1,721,033 research outputs found
Funzione biventricolare in adolescenti e giovani adulti con infezione da HIV: valutazione con ecocardiografia tridimensionale e specole-tracking
Get PDFPremessa: 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
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
Aortic valve “kissing” vegetation: mitral valve endocarditis with functional aortic stenosis
Get PDFThe 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
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
A Novel Index of Right Ventriculoarterial Coupling in Adult Patients With Repaired Tetralogy of Fallot Using Three-Dimensional Speckle-Tracking Echocardiography
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Strain Rate echocardiographic assessment of right ventricular performance in pulmonary arterial hypertension
No full textPurpose: Pulmonary arterial hypertension (PAH) related to different aetiologies (chronic obstructive pulmonary disease -COPD-, congenital heart disease -CHD-; scleroderma
-SCL-) is associated with high morbidity and mortality, with the most common cause of death being decompensated right heart failure. Our purpose was to compare tissue Doppler imaging (TDI) and strain rate imaging (SRI) parameters with conventional
echocardiographic indexes evaluating right ventricular (RV) function, to assess their correlation with pulmonary artery pressure, and to investigate whether different PAH
aetiologies could result in a different impact on RV performance.
Methods: Forty-nine adult patients (pts) with PAH (SCL, 16 pts; COPD, 17 pts; CHD, 16 pts) were studied. All had systolic pulmonary artery pressure .35mmHg. Twenty-nine healthy subjects served as controls. RV ejection fraction (RVEF), fractional shortening (RVFS), and tricuspid flow filling parameters (E/A ratio, DT) were determined. Systodiastolic TDI values (Sw, Ew, Aw), peak systolic strain and systo-diastolic strain rate
values were determined from RV free wall (RVFW) at 3 levels (basal, mid cavity, and apical) in the apical 4-chamber view.
Results: Ew/Aw ratio and strain indexes were lower in pts than in controls (p,0.05 and p,0.001, respectively). There was a trend towards a higher incidence of lower RVEF, RVFS, E/A ratio, and DT in pts compared to controls. No correlation was found between RVEF, RVFS, E/A ratio, DT, and pulmonary artery pressure. A significant correlation was shown between mean peak systolic strain rate at RVFW site and pulmonary artery systolic pressure (r1⁄40.72, p,0.005). Significant decrease in systolic strain rate was obtained at apical FW site in COPD pts (p,0.005), at apical and mid level in CHD pts (p,0.001), and at basal, mid cavity, and apical levels in SCL pts (p,0.001).
Conclusions: In PAH TDI/SRI parameters can determine RV dysfunction that may not be shown by conventional echo indexes and is correlated with severity of pulmonary
artery pressure. Different forms of PAH can differently affect ventricular deformation parameters
Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle tracking echocardiography
No full textBackground. We aimed to assess changes in right ventricular (RV) parameters determined by three-dimensional echocardiography (3DE) and speckle tracking echocardiography (STE) in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive PE).
Methods. We prospectively studied 66 patients at the onset of the acute episode and after a median follow-up of 30 days and six months. Sixty-six controls were selected. RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and myocardial performance index (MPI) were determined. RV systolic pressure (RVSP) was assessed by continuous wave Doppler echocardiography. Three-dimensional right ventricular ejection fraction (3D-RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal, mid and apical segments of free wall (BFW, MFW, AFW) and septum.
Results. TAPSE and FAC were smaller and MPI was larger compared to controls (p<0.05). Global RVLS (p<0.05), MFW-RVLS (p<0.001), and 3D-RVEF (p<0.001) were lower in PE patients than controls. There was earlier reversal of MFW-RVLS values on a 30-day follow-up and longer reversal of 3D-RVEF and RVSP values on a 6-month follow-up. ROC analysis showed that changes in 3D-RVEF and MFW-RVLS were the most sensitive predictors of adverse events. By multivariate analysis, RVSP (p=0.007), MFW-RVLS (p=0.002) and 3D-RVEF (p=0.001) were independently associated with adverse outcomes.
