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Assessment of Left Atrial Function After Percutaneous Coronary Intervention: A Doppler-Based Strain and Strain Rate Study

Sat, 20 Feb 2023 00:00:00 +0330

Conclusions: PCI was accompanied by some improvement in left atrial deformation indices as assessed by tissue Doppler imaging. Revascularization can, therefore, improve patient outcome.,Results: Regarding changes in left trial functional parameters after PCI, those such as the strain of the septal wall and the anterior and inferior walls and the strain rate of the anterior and lateral walls significantly increased following PCI, while the strain of the lateral wall and the strain rate of the septal wall significantly decreased.,Objectives: The present study aimed to assess left atrial function by tissue Doppler parameters of strain and strain rate following percutaneous coronary intervention (PCI).,Patients and Methods: This prospective study recruited 77 consecutive patients with coronary artery disease who underwent PCI. The study end point was to assess left atrial function by regional strain and strain rate parameters before and after PCI via tissue Doppler imaging.,Background: Left atrial function can be critical for risk assessment and prediction of adverse cardiac events. Tissue Doppler of atrial contraction can provide regional and global snapshots of atrial systolic function.

The Right Ventricle: A Comprehensive Review From Anatomy, Physiology, and Mechanics to Hemodynamic, Functional, and Imaging Evaluation

Sat, 20 Feb 2023 00:00:00 +0330

: The right ventricle (RV) is a complex structure with abstruse function that reveals important differences when compared to the left ventricle (LV), so it cannot be described as a simple geometric form and achromatic physiology. As an inference from this fact, in the present review, we aim to describe RV structure including the embryology, anatomy, and physiology and present a functional, hemodynamic, and imaging assessment of the normal and failing RV. So that, we conducted a thorough review based on the database sources such as MEDLINE, PubMed, Cochrane and Google scholar. No restrictions were placed on study date, study design, or language of publication. We searched all valuable and relevant information considering the anatomy, physiology, mechanics, hemodynamic and imaging evaluation of RV.

New-Onset Liver Failure: Pitfalls of an Unusual Diagnosis

Tue, 29 Sep 2023 00:00:00 +0330

Introduction: Heart failure is the second most common cause of ascites after cirrhosis. There are cardiac and noncardiac etiologies of ascites, and the multimodality imaging approach is a rich tool to redefine the final diagnosis.,Case Presentation: We present a case-series where 3 patients were referred to our hospital for further hepatology assessment due to severe abdominal ascites and liver failure. Constrictive pericarditis was diagnosed in all of them. Nowadays, constrictive pericarditis is a well-known disease, but sometimes its clinical presentation may delay the treatment and worsen the prognosis. Our 3 cases had similar clinical scenarios and hemodynamic patterns when undergoing right-heart catheterization, but they had different anatomical pericardium-compromise, requiring different surgical strategies.,Conclusions: Nowadays, multimodality imaging, especially cardiac magnetic resonance imaging and cardiac computed tomography, allows us to study a wide spectrum of the same disease in terms of anatomical compromise and cardiac physiology in order to stratify different prognosis and treatment options. We describe 3 unusual clinical cases where the initial differential diagnosis denoted noncardiac etiologies. The level of serum NT-proBNP proved pivotal to the redefinition of the clinical scenario and differentiation between the cardiac and noncardiac etiologies of new-onset ascites. A multidisciplinary approach in this setting between internists, hepatologists, and cardiologists was helpful to establish the final diagnosis in all the patients.

Subclavian Stenosis in a Patient With Takayasu’s Arteritis and Long-Standing Ankylosing Spondylitis: Utility of IVUS Imaging

Sat, 29 Aug 2023 00:00:00 +0430

Conclusions: Our case is the first report of IVUS imaging of subclavian stenosis resulting from Takayasu’s arteritis and provides insight into the pathology behind such lesions.,Introduction: Takayasu’s arteritis (TA) is a chronic, idiopathic, inflammatory disease that affects large elastic arteries, including the aorta and its main branches. No consensus exists currently on the superiority of surgery over endovascular repair (angioplasty with or without stenting) for vascular lesions in TA.,Case Presentation: A 54-year-old woman with an 11-year history of ankylosing spondylitis (AS) presented with left arm weakness and severe left arm claudication. Duplex ultrasonography of the left upper extremity showed vessel-wall edema of the subclavian, axillary, and brachial arteries. Aortic angiography demonstrated a 70 - 80% stenosis of the left subclavian artery and a long, high-grade stenotic segment of the axillary artery. Intravascular ultrasound (IVUS) of the stenotic subclavian segment showed extensive negative remodeling with minimal plaque formation. The patient responded well to balloon angioplasty on this segment with medical therapy for AS.

A Vanishing Tumor in the Right Pulmonary Apex: A Ghost on the Roof

Sat, 29 Aug 2023 00:00:00 +0430

Conclusions: This is the first case report of a vanishing tumor in the right pulmonary apex.,Case Presentation: Such masses have been designated as vanishing tumors of the lung. It is extremely rare that a vanishing tumor occurs in the apex of the lung.,Introduction: In patients with acute heart failure, pleural fluid localized in an inter-pleural fissure produces a mass on chest X-ray, which mimics a tumor.

Left Atrial Volumes and Function: Evaluation With Real-Time 3D Echocardiography in an Acute Care Setting

