Guideline from the Japanese society of echocardiography: guidance for the management and maintenance of echocardiography equipment: 2022 focused updateDaimon, Masao; Iwano, Hiroyuki; Onishi, Tetsuari; Ohara, Takahiro; Tanaka, Hidekazu; Hirano, Yutaka; Yamada, Hirotsugu; Izumi, Chisato; Nakatani, Satoshi
2022 Journal of Echocardiography
doi: 10.1007/s12574-022-00588-3pmid: 36053459
Echocardiography plays a pivotal role as an imaging modality in modern cardiology practice. Information derived from echocardiography is essential for patient care. The Japanese Society of Echocardiography has promoted echocardiography for routine clinical and research use. One of the missions of the Society is to provide information that is useful for high-quality examinations. To ensure this, we believe that maintaining equipment in good condition and providing a comfortable environment for the examination are important for both the patient and examiner. Thus, the Committee for Guideline Writing of the Japanese Society of Echocardiography originally published brief guidance for the routine use of echocardiography equipment in 2015. In 2018, the committee updated our guidance incorporating the importance of international standardization. In 2022, the committee has revised and updated our guidance in line with the increase in awareness of infection prevention due to the worldwide spread of coronavirus disease 2019 (COVID-19).
Left atrial appendage orifice dimensions in Japanese atrial fibrillation population measured by multiplane transesophageal echocardiographyMiyoshi, Miho; Watanabe, Nozomi; Fukuda, Tomoko; Nishino, Shun; Kimura, Toshiyuki; Furugen, Makoto; Ashikaga, Keiichi; Takahashi, Naohiko; Shibata, Yoshisato
2022 Journal of Echocardiography
doi: 10.1007/s12574-022-00575-8pmid: 35587331
BackgroundSuccessful implantation of the WATCHMAN device requires an accurate understanding of left atrial appendage (LAA) anatomy and orifice dimensions. Racial differences are observed in LAA size when comparing Asians with non-Asians.MethodsA total of 170 patients (123 male, 67.4 ± 9.2 years) with paroxysmal or persistent atrial fibrillation (AF) underwent transesophageal echocardiography before catheter ablation or cardioversion (September 2018 to September 2019). As per the recommendations of the WATCHMAN device, the maximal LAA ostial diameters were measured at multiplane angles of 0°, 45°, 90°, and 135°.ResultsThe majority of patients (121/170, 71%) had an LAA orifice size within 17–25 mm. Fifteen (8.8%) patients had undersized (< 17 mm) and eight (0.5%) had oversized (> 31 mm) LAA. One patient in this population had no LAA. LAA size was significantly larger in patients with persistent AF than in those with paroxysmal AF (23.3 ± 4.2 mm vs. 20.0 ± 3.0 mm, p < 0.001) and in male patients than in female patients (22.4 ± 4.2 vs. 20.9 ± 3.7 mm, p = 0.03). LAA orifice dimension was significantly correlated with CHADS2 score, the left atrial volume (LAV), E/e′, and the left ventricular ejection fraction. Persistent AF, body mass index, and LAV were independently associated with LAA orifice dimension in multivariate analysis.ConclusionThis study demonstrated the distribution of LAA orifice dimension in the Japanese AF patients. This finding should be used as a reference to understand the racial characteristics of LAA size for the WATCHMAN procedure.
Association between cardiovascular risk factors and left ventricular strain distribution in patients without previous cardiovascular diseaseTakahashi, Tomonori; Kusunose, Kenya; Zheng, Robert; Yamaguchi, Natsumi; Hirata, Yukina; Nishio, Susumu; Saijo, Yoshihito; Ise, Takayuki; Yamaguchi, Koji; Yagi, Shusuke; Yamada, Hirotsugu; Soeki, Takeshi; Wakatsuki, Tetsuzo; Sata, Masataka
2022 Journal of Echocardiography
doi: 10.1007/s12574-022-00576-7pmid: 35562627
BackgroundSome cardiovascular (CV) risk factors, such as hypertension and diabetes mellitus, have been reported to reduce left ventricular (LV) longitudinal strain (LS) even in patients with preserved LV ejection fraction. We hypothesized that multiple CV risk factors might cause changes in myocardial strain. Our study aimed to assess the association between multiple CV risk factors and strain in patients without previous CV disease (CVD).MethodsWe retrospectively evaluated 137 patients without CVD, who underwent echocardiography at our institution between May 2017 and February 2020. They were divided into four groups based on the number of risk factors (group 0: no risk factor, group 1: one risk factor, group 2: two risk factors, and groups 3: three or four risk factors). Risk factors were hypertension, dyslipidemia, diabetes mellitus, and chronic kidney disease. Absolute values of global LS (GLS) and relative apical LS ratio (RALSR) defined using the equation: average apical LS/(average basal LS + average mid LS) and was used as a marker of strain distribution.ResultsOut of 137 patients, group 0 had 35 patients, group 1 had 35 patients, group 2 had 32 patients, and group 3 had 35 patients. GLS was 22.4 ± 2.0%, 21.7 ± 2.1%, 21.3 ± 1.8%, 20.7 ± 2.2%, and RALSR was 0.64 ± 0.06, 0.66 ± 0.06, 0.68 ± 0.08, 0.69 ± 0.07 in groups 0–3, respectively. The one-way ANOVA detected significant differences between groups in GLS (p = 0.005) and RALSR (p = 0.037), respectively. Group 3 had a significantly lower GLS and higher RALSR than group 0 (p < 0.05).ConclusionIn patients without previous CVD, LS decreased especially from the basal segment as the number of cardiovascular risks increased. The segmental LS may be markers of occult LV dysfunction in patients with CV risk factors.
