F. Innocenti, C. Donnini, S. Squarciotta, Eleonora de Villa, A. Guzzo, A. Conti, M. Zanobetti, R. Pini
Background: Limited data are available about feasibility and clinical value of left atrium (LA) quantitative evaluation obtained from real time 3D (RT-3D) echocardiography in critically ills. Objectives: Aims of this study were: 1) to evaluate feasibility of RT-3D echocardiography for LA evaluation in an acute care setting and in a population including a majority of critically ills; 2) to evaluate correlation between two-dimensional (2D) and RT-3D echocardiographic LA quantitative evaluation; 3) to assess clinical consistency and prognostic value of LA measurements obtained from RT-3D images in subjects without CV diseases and in patients with AF and CHF, evaluated in the acute phase of the disease. Patients and Methods: In 382 subjects admitted in the emergency department (ED), we evaluated maximal (Volmax) and minimal (Volmin) LA volumes and LA emptying fraction (LA-EF), from RT-3D images, with a semiautomated border detection program. A follow-up was performed in order to evaluate all-cause mortality and new hospital admission for cardiovascular events. Results: The correlation between measures obtained from 2D and 3D was good (LA Volmax: r = 0.896, P < 0.001; Volmin: r = 0.906, P < 0,001; LA EF: r = 0.749, P < 0.001). Among 77 normal subjects, people aged ≥ 65 years demonstrated comparable LA dimensions with younger subjects (LA Volmax: 25 ± 11 vs 20 ± 7 mL/m2, Volmin: 11 ± 7 vs 8 ± 5 mL/m2). Subjects with normal left ventricular ejection fraction showed LA Volmax significantly lower than patients with LV systolic dysfunction or congestive heart failure (23 ± 11 vs 29 ± 10 vs 33 ± 12 mL/m2, P < 0.05). Patients in atrial fibrillation showed a significantly dilated LA compared with subjects in sinus rhytm (24 ± 11 vs 37 ± 22 mL/m2, P < 0.05). LA dimensions were significantly higher in non-survivors (LA Volmax: 33 ± 9 vs 25 ± 9 mL/m2), in patients with a new hospital admission for cardiovascular disease (LA Volmax: 34 ± 13 vs 23 ± 10 mL/m2) or with a new AF episode (LA Volmax: 40 ± 12 vs 24 ± 11 mL/m2, all P < 0.005). Conclusions: RT-3D evaluation of LA volumes and function is feasible in a non selected series of critically ills. LA dilation was associated with a worse outcome in terms of morbidity and mortality.
背景:实时三维(RT-3D)超声心动图对危重症患者左心房(LA)定量评价的可行性及临床价值资料有限。目的:本研究的目的是:1)评估RT-3D超声心动图在急性护理环境和包括大多数危重疾病的人群中评估LA的可行性;2)评价二维(2D)与RT-3D超声心动图LA定量评价的相关性;3)评估RT-3D图像在无CV疾病受试者和AF和CHF患者中的临床一致性和预后价值，在疾病急性期进行评估。患者和方法:在急诊科(ED)收治的382例患者中，我们使用半自动边界检测程序，从RT-3D图像中评估最大(Volmax)和最小(Volmin) LA体积和LA排空分数(LA- ef)。进行随访，以评估全因死亡率和心血管事件的新住院率。结果:2D与3D测量结果相关性良好(LA Volmax: r = 0.896, P < 0.001;Volmin: r = 0.906, P < 0.001;LA EF: r = 0.749, P < 0.001)。在77名正常受试者中，年龄≥65岁的人的LA尺寸与年轻受试者相当(LA Volmax: 25±11 vs 20±7 mL/m2, Volmin: 11±7 vs 8±5 mL/m2)。左室射血分数正常的受试者LA Volmax明显低于左室收缩功能不全或充血性心力衰竭患者(23±11 vs 29±10 vs 33±12 mL/m2, P < 0.05)。心房颤动患者LA明显扩张(24±11 vs 37±22 mL/m2, P < 0.05)。在非幸存者(LA Volmax: 33±9 vs 25±9 mL/m2)、新入院心血管疾病患者(LA Volmax: 34±13 vs 23±10 mL/m2)或新AF发作患者(LA Volmax: 40±12 vs 24±11 mL/m2，均P < 0.005)中，LA尺寸明显更高。结论:RT-3D评估LA体积和功能在非选择性危重疾病系列中是可行的。就发病率和死亡率而言，左室扩张与较差的结果相关。
