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.

Velocity vector imaging in the measurement of left ventricular myocardial mechanics on cardiac magnetic resonance imaging: correlations with echocardiographically derived strain values.

Background: Regional and global function can be measured by echocardiography using speckle-tracking, a technique that has previously been validated against crystal sonomicrometry. However, the application of Velocity Vector Imaging (VVI) to images obtained from cardiac magnetic resonance (CMR) imaging has never been validated against those values derived from VVI applied to two-dimensional echocardiographic images in the same patient group. The aim of this study was to validate for the first time the application of VVI to retrospectively acquired CMR data sets for the assessment of left ventricular strain and rotation, using echocardiographic strain assessment by VVI as the reference technique.

Myocardial mechanical remodeling after septal myectomy for severe obstructive hypertrophic cardiomyopathy.

Background: Septal myectomy for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) is a well-established procedure for symptomatic relief. Myocardial mechanics are abnormal in patients with HOCM, demonstrating low longitudinal strain, high circumferential strain, and high apical rotation compared with healthy subjects. The aim of this study was to determine whether functional improvement after myectomy is associated with improved myocardial mechanics.

Hypertrophy pattern and regional myocardial mechanics are related in septal and apical hypertrophic cardiomyopathy.

Background: Hypertrophic cardiomyopathy (HCM) is associated with considerable phenotypic heterogeneity. Previous studies have shown a relationship between the degree and location of hypertrophy and the prognosis of patients. The aim of this study was to compare left ventricular (LV) circumferential and longitudinal regional mechanics in patients with septal HCM and apical HCM to study the relationship between hypertrophy and function as assessed by myocardial mechanics.

Endothelial function, carotid-femoral stiffness, and plasma matrix metalloproteinase-2 in men with bicuspid aortic valve and dilated aorta.

Objectives: This study sought to examine the relationship between proximal aortic dilation and systemic vascular function in men with bicuspid aortic valve (BAV).

Background: Proximal aortic dilation in subjects with BAV is associated with structural and functional abnormalities in the ascending aorta.

Methods: We studied 32 men (median age 31 years [range 28 to 32 years]) with nonstenotic BAV categorized into 2 subgroups according to proximal ascending aorta dimensions (nondilated or=40 mm, respectively).

Diastolic myocardial mechanics in hypertrophic cardiomyopathy.

Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocardial hypertrophy, fiber disarray, and fibrosis interfering with myocardial force generation and relaxation. Because conventional Doppler echocardiographic methods inadequately assess diastolic function in HCM, the aim of this study was to determine local and global left ventricular (LV) relaxation mechanics in patients with HCM.

Methods: Seventy-two patients with HCM and 32 normal controls were studied.

Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves.

Background: Aortic dilatation is common among adults with bicuspid aortic valves (BAV). Predictors of risk and progression of aortic dilatation are not well described in this setting.

Methods: We analyzed retrospective data on the presence of dilation in several aortic segments in 156 adult patients with BAV who had serial echocardiograms performed at least 1 year apart.

Outcomes in adults with bicuspid aortic valves.

Context: Bicuspid aortic valve is the most common congenital cardiac anomaly in the adult population. Cardiac outcomes in a contemporary population of adults with bicuspid aortic valve have not been systematically determined.

Objective: To determine the frequency and predictors of cardiac outcomes in a large consecutive series of adults with bicuspid aortic valve.

Systolic myocardial mechanics in hypertrophic cardiomyopathy: novel concepts and implications for clinical status.

In hypertrophic cardiomyopathy (HCM), malfunctioning sarcomeric protein, myocyte hypertrophy, fiber disarray, and interstitial fibrosis interfere with systolic myocardial mechanics despite clinically hyperdynamic systolic function. We evaluated local left ventricular (LV) mechanics in 72 patients with HCM and 32 control subjects using 2-dimensional velocity vector imaging. Patients had higher circumferential strain (-34 +/- 9 vs -29 +/- 8, P < .

Myocardial mechanics explains the time course of benefit for septal ethanol ablation for hypertrophic cardiomyopathy.

We hypothesized that the time course of left ventricular (LV) outflow tract gradient reduction during septal ethanol ablation for patients with symptomatic hypertrophic obstructive cardiomyopathy is related to changes in myocardial mechanics. A total of 21 patients with hypertrophic obstructive cardiomyopathy undergoing septal ethanol ablation were analyzed. LV outflow tract gradient decreased with septal balloon occlusion, further decreased postethanol injection, and partially rebounded at discharge (5-6 days postprocedure).

Prognostic value of myocardial perfusion contrast echocardiography in patients with suggested or known ischemic heart disease.

Objective: We sought to determine the prognostic value of myocardial contrast echocardiography (MCE) in patients with known or suggested coronary artery disease compared with technetium-99m sestamibi single photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI).

Background: The prognostic value of SPECT-MPI is well established for patients with coronary artery disease. It is less well defined by MCE.

Enlarged left atrial volume in hypertrophic cardiomyopathy: a marker for disease severity.

Background: Patients with hypertrophic cardiomyopathy and left atrial (LA) enlargement have increased morbidity and mortality. We analyzed the clinical and echocardiographic factors related to LA enlargement, particularly the degree of left ventricular (LV) hypertrophy and diastolic function.

Methods: A total of 104 patients with hypertrophic cardiomyopathy (age 53 +/- 15 years, 64% men) were divided into two groups based on the indexed LA volume (LAVI) (mL/m2) measured by echocardiography: group A (or smaller LAVI group, n = 43) was defined as LAVI < or = 34 mL/m2; and group B (or larger LAVI group, n = 61) as LAVI > 34 mL/m2.

Usefulness of myocardial contrast echocardiographic quantification of risk area for predicting postprocedural complications in patients undergoing septal ethanol ablation for obstructive hypertrophic cardiomyopathy.

Septal ethanol ablation (SEA) is an alternative to surgical myectomy in patients who have drug-refractory obstructive hypertrophic cardiomyopathy. However, permanent atrioventricular conduction block is seen more frequently with SEA. To determine whether septal infarction risk area (SIRA) predicts outcome in patients who have obstructive hypertrophic cardiomyopathy and are undergoing SEA, we evaluated 51 patients (mean age 60 +/- 16, 53% women) who had a successful SEA at Toronto General Hospital (November 1998 to June 2003).

Incremental value of parametric quantitative assessment of myocardial perfusion by triggered Low-Power myocardial contrast echocardiography.

Objectives: The purpose of this study was to compare the assessment of myocardial perfusion by myocardial parametric quantification (MPQ) with technetium-99m sestamibi single-photon emission computed tomographic (SPECT) imaging in humans.

Background: Accurate visual interpretation of myocardial contrast echocardiographic (MCE) images is qualitative and requires considerable experience. Current computer-assisted quantitative perfusion protocols are tedious and lack spatial resolution.

Determination of left ventricular ejection fraction using intravenous contrast and a semiautomated border detection algorithm.

Manual endocardial tracing using Simpson's method (MANUAL SIMP) provides an accurate assessment of left-ventricular ejection fraction (LVEF). We have previously demonstrated in patients who are difficult to image: (1) the incremental accuracy of contrast-enhanced power harmonic imaging and MANUAL SIMP in the calculation of LVEF; and (2) the use of intravenous contrast-combined MANUAL SIMP was the most accurate method of LVEF determination. However, MANUAL SIMP is time-consuming, requires accurate planimetry of the endocardial borders, and is difficult to apply routinely in the clinical situation.