Search

Background: Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) remains an important issue. The aim of this study was to assess the value of a new discongruence index, to predict PPM after TAVR.Methods and Results: A total of 185 patients with severe aortic stenosis who underwent TAVR with the Edwards Sapien prosthesis or CoreValve Revalving system were included (Edwards valve, n=119; Core Valve Revalving system, n=66). Discongruence index was calculated pre-procedurally as the ratio of selected transcatheter valve size (mm) to body surface area (cm 2 ). PPM was defined as effective orifice area (EOA) ≤0.85 cm 2 /m 2 on transthoracic echocardiography before hospital discharge. Mean age was 82±5 years and 72 patients (38.9%) were men. The overall incidence of post-TAVR PPM was 35.1% (n=65). Discongruence index correlated with post-TAVR indexed EOA (y=0.18+0.057x; P<0.001). On multivariate logistic regression analysis, discongruence index was the only independent predictor of post-TAVR PPM (OR, 0.15; 95% CI: 0.03-0.66; P=0.012), and the area under the receiver operating characteristic curve was 0.62 (95% CI: 0.54-0.70, P=0.003), with an optimal cut-off point of 15.02 (sensitivity, 86.2%; specificity, 72.5%; positive predictive value, 74.3%; negative predictive value, 83.4%)., Conclusions: The new discongruence index may be useful tool to predict PPM after TAVR.

Objetives: The clinical and prognostic usefulness of tricuspid annular plane systolic excursion (TAPSE) is well established. However, the ability of TAPSE to assess right ventricular (RV) function in patients with previous tricuspid valve annulopasty is controversial. This study examined the TAPSE suitability in patients with previous tricuspid valve annuloplasty using right ventricular fractional area change (RVFAC) as reference method., Methods: We retrospectively analyzed 53 patients who underwent tricuspid valve annuloplasty at our hospital between 2013 and 2016. TAPSE and RVFAC were obtained in preoperative and postoperative periods using standard methodology., Results: Mean age was 68±12years and 34 patients (64.1%) were women. TAPSE decreased significantly after surgery in comparison with pre-surgical values (17±4.2 Vs 12.9±4.1mm, p<0.001). On the contrary, RVFAC did not change significantly after surgery (37±9.2 Vs 36.2.9, p=0.25). The correlation between RVFAC and TAPSE was better in the preoperative (r=0.63, p<0.0001) than in the postoperative period (r=0.38, P=0.005). Good intra- and interobserver agreement for TAPSE and RVFAC was obtained, with intraclass correlation coefficients of 0.97 and 0.92 for TAPSE; and 0.90 and 0.85 for RVFAC, respectively., Conclusions: These findings suggest that TAPSE is not suitable after tricuspid valve annuloplasty and it leads to an underestimation of RV systolic function. It seems to be appropriate to rely on echocardiographic parameters of global RV function such as RVFAC in this context., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Transcatheter aortic valve implantation (TAVI) is an alternative therapy for high-risk patients with symptomatic aortic stenosis. TAVI without balloon aortic predilation (BPD) has been found to be as feasible and safe as the standard approach with predilation. The aim of this study was to show the usefulness of transesophageal echocardiographic (TEE) criteria during patient selection for TAVI without BPD and compare the results with those from a control group., Methods: Two hundred forty-nine consecutive patients with severe symptomatic aortic stenosis underwent echocardiographic evaluation before TAVI. Two-dimensional and three-dimensional TEE imaging was used to evaluate the aortic annulus and root, leaflet mobility and degree of calcification, orifice characteristics, valve area, and aortic regurgitation. After TEE data were reviewed, patients were considered to be favorable candidates, or not, for TAVI without BPD on the basis of specific echocardiographic criteria., Results: The mean age was 82 ± 5 years. Seventy-nine patients underwent TAVI without BPD, and 170 patients underwent TAVI with BPD. The mean aortic valve area was 0.61 ± 0.16 cm(2), and the mean aortic annular diameter was 2.2 ± 0.25 cm. In the group without BPD, Edwards SAPIEN XT valves were implanted in 64.6% (n = 51) and Medtronic CoreValve prostheses in 35.4% (n = 28). In this group, residual paravalvular aortic regurgitation immediately after valve deployment was seen in 53.2% of patients, without differences from those who underwent TAVI with BPD. Permanent pacemaker implantation was less frequent in the group of patients without BPD (6.3% vs 14.1%, P = .030). Procedure-related mortality was significantly lower in patients without BPD (2.5% vs 11.8%, P = .018)., Conclusions: Thorough TEE assessment of aortic valve features permits the selection of patients with ideal conditions for TAVI without BPD, regardless of the type of prosthesis. Using the echocardiographic criteria described here, it is possible to achieve a good rate of procedural success with a low complication rate in patients undergoing TAVI without BPD., (Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to examine the feasibility of transthoracic two-dimensional (2D)-echocardiography in defining the cavo-tricuspid isthmus (CTI) anatomy and its value concerning the ease of catheter ablation of isthmic atrial flutter (AF)., Methods: CTI analysis was accomplished in 39 cases: 16 necropsy specimens and 23 patients. Sixteen were patients with isthmus-dependent AF and seven controls with other supraventricular re-entrant tachycardias. Two-dimensional transthoracic echocardiography and a right atrium angiogram were performed before radiofrequency catheter ablation (RFCA)., Results: The measurements of the CTI with angiography were compared with those taken with echocardiography and correlation was excellent (r= 0.91; P < 0.0001). In normal patients, the dimension of the vestibular thickness was successfully compared and validated with the histological examination of the necropsy specimens: histology median 6.8 mm, range 4.4-10.5 vs. echo median 6.2 mm, range 5.4-8.7; P: NS. Vestibular thickness was greater in complex than in simple RFCA (13.6 ± 1.9 mm vs. 10.0 ± 2.3 mm; P = 0.01). When vestibular thickness ≥11.5 mm, the ablation prone to be complex (sensitivity 83.3%, specificity 80%, positive predictive value 71.4%, and negative predictive value 88.9%)., Conclusions: Two-dimensional transthoracic echocardiography clearly depicts the inferior isthmus and, displaying the thickness of the tricuspid vestibule, it was related with complexity of the ablation procedure in isthmus-dependent AF.