{"title":"Left atrial volumes and function: Evaluation with real-time 3D echocardiography in an acute care setting","authors":"F. Innocenti, C. Donnini, S. Squarciotta, Eleonora de Villa, A. Guzzo, A. Conti, M. Zanobetti, R. Pini","doi":"10.5812/acvi.34180","DOIUrl":"https://doi.org/10.5812/acvi.34180","url":null,"abstract":"Background: Limited data are available about feasibility and clinical value of left atrium (LA) quantitative evaluation obtained from real time 3D (RT-3D) echocardiography in critically ills. Objectives: Aims of this study were: 1) to evaluate feasibility of RT-3D echocardiography for LA evaluation in an acute care setting and in a population including a majority of critically ills; 2) to evaluate correlation between two-dimensional (2D) and RT-3D echocardiographic LA quantitative evaluation; 3) to assess clinical consistency and prognostic value of LA measurements obtained from RT-3D images in subjects without CV diseases and in patients with AF and CHF, evaluated in the acute phase of the disease. Patients and Methods: In 382 subjects admitted in the emergency department (ED), we evaluated maximal (Volmax) and minimal (Volmin) LA volumes and LA emptying fraction (LA-EF), from RT-3D images, with a semiautomated border detection program. A follow-up was performed in order to evaluate all-cause mortality and new hospital admission for cardiovascular events. Results: The correlation between measures obtained from 2D and 3D was good (LA Volmax: r = 0.896, P < 0.001; Volmin: r = 0.906, P < 0,001; LA EF: r = 0.749, P < 0.001). Among 77 normal subjects, people aged ≥ 65 years demonstrated comparable LA dimensions with younger subjects (LA Volmax: 25 ± 11 vs 20 ± 7 mL/m2, Volmin: 11 ± 7 vs 8 ± 5 mL/m2). Subjects with normal left ventricular ejection fraction showed LA Volmax significantly lower than patients with LV systolic dysfunction or congestive heart failure (23 ± 11 vs 29 ± 10 vs 33 ± 12 mL/m2, P < 0.05). Patients in atrial fibrillation showed a significantly dilated LA compared with subjects in sinus rhytm (24 ± 11 vs 37 ± 22 mL/m2, P < 0.05). LA dimensions were significantly higher in non-survivors (LA Volmax: 33 ± 9 vs 25 ± 9 mL/m2), in patients with a new hospital admission for cardiovascular disease (LA Volmax: 34 ± 13 vs 23 ± 10 mL/m2) or with a new AF episode (LA Volmax: 40 ± 12 vs 24 ± 11 mL/m2, all P < 0.005). Conclusions: RT-3D evaluation of LA volumes and function is feasible in a non selected series of critically ills. LA dilation was associated with a worse outcome in terms of morbidity and mortality.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121185745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The incidence of mechanical complications related to myocardial infarction has decreased over the last decades, and revascularization certainly plays a major role in this change. However, mortality still remains elevated. This is a case of acute papillary muscle rupture secondary to myocardial infarction leading to cardiogenic shock. Case Presentation: A 71-year-old woman presented to an outside hospital complaining of chest pain and shortness of breath. An electrocardiogram was obtained and revealed depression of the ST segments from leads V1 to V4. Troponin I was elevated at 3.0 ng/mL. She was transferred to our facility for a higher level of care. She was found in cardiogenic shock at arrival. A bedside echocardiogram was ordered, which demonstrated papillary muscle rupture with severe mitral regurgitation. A coronary angiogram followed, which diagnosed severe three-vessel disease. After the insertion of an intra-aortic balloon pump, she was transferred emergently to the surgical suite for mitral valve replacement and revascularization. The operation was uneventful. She was discharged to a rehabilitation center after approximately 1 month of hospital stay. Conclusions: Mortality from papillary muscle rupture remains elevated. Survival largely depends on the early surgical repair or the replacement of the mitral valve.
