1,721,051 research outputs found
4D MDCT in the assessment of the tricuspid valve and its spatial relationship with the right coronary artery: A customized tool based on computed tomography for the planning of percutaneous procedures
Full text linkMultidetector computed tomography (MDCT) is currently the imaging technique of choice for the assessment of tricuspid valve (TV) annulus geometry and relationship with the right coronary artery (RCA). However, standardized protocols with a full 3D analysis are still lacking to plan percutaneous procedures for functional tricuspid regurgitation (FTR). A novel customized 4-dimensional tool based on MDCT data was developed and provided accurate information on TV annulus morphology (3D-perimeter, 2D-Area, maximum and minimum diameters, eccentricity index), function and distance to the RCA, crucial for patient selection of percutaneous TV procedures
EACVI survey on standardization of cardiac chambers quantification by transthoracic echocardiography
Full text linkAIMS
To evaluate standard reporting of cardiac chambers size and function by transthoracic echocardiography (TTE), the EACVI Scientific Initiatives Committee performed a survey across European centres. In particular, the routine use of three-dimensional echocardiography (3DE) and speckle tracking-derived myocardial deformation imaging (STE) was explored.
METHODS AND RESULTS
A total of 96 European Echocardiography Laboratories from 22 different countries responded to the survey, which consisted of 20 questions. For most of the standard parameters of cardiac chamber size and function, answers from the centres were homogeneous and demonstrated good adherence to current recommendations. In particular, all centres assessed left ventricular (LV) and left atrial (LA) size combining diameter measurements with volumes obtained using the bi-plane Simpson's method. More variability was observed in the measurements of the right heart chambers and thoracic aorta. Interestingly, >90% of centres had access to 3DE and STE; however, the large majority of centres reserved the use of these techniques for selected cases, particularly for the measure of 3D LV volumes and ejection fraction and global longitudinal strain in patients being considered for cardiac device implantation, surgical intervention (valvular heart disease) or screened for cardiotoxicity. Only 10% of centres used 3DE for right ventricular and LA volumes. Also, <30% of the centres used LA strain imaging.
CONCLUSION
In Europe, a good adherence to current recommendations was observed for most of the standard parameters of cardiac chambers quantification by TTE. Advanced echocardiography modalities, such as 3DE and STE, are widely available but used only in selected cases
Right ventricular strain in Fabry disease: Prognostic implications
Full text linkIntroduction: Left ventricular (LV) hypertrophy is the main feature of cardiac involvement in Anderson-Fabry disease (FD), but the right ventricle (RV) is also frequently affected. Previous studies failed to demonstrate an independent association between conventional parameters of RV performance and outcomes in FD. Nevertheless, if RV free wall strain (RV-FWS), assessed by 2D speckle tracking analysis, may provide a better prognostication is currently unknown. Methods: We retrospectively evaluated the association between RV-FWS and the occurrence of cardiovascular events in a cohort of 56 patients with FD. The study endpoint comprises cardiovascular mortality, severe heart failure symptoms, new-onset atrial fibrillation and major arrhythmias requiring device implantation. Results: Reduced RV-FWS, defined by values lower than 23%, was found in 25 (45%) patients. During a median follow-up of 47 months, 16 (29%) patients met the study endpoint. A ROC-curve analysis confirmed the threshold of reduced RV-FWS (<23%) as the best cut-off for predicting cardiovascular events, but with a lower power compared to left-sided parameters. On univariable Cox regression analysis, RV-FWS, expressed as continuous variable, was significantly associated with the study endpoint (HR: 0.795, 95% CI: 0.710-0.889, p < 0.001). However, RV-FWS did not retain a significant association with outcomes, after adjustment for LV global longitudinal strain or indexed left atrial volume (p = 0.340 and p = 0.289 respectively). Conclusions: RV-FWS was not independently associated with the occurrence of cardiovascular events in FD, confirming previous observations that prognosis is mainly driven by the severity of LV cardiomyopathy
Prognostic Implications of Right Ventricular Size and Function in Patients Undergoing Cardiac Resynchronization Therapy
No full textC ardiac resynchronization therapy (CRT) is an established treatment for patients with symptomatic chronic heart failure, reduced left ventricular ejection fraction (≤35%), and a QRS duration ≥130 ms. 1 Furthermore, chronic left ventricular failure is the most frequent cause of right ventricular (RV) adverse remodeling, a complex process consisting of progressive RV dilatation and dysfunction. 2 Both parameters individually, RV dilatation and RV dysfunction, are important prognostic markers in CRT-recipients. 3,4 However, the prognostic value of both parameters in a single model has not been evaluated. Accordingly, this study evaluated the prognostic value of RV remodeling in CRT-recipients. CRT-recipients with echocardiographic data on RV remodeling, before CRT implantation (both CRT-D and CRT-P), were identified from the departmental database of the Leiden University Medical Center (Leiden, The Netherlands). RV remodeling was assessed by RV size (measured by indexed RV end-diastolic area [right ventricular end-diastolic area−indexed for body surface area] using sex-specific cutoff values to define RV dila-tation: right ventricular end-diastolic area−indexed for body surface area >12.6 cm 2 /m 2 for men and right ven-tricular end-diastolic area−indexed for body surface area >11.5 cm 2 /m 2 for women) and RV function (measured by tricuspid annular plane systolic excursion) with tricus-pid annular plane systolic excursion <17 mm considered as a reduced RV function). 