Trastuzumab-induced cardiotoxicity: heart failure at the crossroads.

Trastuzumab, a drug targeting human epidermal growth factor receptor 2, improves survival rate in women with metastatic breast cancer. Symptomatic heart failure, a serious adverse effect of trastuzumab, occurs in 1% to 4% of patients treated with the antibody, whereas left ventricular ejection fraction declines substantially in 10% of patients. The prevalence of cardiotoxic effects of trastuzumab appears to increase with exposure to anthracyclines.

Effect of echocardiographic contrast on velocity vector imaging myocardial tracking.

Background: Two-dimensional speckle tracking is an evolving ultrasound technology that allows objective evaluation of left ventricular function. The effect of echocardiographic contrast with 2-dimensional speckle tracking image processing is poorly defined.

Methods: A total of 11 patients undergoing clinically indicated transthoracic echocardiography who also required echocardiographic contrast for left ventricular endocardial border enhancement were prospectively studied.

Effect of sildenafil citrate (Viagra) on coronary flow in normal subjects.

Background: The purpose of this study was to evaluate the effect of sildenafil citrate (Viagra) on coronary function in normal subjects.

Methods: The study assessed mean blood pressure, left anterior descending coronary artery (LAD) flow, and echocardiographic variables before and 30 and 60 minutes after taking 50 mg of sildenafil citrate. The mean velocity of LAD flow was assessed with Doppler flow imaging.

Disparate patterns of left ventricular mechanics differentiate constrictive pericarditis from restrictive cardiomyopathy.

Objectives: The purpose of this study was to compare the longitudinal, circumferential, and radial mechanics of the left ventricle (LV) in patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM).

Background: Diastolic dysfunction in CP is related to epicardial tethering and pericardial constraint, whereas in RCM it is predominantly characterized by subendocardial dysfunction. Assessment of variations in longitudinal and circumferential deformation of LV might be useful to distinguish these 2 conditions.

Arterioventricular coupling and ventricular efficiency after antihypertensive therapy: a noninvasive prospective study.

Patients with hypertension exhibit impaired energetic coupling between the ventricle and the arterial system, leading to reduced cardiac mechanic efficiency and exercise capacity. We tested whether blood pressure normalization with current antihypertensive therapy can improve arterioventricular coupling. Eighteen hypertensive patients without other cardiovascular disease were examined before and after antihypertensive therapy.

Sildenafil citrate (Viagra) enhances vasodilatation by atrial natriuretic peptide in normal dogs.

Background: Sildenafil citrate (Viagra) is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5, which might enhance the vasorelaxant and natriuretic actions of atrial natriuretic peptide (ANP) in patients with heart failure. The objective of this study was to examine the combined effect of Viagra on hemodynamic changes during infusion of exogenous ANP.

Methods And Results: Healthy male beagles were used to assess systemic blood pressure, pulmonary artery pressure (PAP), and plasma levels of cGMP.

Effects of simultaneous and optimized sequential cardiac resynchronization therapy on myocardial oxidative metabolism and efficiency.

Introduction: Cardiac resynchronization therapy (CRT) can improve left ventricular (LV) hemodynamics and function. Recent data suggest the energy cost of such improvement is favorable. The effects of sequential CRT on myocardial oxidative metabolism (MVO(2)) and efficiency have not been previously assessed.

History of echocardiography and its future applications in medicine.

This review concisely presents the chronology of events that shaped the development of echocardiography. The concept of "seeing" structures using "sound" dates back to the 1920s, when ultrasound produced by piezoelectric crystals was used to detect flaws in metals. In the early 1950s, Hertz and Edler described the use of ultrasound for assessing mitral-valve disease.

Inferior vena cava aneurysm.

An 89-year-old woman presented to the hospital with an exacerbation of chronic obstructive airway disease and congestive heart failure symptoms. A transthoracic echocardiogram revealed an incidental inferior vena cava aneurysm.

Ventricular fibrillation in late recovery after dobutamine stress echocardiography.

A 62-year-old man with multiple cardiac risk factors, including diabetes mellitus type II, treated hypertension, and hyperlipidemia, had a dobutamine stress echocardiogram performed as part of a preoperative evaluation. At peak stress the patient developed an apical regional wall motion abnormality. Approximately 12 minutes into the recovery period, the patient developed ventricular tachycardia that degenerated into ventricular fibrillation.

Three methods for evaluation of left atrial volume.

Aim: To compare and contrast 3 different echocardiographic methods used to measure left atrial (LA) volume: biplane area length (AL), biplane modified Simpson (SIMP), and prolate ellipse (PE) methods.

Methods And Results: A review of consecutive patients who presented to our outpatient echocardiography laboratory for a resting transthoracic study between April 2006 and May 2006 was performed. Echocardiograms were reexamined and LA volume measured using the AL, SIMP, and PE methods.

Clinical use of carotid intima-media thickness: review of the literature.

Carotid intima-media thickness (CIMT) is a simple and inexpensive tool to assess the cumulative effect of atherosclerotic risk factors and is an independent predictor of future cardiovascular risk. CIMT is commonly used as a surrogate end point in research trials as a marker of atherosclerosis. However, new software programs have made CIMT a clinically practical examination for risk evaluation.