Sat, 29 Aug 2023 00:00:00 +0430

Patients and Methods: In 382 subjects admitted in the emergency department (ED), we evaluated maximal (Volmax) and minimal (Volmin) LA volumes and LA emptying fraction (LA-EF), from RT-3D images, with a semiautomated border detection program. A follow-up was performed in order to evaluate all-cause mortality and new hospital admission for cardiovascular events.,Objectives: Aims of this study were: 1) to evaluate feasibility of RT-3D echocardiography for LA evaluation in an acute care setting and in a population including a majority of critically ills; 2) to evaluate correlation between two-dimensional (2D) and RT-3D echocardiographic LA quantitative evaluation; 3) to assess clinical consistency and prognostic value of LA measurements obtained from RT-3D images in subjects without CV diseases and in patients with AF and CHF, evaluated in the acute phase of the disease.,Results: The correlation between measures obtained from 2D and 3D was good (LA Volmax: r = 0.896, P < 0.001; Volmin: r = 0.906, P < 0,001; LA EF: r = 0.749, P < 0.001). Among 77 normal subjects, people aged ≥ 65 years demonstrated comparable LA dimensions with younger subjects (LA Volmax: 25 ± 11 vs 20 ± 7 mL/m2, Volmin: 11 ± 7 vs 8 ± 5 mL/m2). Subjects with normal left ventricular ejection fraction showed LA Volmax significantly lower than patients with LV systolic dysfunction or congestive heart failure (23 ± 11 vs 29 ± 10 vs 33 ± 12 mL/m2, P < 0.05). Patients in atrial fibrillation showed a significantly dilated LA compared with subjects in sinus rhytm (24 ± 11 vs 37 ± 22 mL/m2, P < 0.05). LA dimensions were significantly higher in non-survivors (LA Volmax: 33 ± 9 vs 25 ± 9 mL/m2), in patients with a new hospital admission for cardiovascular disease (LA Volmax: 34 ± 13 vs 23 ± 10 mL/m2) or with a new AF episode (LA Volmax: 40 ± 12 vs 24 ± 11 mL/m2, all P < 0.005).,Conclusions: RT-3D evaluation of LA volumes and function is feasible in a non selected series of critically ills. LA dilation was associated with a worse outcome in terms of morbidity and mortality.,Background: Limited data are available about feasibility and clinical value of left atrium (LA) quantitative evaluation obtained from real time 3D (RT-3D) echocardiography in critically ills.

Total Effective Radiation Dose Attributable to Medical Imaging in Patients With Acute Chest Pain: A Single-Center Comparison Study Between Dual-Source Coronary CT Angiography and Usual Care

Sat, 29 Aug 2023 00:00:00 +0430

Patients and Methods: We evaluated radiation exposure from initial and downstream testing in a prospectively collected, matched cohort evaluated for CP in the emergency department (ED) with either CCTA compared with usual care over a median follow-up of 19.6 months. Effective radiation dose was calculated using published conversion factors.,Results: Prospective, ECG-triggered acquisition using a 128-slice dual-source multidetector computed tomography (DSCT) scanner was performed in 92.9% of scans with a median effective dose from CCTA of 6.8 mSv (IQR 5.2, 9.1 mSv). CCTA cohort patients were more likely to undergo cardiac testing with exposure to radiation (P < 0.001); however, the median effective dose in patients exposed to radiation from cardiac testing was significantly lower in the CCTA cohort (7.1 mSv vs. 11.8 mSv, P < 0.001). Fewer patients in the CCTA cohort had additional non-cardiac thoracic imaging radiation exposure (40.8%) compared with usual care (92.8%). Total radiation exposure from any source was similar between the CCTA and usual care groups (100% vs 98.4%, P = 0.087), as was median total effective radiation dose (P = 0.105). Upfront CCTA was not associated with higher rates of incidental non-cardiac findings.,Introduction: Coronary CT angiography (CCTA) can safely disposition low to intermediate risk chest pain (CP); however, there is conflicting data with respect to cumulative radiation exposure when compared with usual care over short follow-up intervals.,Objectives: We report the effective radiation dose from index and downstream testing in low to intermediate risk symptomatic patients evaluated for chest pain in the ED with either CCTA or usual care to define various sources of patient radiation dose and quantify effective dose over a year and a half of follow-up.,Conclusions: Initial evaluation of acute chest pain in the ED with CCTA was not associated with an increase in total radiation exposure over a follow-up period of 19 months. CCTA offers a more comprehensive evaluation of multiple thoracic organ systems leading to reduced radiation exposure from non-cardiac thoracic testing and no increase in incidental imaging findings. This may represent an added benefit in this population of patients presenting acutely.

Diagnosis and Management of Papillary Muscle Rupture Complicating Acute Myocardial Infarction: A Case Report and Review of the Literature

Sun, 23 Aug 2023 00:00:00 +0430

Conclusions: Mortality from papillary muscle rupture remains elevated. Survival largely depends on the early surgical repair or the replacement of the mitral valve.,Case Presentation: A 71-year-old woman presented to an outside hospital complaining of chest pain and shortness of breath. An electrocardiogram was obtained and revealed depression of the ST segments from leads V1 to V4. Troponin I was elevated at 3.0 ng/mL. She was transferred to our facility for a higher level of care. She was found in cardiogenic shock at arrival. A bedside echocardiogram was ordered, which demonstrated papillary muscle rupture with severe mitral regurgitation. A coronary angiogram followed, which diagnosed severe three-vessel disease. After the insertion of an intra-aortic balloon pump, she was transferred emergently to the surgical suite for mitral valve replacement and revascularization. The operation was uneventful. She was discharged to a rehabilitation center after approximately 1 month of hospital stay.,Introduction: The incidence of mechanical complications related to myocardial infarction has decreased over the last decades, and revascularization certainly plays a major role in this change. However, mortality still remains elevated. This is a case of acute papillary muscle rupture secondary to myocardial infarction leading to cardiogenic shock.

Relation Between Parameters of Myocardial Mechanics and Ventricular Arterial Coupling: A Three-Dimensional Speckle-Tracking Study in Healthy Adults

Sat, 22 Aug 2023 00:00:00 +0430

Objectives: Our aim was to study the relation between VAC and the parameters of myocardial mechanics using three-dimensional speckle-tracking echocardiography (3DSTE).,Patients and Methods: We studied 68 normal participants (mean age, 35 ± 12.2 y; 36 [53%] males). VAC was measured by the ratio of arterial elastance (Ea) to ventricular elastance (Ees). The peak systolic value of longitudinal strain (LS), circumferential strain (CS), radial strain, three-dimensional global strain (3DGS), apical rotation, torsion, and twist and their time to peak were calculated.,Results: Almost all deformation indices were higher in the women than in the men. LS (r = -0.41, P < 0.01), twist (r = 0.26, P < 0.03), rotation (r = 0.41, P < 0.01), and 3DGS (r = - 0.39, P < 0.01) were associated with age. Although significant associations were found between VAC and Ea or Ees in the men and women, no relation was found between Ea and Ees in both sexes (r = 0.07 in men and r = 0.08 in women). Indeed, VAC had a stronger association with Ea than with Ees (r = 0.708 vs. r = -0.537). Ees and VAC were related to torsion (r = 0.30 vs. r = -0.37; both P < 0.05); and Ea, Ees, and VAC were also associated with CS (r = 0.64, r = -0.45, and r = 0.79; all P < 0.05) and 3DGS (r = -0.55, r = 0.38, and r = -0.64; all P < 0.01).,Background: Understanding the relation between ventricular-arterial coupling (VAC) and myocardial mechanical parameters could offer an adjunctive perspective on left ventricular function.,Conclusions: Amongst all myocardial mechanical parameters, VAC was related to CS and 3DGS as well as torsion.

