patients with asymptomatic, severe AS with a mean age of 78 + or - 9 years, an aortic valve area of 0.

Revisiting the simplified bernoulli equation.

Background: The assessment of the severity of aortic valve stenosis is done by either invasive catheterization or non-invasive Doppler Echocardiography in conjunction with the simplified Bernoulli equation. The catheter measurement is generally considered more accurate, but the procedure is also more likely to have dangerous complications.

Objective: The focus here is on examining computational fluid dynamics as an alternative method for analyzing the echo data and determining whether it can provide results similar to the catheter measurement.

Patients with Alzheimer disease have altered transmitral flow: echocardiographic analysis of the vortex formation time.

Objective: There is considerable epidemiologic evidence that Alzheimer disease (AD) is linked to cardiovascular risk factors and associated with an increased risk of symptomatic left ventricular (LV) dysfunction. Formation of a vortex alongside a diastolic jet signifies an efficient blood transport mechanism. The vortex formation time (VFT) is an index of optimal conditions for vortex formation.

Quantification of left ventricular twisting mechanics by velocity vector imaging in an animal model of pericardial adhesions.

Diagnosis of constrictive pericarditis remains clinically challenging. Untwisting of the left ventricle (LV) is essential for normal LV diastolic function. Echocardiography is able to measure LV twisting mechanics.

Correlation of automated function imaging (AFI) to conventional strain analyses of regional and global right ventricular function.

Background: Automated function imaging is a software tool available to facilitate the efficiency of workflow when analyzing left ventricular strain. In this study, automated function imaging was compared with a conventional approach for the analysis of right ventricular strain in normal and pressure-overloaded right ventricles.

Methods: Twelve pigs were subjected to graded acute right ventricular systolic pressure overload.

Extensive cardiac metastases secondary to uterine leiomyosarcoma.

Uterine leiomyosarcoma metastatic to multiple cardiac chambers occurs infrequently. Over the past 4 decades, there have been only 11 reported cases of cardiac metastasis secondary to uterine leiomyosarcoma. Metastatic cardiac tumors are commonly diagnosed postmortem, although it may be possible to diagnose them during life.

Selective echocardiographic analysis of epicardial and endocardial left ventricular rotational mechanics in an animal model of pericardial adhesions.

Aims: Diagnosis of pericardial adhesions is challenging. Twisting of the left ventricle (LV) is essential for normal LV functioning. We experimentally characterized the impact of pericardial adhesions on epicardial and endocardial LV rotational mechanics with velocity vector imaging (VVI).

Impact of acute moderate elevation in left ventricular afterload on diastolic transmitral flow efficiency: analysis by vortex formation time.

Background: The formation of a vortex alongside a diastolic jet signifies an efficient blood transport mechanism. Vortex formation time (VFT) is an index of the optimal conditions for vortex formation. It was hypothesized that left ventricular (LV) afterload impairs diastolic transmitral flow efficiency and therefore shifts the VFT out of its optimal range.

Increase in the late diastolic filling force is associated with impaired transmitral flow efficiency in acute moderate elevation of left ventricular afterload.

Objective: Analysis of intraventricular flow force and efficiency is a novel concept of quantitatively assessing left ventricular (LV) hemodynamic performance. We have parametrically characterized diastolic filling flow by early inflow force, late inflow force, and total inflow force and by vortex formation time (VFT), a fundamental parameter of fluid transport efficiency. The purpose of this study was to determine what changes in inflow forces characterize a decrease in diastolic blood transport efficiency in acute moderate elevation of LV afterload.

Right ventricular free wall circumferential strain reflects graded elevation in acute right ventricular afterload.

This study was designed to evaluate the concurrent changes in the right ventricular free wall (RVFW) movement in experimentally induced, acute mild, moderate, and severe right ventricle (RV) afterload conditions. In 14 open-chest pigs (weight 43 +/- 4 kg) with preserved pericardia, acute mild (>35 and <50 mmHg), moderate (> or =50 and < or =60 mmHg), and severe (>60 mmHg) increases in RV systolic pressure (RVSP) were induced by constriction of the pulmonary artery. At each step, longitudinal, radial, and circumferential strains and strain rates were measured in both the RVFW and the interventricular septum.

Contrast-enhanced right atrial mass: tumour or thrombus?

We present a case of a 61-year-old female diagnosed with soft-tissue fibrosarcoma of the shoulder with a right atrial mass on transthoracic echocardiogram. To further assess the mass, contrast transoesophageal echo was performed. The mass was highly considered to be a thrombus due to the presence of multiple risk factors: atrial fibrillation, catheter use, and pulmonary embolism.

The ability of heart failure specialists to accurately predict NT-proBNP levels based on clinical assessment and a previous NT-proBNP measurement.

Background: The value of routine aminoterminal pro type B natriuretic peptide (NT-proBNP) measurements in outpatient clinics remains unknown.

Objectives: We sought to determine the accuracy with which heart failure (HF) specialists can predict NT-proBNP levels in HF outpatients based on clinical assessment.

Methods: We prospectively studied 160 consecutive HF patients followed in an outpatient multidisciplinary HF clinic.