782 research outputs found
Role of echocardiography in the assessment and management of adult congenital heart disease in pregnancy
No full textCongenital heart disease represent a large proportion of heart disease in pregnancy. With the exception of patients with Eisenmenger's syndrome, pulmonary vascular obstructive disease, and Marfan's syndrome with aortopathy, maternal death during pregnancy is rare in women with CHD but morbidity occurs such as heart failure, arrhythmias, and stroke. Echocardiography represents a milestone in diagnosis, understanding of pathophysiology, assessment of disease severity and patient monitoring in pregnant women with unoperated and post-operative congenital heart disease
Funzione biventricolare in adolescenti e giovani adulti con infezione da HIV: valutazione con ecocardiografia tridimensionale e specole-tracking
No full textPremessa: lo scopo dello studio è quello di valutare i parametri di deformazione parietale biventricolare attraverso l’ecocardiografia tridimensionale speckle-tracking negli adolescenti e nei giovani adulti con infezione da HIV in terapia antiretrovirale. L’obiettivo finale è quello di rilevare un’eventuale disfunzione miocardica subclinica. Metodi: 21 pazienti con infezione da HIV tra i 12 e i 39 anni, 21 controlli normali della stessa età e 21 pazienti con cardiomiopatia dilatativa non ischemica sono stati studiati con metodiche di ecocardiografia standard e tridimensionale speckle-tracking. Tutti i pazienti con HIV avevano un’infezione ben controllata dalla terapia antiretrovirale con un buono status immunologico e anamnesi negativa per patologie cardiovascolari o altre patologie sistemiche croniche. Sono stati misurati i parametri di ecocardiografia standard relativi alla funzione ventricolare destra e sinistra. Con l’ecocardiografia tridimensionale sono stati misurati lo strain globale longitudinale (LV-GLS), radiale (LV-GRS) e circonferenziale (LV-GCS) del ventricolo sinistro; è inoltre stato calcolato il “twist” del ventricolo sinistro (LV-TW) e l’area strain globale (LV-GAS), intesa come la variazione percentuale dell’area derivata dai vettori dello strain longitudinale e circonferenziale. Sono infine stati misurati lo strain longitudinale globale e quello della parete libera del ventricolo destro. Risultati: i parametri LV-GLS e LV-GAS sono più bassi nei pazienti HIV rispetto ai controlli normali (rispettivamente p=0,002 e p=0,01). Non ci sono differenze significative tra i due gruppi per quanto riguarda i parametri di ecocardiografia standard. E’ stata riscontrata una debole correlazione positiva tra LV-GLS e l’età (r=0,215, p=0,034) e una debole correlazione negativa tra LV-GLS e il nadir dei linfociti T CD4+ (r=0,198, p=0,043). I pazienti con cardiomiopatia dilatativa hanno una riduzione più diffusa e marcata di LV-GLS e LV-GAS rispetto ai controlli (p<0,001), mentre nei pazienti con HIV la compromissione di questi parametri è localizzata soprattutto nelle porzioni basali e apicali del ventricolo sinistro. Anche lo strain longitudinale della parete libera del ventricolo destro è apparso significativamente ridotto nei pazienti con HIV (p=0,03). Nessun paziente aveva un pressione arteriosa sistolica polmonare > 35 mmHg. Conclusioni: l’ecocardiografia tridimensionale speckle-tracking può aiutarci ad identificare i pazienti con infezione da HIV a più alto rischio cardiovascolare, permettendo un’identificazione precoce della disfunzione biventricolare anche in presenza di normali parametri valutati con ecocardiografia standard. La compromissione dello strain nei pazienti HIV è meno marcata e più distrettuale rispetto a quella dei pazienti con cardiomiopatia dilatativa
Aortic valve “kissing” vegetation: mitral valve endocarditis with functional aortic stenosis
No full textThe case is reported of giant mitral valve vegetation that was wedged into the aortic valve plane (aortic valve 'kissing' vegetation), causing obstruction to the left ventricular outflow tract. In such a case, echocardiography plays a key role in the assessment of vegetation morphology, risk of embolization, impact on valvular function and indication for surgery. Because of its size, the obstructive hemodynamics, and the potential to induce aortic valve endocarditis, aortic 'kissing' vegetation requires surgical intervention to preserve the integrity of the valve and improve the hemodynamic status
Assessment of biventricular strain by 3-dimensional speckle-tracking echocardiography in chronic aortic regurgitation
No full textBackground. Patients with chronic severe aortic regurgitation (AR) represent a challenging cohort with high morbidity and mortality. It is known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic AR. The prevalence and clinical impact of right ventricular dysfunction (RVD) on risk stratification and prognosis in these patients is unknown.