Microvascular integrity demonstrated by myocardial contrast echocardiography (MCE) predicts functional recovery after an acute myocardial infarction (AMI). Recently, parametric imaging-based quantitative MCE has been developed. Our aim was to assess the usefulness of parametric imaging-based quantitative MCE parameters to predict the functional recovery of akinetic segments after primary percutaneous transluminal coronary angioplasty (PTCA). Fifty-three consecutive patients with a first AMI were enrolled. They underwent primary PTCA. Standard echocardiography and real-time MCE were performed. Qualitative analysis and parametric imaging-based quantitative parameters were measured offline by different blinded investigators. Dobutamine stress echocardiography was performed 1 month later. A new standard echocardiogram to assess the functional status of the akinetic segments and coronary angiography to evaluate the presence of restenosis at the level of the culprit lesion were performed 6 months later. The mean patient age was 62.9 +/- 14 years, and 42 were men (79%); 170 segments were akinetic. Of these, 105 (62%) recovered their function. The best parameter to predict functional recovery was the myocardial blood flow velocity (beta). These results were better than those obtained using dobutamine stress echocardiography and qualitative MCE to predict functional recovery. In conclusion, parametric imaging-based quantitative MCE is an accurate diagnostic tool to detect stunned myocardium after AMI. Its diagnostic accuracy in predicting the functional recovery of akinetic segments after primary PTCA is better than the accuracy of dobutamine stress echocardiography and qualitative MCE.