5 Subsequently, patients were classified into 4 remodeling patterns: (1) normal RV size and function; (2) RV dilatation and normal RV function; (3) normal RV size and RV dysfunction; (4) RV dilatation and RV dysfunction (Figure). The primary end point was all-cause mortality. Cumulative survival rates were calculated using the Kaplan-Meier method. To investigate the association between RV size and RV function with all-cause mortality , multivariable Cox proportional hazards regression analysis was performed, adjusting for variables known to have an impact on prognosis. The incremental prognos-tic value of RV size and RV function was assessed by likelihood-ratio testing evaluating the change in global χ 2 values. This retrospective analysis was approved by the institutional review board of the Leiden University Medical Center, and the need for patient written informed consent was waived. The research reported in this article adhered to the Helsinki Declaration. The data that support the findings of this study are available from the corresponding author upon reasonable request. Of the 773 patients (mean age 66±10 years, 75% males) included, 264 (34%) patients had pattern 1, 101 (13%) had pattern 2, 256 (33%) had pattern 3, and 152 (20%) had pattern 4, prior to CRT implantation. A total of 414 (54%) patients had an ischemic cause of heart failure. A total of 739 (96%) patients received CRT-D, and only 34 (4%) patients had CRT-P with a comparable distribution among the 4 remodeling patterns. Overall, 130 (17%) patients had atrial fibrillation, and the mean QRS duration was 168±26 ms. Mean left ventricular ejection fraction was 27±8%, mean right ventricular end-diastolic area−indexed for body surface area was 11.5±3.5 cm 2 /m 2 , and mean tricuspid annular plane sys-tolic excursion was 16±5 mm. When comparing the 4 RV remodeling patterns, ischemic cause varied significantlyThe Department of Cardiology, Heart Lung Center, Leiden University Medical Center has received research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Ionis and Medtronic. Dr Stassen received an European Society of Cardiology Training Grant (App000064741). Dr Hirasawa received an European Society of Cardiology Research Grant (R-2018-18122). Dr Delgado received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, Medtronic, MSD and Novartis. Dr Ajmone Marsan received speaker fees from Abbott Vascular and GE Healthcare. Dr Bax received speaker fees from Abbott Vascular. The remaining authors report no conflicts
The year in cardiovascular medicine 2022: the top 10 papers in cardiovascular imaging
No full textСърдечно-съдовата медицина през 2022 г.: 10-те най-добри статии в сърдечно-съдовата образна диагностика The year in cardiovascular medicine 2022: the top 10 papers in cardiovascular imagin
Mitral Annular Disjunction in the Context of Mitral Valve Prolapse: Identifying the At-Risk Patient
Full text link: Mitral annular disjunction (MAD), a separation between the left atrium/mitral valve annulus and the left ventricular myocardium, is frequently seen in patients with arrhythmic mitral valve prolapse. Although an association exists between MAD and ventricular arrhythmias, little is known regarding the identification of individuals at high risk. Multimodality imaging including echocardiography, computed tomography, cardiac magnetic resonance, and positron emission tomography can play an important role in both the diagnosis and risk stratification of MAD. Due to a paucity of data, clinical decision making in a patient with MAD is challenging and remains largely empirical. Although MAD itself can be corrected surgically, the prevention and treatment of associated arrhythmias may require medical therapy, catheter ablation, and an implantable cardioverter-defibrillator. Prospective data are required to define the role of implantable cardioverter-defibrillators, targeted catheter ablation, and surgical correction in selected, at-risk patients
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Evolution of Echocardiography-Derived Hemodynamic Force Parameters After Cardiac Resynchronization Therapy
Full text linkEchocardiography-derived hemodynamic forces (HDF) allow calculation of intraventricular pressure gradients from routine transthoracic echocardiographic images. The evolution of HDF after cardiac resynchronization therapy (CRT) has not been investigated in large cohorts. The aim was to assess HDF in patients with heart failure implanted with CRT versus healthy controls. HDF were assessed before and 6 months after CRT. The following HDF parameters were calculated: (1) apical-basal strength, (2) lateral-septal strength, (3) the ratio of lateral-septal to apical-basal strength ratio, and (4) the force vector angle (1 and 2 representing the magnitude of HDF, 3 and 4 representing the orientation of HDF). In the propulsive phase of systole, the apical-basal impulse and the systolic force vector angle were measured. A total of 197 patients were included (age 64 ± 11 years, 62% male), with left ventricular ejection fraction ≤35%, QRS duration ≥130 ms and left bundle branch block. The magnitude of HDF was significantly lower and the orientation was significantly worse in patients with heart failure versus healthy controls. Immediately after CRT implantation, the apical-basal impulse and systolic force vector angle were significantly increased. Six months after CRT, improvement of apical-basal strength, lateral-septal to apical-basal strength ratio and the force vector angle occurred. When CRT was deactivated at 6 months, the increase in the magnitude of apical-basal HDF remained unchanged while the systolic force vector angle worsened significantly. In conclusion, HDF in CRT recipients reflect the acute effect of CRT and the effect of left ventricular reverse remodeling on intraventricular pressure gradients. Whether HDF analysis provides incremental value over established echocardiographic parameters, remains to be determined.Cardiolog
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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