Multimodality Imaging in Hypertrophic Cardiomyopathy Associated With Anomalous Hypertrophied Papillary Muscles: A Case Report

Sat, 23 May 2023 00:00:00 +0430

Conclusions: According to our multimodality imaging approach, hypertrophic cardiomyopathy was the most probable diagnosis.,Case Presentation: We describe a 73-year-old woman referred to us for consultation because of a giant negative T wave on her electrocardiography. Echocardiography revealed diffuse severe hypertrophy associated with hypertrophied anterolateral papillary muscles with a bifid head and with extensive wall insertion into the apicolateral segment. Three-dimensional echocardiography and cardiac magnetic resonance confirmed these data. Importantly, automated function imaging determined the global longitudinal strain at -10.2%.,Introduction: Multimodality imaging can help rule in/out the diagnosis of hypertrophic cardiomyopathy (HCM) in patients with significant left ventricular (LV) hypertrophy.

An Echo-Dense Cap in the Pericardial Space After Acute Myocardial Infarction: A Case Report

Sat, 23 May 2023 00:00:00 +0430

: Acute myocardial infarction can culminate in sudden cardiac death due to cardiogenic shock and ventricular fibrillation, and also rarely due to cardiac rupture. We present a case of post-infarction myocardial rupture after thrombolytic therapy diagnosed with transthoracic echocardiography and treated with direct closure and coronary artery bypass grafting.

Reverse Left Ventricular Apical Rotation in Dilated Cardiomyopathy

Sat, 23 May 2023 00:00:00 +0430

Conclusions: These findings emphasize the potential clinical benefits of therapeutic procedures such as cardiac resynchronization therapy (CRT) or apex-sparing volume-reduction surgery in DCM. A better definition of the role and implications of reverse apical torsion in DCM and its importance and effectiveness in making therapeutic decisions like CRT implantation requires further studies.,Case Presentation: The patient was a 56-year-old woman, who referred to our clinic with complaints of dyspnea on exertion of 2 years’ duration. By the time of her referral, the patient’s dyspnea had exacerbated and reached New York Heart Association (NYHA) functional class III,Introduction: We describe a 56-year-old woman with dilated cardiomyopathy, whose clinical assessment, including two-dimensional echocardiography, demonstrated a spherical left ventricular geometry with severe left ventricular enlargement and dysfunction as well as reverse apical rotation. Left ventricular twist and torsion were evaluated via echocardiography with velocity vector imaging; the patient was found to have reverse rotational movement. We hereby address these issues from an echocardiographic point of view.

Improved Image Quality of Coronary CT Angiography Using Automatic Motion Correction

Sat, 23 May 2023 00:00:00 +0430

Background: Motion artifacts that degrade image quality of coronary CT angiography (CCTA) in patients with high heart rates may be reduced with specific automatic motion correction algorithms (AMC).,Conclusions: CCTA image quality improves significantly with AMC in patients with high heart rates and reduces the proportion of non-diagnostic examinations.,Results: Mean heart rate during CCTA was 61 ± 8 bpm. CCTA quality improved significantly in the RCA (good-or-excellent in 11/17 AMC vs. 5/17 CR, P = 0.018) and LAD (15/17 vs. 7/17, P = 0.031). Non-diagnostic CCTA in the RCA, LM, LAD, and LCX reduced from 16/68 (CR, 24%) to 7/68 (AMC, 10%). Significant motion correction was observed at low (≤ 60 bpm; P = 0.008), intermediate (61-70 bpm; P < 0.001), and high heart rates (> 70 bpm; P = 0.021). Inter-reader agreement was good. (inter-class-correlation, 0.762).,Patients and Methods: CCTA images (clinical single-source-64-slice-CT system) of 17 consecutive patients with heart rates exceeding 55 bpm were reconstructed with both CR and AMC during the individually best-suited phase of the cardiac cycle. Two independent readers who were blinded to the reconstruction algorithm scored image quality of each coronary artery segment (AHA 15-segment-model; 1: non-diagnostic - 4: excellent). In case of disagreement a third blinded reader assigned a final score. Two-tailed statistical tests (Wilcoxon-matched-pairs, Pearson-correlation) were significant at P < 0.05.,Objectives: We compared coronary-artery delineation between AMC and conventional CCTA reconstruction (CR).

Detection of Undiagnosed Ischemic Heart Disease in Hemodialysis Patients Using Myocardial Perfusion Imaging

