Publications by authors named "Deborah Agler"

Background: Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern.

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Background: In patients with hypertrophic cardiomyopathy and left ventricular outflow tract (LVOT) obstruction, but without basal septal hypertrophy, we sought to identify mitral valve (MV) and papillary muscle (PM) abnormalities that predisposed to LVOT obstruction, using echo and cardiac magnetic resonance.

Methods And Results: We studied 121 patients with hypertrophic cardiomyopathy hypertrophic cardiomyopathy (age, 49±17 years; 60% men; 57% on β-blockers) with a basal septal thickness of ≤1.8 cm who underwent echocardiography (rest+stress) and cine cardiac magnetic resonance.

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Background: Longitudinal strain (LS) imaging is an important tool for the quantification of left ventricular function and deformation, but its assessment is challenging in the presence of echocardiographic contrast agents (CAs). The aim of this study was to test the hypothesis that destruction of microbubbles using high mechanical index (MI) could allow the measurement of LS.

Methods: LS was measured using speckle strain (speckle-tracking LS [STLS]) and Velocity Vector Imaging (VVI) before and after CA administration in 30 consecutive patients.

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Objective: To assess the effects of frame and volume rate on the concordance between two-dimensional speckle tracking strain (2DS) and three-dimensional speckle tracking strain (3DS), and between 2DS and triplane imaging of speckle tracking (Tri-P).

Methods: Global longitudinal strains (GLSs) derived from 2DS, 3DS, and Tri-P were compared among 142 prospectively recruited patients who underwent evaluation of subclinical left ventricle (LV) function.

Results: Feasibility to obtain GLS of 3DS was significantly higher than that of Tri-P (76% vs.

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Objective: In patients with ischemic mitral regurgitation (IMR), we assessed dynamic changes in mitral annular geometry and motion during the cardiac cycle, and examined their association with the severity of IMR, using our computerized three-dimensional (3D) echo method.

Methods: Real-time 3D echo was performed in 12 normal controls and 25 patients with IMR. The saddle-shaped annulus was reconstructed in every 3D volume/frame during a cardiac cycle.

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Background: Left atrial (LA) volume is a prognostic index in chronic mitral regurgitation (MR). However, little is known about LA function in this setting. We hypothesized that LA dysfunction is related to pulmonary hypertension in chronic MR.

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Objectives: This study sought to assess whether longitudinal rotation (LR) affects myocardial systolic velocity profiles and to compare velocity-based measures of dyssynchrony with LR for predicting cardiac resynchronization therapy (CRT) response.

Background: Longitudinal rotation, a rocking motion often seen when the dilated left ventricle (LV) is imaged in its horizontal long-axis plane, is a recently recognized phenomenon and a new predictor of response to CRT.

Methods: One hundred patients with CRT implants and suitable baseline echocardiograms were identified.

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Background: Although atrial ventricular (AV) intervals are often optimized at rest in patients receiving cardiac resynchronization therapy (CRT), there are limited data on the impact of exercise on optimal AV interval.

Methods: In 15 patients with CRT, AV intervals were serially programmed while patients were supine and at rest, and during exercise with heart rates that averaged 20 and 40 beats per minute above their resting rates. Echocardiographic Doppler images were acquired at each programmed AV interval and each rate.

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Echocardiography plays an evolving and important role in the care of heart failure patients treated with biventricular pacing, or cardiac resynchronization therapy (CRT). Numerous recent published reports have utilized echocardiographic techniques to potentially aide in patient selection for CRT prior to implantation and to optimized device settings afterwards. However, no ideal approach has yet been found.

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Background: The geometry of the proximal isovelocity surface area (PISA) of functional mitral regurgitation (MR), which is conventionally assumed to be a hemisphere, remains to be clarified. We investigated the 3-dimensional (3D) geometry of PISA of functional MR as opposed to that of MR due to mitral valve prolapse (MVP) by real-time 3D echocardiography with color Doppler capability.

Methods: Twenty-seven patients with functional MR and 27 patients with MVP were examined.

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Objective: Most studies of the pathogenesis of functional mitral regurgitation (MR) have focused on alterations in ventricular function and geometry. We used a novel 3D echocardiographic method to assess abnormalities in mitral annular (MA) geometry and motion in patients with ischemic MR (IMR) and compared these data to those obtained from normal subjects and from patients with MR caused by dilated cardiomyopathy (DMR).

Methods: Real time 3D echo was performed in 12 normal subjects, 25 with IMR, and 14 with DMR.

