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The aim of this study was to estimate geometric errors made by the two-dimensional (2D) transthoracic echocardiographic (TTE) pulsed-wave Doppler flow (PWDF) method in calculating regurgitant volume (RVol) and effective regurgitant orifice area (EROA) in degenerative mitral regurgitation (MR) by comparison with the three-dimensional (3D) transesophageal echocardiographic (TEE) PWDF method.

Background:Noncompaction cardiomyopathy (NCCM) is a new pathoanatomic entity, disputably believed to result from abnormal arrest in embryonic endomyocardial morphogenesis. During almost three decades of research of NCCM, more knowledge has developed alongside diagnostic uncertainties and precise definition. In this article, we present these uncertainties and provide perspectives on how to overcome these challenges.Areas covered:The uncertainties, about NCCM regarding nomenclature, classification, pathophysiology, and limitations of the current diagnostic criteria will be reviewed. The application of newer imaging modalities will be contrasted in relation to conventional assessments. Finally, future aspirations will be outlined providing a more thoughtful appraisal toward NCCM diagnosis.Expert opinion:Our current understanding of NCCM is limited by heterogeneity of disease spectrum and phenotype–genotype overlap with other cardiac anomalies. Selection bias, small sampling, and retrospective nature limit most of published studies on NCCM. There are three main research fields related to NCCM: pathoanatomic studies, imaging studies, and genetic screening. Besides conventional echocardiography, imaging should include both structural (cardiac MRI, contrast and 3D echocardiography) and functional diagnosis using deformation imaging. These research aspects should be integrated in a collaborative international registry of nonselective populations in order to achieve better understanding and optimal diagnosis of NCCM. Moreover, it holds the promise of the detection of earlier stages of disease. A clear pathoanatomic cut-off definition of NCCM should be the initial step toward uniform imaging diagnosis.

The diagnosis of noncompaction cardiomyopathy (NCCM) remains subject to controversy. Because NCCM is probably caused by an intrauterine arrest of the myocardial fiber compaction during embryogenesis, it may be anticipated that the myocardial fiber helices, normally causing left ventricular (LV) twist, will also not develop properly. The resultant LV rigid body rotation (RBR) may strengthen the diagnosis of NCCM. The purpose of the current study was to explore the diagnostic value of RBR in a large group of patients with prominent trabeculations.

Hypotension during haemodialysis results from an inadequate cardiovascular response to ultrafiltration-induced hypovolaemia. It has been suggested that plasma volume could be increased as a result of systemic vasoconstriction.

LV systolic dysfunction in dialysis patients has been implicated in the genesis of dialysis hypotension. End-systolic elastance (E(es)), a relatively load-independent parameter of myocardial contractility, was assessed by testing the acute left ventricular (LV) response to nitroglycerine (NTG) in hypotension-prone (HP) and hypotension-resistant (HR) patients.

An increase in serum Ca2+ during hemodialysis (HD) may lead to impaired left ventricular (LV) relaxation. Since LV diastolic function assessment in dialysis patients is hampered by preload dependence of Doppler measurements, we tested the effect of HD without ultrafiltration (UF) on these measurements. Transmitral E and A velocities, and mitral annulus eand avelocities were measured in 10 patients before and after 1 h of HD without UF. Dialysate Ca2+ was 1.75 mmol/l. Serum Ca2+ after 1 h (1.31 mmol/l; 1.28–1.46 mmol/l) was higher (p = 0.002) than before HD (1.24 mmol/l; 1.09–1.32 mmol/l). E/A (0.8; 0.4–2.8) and e/a(0.7; 0.4–1.3) after 1 h were not different than E/A (0.8; 0.6–5.1) and e/a(0.7; 0.4–1.8) before HD. The increase in serum Ca2+ does not lead to a change in Doppler parameters of LV diastolic function. Changes in these parameters after combined HD-UF are related to preload, not to serum Ca2+.

Objectives. This study was done to ascertain whether three-dimensional echocardiography can facilitate the diagnosis of mitral valve abnormalities.