Sat, 23 May 2023 00:00:00 +0430

Conclusions: The prevalence of undiagnosed IHD in the HD patients was considerable. We, therefore, suggest that IHD be assessed in HD patients, especially those at high risk due to positive family history of CAD, hypertension, left ventricular hypertrophy, diabetes mellitus, Kt/V < 1.2, low ferritin levels, and high levels of intact parathyroid hormone.,Results: Sixty-nine HD patients were studied using dipyridamole MPI with Tc 99 m sestamibi. The mean age, body mass index, and mean duration of HD were 52.1 ± 13.8 years, 21.23 ± 4.79 kg/m2, and 48.2 ± 34.9 months, respectively. The patients were divided into two groups based on MPI: IHD-positive group (21.7%) and IHD-negative group (78.3%). IHD was more prevalent in the patients with diabetes mellitus, hypertension, positive family history of CAD, low HD adequacy index (Kt/V < 1.2), left ventricular hypertrophy, high intact parathyroid hormone levels, electrocardiographic abnormalities, and low ferritin levels. A statistically significant correlation was also detected between IHD and aging (P < 0.05).,Patients and Methods: In this cross-sectional descriptive study, HD patients who met the inclusion criteria were selected. Demographic, clinical, and paraclinical data were obtained via interviews and medical records. Bedside electrocardiography, resting echocardiography, and nuclear MPI with dipyridamole were done. The data were analyzed using descriptive statistical methods for detecting the prevalence of undiagnosed IHD in the HD patients. The chi-square test and the independent t-test were used to identify the high-risk HD patients.,Objectives: The aim of this study was to detect undiagnosed ischemic heart disease (IHD) using dipyridamole myocardial perfusion imaging (MPI) in HD patients.,Background: Coronary artery disease (CAD) is prevalent but very difficult to diagnose in hemodialysis (HD) patients compared with non-uremic individuals.

Comparison of Echocardiographic Variables Between Systemic Lupus Erythematosus Patients and a Control Group

Sat, 23 May 2023 00:00:00 +0430

Conclusions: Silent ventricular systolic dysfunction was more common in the patients with SLE than in the control group. Newer echocardiographic techniques such as two-dimensional STE provide an earlier chance for the detection of subclinical LV systolic dysfunction. Our findings were independent of the traditional risk factors.,Results: The mean duration of SLE was 5.5 ± 3.4 years in our patients. No significant difference was found between the two groups concerning the LV and left atrium size, LV ejection fraction, right ventricular (RV) systolic function, RV and LV diastolic function, and pulmonary artery pressure. The LV global longitudinal strain was less in the SLE patients (-18.56 ± 2.50% vs. -19.89 ± 1.94%; P = 0.028). The LV mass was greater, though not statistically significant, in the SLE patients (111 ± 29.54 g vs. 104.37 ± 27.39 g; P = 0.468). The interventricular septal diameter was thicker in the SLE patients (0.79 ± 0.15 cm vs. 0.77 ± 0.10 cm; P = 0.046).,Patients and Methods: This case-control study was conducted in 45 SLE patients (88% female; mean age = 31.2 ± 8.2 years) and 25 healthy controls (87% female; mean age = 30.3 ± 7.7 years), matched in terms of age and sex. Both groups had no clinical signs and symptoms of cardiac problems or risk factors for cardiovascular diseases. Both SLE and control groups underwent echocardiography for the assessment of the ventricular function and the sizes and diameters of the chambers. Two-dimensional STE was used for the measurement of the left ventricular (LV) global longitudinal systolic strain.,Background: Cardiovascular diseases increase morbidity and mortality in patients with systemic lupus erythematosus (SLE).The cardiac involvement could be silent. Echocardiography can be used as a noninvasive tool for the assessment of the ventricular function.,Objectives: We sought to evaluate different echocardiographic parameters via tissue Doppler imaging and speckle-tracking echocardiography (STE) in addition to conventional echocardiography.

Transthoracic Echocardiography Versus Cardiac MRI in the Diagnosis of Acute Myocarditis

Fri, 20 Feb 2023 03:30:00 +0330

Case Presentation: We present a case with a typical picture of myocarditis but normal echocardiographic findings, the diagnosis of which was confirmed by cardiac MRI.,Discussion: In particular, cardiac MRI data are useful in borderline cases or in the presence of discrepancy between clinical picture and echocardiographic results. ,Introduction: The diagnosis of myocarditis based on a spectrum of findings, including symptoms, clinical examination, electrocardiography, biomarkers, and echocardiography, can be non-specific. Cardiac magnetic resonance imaging (MRI), has become the primary noninvasive technique in patients with suspected myocarditis in some countries.

Cerebrovascular Accident and Mesenteric Ischemia Following Diagnostic Coronary Angiography

Fri, 20 Feb 2023 03:30:00 +0330

Conclusions: Trauma induced by the tip of the catheter at the contact location with the LV wall in a patient with mild hypercoagulable state accounted for intracardiac thrombosis formation and its embolization to the brain and intestines.,Introduction: Coronary angiography can be complicated by some major complications such as stroke. ,Case Presentation: We describe a patient who presented with hemiparesia. He had undergone coronary angiography on his right and left coronary arteries as well as his left ventricle (LV) via the radial artery access 10 days earlier using a 6-French Tiger catheter. Transthoracic echocardiography showed a large (36 × 25 mm) inhomogeneous mobile mass attached to the apicoseptal LV segment. His serum protein S was low (60% [normal = 77 - 140%]), while his protein C was normal and lupus anticoagulant was negative. During hospitalization, he developed severe abdominal pain, for which mesenteric ischemia was diagnosed. First, he underwent surgery for the resection of the infarcted intestinal segments. Then cardiac surgery was done to remove the mass. The mass was diagnosed as a thrombus. After the surgery, the general condition of the patient deteriorated and blood culture showed acinetobacter septicemia. Finally, he died due to sepsis. A review of his coronary angiography revealed that after the contrast media had left the LV, there was still dye at the contact point between the tip of the catheter and the LV, which was compatible with the location of thrombus formation.

Bubbles in Pericardial Fluid: Multimodality Imaging in Iatrogenic Hydropneumopericardium

Fri, 20 Feb 2023 00:00:00 +0330

Introduction: The term hydropneumopericardium describes the simultaneous accumulation of fluid and gas in the pericardial sac. This condition is mostly caused by primary infiltrative lesions from the adjacent organs, pericardial infections, or trauma and is a very rare situation, usually with favorable outcomes.,Case Presentation: We describe a female patient with Lutembacher’s syndrome complicated by cardiac tamponade. After surgical treatment, she developed iatrogenic hydropneumopericardium, which was treated conservatively.,Conclusions: Iatrogenic hydropneumopericardium can be managed conservatively with supportive measures, and most of these cases resolve spontaneously if they are not large and destabilizing.