Methods. Eighteen patients (mean age 64±13 years) with severe chronic AR and eighteen age-matched healthy subjects selected as controls were studied. LV and RV longitudinal, circumferential and radial strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). Global area strain (GAS) was obtained by 3DSTE as the percentage variation in the surface area defined by the longitudinal and circumferential strain vectors. Data analysis was performed offline. RVD was defined as global longitudinal strain of RV free-wall <15%. Cox proportional hazards modeling was used to risk-adjust comparisons for the end point of all-cause mortality.
Results. Impairment of LV global longitudinal strain (-15.9% vs -19.3%, p = .015), global circumferential strain (-17.8% vs -26.4%, p = .006), global radial strain (27.3% vs 34.6%, p = .026) and global area strain (-21.4% vs -38.5%, p = .008) was observed in patients with AR compared to controls. The presence of RVD (hazard ratio, 2.86; 95% CI, 1.36-7.13; p = 0.032) was an independent risk factor associated with all-cause mortality despite several adjustments for potential clinical and echocardiographic confounders such as aortic valve replacement, severity of tricuspid regurgitation, and left ventricular global longitudinal strain.
Conclusions. Baseline RVD is common in patients with chronic severe aortic regurgitation. Quantification of right ventricular systolic function in these patients provides important additional prognostic value and risk stratification
Echocardiographic Myocardial Imaging Reveals Segmental Cardiomyopathy in Churg-Strauss Syndrome
No full textCardiovascular involvement is the leading cause of morbidity and death in Churg-Strauss syndrome. Herein, we describe the case of a 47-year-old man with Churg-Strauss syndrome, in whom the use of novel echocardiographic techniques revealed segmental cardiomyopathy. Tissue Doppler and speckle-tracking imaging showed that both longitudinal and radial strain were impaired at the septal level and that the impairment of circumferential strain affected left ventricular torsion. Our case shows that advanced echocardiography with myocardial strain imaging in multiple vectors can identify systolic-diastolic abnormalities in a patient with myocardial infiltration and a normal left ventricular ejection fraction. (Tex Heart lint J 2010;37(5):594-7
Value of conventional and speckle tracking echocardiography in the assessment of biventricular function in secondary mitral regurgitation after repair with the MitraClip system
No full textBackground. The aim of this study was to determine the comparative value of conventional echocardiography and two-dimensional (2STE) and three-dimensional speckle-tracking echocardiography (3DSTE) in the assessment of left (LV) and right (RV) ventricular function after percutaneous mitral valve repair with the MitraClip system in high-risk surgical patients with moderate-to-severe or severe secondary mitral regurgitation (MR).
Methods. Twenty-nine patients underwent two-dimensional transthoracic echocardiography before mitral clip implantation and after 6-month follow-up. LV and RV longitudinal strains were obtained by 2DSTE and 3DSTE. LV circumferential, radial, and area strains were calculated by 3DSTE. Data analysis was performed offline.
Results. At 6-month follow-up a significant improvement was shown in 2D LV ejection fraction (pII) after the procedure.
Conclusions. Our data showed overall LV-RV performance indices improvement after clip implantation as well as lower post-procedural LV echocardiographic values in patients with worse pre-existing RV function. These findings could help in guiding MR treatment strategies suggesting different therapies in the presence of marked RV impairment or viceversa anticipating the procedure in case of evolving RV dysfunction
Lidia Shank
No full textPhotograph - Portrait of Lidia Shank, a member of the Canadian Women's Army Corps, in uniform. Athabasca, Albert
Ed and Lidia Loxam
No full textPhotograph - Ed Loxam and Lidia Loxam (nee Shank) inside a cabin, Athabasca, Albert
Early diagnosis of cardiovascular diseases in workers: role of standard and advanced echocardiography
No full textCardiovascular disease (CVD) still remains the main cause of morbidity and mortality and consequently early diagnosis is of paramount importance. Working conditions can be regarded as an additional risk factor for CVD. Since different aspects of the job may affect vascular health differently, it is important to consider occupation from multiple perspectives to better assess occupational impacts on health. Standard echocardiography has several targets in the cardiac population, as the assessment of myocardial performance, valvular and/or congenital heart disease, and hemodynamics. Three-dimensional echocardiography gained attention recently as a viable clinical tool in assessing left ventricular (LV) and right ventricular (RV), volume, and shape. Two-dimensional (2DSTE) and, more recently, three-dimensional speckle tracking echocardiography (3DSTE) have also emerged as methods for detection of global and regional myocardial dysfunction in various cardiovascular diseases, and applied to the diagnosis of subtle LV and RV dysfunction. Although these novel echocardiographic imaging modalities have advanced our understanding of LV and RV mechanics, overlapping patterns often show challenges that limit their clinical utility. This review will describe the current state of standard and advanced echocardiography in early detection (secondary prevention) of CVD and address future directions for this potentially important diagnostic strategy
- …