{"title":"Diagnosis and management of papillary muscle rupture complicating acute myocardial infarction: A case report and review of the literature","authors":"K. Suarez, Kipp Slicker, V. Torres","doi":"10.5812/acvi.30490","DOIUrl":"https://doi.org/10.5812/acvi.30490","url":null,"abstract":"Introduction: The incidence of mechanical complications related to myocardial infarction has decreased over the last decades, and revascularization certainly plays a major role in this change. However, mortality still remains elevated. This is a case of acute papillary muscle rupture secondary to myocardial infarction leading to cardiogenic shock. Case Presentation: A 71-year-old woman presented to an outside hospital complaining of chest pain and shortness of breath. An electrocardiogram was obtained and revealed depression of the ST segments from leads V1 to V4. Troponin I was elevated at 3.0 ng/mL. She was transferred to our facility for a higher level of care. She was found in cardiogenic shock at arrival. A bedside echocardiogram was ordered, which demonstrated papillary muscle rupture with severe mitral regurgitation. A coronary angiogram followed, which diagnosed severe three-vessel disease. After the insertion of an intra-aortic balloon pump, she was transferred emergently to the surgical suite for mitral valve replacement and revascularization. The operation was uneventful. She was discharged to a rehabilitation center after approximately 1 month of hospital stay. Conclusions: Mortality from papillary muscle rupture remains elevated. Survival largely depends on the early surgical repair or the replacement of the mitral valve.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125403157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thalassemia is an important congenital hereditary disorder that is highly endemic in Southeast Asia (1). Patients with thalassemia usually suffer from fragile red blood cells and severe anemia. Blood transfusion is usually required, and long-term transfusion can result in excessive iron accumulation in several organs including the cardiovascular system (2). The cardiovascular problem in patients with thalassemia is an intriguing issue. However, there are only a few reports on cardiovascular imaging among thalassemic patients. According to Peng et al. (3) iron cardiomyopathy is a significant problem in thalassemic patients; magnetic resonance imaging and echocardiography can be used to assess such patients but reliability is the major problem. Nevertheless, it is hard to access advanced imaging technology in real clinical practice given that many patients live in poor settings such as rural communities in Southeast Asia, South Asia, and South America. Based on PubMed search, there are few reports on cardiovascular imaging in thalassemia. Magnetic resonance T2 * imaging is reported in some publications. Djer et al. (4) reported an observation on the correlation between T2 * cardiovascular magnetic resonance (CMR) and left ventricular function and mass in adolescent and adult major thalassemia patients with iron overload and concluded that myocardial conduction time by T2 * CMR has a moderate positive correlation with diastolic function and moderate negative correlation with serum ferritin, but not with left ventricular mass index and systolic function. A study conducted by He (5) concluded that magnetic resonance T2 * imaging is useful for the assessment of iron overload among thalassemic patients. Indubitably, imaging modalities can be useful in the diagnosis of cardiac pathology due to iron overload. Nonetheless, the question remains as to its effectiveness in the follow-up of such patients. Recently, Baksi and Pennell (6) reported that the use of magnetic resonance T2 * imaging might be limited at follow-up. Additionally, Akcay et al. (7) reported no relationship between magnetic resonance T2* imaging and the markers used in the follow-up of patients with thalassemia. Cardiovascular imaging in patients with thalassemia can be fertile ground for further research in cardiovascular imaging medicine.