Ventricular Dyssynchrony Markers in Healthy Black African Subjects: A Tissue Doppler Imaging Study

Fri, 20 Feb 2023 00:00:00 +0330

Conclusions: Large-scale studies on the healthy black African population could assess the relationship between diastolic dyssynchrony and changes in myocardial performance related to racial differences.,Results: The frequency of some dyssynchrony markers was similar to that of other studies. The difference between maximal time-to-peak systolic velocity and minimal time-to-peak systolic velocity was correlated with age and was higher among women. The prevalence of diastolic dyssynchrony was higher in black African subjects.,Patients and Methods: Fifty healthy black African were enrolled consecutively over a period of 3 months. Time-to-peak systolic velocities (TS) and Time-to-peak early diastolic velocities (TE) were measured at the four basal segments of left ventricle. Five dyssynchrony markers were assessed: difference between maximal time-to-peak systolic velocity and minimal time-to-peak systolic velocity, time between septal time-to-peak systolic velocity and lateral time-to peak systolic velocity, standard deviation of time-to-peak systolic velocity of the four basal segments, difference between maximal time-to-peak early diastolic velocity and minimal time-to-peak early diastolic velocity, and standard deviation of time-to-peak early diastolic velocity of the four basal segments.,Objectives: The purpose of this study was to measure time-to-peak of systolic and diastolic velocities of different segments of left ventricle and apply ventricular dyssynchrony markers to healthy black African subjects.,Background: Tissue Doppler is a promising method that allows the measurement of time of systolic and diastolic tissue velocities. Ventricular dyssynchrony was assessed in patients with heart failure. In sub-Saharan Africa, very few studies have focused on ventricular dyssynchrony in healthy subjects.

Echocardiographic Assessment of the Vibratory Innocent Murmur in Children: a Case-Control Study

Fri, 20 Feb 2023 00:00:00 +0330

Conclusions: The vibratory innocent murmur is associated with the presence of left ventricular false tendon and higher left ventricular outflow tract velocity. The presence of the left ventricular false tendon was somewhat associated with decreased early diastolic myocardial velocity. Normal left ventricular systolic and diastolic function can be used as a reassurance in cases with the vibratory innocent murmur.,Results: The left ventricular false tendon was present in 84% of cases and 22% of controls (P < 0.001). Left ventricular outflow tract velocity was significantly higher in cases than in controls (P < 0.001). Early diastolic myocardial velocity at the base of the interventricular septum was lower in cases with false tendon than those without false tendon (P = 0.048). No significant difference was found regarding ascending aorta diameter, cardiac output and ejection fraction between the two groups. Left ventricular diastolic function was normal in all cases and controls.,Background: Vibratory innocent murmur is the most common precordial innocent murmur in children. The mechanism of vibratory innocent murmur is still unclear.,Patients and Methods: The prospective cross-sectional study was conducted using 32 children who had the vibratory innocent murmur (cases) in Chiang Mai University Hospital and 27 normal healthy children (controls). Two-dimension, Doppler, and tissue Doppler echocardiography were performed on each subject to examine the difference between cases and controls.,Objectives: The aim of this study is to learn the mechanism of the vibratory innocent murmur.

Left Ventricular Torsional Parameters in Patients With Non-Ischemic Dilated Cardiomyopathy

Fri, 20 Feb 2023 00:00:00 +0330

Conclusions: LV twist, torsion and untwist and also rate of them are significantly impaired in DCM and this impairment is well-related to LV global systolic and diastolic dysfunction. VVI is a new noninvasive technique that can be used to evaluate LV torsional parameters.,Results: LV twist value (5.54 ± 1.94° in DCM VS. 11.5 ± 2.45° in control group) and also LV torsion (0.71 ± 0.28°/cm in DCM VS. 1.53 ± 0.42°/cm in control group) were significantly decreased in DCM patients compared with normal group (P < 0.001 for both); also, the twisting rate was notably lower in DCM vs. control (38.68 ± 14.43°/s in DCM vs. 75.88 ± 17.25°/s in control; P < 0.001) and also untwisting rate (36.28 ± 13.48°/s in DCM vs. -73.79 ± 24.45°/s in control; P < 0.001), However normalization of these times for systolic duration or LV length creates different values.,Background: Velocity vector imaging (VVI) is a new echocardiography method to assess myocardial deformation in two dimensions.,Objectives: In this study, we used VVI to evaluate left ventricular (LV) main torsional parameters in non-ischemic dilated cardiomyopathy (DCM) patients in compared with normal subjects.,Patients and Methods: Twenty-six DCM patients and Twenty-four normal subjects were assessed. Echocardiographic images of the short axis apical and basal views of LV were processed by VVI software to measure peak rotation degrees and also peak rotation rates in systole. LV twist was well-defined as the net difference between apical and basal rotation values and also LV torsion was considered as LV twist divided by left ventricular diastolic longitudinal length. In addition, peak untwisting value and untwisting rate were measured in diastole too.

Echocardiographic Evaluation of Orthotopic Heart Transplantation: Single-Center Experience

Thu, 27 Nov 2023 00:00:00 +0330

Conclusions: The cardiac grafts at 5 months' post-HTx follow-up were characterized by normal LV dimensions and EF. Also, RV dysfunction and tricuspid regurgitation were frequent findings, but they were not associated with the clinical signs of congestive heart failure, morbidity, and mortality in the majority of our patients.,Background: In patients with advanced heart failure, significant improvement in pharmacological and non-pharmacological treatment strategies has conferred better survival rates and quality of life.,Objectives: This is a report on echocardiographic findings in heart transplantation (HTx) patients in their first 5 postoperative months.,Patients and Methods: Twenty patients undergoing HTx between September 2009 and July 2010 whose clinical and echocardiographic findings had been registered monthly for 5 months after HTx were enrolled.,Results: Eleven males and five females at a mean age of 33 years [range = 17-58 years] were enrolled in the study. The mean of the left ventricular ejection fraction (LVEF) was 52 ± 8.2 % and 58 ± 2.5 % on the first day and at 5 months after HTx, respectively. There was no LV enlargement at 5 months' follow-up. The right ventricle (RV) was mildly enlarged, but the reduced baseline RV function showed improvement at the 5th postoperative month (mean TAPSE was 11.7 ± 3.3 mm on the first post-HTx day versus 17.2 ± 6.3 mm after 5 months; P < 0.005). The pulmonary arterial pressure was slightly elevated at baseline, and it showed no significant decrease 5 months after HTx. More than 90% of the cases showed only mild tricuspid regurgitation at 5 months' follow-up. The tissue Doppler imaging-derived velocities of the medial and lateral mitral annuli and the tricuspid annulus demonstrated a gradual increment during the follow-up and reached their highest value at 5 months' follow-up.