Introduction and Objectives: Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE; and b) to assess the usefulness of these measurements in predicting functional recovery of these segments., Patients and Method: The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images., Results: The patients' mean age was 62.3+/-14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (beta): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion., Conclusions: Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods.

End-diastolic volume and end-systolic volume were measured in 35 consecutive patients with cardiomyopathy using 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography (2, 4, and 8 planes) and cardiac magnetic resonance imaging. Three-dimensional echocardiography correlates better with magnetic resonance imaging than does 2-D echocardiography. Its accuracy improves with the increase in the number of planes used. Two-dimensional echocardiography underestimates volumes, mainly in the subgroup with an ejection fraction of <50%, whereas 3-D echocardiography does not, if enough planes are used. However, in patients with an end-diastolic volume > or =150 ml, the underestimation of 3-D echocardiography is statistically significant. Increasing the number of planes to 8 reduces this bias. Conversely, patients with an end-diastolic volume <150 ml are accurately studied with just 4 planes.

Background and Aim of the Study: Higher morbidity and mortality have been attributed to patients suffering endocarditis but with negative blood cultures. The study aim was to determine whether, in the present era of routine echocardiography, patients with negative-culture endocarditis had a worse short- and long-term outcome, and whether outcomes in patients with true negative and aborted positive blood cultures were different., Methods: When endocarditis was clinically suspected, an early (<24 h) echocardiographic examination was performed in all patients, regardless of blood culture results. In total, 151 patients diagnosed with infective endocarditis (IE) comprised the study group. Among these patients, 40 (26%) had negative blood cultures, and 28 of this subgroup (70%) had received previous antibiotic therapy. Short- and long-term features and prognosis were compared between both groups. The combined main end-point was death or need for surgical repair., Results: Similar anatomic and clinical characteristics were present among those patients with positive and negative cultures. In addition, mortality and need for surgery with regard to short- and long-term follow up of both groups was similar. There were no significant differences between patients with true- or aborted-negative cultures in terms of short- and long-term prognosis., Conclusion: No differences in short- and long-term prognosis were seen among patients with IE and positive versus negative blood cultures. The prognosis was also similar between those with true negative culture versus aborted negative cultures. Early echocardiography in patients with clinically suspected IE may have changed the outcome in patients with negative cultures.

Introduction: The quantitative measurement of the left ventricle by echocardiography is a fundamental tool in the diagnosis and prognosis of acquired and congenital diseases in the pediatric population. The objective of this study was to validate an automated three‐dimensional adaptive analytic echocardiographic algorithm, the so‐called Heart Model® (HM) in the pediatric population, using as comparators the left atrial and left ventricular volumes and left ventricular ejection fraction obtained by means of conventional 2D and 3D echocardiography. Methods: Pilot study, where a population comprised of 75 consecutive patients aged 6–17 years who attended a pediatric cardiology clinic, was evaluated. Every patient underwent a conventional 2D and 3D echocardiography and an analysis using HM. Conventional 3D echo was used as the reference method. Results: Seventy‐five patients were analyzed. Mean age was 11.2 (4.0) years (52.2% women). The intraclass correlation coefficient of HM vs 2D echo was poor, but it was good for the agreement between HM and 3D echo for left ventricular end‐diastolic volume (ICC: 0.98; 95% CI: 0.97–0.99; P < 0.001), left ventricular end‐systolic volume ICC: 0.98; 95% CI: 0.96–0.99; P = 0.001), and left ventricular ejection fraction (ICC: 0.87; 95% CI: 0.78–0.92; P < 0.001). The agreement was also good for the three parameters when the analysis was performed according to body weight. Conclusions: Heart Model® is a feasible and accurate tool for the evaluation of left atrial and left ventricular volumes and left ventricular ejection fraction in pediatric population aged above 6 years. [ABSTRACT FROM AUTHOR]