{"title":"Cardiovascular imaging in thalassemia: An issue with limited data","authors":"S. Tin, V. Wiwanitkit","doi":"10.5812/ACVI.33506","DOIUrl":"https://doi.org/10.5812/ACVI.33506","url":null,"abstract":"Thalassemia is an important congenital hereditary disorder that is highly endemic in Southeast Asia (1). Patients with thalassemia usually suffer from fragile red blood cells and severe anemia. Blood transfusion is usually required, and long-term transfusion can result in excessive iron accumulation in several organs including the cardiovascular system (2). The cardiovascular problem in patients with thalassemia is an intriguing issue. However, there are only a few reports on cardiovascular imaging among thalassemic patients. According to Peng et al. (3) iron cardiomyopathy is a significant problem in thalassemic patients; magnetic resonance imaging and echocardiography can be used to assess such patients but reliability is the major problem. Nevertheless, it is hard to access advanced imaging technology in real clinical practice given that many patients live in poor settings such as rural communities in Southeast Asia, South Asia, and South America. Based on PubMed search, there are few reports on cardiovascular imaging in thalassemia. Magnetic resonance T2 * imaging is reported in some publications. Djer et al. (4) reported an observation on the correlation between T2 * cardiovascular magnetic resonance (CMR) and left ventricular function and mass in adolescent and adult major thalassemia patients with iron overload and concluded that myocardial conduction time by T2 * CMR has a moderate positive correlation with diastolic function and moderate negative correlation with serum ferritin, but not with left ventricular mass index and systolic function. A study conducted by He (5) concluded that magnetic resonance T2 * imaging is useful for the assessment of iron overload among thalassemic patients. Indubitably, imaging modalities can be useful in the diagnosis of cardiac pathology due to iron overload. Nonetheless, the question remains as to its effectiveness in the follow-up of such patients. Recently, Baksi and Pennell (6) reported that the use of magnetic resonance T2 * imaging might be limited at follow-up. Additionally, Akcay et al. (7) reported no relationship between magnetic resonance T2* imaging and the markers used in the follow-up of patients with thalassemia. Cardiovascular imaging in patients with thalassemia can be fertile ground for further research in cardiovascular imaging medicine.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128638187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Esmaeilzadeh., H. Salehi, Rabiya Malik, H. Bakhshandeh, Ayan R. Patel, N. Pandian
Background: Understanding the relation between ventricular-arterial coupling (VAC) and myocardial mechanical parameters could offer an adjunctive perspective on left ventricular function. Objectives: Our aim was to study the relation between VAC and the parameters of myocardial mechanics using three-dimensional speckle-tracking echocardiography (3DSTE). Patients and Methods: We studied 68 normal participants (mean age, 35 ± 12.2 y; 36 [53%] males). VAC was measured by the ratio of arterial elastance (Ea) to ventricular elastance (Ees). The peak systolic value of longitudinal strain (LS), circumferential strain (CS), radial strain, three-dimensional global strain (3DGS), apical rotation, torsion, and twist and their time to peak were calculated. Results: Almost all deformation indices were higher in the women than in the men. LS (r = -0.41, P < 0.01), twist (r = 0.26, P < 0.03), rotation (r = 0.41, P < 0.01), and 3DGS (r = - 0.39, P < 0.01) were associated with age. Although significant associations were found between VAC and Ea or Ees in the men and women, no relation was found between Ea and Ees in both sexes (r = 0.07 in men and r = 0.08 in women). Indeed, VAC had a stronger association with Ea than with Ees (r = 0.708 vs. r = -0.537). Ees and VAC were related to torsion (r = 0.30 vs. r = -0.37; both P < 0.05); and Ea, Ees, and VAC were also associated with CS (r = 0.64, r = -0.45, and r = 0.79; all P < 0.05) and 3DGS (r = -0.55, r = 0.38, and r = -0.64; all P < 0.01). Conclusions: Amongst all myocardial mechanical parameters, VAC was related to CS and 3DGS as well as torsion.
背景:了解心室-动脉耦合(VAC)与心肌力学参数的关系可以为左心室功能的研究提供辅助视角。目的:应用三维斑点跟踪超声心动图(3DSTE)研究心肌力学参数与心室电位的关系。患者和方法:我们研究了68名正常受试者(平均年龄35±12.2岁;36[53%]男性)。以动脉弹性(Ea)与心室弹性(Ees)之比测量VAC。计算纵向应变(LS)、周向应变(CS)、径向应变、三维总应变(3DGS)、根尖旋转、扭转和扭转的收缩峰值及其达到峰值的时间。结果:女性几乎所有的变形指标都高于男性。LS (r = -0.41, P < 0.01)、twist (r = 0.26, P < 0.03)、rotation (r = 0.41, P < 0.01)、3DGS (r = - 0.39, P < 0.01)与年龄相关。尽管在男性和女性中发现VAC与Ea或Ees之间存在显著关联，但在两性中没有发现Ea和Ees之间的关系(男性r = 0.07，女性r = 0.08)。事实上，VAC与Ea的相关性强于Ees (r = 0.708 vs. r = -0.537)。Ees和VAC与扭转相关(r = 0.30 vs r = -0.37;P < 0.05);Ea、Ees和VAC也与CS相关(r = 0.64、r = -0.45和r = 0.79;P < 0.05)和3DGS (r = -0.55, r = 0.38, r = -0.64;P < 0.01)。结论:各心肌力学参数中，VAC与CS、3DGS及扭转有关。