Masked Ischemia on Myocardial Perfusion Imaging: A Case Example

Sun, 16 Nov 2023 00:00:00 +0330

Discussion: The reason is that we assess the relative and not absolute differences of the tracer uptake in this imaging modality. There may be other findings on MPI images which could help us overcome this pitfall, including detecting wall motion abnormalities, lung uptake of the tracer, or transient ischemic dilation. Another important issue is the ECG changes during exercise stress testing, which could point to a more extensive coronary artery disease than the one detected on MPI images alone.,Case Presentation: A 67-year-old man underwent exercise electrocardiography (ECG)-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for evaluating his mild dyspnea on exertion (New York Heart Association class I). Images showed inducible ischemia of severe intensity in the interior walls and moderate intensity in the apicoseptal and anteroseptal segments, but exercise stress to induce coronary hyperemia revealed marked ST-segment depressions in low heart rates and the patient complained of only mild dyspnea during these ECG changes. He subsequently underwent coronary angiography, which revealed left main and severe three-vessel disease. This discrepancy between the SPECT perfusion images and the extent of coronary artery disease in this case represents the masking of one ischemic territory (left system) by another more severely ischemic territory (right system).,Introduction: Electrocardiography (ECG)-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the diagnosis and prognosis of coronary artery disease (CAD) is the most commonly performed imaging procedure in nuclear cardiology.

Libman-Sacks Endocarditis and Cerebral Infarction in Antiphospholipid Syndrome: A Case Report

Sat, 15 Nov 2023 00:00:00 +0330

: Valvular heart disease is a considerable finding in the antiphospholipid antibody syndrome (APS). The involvement of the mitral and aortic valves is more common in the form of leaflet thickening or aseptic verrucous vegetations called the Libman-Sacks endocarditis. In addition to the detrimental effects of endocarditis on the valves, it can lead to serious thromboembolic complications. Here we report our experience with a young woman, who had a history of transient ischemic attack 2 months earlier and referred to us due to severe vaginal bleeding. On echocardiography, several irregular masses were observed on the atrial side of both mitral valve leaflets. On rheumatologic work-up, she was found to have positive anticardiolipin IgG and lupus anticoagulant. During hospitalization, the patient suffered thrombotic stroke and computed tomography (CT) scan showed a parietal lobe ischemic lesion. With evidence of positive antiphospholipid antibodies and arterial thrombosis, negative blood culture, and no fever, the diagnosis of the Libman-Sacks endocarditis was established. The patient was discharged with good general condition and received Hydroxychloroquine, Warfarin, and Prednisolone. On follow-up echocardiography, intra-cardiac masses were not detected any more and no residual neurologic deficits were found.

Cardiac CT Angiography of a Membranous Ventricular Septal Aneurysm Short Title: Ventricular Septal Aneurysm

Wed, 12 Nov 2023 00:00:00 +0330

: The most frequent congenital heart defects in the neonatal period are ventricular septal defects. Ventricular septal aneurysms can rarely develop from an interventricular septal (IVS) defect in adults. We describe a 47-year-old man with an aneurysm in the IVS growing towards the right ventricle, which was confirmed by cardiac computed tomographic angiography and was missed by echocardiography.

Biventricular Mural Thrombi in Patients With Dilated Cardiomyopathies: Case Reports and Review

Wed, 12 Nov 2023 00:00:00 +0330

Discussion: There are other causes of dilated cardiomyopathies which could be transient like peripartum cardiomyopathy. The development of biventricular mural thrombi is rare, and it mainly increases the risk of embolization in the systemic and pulmonary circulations.,Case Presentation: We present two case reports of post-myocardial infarction sequel leading to ischemic cardiomyopathy and peripartum cardiomyopathy leading to biventricular mural thrombi formation and provide a brief review of literature regarding their etiopathogenesis and management.,Introduction: The combination of the aging of the population and improved survival after acute myocardial infarction has created a rapid growth in the number of patients currently living with chronic heart failure, with a concomitant increase in morbidity and mortality.

Which Type of Right Ventricular Pressure Overload Is Worse? An Echocardiographic Comparison Between Pulmonary Stenosis and Pulmonary Arterial Hypertension

Tue, 11 Nov 2023 00:00:00 +0330

Conclusions: It seems that severe PAH aggravates the RV function more severely.,Results: Significant tricuspid regurgitation was more prevalent in the PAH group than in the PS group (61% vs. 18.5%; P < 0.001). The abnormalities in the RV myocardial performance index, RV areas, and RV fractional area change were significantly more robust in the PAH group (all Ps < 0.05) despite the higher net RV systolic pressure in the PS group as compared to the PAH group (121 ± 39 vs. 88 ± 26 mmHg; P < 0.001).,Background: Some studies have evaluated the right ventricular (RV) function in volume-overload and pressure-overload conditions and have always categorized pulmonary arterial hypertension (PAH) in the latter group. However, PAH and pulmonary stenosis (PS) are two frequent diseases, both resulting in the RV pressure overload.,Objectives: The aim of this study was to evaluate the RV response to two causes of the RV pressure overload: severe PAH and PS.,Patients and Methods: Eighteen patients with PAH at a mean age of 43 ± 12 years (66.6% female) and 16 patients with PS at a mean age of 33 ± 17 years (56.35% female) were enrolled. Standard echocardiography, tissue Doppler, and longitudinal strain imaging at the base, mid, and apical levels of the RV free wall were done.

Is There any Difference in Cardiogoniometry Parameters of Ischemic and Nonischemic Cardiomyopathy in Patients with Left Bundle Branch Block?

