Recommendations of the European Association of Echocardiography: how to use echo-Doppler in clinical trials: different modalities for different purposes.

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.

Monitoring in vivo absorption of a drug-eluting bioabsorbable stent with intravascular ultrasound-derived parameters a feasibility study.

Objectives: The aim of this study was to investigate the feasibility of using quantitative differential echogenicity to monitor the in vivo absorption process of a drug-eluting poly-l-lactic-acid (PLLA) bioabsorbable stent (BVS, Abbott Vascular, Santa Clara, California).

Background: A new bioabsorbable, balloon-expanded coronary stent was recently evaluated in a first-in-man study. Little is known about the absorption process in vivo in diseased human coronary arteries.

Compositional volumetry of non-calcified coronary plaques by multislice computed tomography: an ex vivo feasibility study.

Aims: Non-invasive quantitative compositional analysis of coronary plaque would be a major advantage to study coronary artery disease. This study explores the application to use the Hounsfield units (HU) distribution of coronary plaques imaged by multislice computed tomography-coronary angiography (MSCT-CA).

Methods And Results: A dedicated computer-assisted method was developed to measure the HU distribution within a coronary plaque by MSCT-CA.

European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography.

The main mission statement of the European Association of Echocardiography (EAE) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound in Europe'. As competence and quality control issues are increasingly recognized by patients, physicians, and payers, the EAE has established recommendations for training, competence, and quality improvement in echocardiography. The purpose of this document is to provide the requirements for training and competence in echocardiography, to outline the principles of quality measurement, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice in Europe.

Coronary calcium significantly affects quantitative analysis of coronary ultrasound: importance for atherosclerosis progression/regression studies.

Background: Coronary atherosclerosis is a dynamic process, which progresses differently in coronary segments containing noncalcified or calcified plaques. This may have implications for the study of the effects of therapy on progression/regression.

Objective: To test this hypothesis, we performed a post-hoc analysis on data of a randomized trial in which perindopril treatment was compared with placebo on progression/regression of atherosclerosis with regard to the degree of calcification.

Partial ventricular septal defect (Pacman Heart).

Complete ventricular septal defects (VSD) can be congenital (estimated prevalence 0.5% in live births) (Roguin N, et al. High prevalence of muscular ventricular septal defect in neonates.

Contrast-enhanced three-dimensional dobutamine stress echocardiography: between Scylla and Charybdis?

Aims: Real-time three-dimensional echocardiography (RT3DE) allows quick volumetric scanning of the left ventricle (LV). We evaluated the diagnostic accuracy of contrast-enhanced stress RT3DE for the detection of coronary artery disease (CAD) in comparison with coronary arteriography as the reference technique.

Methods And Results: Forty-five consecutive patients (age 59 +/- 10, 31 males) referred for coronary angiography were examined by contrast-enhanced RT3DE.

Three-dimensional and quantitative analysis of atherosclerotic plaque composition by automated differential echogenicity.

Objective: To validate automated and quantitative three-dimensional analysis of coronary plaque composition using intracoronary ultrasound (ICUS).

Background: ICUS displays different tissue components based on their acoustic properties in 256 grey-levels. We hypothesised that computer-assisted image analysis (differential echogenicity) would permit automated quantification of several tissue components in atherosclerotic plaques.

Comparison of contrast agent-enhanced versus non-contrast agent-enhanced real-time three-dimensional echocardiography for analysis of left ventricular systolic function.

Ultrasound contrast has shown to improve endocardial border definition. The purpose of this study was to evaluate the value of contrast agent-enhanced versus non-contrast agent-enhanced real-time 3-dimensional echocardiography (RT3DE) for the assessment of left ventricular (LV) volumes and ejection fraction. Thirty-nine unselected patients underwent RT3DE with and without SonoVue contrast agent enhancement and magnetic resonance imaging (MRI) on the same day.

Three-dimensional echocardiographic analysis of left ventricular function during hemodialysis.

Background: The effects of hemodialysis (HD) on left ventricular (LV) function have been studied by various echocardiographic techniques (M-mode, 2D echocardiography). These studies are hampered by a low accuracy of measurements because of geometric assumptions regarding LV shape. Three-dimensional echocardiography (3DE) overcomes this limitation.

Can echocardiographic findings predict falls in older persons?

Background: The European and American guidelines state the need for echocardiography in patients with syncope. 50% of older adults with syncope present with a fall. Nonetheless, up to now no data have been published addressing echocardiographic abnormalities in older fallers.

Reproducible coronary plaque quantification by multislice computed tomography.

Background: The aim of this study was to investigate reproducibility and accuracy of computer-assisted coronary plaque measurements by multislice computed tomography coronary angiography (QMSCT-CA).

Methods And Results: Forty-eight patients undergoing MSCT-CA and coronary arteriography for symptomatic coronary artery disease and quantitative intravascular ultrasound (IVUS, QCU) were examined. Two investigators performed the QMSCT-CA twice and a third investigator performed the QCU, all blinded for each other's results.

Efficient quantification of the left ventricular volume using 3-dimensional echocardiography: the minimal number of equiangular long-axis images for accurate quantification of the left ventricular volume.

For quantification of the left ventricular volume from 3-dimensional echocardiograms a number of cross-sectional images are used. The goal of this study was to determine the minimum number of long-axis images necessary for accurate quantification of the left ventricular volume. A strong correlation was observed between volumes obtained from magnetic resonance imaging and 3-dimensional echocardiography using 16 equiangular images (r = 0.