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Cardiac resynchronization therapy has been established as an adjunctive treatment for patients with severe left ventricular systolic dysfunction and medically refractory heart failure symptoms with a prolonged electrocardiographic QRS interval. Echocardiography has emerged as a useful method to evaluate patients who are considered for cardiac resynchronization therapy. This review outlines measurements of ventricular performance to be used in this patient population including echocardiographic optimization of cardiac resynchronization therapy device settings.

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Cardiac resynchronization therapy (CRT) has been established as an adjunctive treatment for patients with left ventricular systolic dysfunction and medically refractory heart failure with a wide QRS interval. Echocardiography can be used to determine the response in left ventricular structure and function after device implantation and emerging evidence as a method for selection of patients who may derive clinical benefit from CRT. This review discusses the applications of CRT, including results of clinical trials and the current experience using echocardiography.

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Objective: We sought to elucidate the geometric determinants of ischemic mitral regurgitation (IMR) in patients with chronic anterior myocardial infarction (MI).

Materials And Methods: In 16 patients with anterior MI only (Group A) and 18 patients with both anterior and inferoposterior MI (Group B), three parallel equidistant anteroposterior (AP) planes (medial, central, lateral) perpendicular to the mitral valvular commissure-commissure plane were generated. The systolic tenting area of the mitral valve (MVTa) and the angles between the annular plane and leaflets (anterior, Aalpha; posterior, Palpha) on the AP planes were measured.

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By geometric analysis of real-time 3-dimensional echocardiography performed in 39 patients with hypertrophic obstructive cardiomyopathy and definite systolic anterior motion of the mitral valve, we found that the angle between the mitral annular plane and basal portion of the anterior mitral valve leaflet, and the angle between the basal portion of the anterior leaflet and its tip portion measured in the medial and central anteroposterior planes, were significantly smaller than those in the lateral plane. The distance between the interventricular septum and the anterior mitral valve tip in the medial and central plane was also significantly smaller than that in the lateral plane. The lateral distance between the interventricular septum and the anterior mitral valve tip was the only independent determinant of left ventricular outflow tract pressure gradient by multiple stepwise regression analysis.

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The optimal pacing site in cardiac resynchronization therapy (CRT) remains controversial. Tissue synchronization imaging is a novel echocardiographic technique that color-codes for areas of maximal delay in myocardial velocities. This study aimed to identify whether the left ventricular (LV) pacing lead position in CRT should be guided by a patient's area of maximal mechanical delay.

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Objectives: The aim of this study was to investigate the relationship between dynamics of functional mitral regurgitation (MR) and the degree of electrical conduction disturbance, and to evaluate the impact of cardiac resynchronization therapy (CRT) on MR severity and its phasic pattern.

Background: Mechanisms of phasic changes of functional MR, which may be determined by annulus dilation and tethering of the leaflet, remain unclear.

Methods: Transthoracic two-dimensional echocardiography was performed in 60 patients with functional MR.

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Background: The comparative impact of percutaneous alcohol septal reduction (ASR) and surgical myectomy on the left ventricular outflow tract (LVOT) area in patients with obstructive hypertrophic cardiomyopathy (HC) is not well defined. Real-time 3-dimensional echocardiography (RT3DE) provides accurate information about the LVOT geometry and shape. We aimed to analyze the change in LVOT area after septal reduction interventions in patients with obstructive HC using RT3DE.

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We developed an automated mitral annular tracking method based on a digital processing of high frame rate cineloop images of 2-dimensional echocardiography. In this study, its feasibility and accuracy was validated in 11 healthy volunteers and 16 patients with left ventricular (LV) dysfunction. The mitral annular excursion measured by automated mitral annular tracking agreed well with that measured by 3-dimensional echocardiography and correlated with LV ejection fraction.

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Background: Annular geometry and motion in functional ischemic mitral regurgitation are incompletely understood. Three-dimensional echocardiography demonstrates saddle-shaped annular geometry, but standard methodology does not enable quantification of annular motion. Therefore, a novel technique using three-dimensional echocardiography and computer software was used to characterize alterations in mitral annular geometry and motion in patients with ischemic mitral regurgitation.

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Aims: To validate the accuracy of mitral annular motion assessed by real-time three-dimensional echocardiography (RT3DE) as a surrogate for determination of the left ventricular function in comparison with magnetic resonance imaging (MRI).

Methods And Results: Forty-seven patients with a variety of cardiac pathologies underwent both RT3DE and MRI exams. After 3D data sets were transferred to a PC with a custom-made program, nine consecutive rotational apical plane images (20 degrees apart) were displayed.

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