Certain chemotherapy drugs for breast cancer may induce cardiotoxicity and these patients should be echocardiographically monitored. The performance of a focused echocardiographic evaluation (echoscopy) at the patient's location by a non-cardiologist appears to be feasible. The aim of the present study was to assess the accuracy of echoscopy performed by medical oncologists in an outpatient clinic using hand-held echocardiography devices. The study cohort comprised consecutive unselected patients who attended an oncology outpatient clinic. Two medical oncologists attended a one-week training period, which included theoretical and practical teaching by an expert cardiologist. Every subject underwent two echo examinations. The first examination was performed by an oncologist using a hand-held echo device and the second was performed by a cardiologist using a 'premium' device. Out of the 101 enrolled patients, 32 were men (31.7%) and the mean age was 56.03±16.88 years. There was a good global agreement [intra-class correlation coefficient (ICC): 0.65 for left ventricular ejection fraction (LVEF)]. When the results were analyzed depending on the period of time when the echo studies were performed, a clear and short learning curve was observed: LVEF started at ICC=0.58 and increased to 0.66 and 0.77 in the second and third period, respectively. There were extremely few clinically significant differences and a learning curve was also evident. In conclusion, cardiac echoscopy performed by an oncologist with a hand-held device may lead to a similar clinical management as a study performed by an expert cardiologist with a 'premium' system in patients under chemotherapy following a short training period. [ABSTRACT FROM AUTHOR]

Background/Objectives Atrial fibrillation ( AF) is the most common cardiac arrhythmia and is associated with a significantly high risk of stroke and systemic embolism. The aim of our study was to assess the association between left atrium ( LA) mechanics measured by 3D wall-motion tracking (3 DWMT) technology and the most common thromboembolic risk scores ( CHADS2, CHA2 DS2- VASc). Methods A total of 101 consecutive patients with permanent AF referred were included. Conventional bidimensional (2D) LA parameters, and LA mechanics by means of 3 DWMT were studied. Association between LA 2D and 3 DWMT parameters and both risk scores was evaluated as well as its correlation with every component of the score individually. Results Mean age was 78 ± 10 years. Mean CHADS2 was 2.7 ± 1.3 and mean CHA2 DS2- VASc was 4.4 ± 1.7. Values of 2D and 3 DWTM LA parameters were: 2D area 26.4 ± 9.7 cm2, 2D volume index 49.4 ± 10.1 mL/m2, 3 DWMT left atrial emptying fraction ( LAEF) 15.9 ± 8.4%, longitudinal strain 9.1 ± 4.5% and area strain 14.9 ± 8.8%. Linear regression analysis showed statistically significant correlation between LA longitudinal strain and LAEF with CHADS2 and CHA2 DS2- VASc scores. For each 10% variation in longitudinal strain, CHADS2 and CHA2 DS2- VASc scores change in 0.7 and 0.8 points, respectively. Conclusions Left atrial longitudinal strain and emptying fraction assessed by 3D WMT technology have correlation with both CHADS2 and CHA2 DS2- VASc scores. Each 10% of variation in longitudinal strain represents a 0.7 and 0.8 points change in those risk scores. LA mechanics evaluation might provide additional value to risk scores and could be considered to be a predictor of stroke in patients with AF. [ABSTRACT FROM AUTHOR]