Harmonic 3-D echocardiography with a fast-rotating ultrasound transducer.

Although the advantages of three-dimensional (3-D) echocardiography have been acknowledged, its application for routine diagnosis is still very limited. This is mainly due to the relatively long acquisition time. Only recently has this problem been addressed with the introduction of new real-time 3-D echo systems.

Rapid and accurate measurement of left ventricular function with a new second-harmonic fast-rotating transducer and semi-automated border detection.

Measurement of left ventricular (LV) volume and function are the most common clinical referral questions to the echocardiography laboratory. A fast, practical, and accurate method would offer important advantages to obtain this important information. To validate a new practical method for rapid measurement of LV volume and function.

Benefits of coronary revascularisation in diabetic and non-diabetic patients with ischaemic cardiomyopathy: role of myocardial viability.

Background: Diabetes mellitus in patients with coronary artery disease is associated with poor outcome. In this study, the relation between myocardial viability, diabetes, coronary revascularisation and outcome was evaluated.

Methods: 129 patients (31 diabetic, 98 non-diabetic) with ischaemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability.

Clinical and prognostic implications of angina pectoris developing during dobutamine stress echocardiography in the absence of inducible wall motion abnormalities.

This study assessed the incidence, clinical correlates, and prognostic significance of angina during dobutamine stress echocardiography (DSE) in patients who did not have inducible wall motion abnormalities. We studied 2,117 patients (61 +/- 13 years of age; 1,149 men) who underwent large-dose DSE and had no new or worsening wall motion abnormalities during DSE. Follow-up events were hard cardiac events (cardiac death or nonfatal myocardial infarction) and myocardial revascularization.

Effect of myocardial ischemia during dobutamine stress echocardiography on cardiac mortality in patients with heart failure secondary to ischemic cardiomyopathy.

This study assessed the effect of ischemia during dobutamine stress echocardiography (DSE) on cardiac mortality in patients with heart failure. We studied 528 patients (62 +/- 11 years of age, 402 men) who had heart failure and previous myocardial infarction or known coronary artery disease and underwent DSE. Ischemia was defined as new or worsening wall motion abnormalities or a biphasic response.

Relation of improvement in left ventricular ejection fraction versus improvement in heart failure symptoms after coronary revascularization in patients with ischemic cardiomyopathy.

In the present study, the relation between improvement in the left ventricular ejection fraction (LVEF) and heart failure symptoms was evaluated in 100 patients with ischemic cardiomyopathy undergoing coronary revascularization. In patients with viable myocardium, the improvement in the LVEF after revascularization was accompanied by improvement in heart failure symptoms in most patients (80%); most viable patients (75%) without improvement in LVEF also showed an improvement in New York Heart Association functional class. Conversely, most nonviable patients failed to improve in LVEF or New York Heart Association class.

The presence of contractile reserve has no predictive value for the evolution of left ventricular function following atrio-ventricular node ablation in patients with permanent atrial fibrillation.

Aims: Transcatheter ablation of the atrio-ventricular (AV) node followed by ventricular pacing has been shown to improve symptoms and quality of life (QOL) of patients with permanent atrial fibrillation (AF). In a considerable number of patients, cardiac function deteriorates after AV node ablation. We aimed to determine whether the absence of contractile reserve assessed by low dose dobutamine stress echocardiography (LDDSE) could identify those patients whose left ventricular (LV) function deteriorates after AV node ablation.

Impact of hand-carried cardiac ultrasound on diagnosis and management during cardiac consultation rounds.

Aim: To evaluate the impact of hand-carried cardiac ultrasound (HCU) on the diagnosis and management of patients during cardiac consultation rounds.

Methods And Results: One hundred and fifty patients hospitalized in non-cardiac units were included after the consulting cardiologist felt that an echocardiographic examination was indicated as part of his work-up. They were randomly allocated to echocardiography with an HCU device (SonoHeart, SonoSite, Inc.

Current subjective state of health, and longitudinal psychological well-being over a period of 10 years, in a cohort of adults with congenital cardiac disease.

Objective: To examine the current subjective state of health, and the longitudinal course of psychological well-being, in adult patients with congenital cardiac malformations.

Methods: Our study concerns the second follow-up of a cohort of patients with congenital cardiac malformations. We examined 362 consecutive patients, aged from 20 to 46 years, who underwent surgical procedures for treatment of congenital cardiac disease between 1968 and 1980, specifically for treatment of atrial and ventricular septal defects, tetralogy of Fallot, transposition, and pulmonary stenosis.

Usefulness of contrast echocardiography for diagnosis of left ventricular noncompaction.

Many imaging modalities have been evaluated for the diagnosis of left ventricular noncompaction (LVNC). Echocardiography with color Doppler flow imaging is currently the diagnostic modality of choice. In this study, the usefulness of contrast echocardiography to diagnose LVNC was examined, and the diagnostic criteria were evaluated.

Post-systolic shortening during dobutamine stress echocardiography predicts cardiac survival in patients with severe left ventricular dysfunction.

Background: Patients with severe left ventricular dysfunction and myocardial viability by dobutamine stress echocardiography (DSE) or F18-fluorodeoxyglucose-single-photon emission computed tomography (FDG-SPECT), experience improved survival after coronary revascularization. Pulsed wave-tissue Doppler imaging (PW-TDI)-derived ejection phase shortening (EPS) and post-systolic shortening (PSS) velocities may help to quantify DSE. We assessed these variables in a prospective long-term follow-up.