Prognostic value of diastolic function parameters in significant aortic regurgitation: the role of the left atrial strainGarcía Martín, Ana; Abellás Sequeiros, María; González Gómez, Ariana González; Rincón Díaz, Luis Miguel; Monteagudo Ruiz, Juan Manuel; Hinojar Baydés, Rocío; Moya Mur, Jose Luis; Zamorano, José Luis; Fernández-Golfín, Covadonga
2022 Journal of Echocardiography
doi: 10.1007/s12574-022-00577-6pmid: 35579751
BackgroundThe management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. The aim of this study was to analyze the prognostic significance of the diastolic function evaluated by echocardiography, in asymptomatic patients with sAR.MethodsA total of 126 patients with asymptomatic sAR evaluated in the Heart Valve Clinic were retrospective included. Conventional echocardiographic systolic and diastolic function parameters were assessed. Left atrial (LA) auto-strain analysis was performed in a sub-group of 57 patients. A combined end-point of hospital admission due to heart failure, cardiovascular mortality, or aortic valve surgery was defined.ResultsDuring a median follow-up of 34.1 (interquartile range 16.5–48.1) months, 25 (19.8%) patients reached the combined end-point.Univariate analysis showed that LV volumes, LV ejection fraction (LVEF), LV-GLS, E wave, E/e’ ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate analysis that tested all classical echocardiographic variables statistically significant in the univariate model showed that LVEDV (HR = 1.02; 95% CI 1.01–1.03; p < 0.001) and E/e’ ratio (HR = 1.12; 95% CI 1.03–123; p = 0.01) were significant predictors of events. Kaplan–Meier curve, stratified by median value of LASr, showed that lower LASr values (less than median of 34%) were associated with higher rates of events (p = 0.013).ConclusionIn this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LASr played a significant predictor role.
Feasibility of tissue-tracking mitral annular displacement in single four-chamber view as a simple index of left ventricular longitudinal deformationTerada, Kosei; Hozumi, Takeshi; Fujita, Suwako; Takemoto, Kazushi; Nishi, Takahiro; Khalifa, Amir Kh. M.; Kubo, Takashi; Tanaka, Atsushi; Akasaka, Takashi
2022 Journal of Echocardiography
doi: 10.1007/s12574-022-00578-5pmid: 35637407
BackgroundLeft ventricular global longitudinal strain (LVGLS) has prognostic value for adverse cardiac events. Application of speckle-tracking technology to mitral annulus provides easy assessment of tissue-tracking mitral annular displacement (TMAD) in apical four-chamber view. The study aimed to examine whether TMAD can be used as a simple index of LV longitudinal deformation in patients with and without preserved ejection fraction (EF).MethodsThe study population consisted of 95 consecutive subjects. GLS was assessed from three apical views. TMAD was evaluated as the base-to-apex displacement of septal (TMADsep), lateral (TMADlat), and mid-point of annular line (TMADmid) in apical 4-chamber view. The percentage of TMADmid to LV length from the mid-point of mitral annuls to the apex at end-diastole (%TMADmid) was calculated. We compared each TMAD parameter with GLS by linear regression analysis, and analyzed each TMAD parameter by receiver operating characteristic (ROC) curve to detect impaired LV longitudinal deformation (|GLS|< 15.0%).ResultsThere were good correlations between each TMAD parameter and GLS (TMADsep: r2 = 0.59, p < 0.01. TMADlat: r2 = 0.65, p < 0.01. TMADmid: r2 = 0.68, p < 0.01. %TMADmid: r2 = 0.75, p < 0.01). According to ROC curve, %TMADmid < 10.5% was the best cut-off value in determining impaired LV longitudinal deformation (|GLS|≤ 15.0%) with a sensitivity of 95% and a specificity of 93%. The area under the curve (AUC) of %TMADmid was 0.98 (95% confidence intervals (CI) 0.93–0.99).ConclusionsTMAD using speckle-tracking echocardiography quickly estimated from single apical four-chamber view can be used as a simple index for detection of impaired LV longitudinal deformation in patients with and without preserved EF.