Background Left atrium (LA) size assessment is clinically relevant, but the accuracy of two-dimensional echocardiographic (2D-echo) methods is limited. Three-dimensional (3D) echocardiography is an excellent alternative but is far from being used in daily clinical practice. Three-dimensional-wall motion tracking (3D-WMT) allows us to obtain volumes in a very simple and rapid manner. The aims of this study were to evaluate the accuracy of 3D-WMT technology to assess LA volume using cardiac magnetic resonance (CMR) as a reference method, to evaluate its reproducibility, and to determine its added clinical value to classify the LA enlargement severity. Methods and results Seventy consecutive patients referred for a CMR study were prospectively enrolled. They underwent LA volume assessment by means of 2D-echo, 3D-WMT, and CMR. Inter-methods agreement was assessed. The mean age was 56 ± 18 years and 42 patients (60%) were males. Average maximal LA volume obtained by 2D-echo, 3D-WMT, and CMR were 63.33 ± 26.82, 79.80 ± 29.0, and 79.80 ± 28.99 mL, respectively. Univariate linear regression analysis showed a good correlation between 3D-WMT and CMR (r = 0.83; P < 0.001). The agreement analysis showed a similar result (ICC = 0.83; 95% CI = 0.74–0.89; P < 0.001). Furthermore, the LA enlargement degree was better evaluated with 3D-WMT than with 2D-echo. Conclusion This study validates LA volume measurements obtained using the new and fast 3D-WMT technology, compared with CMR. This method is fast, accurate, and reproducible, and it allows a better classification of left LA enlargement severity compared with 2D-echo. [ABSTRACT FROM PUBLISHER]

Objectives The aim of this study was to examine the feasibility of transthoracic two-dimensional (2D)-echocardiography in defining the cavo-tricuspid isthmus (CTI) anatomy and its value concerning the ease of catheter ablation of isthmic atrial flutter (AF). Methods CTI analysis was accomplished in 39 cases: 16 necropsy specimens and 23 patients. Sixteen were patients with isthmus-dependent AF and seven controls with other supraventricular re-entrant tachycardias. Two-dimensional transthoracic echocardiography and a right atrium angiogram were performed before radiofrequency catheter ablation (RFCA). Results The measurements of the CTI with angiography were compared with those taken with echocardiography and correlation was excellent (r= 0.91; P < 0.0001). In normal patients, the dimension of the vestibular thickness was successfully compared and validated with the histological examination of the necropsy specimens: histology median 6.8 mm, range 4.4–10.5 vs. echo median 6.2 mm, range 5.4–8.7; P: NS. Vestibular thickness was greater in complex than in simple RFCA (13.6 ± 1.9 mm vs. 10.0 ± 2.3 mm; P = 0.01). When vestibular thickness ≥11.5 mm, the ablation prone to be complex (sensitivity 83.3%, specificity 80%, positive predictive value 71.4%, and negative predictive value 88.9%). Conclusions Two-dimensional transthoracic echocardiography clearly depicts the inferior isthmus and, displaying the thickness of the tricuspid vestibule, it was related with complexity of the ablation procedure in isthmus-dependent AF. [ABSTRACT FROM PUBLISHER]

Background Current guidelines do not recommend routine assessment of right atrial volume due to the lack of standardized data. Three-dimensional wall-motion tracking (3 D- WMT) is a new technology that allows us to calculate volumes without any geometric assumptions. The aim of this study was to define the indexed reference values for two-dimensional echocardiography (2 D-echo) and 3 D- WMT in adult healthy population and to assess the intermethod, intra- and interobserver agreement. Methods Prospective study. Nonselected healthy subjects were enrolled. Every patient underwent a 2 D-echo and a 3 D- WMT examination. 2 D-echo right atrial volume was obtained by using the area-length method ( A- L) from four- and two-chamber view. 3 D-echo volumes were assessed by 3 D- WMT. Values were indexed by the patient's body surface area. Results Sixty consecutive healthy subjects were enrolled. Mean age was 57 ± 12-years old and 27 patients (45%) were male. Average indexed right atrial volume obtained by 2 D-echo and 3 D-echo was 16.76 ± 8.15 mL/m2 and 19.05 ± 6.87 mL/m2, respectively. Univariate linear regression analysis between 2 D-echo and 3 D-echo right atrial volumes shows a weak correlation between right atrial volume obtained with 2 D-echo compared with 3 D- WMT (r = 0.29, CI 95% 0.029-0.66, P = 0.033). The agreement analysis shows a similar result (intraclass correlation coefficient [ ICC] = 0.28). The intra- and interobserver agreement analysis showed a better agreement when using 3 D- WMT. Conclusions This is the first study that reports the reference indexed right atrial volume values by means of 2 D-echo and 3 D-echo in healthy population. 3 D- WMT is a feasible and reproducible method to determine right atrial volume. [ABSTRACT FROM AUTHOR]