Conclusions. Acute submassive PE has a significant impact on RV function as assessed by 3DE and STE. Decrease in MFW-RVLS and 3D-RVEF may persist during short and long-term follow-up and correlate with unfavorable outcome
Analysis of valvar and left ventricular parameters in infective aortic endocarditis as predictors of outcome: a combined assessment by transesophageal and strain echocardiography
No full textPurpose. The timing of surgery is crucial for patients with aortic endocarditis in whom medical therapy fails. The aim of our study is to identify potential echocardiographic "markers" of adverse events in patients with aortic regurgitation from infective endocarditis.
Methods. Fifteen patients with aortic regurgitation (AR) from infective endocarditis were studied by transesopageal echocardiography (TEE) and transthoracic speckle tracking echocardiography (STE). Fifteen healthy subjects were selected as controls. Vegetation size was assessed by TEE. Standard transthoracic echocardiographic parameters were determined. Global left ventricular (LV) longitudinal strain (LS), radial and circumferential strain were measured by STE. Averaged LV rotation and rotational velocities from the base and apex were obtained and used for calculation of LV torsion (LVtor). Mitral annular velocities were also obtained by tissue Doppler imaging (TDI).
Results. Mean percentage intraobserver variability was 6% for LV-LS and 8% for LV-tor, and mean percentage interobserver variability was 11% for for LV-LS and 12% for LV-tor. Severe AR had decreased LS compared with control subjects. LVtor decreased significantly in severe AR compared to normals (p<.001) as a result of a predominant decrease in apical rotation. By multivariate analysis, LV-LS (p=0.03), LV-tor (p=0.008) and vegetation size (p=0.009) were predictive of adverse events. ROC curves suggested that thresholds offering an adequate compromise between sensitivity and specificity for adverse events detection were -18.4% for mean global LV-LS (AUC .76), 12mm for vegetation size (AUC .84), and 19.7degrees for LVtor (AUC .89). The combination of vegetation size and LVtor had the highest diagnostic accuracy for identifying adverse outcome, superior to vegetation size (p=.008) or LVtor alone (p=.026).
Conclusions. The combined evaluation of the characteristics of vegetating masses and LV function strain parameters improve the sensitivity of echocardiographic indices in predicting cardiac morbidity and mortality of aortic regurgitation from infective endocarditis
Right ventricular dysfunction and dyssynchrony after surgical repair of tetralogy of fallot: a three-dimensional and speckle tracking echocardiographic study
No full textBackground. Prolonged QRS duration and mechanic-electrical interaction are markers of increased sudden death risk in tetralogy of Fallot (TF). The combined effects of preoperative hypertrophy and hypoxia, possible intraoperative myocardial damage, type of reconstruction, and acquired postoperative lesions such as pulmonary regurgitation may result in impaired RV deformation. Recently speckle tracking echocardiography (STE) has been proposed to assess mechanical dyssynchrony in these patients but the role of electromechanical dysfunction is not completely clear.
Methods. Fifteeen patients after TF repair (aged 17-51years) with dilated right ventricle, right bundle branch block (QRS 120ms), and NYHA class I or greater were studied with two-dimensional and three-dimensional echocardiography (3DE) and STE. Right ventricular volumes and right ventricular ejection fractions (3D-RVEF) were obtained. Right intraventricular dyssynchrony was determined as the difference between the longest and shortest electromechanical coupling times in the basal septal and lateral RV segments. Interventricular dyssynchrony was determined as the difference between electromechanical coupling times in the basal lateral LV segment and the most delayed RV segment. Fifteeen age-matched healthy subjects were selected as controls.
Results. Right intraventricular dyssynchrony (76.223.8ms vs 12.79.1ms) and interventricular dyssynchrony (75.224.3ms vs 11.38.2ms) were shown in patients compared to normal controls. Right intraventricular dyssynchrony correlated with RV longitudinal strain, 3D RV end-systolic volume, and QRS duration. Interventricular dyssynchrony correlated with RV longitudinal strain , RV systolic pressure, 3D-RVEF, and QRS duration. Reduced RV strain, 3D-RVEF and prolonged QRS duration were the main determinant factors predicting dyssynchrony by multivariate analysis. On ROC curves RV strain and 3D-RVEF had optimal predictive accuracy of the NYHA functional class and a larger area under the receiver operating characteristic curve than the QRS duration.
Conclusions. RV systolic dysfunction and dyssynchrony can be identified in patients with repaired TF by 3DE and STE. Dyssynchrony is associated with reduced 3D-RVEF and RV myocardial deformation
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