Fri, 05 Sep 2023 00:00:00 +0430

Background: Differentiating ischemic from nonischemic cardiomyopathy is important both prognostically and therapeutically, although it may be difficult clinically.,Objectives: We aimed to determine the diagnostic power of Cardiogoniometry (CGM) in the differentiation of the ischemic from the nonischemic etiology of left bundle branch block (LBBB).,Patients and Methods: We studied 37 patients with LBBB on the electrocardiogram (ECG) and left ventricular ejection fraction (LVEF) < 30%. All of them underwent coronary angiography, and 33 patients were included. Eighteen patients were categorized as the ischemic cardiomyopathy group, and 15 patients with normal coronary angiography were assigned to the nonischemic cardiomyopathy group. Then, CGM parameters were studied and compared between the two groups.,Results: Both ischemic and nonischemic cardiomyopathy groups were similar in age, LVEF, weight, height, and body mass index. Interestingly, there were no significant differences in the average value of the 40 CGM parameters that were analyzed in this study between the two study groups.,Conclusions: When LBBB is the underlying rhythm, CGM cannot differentiate ischemic from nonischemic patients with good accuracy. Large studies, however, are needed to confirm our results.

Effects of Contrast Media Selection upon Heart Rate and Heat Sensation During Coronary Computed Tomographic Angiography

Tue, 05 Aug 2023 00:00:00 +0430

Conclusions: Compared to Iohexol and Iopamidol, Iodixanol use was associated with a lower patient perception of heat and lower HR while maintaining similar contrast-to-noise and signal-to-noise ratios.,Results: Baseline HR was similar across the patients assigned to Iohexol, Iopamidol, and Iodixanol (65.3 ± 9.7, 66.9 ± 10.9, and 65.3 ± 13.3, respectively; P = NS). Compared to Iohexol and Iopamidol, Iodixanol use was associated with lower HR at the time of image acquisition and immediately after CCTA (53.2 ± 8.0 bpm, 56.3 ± 7.8 bpm, and 56.8 ± 6.5 bpm; P = 0.069 and P = 0.032). A greater proportion of patients achieved HR ≤ 55 beats per minute (bpm) with Iodixanol (63%) than with Iohexol (42%; P = 0.025) and Iopamidol (39%; P = 0.011). As was expected, Iodixanol (2.34 ± 2.02) was associated with a lower perception of heat than Iohexol (6.13 ± 1.89; P < 0.001) and Iopamidol (5.22 ± 2.10; P < 0.001). Image quality was similar in all three groups.,Objectives: The aim of the study was to compare the impact of contrast media selection in CCTA upon HR and image quality.,Patients and Methods: A total of 173 patients undergoing CCTA between February and April 2011 were allocated to different contrast media (Iodixanol, Iohexol, and Iopamidol) in 2-week blocks. The groups were analyzed for differences in baseline characteristics, imaging parameters, image quality, HR, and HR variability. Patients were also surveyed for perception of heat.,Background: Coronary computed tomographic angiography (CCTA) image quality is dependent on heart rate (HR). Beta blockers are commonly administered before CCTA to lower HR and minimize variability. However, contrast media may also impact upon HR and image quality. Since iso-osmolar contrast media induce less vasodilation, this may decrease a patient’s sensation of heat, minimizing patient discomfort and improving HR control and variability.

Right Ventricular Strain and Strain Rate in Patients With Systemic Sclerosis Without Pulmonary Hypertension

Tue, 05 Aug 2023 00:00:00 +0430

Conclusions: This study indicated that the RV systolic strain and strain rate can be used to detect early RV systolic dysfunction in SSc patients without pulmonary hypertension. These parameters may be useful for the provision of a more adequate management of SSc patients.,Results: In the SSc patients, the RV strain (- 19 ± 10 vs. - 25 ± 4 %; P = 0.004) and the systolic strain rate (- 1.3 ± 0.5 vs. - 1.5 ± 0.3, s-1; P = 0.03) were significantly lower than those in the control group.,Objectives: The aim of this study was to assess strain-based measures of the RV systolic function in patients with SSc without pulmonary hypertension.,Materials and Methods: Thirty-eight consecutive SSc patients (mean age = 48.1 ± 13 years) with normal pulmonary artery pressure and left ventricular ejection fraction and 27 healthy subjects (mean age = 53.2 ± 10 years) were investigated. The RV systolic strain and strain rate were assessed using standard echocardiography with tissue Doppler imaging (TDI) and compared with the results of the healthy subjects.,Background: Cardiac involvement in Systemic Sclerosis (SSc) is a major risk factor for death. The aim of this study was to evaluate strain-based measures of the right ventricular (RV) systolic function in SSc patients without pulmonary hypertension.

Left Ventricular Volume and Function Assessment: a Comparison Study between Echocardiography and Ventriculography

Tue, 05 Aug 2023 00:00:00 +0430

Conclusions: Despite the widespread use of 2D LVEF and its good agreement with ventriculography, strain analysis seems to be more reliable as a quantitative tool for ventricular assessment.,Results: The LVEF values obtained by the two methods of ventriculography and echocardiography were not significantly different. The highest correlation regarding the echocardiographic LVEF was obtained in the angiographic right anterior oblique view (P < 0.001, r = 0.95). There was a good agreement as regards the biplane LVEF between 2D echocardiography and ventriculography (-0.5 ± 13.27; CI of 95%). The GLS showed a significant correlation with the estimated EF in both methods, the highest being with the Biplane Simpson method (r = -0.84; P < 0.001). Linear regression was used to obtain the formula for estimating the 2D LVEF from the GLS [LVEF = 2.53 (GLS) + 10.48]. The GLS values ≥ -21.7% and≤ -11.7% were consistent with normal and severe global LV systolic dysfunction, respectively. The inter- and intra-observer agreement was more evident in the GLS measurement rather than in the LVEF.,Objectives: This study was aimed at comparing the LVEF and LV volumes obtained by the two methods of catheterization and two-dimensional (2D) echocardiography (available in our institution) and assessing the correlation between the LVEF and the GLS.,Patients and Methods: In this cross-sectional study, 45 patients were recruited from coronary angiography candidates. The patients underwent echocardiography immediately before catheterization. The LVEF and LV volumes were measured via echocardiography using the apical four- and two chamber-views. The GLS was calculated through the automated functional imaging algorithm. Left ventriculography was performed by calculating the LVEF in the right and left oblique views.,Background: The left ventricular ejection fraction (LVEF) measurement is a common tool for evaluating the LV systolic function. The application of the global longitudinal systolic strain (GLS) parameter in the assessment of the myocardial function has also received special attention recently.