Aims Paravalvular aortic regurgitation (AR) is common after transcatheter aortic valve implantation (TAVI). This study aimed to assess the prosthesis/aortic annulus discongruence by three-dimensional (3D) transoesophageal (TOE) planimetry of aortic annulus and its impact on the occurrence of significant AR after TAVI. Methods and results We included 33 patients who underwent TAVI with a balloon expandable device for severe aortic stenosis. To appraise the prosthesis/annulus discongruence, we defined a ‘mismatch index’ expressed as: annulus area − prosthesis area. The aortic annulus area was planimetered with 3D TOE, and approximated by circular area formula (π r2) using annulus diameter obtained by two-dimensional (2D) TOE. After TAVI, 13 patients (39.3%) developed significant AR (≥2/4). The occurrence of significant AR was associated to the 3D planimetered annulus area (P = 0.04), and the ‘mismatch index’ obtained through 3D planimetered annulus area (P = 0.03), but not to ‘mismatch index’ derived of 2D annulus diameter. In multivariate analysis, ‘mismatch index’ for 3D planimetered annulus area was the only independent predictor of significant AR (odds ratio: 10.614; 95% CI: 1.044–17.21; P = 0.04). The area under the receiver operating characteristic curve for the ‘mismatch index’ by the 3D planimetered annulus area was 0.76 (95% CI: 0.54–0.92), whereas for ‘mismatch index’ obtained by the 2D circular area was 0.36 (95% CI: 0.17–0.55). Using the 3D planimetered annulus area as the reference parameter to decide the prosthetic size, the choice would have been different in 21 patients (63%). Conclusion Three-dimensional TOE planimetry of aortic annulus improves the assessment of prosthesis/annulus discongruence and predicts the appearance of significant AR after TAVI. [ABSTRACT FROM PUBLISHER]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: High blood pressure increases left ventricular (LV) after-load. Furthermore, LV response to that high blood pressure varies among different subjects. Nevertheless, myocardial deformation behavior in these different adaptative responses has not been analyzed until now. Methods: Prospective study in which 66 consecutive hypertensive patients were enrolled in between May and August 2009. Every patient underwent a standard echocardiographic study and a three-dimensional-wall motion tracking (3D-WMT) study. The patients were classified according to parameters derived from echocardiography in four different groups: normal geometry, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Results: Mean age was 68 years (57-74.25; 51.5% male). Comparing the four groups, significant differences were found for the five 3D-WMT-derived parameters. When patients were compared with hypertensive patients with normal geometry, our finding show that: (a) LV average torsion is the only impaired parameter that is found in the LV concentric remodelling group (P < 0.05 vs. group 1); (b) there is a trend for an increase (P = 0.055) in LV average radial strain in the group with concentric hypertrophy and this increase is accompanied by a significant decrease in the remaining studied parameters (P < 0.05); and (c) in the LV eccentric hypertrophy group, there is a significant impairment in all the studied parameters (P < 0.05). Conclusions: LV adaptative response to hypertension is accompanied by a modification or even impairment, in LV myocardial deformation evaluated by 3D-WMT. This assessment might be useful to detect early and subtle deformation impairments in hypertensive patients and it could help optimize their clinical management. (Echocardiography 2010;27:1238-1246) [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Aims: The identification of valuable markers of sudden cardiac death (SCD) in patients with established HF remains a challenge. We sought to assess the value of clinical, echocardiographic and biochemical variables to predict SCD in a consecutive cohort of patients with heart failure (HF) due to systolic dysfunction. Methods: A cohort of 494 patients with established HF had baseline echocardiographic and NT-proBNP measurements and were followed for 942±323 days. Results: Fifty patients suffered SCD. Independent predictors of SCD were indexed LA size >26 mm/m2 (HR 2.8; 95% CI 1.5–5.0; p =0.0007), NT-proBNP >908 ng/L (HR 3.1; 95% CI 1.5–6.7; p =0.003), history of myocardial infarction (HR 2.3; 95% CI 1.3–4.1; p =0.007), peripheral oedema (HR 2.1; 95% CI 1.1–3.9; p =0.02), and diabetes mellitus (HR 1.9; 95% CI 1.1–3.3; p =0.03). NYHA functional class, left ventricular ejection fraction and glomerular filtration rate were not independent predictors of SCD in this cohort. Notably, the combination of both LA size >26 mm/m2 and NT-proBNP >908 ng/L increased the risk of SCD (HR 4.3; 95% CI 2.5–7.6; p <0.0001). At 36 months, risk of SCD in patients with indexed LA size ≤26 mm/m2 and NT-proBNP ≤908 ng/L was 3%, while in patients with indexed LA size >26 mm/m2 and NT-proBNP >908 ng/L reached 25% (p <0.0001). Conclusions: Among HF patients, indexed LA size and NT-proBNP levels are more useful to stratify risk of SCD than other clinical, echocardiographic or biochemical variables. The combination of these two parameters should be considered for predicting SCD in patients with HF. [Copyright &y& Elsevier]