{"title":"Relation between parameters of myocardial mechanics and ventricular arterial coupling: A three-dimensional speckle-tracking study in healthy adults","authors":"M. Esmaeilzadeh., H. Salehi, Rabiya Malik, H. Bakhshandeh, Ayan R. Patel, N. Pandian","doi":"10.5812/acvi.33216","DOIUrl":"https://doi.org/10.5812/acvi.33216","url":null,"abstract":"Background: Understanding the relation between ventricular-arterial coupling (VAC) and myocardial mechanical parameters could offer an adjunctive perspective on left ventricular function. Objectives: Our aim was to study the relation between VAC and the parameters of myocardial mechanics using three-dimensional speckle-tracking echocardiography (3DSTE). Patients and Methods: We studied 68 normal participants (mean age, 35 ± 12.2 y; 36 [53%] males). VAC was measured by the ratio of arterial elastance (Ea) to ventricular elastance (Ees). The peak systolic value of longitudinal strain (LS), circumferential strain (CS), radial strain, three-dimensional global strain (3DGS), apical rotation, torsion, and twist and their time to peak were calculated. Results: Almost all deformation indices were higher in the women than in the men. LS (r = -0.41, P < 0.01), twist (r = 0.26, P < 0.03), rotation (r = 0.41, P < 0.01), and 3DGS (r = - 0.39, P < 0.01) were associated with age. Although significant associations were found between VAC and Ea or Ees in the men and women, no relation was found between Ea and Ees in both sexes (r = 0.07 in men and r = 0.08 in women). Indeed, VAC had a stronger association with Ea than with Ees (r = 0.708 vs. r = -0.537). Ees and VAC were related to torsion (r = 0.30 vs. r = -0.37; both P < 0.05); and Ea, Ees, and VAC were also associated with CS (r = 0.64, r = -0.45, and r = 0.79; all P < 0.05) and 3DGS (r = -0.55, r = 0.38, and r = -0.64; all P < 0.01). Conclusions: Amongst all myocardial mechanical parameters, VAC was related to CS and 3DGS as well as torsion.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"81 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129512632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical application of left ventricular twist: A twist in the right direction?","authors":"S. Saha","doi":"10.5812/acvi.31252","DOIUrl":"https://doi.org/10.5812/acvi.31252","url":null,"abstract":"","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122615172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Poorzand, S. Mirfeizi, A. Javanbakht, Hedieh Alimi
Background: Cardiovascular diseases increase morbidity and mortality in patients with systemic lupus erythematosus (SLE). The cardiac involvement could be silent. Echocardiography can be used as a noninvasive tool for the assessment of the ventricular function. Objectives: We sought to evaluate different echocardiographic parameters via tissue Doppler imaging and speckle-tracking echocardiography (STE) in addition to conventional echocardiography. Patients and Methods: This case-control study was conducted in 45 SLE patients (88% female; mean age = 31.2 ± 8.2 years) and 25 healthy controls (87% female; mean age = 30.3 ± 7.7 years), matched in terms of age and sex. Both groups had no clinical signs and symptoms of cardiac problems or risk factors for cardiovascular diseases. Both SLE and control groups underwent echocardiography for the assessment of the ventricular function and the sizes and diameters of the chambers. Two-dimensional STE was used for the measurement of the left ventricular (LV) global longitudinal systolic strain. Results: The mean duration of SLE was 5.5 ± 3.4 years in our patients. No significant difference was found between the two groups concerning the LV and left atrium size, LV ejection fraction, right ventricular (RV) systolic function, RV and LV diastolic function, and pulmonary artery pressure. The LV global longitudinal strain was less in the SLE patients (-18.56 ± 2.50% vs. -19.89 ± 1.94%; P = 0.028). The LV mass was greater, though not statistically significant, in the SLE patients (111 ± 29.54 g vs. 104.37 ± 27.39 g; P = 0.468). The interventricular septal diameter was thicker in the SLE patients (0.79 ± 0.15 cm vs. 0.77 ± 0.10 cm; P = 0.046). Conclusions: Silent ventricular systolic dysfunction was more common in the patients with SLE than in the control group. Newer echocardiographic techniques such as two-dimensional STE provide an earlier chance for the detection of subclinical LV systolic dysfunction. Our findings were independent of the traditional risk factors.
