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2019| July-September | Volume 29 | Issue 3
Online since
October 22, 2019
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ORIGINAL ARTICLES
Analysis of regional right ventricular function by tissue doppler imaging in patients with aortic stenosis
Maria Vincenza Polito, Stephan Stoebe, Gennaro Galasso, Roberta De Rosa, Rodolfo Citro, Federico Piscione, Ulrich Laufs, Andreas Hagendorff
July-September 2019, 29(3):111-118
DOI
:10.4103/jcecho.jcecho_27_19
PMID
:31728301
Background:
Right ventricular (RV) dysfunction is frequently observed in patients with aortic stenosis (AS). Nevertheless, assessment of regional RV deformation is yet not performed. The aim of the study was to analyze the impact of moderate and severe AS on global and regional RV function by a multisegmental approach using tissue Doppler imaging (TDI).
Methods:
In 50 patients (Group I – AS [
n
= 25] and Group II – normal controls [
n
= 25]), additional echocardiographic views of the RV were prospectively performed. The TDI sample volume was placed in the basal myocardial region of the anterior (RV-anterior), inferior (RV-inferior), and free RV wall (RV-free wall) to assess the following parameters: S'
RV
, E'
RV
, and A'
RV
waves; IVCT
RV
; IVRT
RV
; and myocardial performance index (MPI
RV
).
Results:
In AS patients, left ventricular (LV) mass index, left atrial (LA) volume index, and LV end-diastolic pressure were significantly increased. Moreover, AS patients had higher systolic pulmonary artery pressure (sPAP) and lower values for PV AccT (
P
< 0.0001), but TAPSE was not different between the two groups (
P
= 0.062). In AS patients, IVRT
RV-anterior
, IVRT
RV-inferior
, and IVRT
RV-free
wall
and MPI
RV
were statistically increased (
P
< 0.0001). A significant correlation between IVRT
RV
(evaluated at all three regions) and the parameters including sPAP, PV AccT, and E
LV
/e'
LV
ratio was observed in AS. A strong correlation was observed between IVRT
RV-free
wall/inferior
and AS severity by evaluation of velocities, gradient, and aortic valve area (
P
< 0.0001).
Conclusions:
The present study reports a correlation between the severity of AS and the increase of IVRT
RV
and MPI
RV
. Thus, a distinct analysis of RV performance is important for echocardiographic evaluation of patients with AS.
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81
The utility of eccentricity index as a measure of the right ventricular function in a lung resection cohort
Wai Huang Teng, Philip J McCall, Benjamin G Shelley
July-September 2019, 29(3):103-110
DOI
:10.4103/jcecho.jcecho_19_19
PMID
:31728300
Context:
Right ventricular (RV) dysfunction occurs after lung resection and is associated with postoperative morbidity. Noninvasive evaluation of the RV is challenging, particularly in the postoperative period. A reliable measure of RV function would have value in this population.
Aims:
This study compares eccentricity index (EI) obtained by transthoracic echocardiography (TTE) with cardiovascular magnetic resonance (CMR) determined measures of RV function in a lung resection cohort. CMR is the reference method for noninvasive assessment of RV function.
Design and Setting:
Prospective observational cohort study at a single tertiary hospital.
Materials and Methods:
Twenty-eight patients scheduled for elective lung resection underwent contemporaneous TTE and CMR imaging preoperatively, on postoperative day (POD) 2 and at 2-month. Systolic and diastolic EI was measured offline from anonymized and randomized TTE and CMR images.
Statistical Analysis:
Bland–Altman analysis was performed to determine agreement between EI
TTE
and EI
CMR
. Changes over time and comparison with CMR determined RV ejection fraction (RVEF
CMR
) was assessed.
Results:
Bland–Altman analysis showed a negligible mean difference between EI
TTE
and EI
CMR
, but limits of agreement were wide (SD 0.24 and 0.28). There were no significant changes in EI
TTE
and EI
CMR
over time (
P
> 0.35). We found no association between EI
TTE
with RVEF
CMR
at all-time points (
P
> 0.22). Systolic and diastolic EI
CMR
on POD 2 demonstrated moderate association with RVEF
CMR
(
r
= −0.54 and
r
= −0.59,
P
≤ 0.01). At 2-month, only diastolic EI
CMR
correlated with RVEF
CMR
(
r
= −0.43,
P
= 0.03). There were no meaningful associations between EI
TTE
and EI
CMR
with TTE-derived RV systolic pressure (
P
> 0.31).