Copyright of Archivos de Cardiología de México is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Aim: Myocardial performance index (MPI) is usually measured with pulsed wave Doppler (PWD). Our aim was to assess the degree of agreement between PWD and a method based on tissue Doppler imaging (TDI). Methods and results: Seventy-five patients with prior myocardial infarction and 20 healthy subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI at septal and lateral sides of mitral annulus. MPI and TDI-MPI at septal side showed the best intraclass correlation coefficient (ICC=0.54; p <0.0005). Ninety-five percent interval of agreement ranged from −0.27 to 0.22. These differences were attributed to discrepancies in isovolumic contraction and relaxation times. In the healthy group the results were similar (ICC=0.44), although the 95% interval of agreement was lower (from −0.13 to 0.12). Conclusions: The agreement between PWD and TDI in the measurement of MPI is only moderate. This should be taken into account in the interpretation of studies in which TDI is used for this measurement. [Copyright &y& Elsevier]

In this report, we present the case of an 85‐year‐old patient with a recent history of an infective endocarditis (IE) referred to our hospital for severe mitral regurgitation. After closer observation, echocardiography showed a large pseudoaneurysm in the posterior mitral annulus opening into the left ventricle. Anatomical assessment by 2D and 3D transesophageal echocardiogram (TEE) was essential for a detailed morphologic characterization and surgical procedure delineation. This type of IE mitral periannular extension is uncommon and early surgical intervention is critical, however the outcome is still often adverse. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 85 year old man who presented to the emergency room of a hospital with nonradiating, midsternal chest pressure with associated dyspnea. A discussion of diagnostic testing which was conducted on the man, and led to him receiving a diagnosis of a bilateral pulmonary embolism with an unusual pattern of right ventricular wall motion, is presented.

The article describes a case of mycotic pseudoaneurysm of the ascending aorta in a 49-year-old man consulted for progressive dyspnoea and bilateral lower extremity oedema. Topics include the patient's medical history, results of his transthoracic echocardiography, and the risk of mycotic pseudoaneurysm.

The article presents a case study of a 75-year-old woman with undefined transaortic high-pressure gradient obtained by transthoracic echocardiography.

An image is presented for Aortic pseudoaneurysm with fistulization to the left ventricle of a 66-year-old woman suffering from acute decompensated heart failure.

The article presents transthoracic echocardiogram images of an 82-year old male subject after he underwent underwent successful percutaneous coronary intervention; X-ray, echocardiogram and colour doppler images of the same subject are presented, showing Left ventricular pseudoaneurysm.