背景:心血管疾病增加系统性红斑狼疮(SLE)患者的发病率和死亡率。心脏受累可能没有症状。超声心动图可作为评估心室功能的无创工具。目的:我们试图通过组织多普勒成像和斑点跟踪超声心动图(STE)来评估不同的超声心动图参数。患者和方法:本病例对照研究纳入45例SLE患者(88%为女性;平均年龄= 31.2±8.2岁)和25名健康对照者(87%为女性;平均年龄= 30.3±7.7岁)，年龄、性别相符。两组患者均无心脏问题或心血管疾病危险因素的临床体征和症状。SLE组和对照组均行超声心动图检查心室功能、心室大小和直径。二维STE用于测量左室(LV)整体纵向收缩应变。结果:患者SLE的平均病程为5.5±3.4年。两组左室和左室大小、左室射血分数、右室收缩功能、右室和左室舒张功能、肺动脉压均无显著差异。SLE患者左室整体纵向应变较小(-18.56±2.50% vs -19.89±1.94%;P = 0.028)。SLE患者的左室质量更大(111±29.54 g vs 104.37±27.39 g)，但无统计学意义;P = 0.468)。SLE患者室间隔直径较粗(0.79±0.15 cm vs 0.77±0.10 cm);P = 0.046)。结论:SLE患者无症状性心室收缩功能障碍较对照组更为常见。较新的超声心动图技术，如二维超声心动图，为检测亚临床左室收缩功能障碍提供了更早的机会。我们的发现与传统的风险因素无关。
{"title":"Comparison of echocardiographic variables between systemic lupus erythematosus patients and a control group","authors":"H. Poorzand, S. Mirfeizi, A. Javanbakht, Hedieh Alimi","doi":"10.5812/acvi.30009","DOIUrl":"https://doi.org/10.5812/acvi.30009","url":null,"abstract":"Background: Cardiovascular diseases increase morbidity and mortality in patients with systemic lupus erythematosus (SLE). The cardiac involvement could be silent. Echocardiography can be used as a noninvasive tool for the assessment of the ventricular function. Objectives: We sought to evaluate different echocardiographic parameters via tissue Doppler imaging and speckle-tracking echocardiography (STE) in addition to conventional echocardiography. Patients and Methods: This case-control study was conducted in 45 SLE patients (88% female; mean age = 31.2 ± 8.2 years) and 25 healthy controls (87% female; mean age = 30.3 ± 7.7 years), matched in terms of age and sex. Both groups had no clinical signs and symptoms of cardiac problems or risk factors for cardiovascular diseases. Both SLE and control groups underwent echocardiography for the assessment of the ventricular function and the sizes and diameters of the chambers. Two-dimensional STE was used for the measurement of the left ventricular (LV) global longitudinal systolic strain. Results: The mean duration of SLE was 5.5 ± 3.4 years in our patients. No significant difference was found between the two groups concerning the LV and left atrium size, LV ejection fraction, right ventricular (RV) systolic function, RV and LV diastolic function, and pulmonary artery pressure. The LV global longitudinal strain was less in the SLE patients (-18.56 ± 2.50% vs. -19.89 ± 1.94%; P = 0.028). The LV mass was greater, though not statistically significant, in the SLE patients (111 ± 29.54 g vs. 104.37 ± 27.39 g; P = 0.468). The interventricular septal diameter was thicker in the SLE patients (0.79 ± 0.15 cm vs. 0.77 ± 0.10 cm; P = 0.046). Conclusions: Silent ventricular systolic dysfunction was more common in the patients with SLE than in the control group. Newer echocardiographic techniques such as two-dimensional STE provide an earlier chance for the detection of subclinical LV systolic dysfunction. Our findings were independent of the traditional risk factors.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132855430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Bischoff, L. Geyer, M. Reiser, Ullrich Mueller Lisse
Background: Motion artifacts that degrade image quality of coronary CT angiography (CCTA) in patients with high heart rates may be reduced with specific automatic motion correction algorithms (AMC). Objectives: We compared coronary-artery delineation between AMC and conventional CCTA reconstruction (CR). Patients and Methods: CCTA images (clinical single-source-64-slice-CT system) of 17 consecutive patients with heart rates exceeding 55 bpm were reconstructed with both CR and AMC during the individually best-suited phase of the cardiac cycle. Two independent readers who were blinded to the reconstruction algorithm scored image quality of each coronary artery segment (AHA 15-segment-model; 1: non-diagnostic - 4: excellent). In case of disagreement a third blinded reader assigned a final score. Two-tailed statistical tests (Wilcoxon-matched-pairs, Pearson-correlation) were significant at P < 0.05. Results: Mean heart rate during CCTA was 61 ± 8 bpm. CCTA quality improved significantly in the RCA (good-or-excellent in 11/17 AMC vs. 5/17 CR, P = 0.018) and LAD (15/17 vs. 7/17, P = 0.031). Non-diagnostic CCTA in the RCA, LM, LAD, and LCX reduced from 16/68 (CR, 24%) to 7/68 (AMC, 10%). Significant motion correction was observed at low (≤ 60 bpm; P = 0.008), intermediate (61-70 bpm; P < 0.001), and high heart rates (> 70 bpm; P = 0.021). Inter-reader agreement was good. (inter-class-correlation, 0.762). Conclusions: CCTA image quality improves significantly with AMC in patients with high heart rates and reduces the proportion of non-diagnostic examinations.