Multiplane imaging with a rotating phased-array transducer from within the esophagus represents the latest development in transesophageal cardiac ultrasound. Transverse, longitudinal, and all possible intermediate oblique planes are easily obtained from the same transducer with minimal probe manipulation. Three-dimensional conceptualization of complex structures and pathologic conditions is facilitated. The major advantages are a simplified examination procedure and much less patient discomfort than monoplane and biplane probe imaging.

Dynamic three-dimensional echocardiography enables objective analysis of structures and pathologic conditions of complex geometry. In addition, it may provide more accurate quantitative analysis of cardiac function. This study presents the first results obtained with multiplane transesophageal diagnostic imaging system that is connected to a dedicated software configuration allowing three-dimensional tissue reconstruction and its dynamic display at 25 frames/sec. In addition, it permits "computer slicing" through the beating heart along arbitrary orientations and the display of synthetic cross sections along thse orientations with excellent resolution and grey values (dynamic anyplane echocardiography). The advantage of a multiplane transesophageal imaging transducer is that the acquisition of cross sections for three-dimensional reconstruction becomes an integral part of a routine diagnostic transesophageal study and only requires an additional 7 to 10 minutes of examination time. This approach will help to develop three-dimensional echocardiography and synthetic anyplane echocardiography into a practical clinical tool offering diagnostic information similar to magnetic resonance imaging.

Aims This study sought to investigate regional left ventricular (LV) rotation in patients with hypertrophic cardiomyopathy (HCM). Methods and results The study comprised 44 patients with HCM with a typical reverse septal curvature (age 40 ± 14 years, 33 men) and 44 healthy volunteers (age 39 ± 14 years, 32 men) in whom LV rotation could be assessed at the basal and apical LV level with speckle-tracking echocardiography, using the QLAB Advanced Quantification Software version 6.0 (Philips, Best, The Netherlands). In HCM patients, lower values of initial counter-clockwise rotation at the basal LV level (1.5 ± 1.2 vs. 0.6 ± 0.9°, P < 0.001) were seen, in particular in the septal segment (1.7 ± 1.6 vs. 0.4 ± 0.7°, P < 0.001). After this period, the direction of rotation changed to clockwise with a peak basal rotation of −4.8 ± 2.0° in controls vs. −6.1 ± 2.5° in HCM patients (P < 0.05). Peak basal rotation in HCM patients was in particular higher in the anterior (−6.6 ± 3.0 vs. −4.4 ± 2.4°, P < 0.01) and septal (−5.4 ± 2.6 vs. −3.9 ± 1.9°, P < 0.05) segments. The normalized (corrected for peak basal rotation) global back-rotation rate was lower in HCM patients (4.1 ± 3.1 vs. 6.3 ± 4.9 s–1, P < 0.05), in particular driven by a lower rate in the septal segment (3.8 ± 2.6 vs. 6.4 ± 4.8 s−1, P < 0.01). At the apical level, changes in rotation and back-rotation were more homogeneous. Conclusion Changes in rotation and back-rotation at the LV basal level in HCM patients are mainly caused by regional changes in the basal septal and anterior segments, the segments mostly involved in the hypertrophic process.

Objective: Three-dimensional echocardiographic assessment of myocardial ischemia using contrast echocardiography has been hampered by limitations of available contrast agents and analytic software. In the study presented, a three-dimensional perfusion imaging method was evaluated in the porcine model of myocardial ischemia using a novel contrast agent. Methods: Three-dimensional echocardiography was performed in eight open-chested pigs before, during and after left anterior descending (six animals) or circumflex (two animals) coronary artery occlusion. The intramyocardial contrast effect was obtained by left atrial injection of MyomapTM, a deposit contrast agent. Results: Myocardial opacification was visible in all studies and retained in all three-dimensional datasets. Three-dimensional intensity analysis demonstrated a significant difference, exceeding 20 intensity units in every animal (in 127-level scale), between perfused and non-perfused myocardium. Reperfusion followed by contrast reinjection resulted in homogenous myocardial enhancement. Myocardial mass at risk was clearly delineated in all studies and measured with a mean error of –0.1±2.0 g against real mass (p=non-significant). Spatial extent of ischemia could be displayed in volume-rendered reconstruction of separate perfusion territories. Conclusions: Quantitative analysis of myocardial contrast enhancement from three-dimensional datasets is feasible and allows accurate measurement of myocardial mass at risk.