The article presents a case study of a 85-year-old woman having symptoms of polymyalgia rheumatica, underwent computed tomographic scan which revealed the presence of thin-walled homogeneous lesion in the anterior mediastinum behind the sternum and in front of the great arteries.

Abstract: Background: Recently, high-frequency transducers have been introduced in echocardiography laboratories to non-invasively evaluate peripheral arteries. Our aim was to assess the usefulness of these non-invasive vascular ultrasonic techniques in differentiating between ischemic and non-ischemic dilated cardiomyopathy. Methods: Forty patients with dilated cardiomyopathy of uncertain origin who underwent echocardiographic examination were studied. In all patients, carotid, femoral, and brachial arteries were scanned using high-frequency transducers in order to detect atherosclerotic plaques and to measure intima-media wall thickness. Also, flow-mediated vasodilation was measured at the brachial artery. Results: Of the 40 patients studied, 24 (60%) had significant coronary lesions. In patients with ischemic cardiomyopathy, carotid plaques were found more frequently (79% vs. 25%, p=0.001), and intima-media wall thickness was higher in carotid (1.14±0.23 vs. 0.84±0.20 mm, &#60;0.001), femoral (1.21±0.15 vs. 0.90±0.17 mm, p&#60;0.001), and brachial (0.85±0.11 vs. 0.68±0.12, p&#60;0.001) arteries. Carotid intima-media thickness of 1 mm or more was 83% sensitive and 69% specific for the diagnosis of ischemic cardiomyopathy. The highest diagnostic accuracy for any isolated vascular finding was obtained for femoral intima-media thickness greater than 1.1 mm (83% sensitivity, 88% specificity) and for brachial intima-media thickness greater than 0.7 mm (88% sensitivity and 81% specificity). The highest sensitivity (92%) was obtained for the presence of 1 or more vascular findings, and the highest specificity (94%) for 3 or more vascular findings. Conclusion: Non-invasive assessment of peripheral arteries is of help in differentiating between ischemic and non-ischemic dilated cardiomyopathy. These ultrasonic techniques should be considered as complementary examinations in the evaluation of patients with dilated cardiomyopathy in echocardiography laboratories. [Copyright &y& Elsevier]

Background and Objective: Contrast echocardiography has been recently introduced as a new technique for evaluating myocardial perfusion in a qualitative basis. The objective of this study was to test whether a visual subjective evaluation of myocardial perfusion by myocardial contrast echocardiography adequately matches the data obtained with an off-line quantification of myocardial perfusion. Methods: Sixty-one myocardial segments were evaluated by myocardial contrast echocardiography with Ultra-harmonic and Multiframe Triggering in 11 patients 3-7 days after an anterior myocardial infarction, using SH-U 563A (Levovistaˆ, Schering AG, Berlin, Germany) as contrast agent. Myocardial perfusion was classified as grade 1 (absent), 2 (patchy or incomplete) and 3 (complete) in each segment. The quantitative analysis was performed off-line by a different investigator blinded to the qualitative evaluation, using a commercially available software. The quantitative data on grey-scale obtained were compared between grade 1, 2 and 3 segments. Results: Of the 61 segments, 45 (73.8%) were classified as grade 3, whereas the remaining 16 (26.2%) were considered to be abnormally perfused (grade 2: n=12, 19.6%; grade 1: n=4, 6.6%). Segments with grade 1 perfusion had a significantly higher grey-scale value (123.6±41.3 vs. 70.1±34.3, p=0.004). However, there were no significant differences between segments with perfusion grade 2 and 3 (76.8±33.2 vs. 68.3±34.8, p=0.452). Conclusion: Qualitative assessment of myocardial perfusion by Ultra-harmonic and Multiframe Triggering is of limited value, since only myocardial segments with absent perfusion may be reliably identified. This findings support the need of quantification in the evaluation of myocardial perfusion by contrast echocardiography. [Copyright &y& Elsevier]