背景:高心率患者冠状动脉CT血管造影(CCTA)图像质量下降的运动伪影可以通过特定的自动运动校正算法(AMC)来降低。目的:我们比较了AMC和传统CCTA重建(CR)的冠状动脉描绘。患者和方法:连续17例心率超过55bpm的患者的CCTA图像(临床单源64层ct系统)在各自最适合的心脏周期阶段用CR和AMC重建。两名独立的读者对重建算法不知情，对每个冠状动脉段的图像质量进行评分(AHA 15段模型;1:非诊断性- 4:优秀)。如果意见不一致，则由第三位盲眼读者给出最终分数。双侧统计检验(wilcox - matching -pairs, Pearson-correlation) P < 0.05显著。结果:CCTA期间平均心率为61±8bpm。CCTA质量在RCA (11/17 AMC vs 5/17 CR, P = 0.018)和LAD (15/17 vs 7/17, P = 0.031)中显著改善。RCA、LM、LAD和LCX的非诊断性CCTA从16/68 (CR, 24%)降至7/68 (AMC, 10%)。在低(≤60 bpm;P = 0.008)，中级(61-70 bpm;P < 0.001)和高心率(> 70 bpm;P = 0.021)。读者之间的共识很好。(inter-class-correlation, 0.762)。结论:高心率患者采用AMC后，CCTA图像质量明显改善，非诊断性检查比例降低。
{"title":"Improved image quality of coronary CT angiography using automatic motion correction","authors":"B. Bischoff, L. Geyer, M. Reiser, Ullrich Mueller Lisse","doi":"10.5812/acvi.28932v2","DOIUrl":"https://doi.org/10.5812/acvi.28932v2","url":null,"abstract":"Background: Motion artifacts that degrade image quality of coronary CT angiography (CCTA) in patients with high heart rates may be reduced with specific automatic motion correction algorithms (AMC). Objectives: We compared coronary-artery delineation between AMC and conventional CCTA reconstruction (CR). Patients and Methods: CCTA images (clinical single-source-64-slice-CT system) of 17 consecutive patients with heart rates exceeding 55 bpm were reconstructed with both CR and AMC during the individually best-suited phase of the cardiac cycle. Two independent readers who were blinded to the reconstruction algorithm scored image quality of each coronary artery segment (AHA 15-segment-model; 1: non-diagnostic - 4: excellent). In case of disagreement a third blinded reader assigned a final score. Two-tailed statistical tests (Wilcoxon-matched-pairs, Pearson-correlation) were significant at P < 0.05. Results: Mean heart rate during CCTA was 61 ± 8 bpm. CCTA quality improved significantly in the RCA (good-or-excellent in 11/17 AMC vs. 5/17 CR, P = 0.018) and LAD (15/17 vs. 7/17, P = 0.031). Non-diagnostic CCTA in the RCA, LM, LAD, and LCX reduced from 16/68 (CR, 24%) to 7/68 (AMC, 10%). Significant motion correction was observed at low (≤ 60 bpm; P = 0.008), intermediate (61-70 bpm; P < 0.001), and high heart rates (> 70 bpm; P = 0.021). Inter-reader agreement was good. (inter-class-correlation, 0.762). Conclusions: CCTA image quality improves significantly with AMC in patients with high heart rates and reduces the proportion of non-diagnostic examinations.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127470934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: We describe a 56-year-old woman with dilated cardiomyopathy, whose clinical assessment, including two-dimensional echocardiography, demonstrated a spherical left ventricular geometry with severe left ventricular enlargement and dysfunction as well as reverse apical rotation. Left ventricular twist and torsion were evaluated via echocardiography with velocity vector imaging; the patient was found to have reverse rotational movement. We hereby address these issues from an echocardiographic point of view. Case Presentation: The patient was a 56-year-old woman, who referred to our clinic with complaints of dyspnea on exertion of 2 years' duration. By the time of her referral, the patient's dyspnea had exacerbated and reached New York Heart Association (NYHA) functional class III. Conclusions: These findings emphasize the potential clinical benefits of therapeutic procedures such as cardiac resynchronization therapy (CRT) or apex-sparing volume-reduction surgery in DCM. A better definition of the role and implications of reverse apical torsion in DCM and its importance and effectiveness in making therapeutic decisions like CRT implantation requires further studies.