Conclusions:
TTE determined EI is not useful as a noninvasive method of assessing RV function following lung resection.
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CASE REPORTS
From bicuspid to quadricuspid aortic valve: The clinical case of a 38-year-old woman with chest pain
Paolo Diego L'Angiocola, Davide Liborio Vetrano, Gerardina Lardieri
July-September 2019, 29(3):119-122
DOI
:10.4103/jcecho.jcecho_21_19
PMID
:31728302
We report a case of a 38-year-old woman with an alleged diagnosis of bicuspid aortic valve disease that was correctly identified as quadricuspid aortic valve (QAV) disease in our cardiology unit. In this case report, we focus on echocardiographic features of this rare congenital valve disease aiming to provide useful tips to achieve correct differential diagnosis according to the updated echocardiographic international guidelines and recommendations, briefly reviewing other QAV cases reported in the current literature as well. In conclusion, we strongly recommend adhering to practical echocardiographic guidelines to reduce interobserver variability, not to miss the diagnosis of rare congenital defects like the one we reported.
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2,132
109
Complications of pulmonic valve endocarditis in repaired tetralogy of fallot
Hasan Ashraf, Kruti Pandya, Matthew Wack, Stephen Sawada
July-September 2019, 29(3):123-125
DOI
:10.4103/jcecho.jcecho_17_19
PMID
:31728303
Transthoracic echocardiography plays a pivotal role in the diagnosis of complications, evaluation of hemodynamics, and management of patients with surgically repaired congenital heart disease. Late complications of surgically corrected tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease, include pulmonary regurgitation (PR), ventricular septal defect (VSD) patch leakage, and residual right ventricular outflow tract obstruction. We present a case of severe PR secondary to Bartonella endocarditis in an adult with a history of repaired TOF in which echocardiography was instrumental in the diagnosis of severe PR, residual VSD, and a right-to-left shunt through an unsuspected patent foramen ovale.
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948
51
Capillary hemangioma of the left ventricle
Giacomo Maria Cioffi, Vera Lucia Paiocchi, Laura Anna Leo, Enrico Ferrari, Francesco Fulvio Faletra
July-September 2019, 29(3):126-128
DOI
:10.4103/jcecho.jcecho_31_19
PMID
:31728304
We present the case of a young woman complaining of aspecific symptoms of malaise and dyspnea admitted to our Cardiology Department for investigations. Two-dimensional (2D)/3D transthoracic echocardiography showed an echogenic, sessile mass adhering to the midsegment of the posterior interventricular septum. The patient refused transesophageal echocardiography. For further investigation, a cardiac magnetic resonance imaging was performed, which raised suspicion of a benign tumor. Ultimately, the patient underwent uncomplicated cardiac surgery with total excision of the mass. Histopathology examination revealed a capillary hemangioma.
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1,010
48
Implantation of a dual-chamber pacemaker in a patient with situs inversus and dextrocardia using a novel ultrasound technique
Joćo B Augusto, Mariana Faustino, Miguel B Santos, Nuno Cabanelas, Francisco Madeira, Carlos Morais
July-September 2019, 29(3):129-131
DOI
:10.4103/jcecho.jcecho_29_19
PMID
:31728305
We report a case of a 43-year-old man with situs inversus and dextrocardia who was admitted with syncope in the setting of complete atrioventricular block. The complex anatomy poses a considerable challenge to transvenous permanent pacemaker implantation. We employed a novel technique using vascular ultrasound and agitated saline solution to assist with lead positioning. This technique could be useful in pediatric populations or younger patients, in whom the use of ionizing radiation is an important issue.
