Functional mitral regurgitation, updated: ventricular or atrial?Abe, Yukio; Takahashi, Yosuke; Shibata, Toshihiko
2020 Journal of Echocardiography
doi: 10.1007/s12574-019-00453-wpmid: 31728977
Lone atrial fibrillation (AF) can cause functional mitral regurgitation (MR), commonly referred to as “atrial functional MR (AFMR).” This type of MR has recently received much attention as an important cause of heart failure, and it represents a considerable therapeutic target in heart failure patients with AF. Mitral annular dilatation due to left atrial (LA) dilatation can be recognized as an original cause of AFMR, whereas the exact cascade of AFMR etiologies has not been established. AFMR is typically classified as Carpentier type I, and is likely to have a central jet. In contrast, a proportion of AFMR is classified as a combination of Carpentier type I for a flattened anterior mitral leaflet and Carpentier type IIIb for a tethered posterior mitral leaflet and is likely to have an eccentric jet directed toward the LA posterior wall. The traditional functional MR occurring in patients with left ventricular (LV) dilatation and/or systolic dysfunction, which is classified as Carpentier type IIIb, has since been designated “ventricular functional MR (VFMR)” to distinguish it from AFMR. Traditional VFMR, newly recognized AFMR, and their etiologic relations to LV/LA size and function are discussed in this review article.
New horizon of fusion imaging using echocardiography: its progress in the diagnosis and treatment of cardiovascular diseaseTakaya, Yoichi; Ito, Hiroshi
2020 Journal of Echocardiography
doi: 10.1007/s12574-019-00455-8pmid: 31768925
Cardiac imaging modalities are essential for the management of cardiac diseases. Multimodality imaging, such as echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance imaging, and fluoroscopy, is required for assessing cardiac condition. In recent years, fusion imaging, which integrates different imaging modalities on the same screen, has been developed. Because the fusion imaging is able to merge the advantages of each modality, it has the potential to be valuable for accurate diagnosis as well as the planning of therapeutic strategies. In the clinical setting, the fusion imaging of real-time transthoracic echocardiography with cardiac CT displayed side by side has reportedly been effective for the diagnosis and the assessment of disease severity in patients with adult congenital heart disease. The overlay of real-time three-dimensional transesophageal echocardiography onto fluoroscopy, which is dynamic fusion imaging, has been used for structural heart disease interventions. The fusion imaging has become increasingly important in the field of cardiac diseases. This review discusses the benefits of echocardiographic fusion imaging.
Percentile curves for left ventricle structural, functional and haemodynamic parameters obtained in healthy children and adolescents from echocardiography-derived dataDíaz, Alejandro; Zócalo, Yanina; Bia, Daniel
2020 Journal of Echocardiography
doi: 10.1007/s12574-019-00425-0pmid: 30927161
BackgroundTransthoracic echocardiography is the most common non-invasive technique for the study of the left ventricle (LV) and the proximal aorta. Despite the clinical value, there is scarcity of data about reference intervals (RIs) and percentiles for thoracic aorta dimension and LV structural and functional parameters, obtained from population-based studies in children and adolescents. The aim was to generate RIs for LV, haemodynamic and thoracic aorta parameters obtained from transthoracic echocardiography in healthy children, adolescents and young adults from a South-American population.MethodsOne thousand ninety-five healthy subjects (5–24 years) were studied (M-mode, B-mode and Doppler echocardiography).ResultsRIs for LV structural (diameters, volumes and wall thickness) and functional (stroke volume, cardiac output, cardiac index, transmitral E and A flow waves velocities) parameters; systemic vascular resistance and aortic root diameter were obtained using parametric regression analyzes based on fractional polynomials. Covariate analysis (i.e., adjusting for age, body surface) showed that specific sex-specific RIs were necessary. Then, age, body height (BH), body weight (BW), body surface area (BSA), and sex-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th and 99th percentiles were obtained. Our results were in agreement with and complimentary to available international databases.ConclusionThis study provides RIs for echocardiography-derived haemodynamic, LV (structural and functional) and aortic parameters in children, adolescents and young adults considering data obtained from the largest Argentinean database. In early stages of life an adequate interpretation of echocardiography-derived LV and aortic parameters requires considering age, BH, BW, BSA and/or sex-specific RIs.
Sonographer quality managementMarriner, Mieko
2020 Journal of Echocardiography
doi: 10.1007/s12574-019-00430-3pmid: 31190291
BackgroundThe echocardiogram is the second most used diagnostic tool for cardiovascular patient care. Qualified sonographers are needed to consistently produce high-quality echocardiograms to provide high-quality patient care.MethodsOur department uses the three major management tools to assure sonographers are qualified. (1) ASE guidelines and standards. (2) Sonographer registry system and (3) quality improvement (QI) program with the accreditation of Echo Lab. QI measures are done quarterly assessing the appropriate use criteria for echocardiography, interpreter and sonographer variability, timeliness and completeness and correlations. The variabilities are assessed along ASE guidelines and standards.ResultsQI measures are mainly done by Medical Director and Technical Director. Medical Director and Technical Director discuss with individual interpreter and sonographer after QI measures are done each quarter as the feedback. Through the feedback improving the individual sonographer skills and understanding of Echo result. Our Echo Lab is accredited by Intersocietal Accreditation Commission (IAC). Accredited Echo Labs have to follow the IAC standards for echocardiography which includes those QI measures. Every sonographer in our lab is registered and complied for CME requirement to update their knowledge and skills. Twice a year QI meeting will be held and discuss about those QI measures and make consensus as Echo Lab.ConclusionsRegistered sonographer with systematic quality checking system of their work will be achieved improving the high-quality echocardiogram and leading to the high-quality patient care.