{"title":"Reverse left ventricular apical rotation in dilated cardiomyopathy","authors":"Z. Ojaghi-haghighi, A. Alizadehasl, A. Hashemi","doi":"10.5812/acvi.28112","DOIUrl":"https://doi.org/10.5812/acvi.28112","url":null,"abstract":"Introduction: We describe a 56-year-old woman with dilated cardiomyopathy, whose clinical assessment, including two-dimensional echocardiography, demonstrated a spherical left ventricular geometry with severe left ventricular enlargement and dysfunction as well as reverse apical rotation. Left ventricular twist and torsion were evaluated via echocardiography with velocity vector imaging; the patient was found to have reverse rotational movement. We hereby address these issues from an echocardiographic point of view. Case Presentation: The patient was a 56-year-old woman, who referred to our clinic with complaints of dyspnea on exertion of 2 years' duration. By the time of her referral, the patient's dyspnea had exacerbated and reached New York Heart Association (NYHA) functional class III. Conclusions: These findings emphasize the potential clinical benefits of therapeutic procedures such as cardiac resynchronization therapy (CRT) or apex-sparing volume-reduction surgery in DCM. A better definition of the role and implications of reverse apical torsion in DCM and its importance and effectiveness in making therapeutic decisions like CRT implantation requires further studies.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134495608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Kammoun, Lemone Houchinne, S. Marrakchi, W. Amara, Z. Elhaj, S. Mokrani, F. Added, S. Kachboura
Introduction: Multimodality imaging can help rule in/out the diagnosis of hypertrophic cardiomyopathy (HCM) in patients with significant left ventricular (LV) hypertrophy. Case Presentation: We describe a 73-year-old woman referred to us for consultation because of a giant negative T wave on her electrocardiography. Echocardiography revealed diffuse severe hypertrophy associated with hypertrophied anterolateral papillary muscles with a bifid head and with extensive wall insertion into the apicolateral segment. Three-dimensional echocardiography and cardiac magnetic resonance confirmed these data. Importantly, automated function imaging determined the global longitudinal strain at -10.2%. Conclusions: According to our multimodality imaging approach, hypertrophic cardiomyopathy was the most probable diagnosis.
{"title":"Multimodality imaging in hypertrophic cardiomyopathy associated with anomalous hypertrophied papillary muscles: A case report","authors":"I. Kammoun, Lemone Houchinne, S. Marrakchi, W. Amara, Z. Elhaj, S. Mokrani, F. Added, S. Kachboura","doi":"10.5812/acvi.22268","DOIUrl":"https://doi.org/10.5812/acvi.22268","url":null,"abstract":"Introduction: Multimodality imaging can help rule in/out the diagnosis of hypertrophic cardiomyopathy (HCM) in patients with significant left ventricular (LV) hypertrophy. Case Presentation: We describe a 73-year-old woman referred to us for consultation because of a giant negative T wave on her electrocardiography. Echocardiography revealed diffuse severe hypertrophy associated with hypertrophied anterolateral papillary muscles with a bifid head and with extensive wall insertion into the apicolateral segment. Three-dimensional echocardiography and cardiac magnetic resonance confirmed these data. Importantly, automated function imaging determined the global longitudinal strain at -10.2%. Conclusions: According to our multimodality imaging approach, hypertrophic cardiomyopathy was the most probable diagnosis.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131409271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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