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933
42
ORIGINAL ARTICLES
Normal values of the mitral-aortic intervalvular fibrosa thickness: A multimodality study
Alberto Cresti, Pasquale Baratta, Francesco De Sensi, Marco Solari, Bruno Sposato, Stefano Minelli, Nevada Cioffi, Luca Franci, M Scalese, Ugo Limbruno
July-September 2019, 29(3):95-102
DOI
:10.4103/jcecho.jcecho_28_19
PMID
:31728299
Background:
The avascular region of the fibrous body between the mitral and aortic valves, named mitral-aortic intervalvular fibrosa (MAIVF), is often involved in the periaortic diffusion of infective endocarditis (IE), resulting in abscess or pseudoaneurysm formation. The early recognition of these life-threatening complications is of crucial importance, as urgent surgical correction is necessary. In the first stages of the abscess formation, the only sign is an increased thickness of the MAIVF. To the best of our knowledge, normal transesophageal echocardiography (TEE) examination reference values for MAIVF thickness has not yet been established. The aim of the study was to define the normal ranges of MAIVF thickness in a population of healthy adults who underwent a TEE examination.
Materials and Methods:
A population of consecutive adult patients who underwent a TEE examination was enrolled in the study. Measurement was performed in short-axis (SAX) and long-axis (LAX) views. Mean-2 standard deviations (mean-2SDs) and 5%, 10%, 90%, and 95% confidence intervals were evaluated. A comparison with MAIVF thickness in patients affected by aortic IE complicated by abscess formation was performed, and receiver operating characteristic (ROC) curves were constructed to achieve the optimal cutoff value of normality.
Results:
A total of 477 consecutive Caucasian adult patients were enrolled (mean age: 69 years, range: 27–93 years). Mean-2SD MAIVF measurement in SAX view was 0.325 cm (95% confidence interval [CI]: 0.319–0.330 cm) and in LAX view was 0.340 cm (95% CI: 0.334–0.346 cm). Computed tomography–MAIVF mean measurement (±2SD) was 0.237 cm (95% CI: 0.110–0.340 cm). ROC curves showed that a cutoff SAX value measurement of 0.552 (area under the curve [AUC]: 95.2%) had a sensibility of 88.2% and a specificity of 92.4%; a LAX measurement value of 0.623 (AUC: 93.3%) had a sensibility of 82.7% and a specificity of 85.7%. The multivariate analysis showed no significant correlation between MAIVF thickness, age, and sex.
Conclusion:
In healthy patients, MAIVF thickness should not exceed 0.600 cm. Above these values, the suspicion of a periaortic abscess formation should be raised. MAIVF increased thickness may be an early sign of perivalvular diffusion requiring an urgent endocarditis team evaluation.
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1,654
84
REVIEW ARTICLE
Cardiac magnetic resonance in primary prevention of sudden cardiac death
Giorgio Faganello, Aldostefano Porcari, Federico Biondi, Marco Merlo, Antonio De Luca, Giancarlo Vitrella, Manuel Belgrano, Lorenzo Pagnan, Andrea Di Lenarda, Gianfranco Sinagra
July-September 2019, 29(3):89-94
DOI
:10.4103/jcecho.jcecho_25_19
PMID
:31728298
Sudden death accounts for 400,000 deaths annually in the United States. Most sudden deaths are cardiac and are related to arrhythmias secondary to structural heart disease or primary electrical abnormalities of the heart. Implantable cardioverter defibrillator significantly improves survival in patients at increased risk of life-threatening arrhythmias, but better selection of eligible patients is required to avoid unnecessary implantation and identify those patients who may benefit most from this therapy. Left ventricular (LV) ejection fraction (EF) measured by echocardiography has been considered the most reliable parameter for long-term outcome in many cardiac diseases. However, LVEF is an inaccurate parameter for arrhythmic risk assessment as patients with normal or mildly reduced LV systolic function could experience sudden cardiac death (SCD). Among other tools for arrhythmic stratification, magnetic resonance (CMR) provides the most comprehensive cardiac evaluation including
in vivo
tissue characterization and significantly aids in the identification of patients at higher SCD risk. Most of the evidence are related to late gadolinium enhancement (LGE), which was proven to detect cardiac fibrosis. LGE has been reported to add incremental value for prognostic stratification and SCD prediction across a wide range of cardiac diseases, including both ischemic and nonischemic cardiomyopathies. In addition, T1, T2 mapping and extracellular volume assessment were reported to add incremental value for arrhythmic assessment despite suffering from several technical limitations. CMR should be part of a multiparametric approach for patients' evaluation, and it will play a pivotal role in prognostic stratification according to the current evidence.
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130
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Online since 08 August, 2013