Comparison of transthoracic and transesophageal echocardiography for transcatheter aortic valve replacement sizing in high-risk patientsFox, Henrik; Hemmann, Katrin; Lehmann, Ralf
2020 Journal of Echocardiography
doi: 10.1007/s12574-019-00448-7pmid: 31630329
BackgroundUntreated symptomatic high-grade aortic stenosis remains a lethal disease requiring individually adapted valve replacement. High-risk surgical patients benefit from transcatheter aortic valve replacement (TAVR), but there is no uniform standard for patient selection and valve sizing and it is still unclear whether transthoracic (TTE) or transesophageal (TEE) echocardiography is superior in preprocedural aortic annulus sizing. As preprocedural sizing of the native aortic annulus diameter is crucial to outcome and survival, we report the results of a direct comparison between preprocedural sizing with TTE and TEE including subsequent outcomes in a high-risk TAVR population.MethodsA total of 149 TAVR patients were enrolled for TTE and TEE comparison, and an additional 15 patients without structural heart disease were investigated as control group to determine the influence of aortic valve calcification on TTE and TEE aortic annulus diameter measurements.ResultsOverall standardized TTE and TEE measurements for aortic annulus sizing showed excellent correlation at good image quality (p < 0.01, r = 0.934). Calcification of the aortic annulus diameter was not found to exert a noteworthy negative influence on measurements for both standardized TTE and TEE and complication rates did not differ for mortality, periprocedural stroke and paraprosthetic regurgitation.ConclusionsTransthoracic echocardiography and TEE are both equally suitable methods of preprocedural aortic annulus size evaluation in preparation of TAVR procedures.
Detection of abnormal myocardial deformation during acute myocardial ischemia using three-dimensional speckle tracking echocardiographyHioki, Ayana; Asanuma, Toshihiko; Masuda, Kasumi; Sakurai, Daisuke; Nakatani, Satoshi
2020 Journal of Echocardiography
doi: 10.1007/s12574-019-00449-6pmid: 31667676
BackgroundThree-dimensional (3D) speckle tracking echocardiography can simultaneously evaluate circumferential, longitudinal, and radial strain without being affected by through-plane motion. Moreover, the assessment of area change ratio may allow measuring regional myocardial deformation more accurately. We investigated the changes in each deformation parameter during acute coronary flow reduction, and evaluated whether the spatial extent of the abnormal values in each deformation parameter corresponded to that of the perfusion abnormality.MethodsIn 10 dogs, myocardial strains of three directions and area change ratio were analyzed at baseline and during three different ischemic conditions. The peak systolic value and the post-systolic index (PSI) were measured in both the ischemic and normal segments. The function abnormality, derived from the deformation parameter, and the perfusion abnormality, derived from Evans blue staining, were evaluated in each segment during complete occlusion and the concordance rate between both abnormalities was calculated.ResultsIn all deformation parameters, the peak systolic value tended to gradually decrease and the PSI tended to gradually increase with the severity of flow reduction in the ischemic segment. Especially in area change ratio, significant changes were observed in both the peak systolic value and the PSI during occlusion compared to baseline. The concordance rate was the highest in the PSI assessed by area change ratio.ConclusionsAmong 3D myocardial deformation parameters, area change ratio demonstrated better detectability of acute coronary flow reduction than conventional strain components. Area change ratio may be a useful parameter for detecting acute ischemia by 3D speckle tracking echocardiography.
Predictors and prognostic impact of secondary mitral regurgitation in myocardial infarction with preserved ejection fractionNogi, Maki; Okura, Hiroyuki; Kataoka, Toru; Yoshida, Kiyoshi
2020 Journal of Echocardiography
doi: 10.1007/s12574-019-00451-ypmid: 31696389
BackgroundSecondary or functional mitral regurgitation (FMR) has been reported associated with poor prognosis in patients with ischemic or non-ischemic cardiomyopathy. Prognostic impact of the FMR in myocardial infarction with preserved ejection fraction (MIpEF) is unknown. The aim of this study was to investigate predictors and prognostic impact of FMR in MIpEF.MethodsA total of 556 patients with MIpEF were selected from the Bell Land General Hospital MI (BELAMI) registry (n = 953). Patients were grouped according to the presence or absence of severe FMR. Clinical endpoint was all-cause death.ResultsSevere FMR was present in 26 patients (4.7%) (FMR group) and absent in 530 patients (control). FMR group was older (77.5 ± 7.2 vs. 67.3 ± 11.3 years, P < 0.01) and had more female gender (54% vs. 28%, P < 0.01). By echocardiography, FMR group had larger left atrial diameter and left ventricular end-systolic volume. E and E/e′ were significantly higher and deceleration time of E was significantly shorter in FMR group. By Kaplan–Meier analysis, survival was significantly lower in FMR group than in control (log-rank, P = 0.004).ConclusionSevere FMR is rare in MI patients with preserved EF but is associated with poor long-term prognosis.