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Objective: There is conflicting data regarding the tricuspid annular velocities and their relation to right ventricular filling pressures. We aimed to assess if the time interval between the onset of tricuspid E wave and annular Ea wave has any correlation with right sided filling pressure in patients with heart failure.Methods: Thirty heart failure patients (left ventricular ejection fraction≤35%) were enrolled. Echocardiography was performed to obtain tricuspid inflow and tissue Doppler annular velocities just before a standard right heart catheterization. The right atrial pressure was obtained from right heart catheterization. The E/Ea [the ratio of peak velocity of early tricuspid inflow wave (E) to peak velocity of early diastolic wave of the lateral tricuspid annulus (Ea)] and the time intervals between the beginning of R wave of electrocardiogram and onset of E (TE) as well as between the beginning of R wave and onset of Et (TEa) were measured, TE-Ea was calculated as TE-TEa.Results: The mean right atrial pressure (RAP) was 8.8 (SD=4.7) mm Hg. The mean TE-Ea was + 8.61 milliseconds. There was no significant correlation between RAP and E/Ea (r=0.08, p>0.05) but the correlation between TE-Ea and RAP was significant (r=0.5, p=0.01).Conclusion: According to our results and in contrary to some prior studies, we showed for the first time that right side TE-Ea stands as a better surrogate of right atrial pressure than E/Ea in heart failure patients. This finding needs more accurate studies and could present TE-Ea as a feasible tool to look into hemodynamics of heart failure patients. [ABSTRACT FROM AUTHOR]

Objective: There is conflicting data regarding the tricuspid annular velocities and their relation to right ventricular filling pressures. We aimed to assess if the time interval between the onset of tricuspid E wave and annular Ea wave has any correlation with right sided filling pressure in patients with heart failure. Methods: Thirty heart failure patients (left ventricular ejection fraction<35%) were enrolled. Echocardiography was performed to obtain tricus-pid inflow and tissue Doppler annular velocities just before a standard right heart catheterization. The right atrial pressure was obtained from right heart catheterization. The E/Ea [the ratio of peak velocity of early tricuspid inflow wave (E) to peak velocity of early diastolic wave of the lateral tricuspid annulus (Ea)] and the time intervals between the beginning of R wave of electrocardiogram and onset of E (TE) as well as between the beginning of R wave and onset of Et (TEa) were measured, TE-Ea was calculated as TE-Ea. Results: The mean right atrial pressure (RAP) was 8.8 (SD=4.7) mm Hg. The mean TE-Ea was + 8.61 milliseconds. There was no significant cor-relation between RAP and E/Ea (r=0.08, p>0.05) but the correlation between TE-Ea and RAP was significant (r=0.5, p=0.01). Conclusion: According to our results and in contrary to some prior studies, we showed for the first time that right side TE-Ea stands as a better surrogate of right atrial pressure than E/Ea in heart failure patients. This finding needs more accurate studies and could present TE-Ea as a feasible tool to look into hemodynamics of heart failure patients. [ABSTRACT FROM AUTHOR]

Background: Noninvasive techniques for the localization of the accessory pathways (APs) might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome. Methods: We prospectively studied 25 patients (mean age = 32 ± 17 years, 58.3% men) with evidence of pre-excitation on electrocardiography (ECG). Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave (δ) and the onset of regional myocardial contraction (δ-So), peak systolic motion (δ-Sm), regional strain (δ-ε), peak strain (δ-εp), and peak strain rate (δ-SRp) were measured. Results: There was a significant difference between time to onset of delta wave to onset of peak systolic motion (mean ± SD) in the AP location (A) and normal segments (B) versus that in the normal volunteers (C) [A: (57.08 ± 23.88 msec) vs. B: (75.20 ± 14.75) vs. C: (72.9 0 ± 11.16); p value (A vs. B) = 0.004 and p value (A vs. C) = 0.18] and [A: (49.17 ± 35.79) vs. B: (67.60 ± 14.51) vs. C: (67.40 ± 6.06 msec); p value ( A vs. B) < 0.001 and p value (A vs. C) = 0.12, respectively]. Conclusion: Our study showed that strain imaging parameters [(δ-So) and (δ-Strain)] are superior to the ECG in the localization of the APs (84% vs. 76%). [ABSTRACT FROM AUTHOR]

We report the case of a male patient with community-acquired quadruple-valve endocarditis on presumed normal native valves. This patient had originally presented elsewhere with generalized edema and malaise and had been diagnosed with suspicious endocarditis and renal dysfunction, for which he unfortunately received incomplete treatment. Transthoracic and transesophageal echocardiographic examinations confirmed quadruple-valve endocarditis and ventricular septal defect.

Background: Noninvasive techniques for the localization of the accessory pathways (APs) might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome., Methods: We prospectively studied 25 patients (mean age = 32 ± 17 years, 58.3% men) with evidence of pre-excitation on electrocardiography (ECG). Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave (δ) and the onset of regional myocardial contraction (δ-So), peak systolic motion (δ-Sm), regional strain (δ-ε), peak strain (δ-εp), and peak strain rate (δ-SRp) were measured., Results: There was a significant difference between time to onset of delta wave to onset of peak systolic motion (mean ± SD) in the AP location (A) and normal segments (B) versus that in the normal volunteers (C) [A: (57.08 ± 23.88 msec) vs. B: (75.20 ± 14.75) vs. C: (72.9 0 ± 11.16); p value (A vs. B) = 0.004 and p value (A vs. C) = 0.18] and [A: (49.17 ± 35.79) vs. B: (67.60 ± 14.51) vs. C: (67.40 ± 6.06 msec); p value (A vs. B) < 0.001 and p value (A vs. C) = 0.12, respectively]., Conclusion: Our study showed that strain imaging parameters [(δ-So) and (δ-Strain)] are superior to the ECG in the localization of the APs (84% vs. 76%).