Does implantation of sonomicrometry crystals alter regional cardiac muscle function?

Background: Sonomicrometry is a gold standard in experimental studies on myocardial motion. However, limited information exists regarding mechanical and biochemical changes produced by sonomicrometry crystal (SC) insertion into the myocardial wall.

Methods: In 10 open-chest pigs, we implanted SCs into the inner half of apical anterior and midposterior regions.

Echocardiographic assessment of right heart hemodynamic parameters.

Echocardiography is currently the primary clinical method for the noninvasive measurement of right heart hemodynamic parameters and is an indispensable tool for the initial assessment, diagnosis, longitudinal follow-up, and prognostication of patients with abnormal right heart function. This review will discuss the echocardiographic methods used to estimate right heart hemodynamic parameters.

Left ventricular form and function revisited: applied translational science to cardiovascular ultrasound imaging.

Doppler tissue imaging (DTI) and DTI-derived strain imaging are robust physiologic tools used for the noninvasive assessment of regional myocardial function. As a result of high temporal and spatial resolution, regional function can be assessed for each phase of the cardiac cycle and within the transmural layers of the myocardial wall. Newer techniques that measure myocardial motion by speckle tracking in gray-scale images have overcome the angle dependence of DTI strain, allowing for measurement of 2-dimensional strain and cardiac rotation.

Comparison of cardiac structural and functional changes in obese otherwise healthy adults with versus without obstructive sleep apnea.

Obstructive sleep apnea (OSA) and obesity have been linked to systolic and diastolic dysfunction of the left ventricle. Right ventricular function is poorly understood in the 2 clinical conditions. Data from this study show that otherwise healthy obese patients with OSA had increased an left atrial volume index compared with similarly obese patients without OSA (16.

Vascular abnormalities in primary amyloidosis.

Aims: Primary amyloidosis (AL) is a systemic disease; however, there is limited information regarding the presence and character of vascular abnormalities.

Methods And Results: Validated ultrasound techniques were used to prospectively determine carotid artery intimal-medial thickness (IMT) and brachial artery flow-mediated dilatation (FMD) in 59 consecutive AL patients and 17 age-similar, healthy, asymptomatic volunteers (CON). Carotid IMT was increased in AL when compared with CON (0.

Left ventricular isovolumic flow sequence during sinus and paced rhythms: new insights from use of high-resolution Doppler and ultrasonic digital particle imaging velocimetry.

Objectives: We sought to clarify the role of isovolumic intervals during a cardiac cycle by in vivo visualization of left ventricular (LV) intracavitary flow dynamics.

Background: Asynchronous LV deformation during isovolumic contraction (IVC) and isovolumic relaxation (IVR) might represent a transient feature of myocardial wall mechanics that reverses the direction of blood flow.

Methods: In 10 beating porcine hearts, the changes in LV intracavitary flow were recorded at baseline and after LV epicardial and right atrial pacing with high-resolution Doppler and contrast echocardiography.

Diastolic function: a sonographer's approach to the essential echocardiographic measurements of left ventricular diastolic function.

Noninvasive assessment of left ventricular filling pressures by echocardiography has been validated by invasive hemodynamic studies and correlated with clinical findings. A comprehensive echocardiographic examination based on the referral diagnosis and patient symptomatology routinely includes efforts to measure specific parameters of left ventricular diastolic function. We provide a step-by-step approach to goal-directed echocardiographic assessment of diastolic function.

High spatial resolution speckle tracking improves accuracy of 2-dimensional strain measurements: an update on a new method in functional echocardiography.

Background: We previously found that a 2-dimensional (2D) strain echocardiography method had some limitations in the assessment of low magnitudes and rates of deformation. Here, we study whether a recently introduced high spatial resolution speckle tracking (HRT) method improves accuracy of 2D strain measurements.

Methods: A gelatin block was cyclically compressed by a hydraulic piston.

Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease.

We investigated the influence of > or =70% luminal coronary artery stenosis on regional diastolic deformation at rest using 2-dimensional strain echocardiography. We prospectively imaged patients during/within 24 hours of coronary angiography. Longitudinal systolic (SRs), early (SRe), and late diastolic strain rates, systolic, early, and late diastolic strain and times to isovolumic relaxation and peak SRe were measured in the 3 major vascular territories.

Left ventricular structure and function: basic science for cardiac imaging.

The myofiber geometry of the left ventricle (LV) changes gradually from a right-handed helix in the subendocardium to a left-handed helix in the subepicardium. In this review, we associate the LV myofiber architecture with emerging concepts of the electromechanical sequence in a beating heart. We discuss: 1) the morphogenesis and anatomical arrangement of muscle fibers in the adult LV; 2) the sequence of depolarization and repolarization; 3) the physiological inhomogeneity of transmural myocardial mechanics and the apex-to-base sequence of longitudinal and circumferential deformation; 4) the sequence of LV rotation; and 5) the link between LV deformation and the intracavitary flow direction observed during each phase of the cardiac cycle.