Multimodality Imaging of a Cardiac Angiosarcoma

Sun, 25 May 2023 00:00:00 +0430

Introduction: While primary malignant tumors of the heart are rare, angiosarcomas are the most common cardiac malignant tumors.,Case Presentation: We describe a 23-year-old woman who presented with a right atrial mass, which was discovered to be a cardiac angiosarcoma. We demonstrate the use of several noninvasive imaging modalities along with pathology confirmation for the definitive and comprehensive diagnosis of a cardiac angiosarcoma, a rare entity by itself.,Conclusions: With the increasing availability of noninvasive imaging techniques, the diagnosis of angiosarcomas can be made at earlier stages. If angiosarcomas are left untreated, their prognosis is very poor. Therapeutic options include surgical excision, chemotherapy, radiation therapy, and heart transplantation or a combination of these.

Is Screening Imaging Necessary in Dilated Cardiomyopathy?

Sat, 24 May 2023 00:00:00 +0430

Introduction: Dilated cardiomyopathy (DCM) is the leading cause of heart failure and arrhythmia.,Case Presentation: A 47-year-old male, diagnosed with dilated cardiomyopathy, died due to heart failure. During the screening of his family members, his 17-year-old daughter and 9-year-old son also had dilated cardiomyopathy. Another daughter had died suddenly at the age of 12 years.,Conclusions: We herein describe 3 patients with dilated cardiomyopathy developing in the father, daughter, and son of the same family and justify the importance of the screening test as an important tool for identifying families affected by familial dilated cardiomyopathy.

How to Construct a 3D Mathematical/Computer Model of the Left Ventricle

Sat, 24 May 2023 00:00:00 +0430

Conclusions: These studies will enable physicians to diagnose and follow up many cardiac diseases when this software is interfaced within echocardiographic machines.,Results: Myocardial fibers initiate from the posterior basal region of the heart, continue through the left ventricular free wall, reach the septum, loop around the apex, ascend, and end at the superior-anterior edge of the left ventricle.,Background: How can mathematics help us to understand the mechanism of the cardiac motion? The best known approach is to take a mathematical model of the fibered structure and insert it into a more-or-less complex model of a cardiac architecture.,Objectives: We provide a new mathematical tool by introducing the notions strains, which are two-by-two and three-by-three matrices.,Materials and Methods: Using motion and deformation echocardiographic data, force vectors of myocardial samples were estimated by MATLAB software, interfaced in the echocardiograph system. Dynamic orientation contraction (through the cardiac cycle) of every individual myocardial fiber could be created by adding together the sequential steps of the multiple fragmented sectors of that fiber.

Is There Any Positive Remodeling after Enhanced External Counter Pulsation in Patients With Severe Refractory Angina?

Thu, 22 May 2023 00:00:00 +0430

Background: Patients with severe refractory cardiac angina who are not candidates for any form of invasive treatment and are already on optimal medical therapy have few therapeutic options. Enhanced external counter pulsation (EECP) offers an alternative palliative and possibly therapeutic option for these patients. EECP achieves this by inducing hemodynamic effects much similar to those of the intra-aortic balloon pump.,Objectives: We sought to further evaluate these therapeutic effects, especially on the basis of echocardiographic data.,Patients and Methods: Thirty-two patients who had severe refractory angina despite full anti-ischemic medication and were poor candidates for invasive procedures were evaluated. After undergoing 35 sessions of EECP, the patients were followed up for 6 months for adverse events, change in quality of life, severity of the remaining symptoms according to the Canadian Cardiovascular Society (CCS) classification, and echocardiographic changes.,Results: After receiving standard EECP treatment regimen, the patients showed a marked increase in quality of life scores; a significant decrease in left ventricular (LV) end-diastolic volume index after 6 months (P = 0.045), in tandem with an increase in the LV myocardial performance index (P = 0.04) with no significant change in the LV ejection fraction; and a significant decrease in the CCS scores (P = 0.01). In addition, physical performance measures, including time to unset of angina during the exercise test, were significantly increased.,Conclusions: EECP is a useful and low-risk additive therapeutic option in patients with end-stage and non-responsive angina symptoms who are receiving optimal medical conventional treatments and are not good candidates for invasive procedures. This treatment can induce some positive remodeling in the LV.

A Giant Eustachian Valve Protruding Into the Right Ventricle: A Case Report

Wed, 21 May 2023 00:00:00 +0430

Introduction: The Eustachian valve (EV) remnant, when present in adults, is usually rudimentary. However, in echocardiographic examinations, it may appear as a mobile long structure in the right atrium, and it rarely protrudes into the right ventricle. When it is quite large, the EV remnant could be misdiagnosed as a right atrial tumor, thrombus, or vegetation.,Case Presentation: An 83-year-old patient was referred to the surgical ward for the excision of a gastric adenocarcinoma. In the course of preoperative assessment, transthoracic echocardiography showed a right atrial mobile filamentous mass that was protruding into the right ventricle. Differential diagnosis included a tumor or thrombus. After a precise evaluation through multiple views, the mass was demonstrated to be a giant EV, 7.3 cm in length.,Conclusions: The giant EV remnant can persist in adults and is often diagnosed incidentally via echocardiography. Transthoracic echocardiography is a reliable noninvasive method for the diagnosis of the EV remnant and could help avoid its misdiagnosis as a tumor or thrombus. Nevertheless, sometimes transesophageal echocardiography is necessary to confirm the diagnosis or to demonstrate the existence of an additive clot on it.

Conus Artery in Coronary CT Angiography

Tue, 20 May 2023 00:00:00 +0430

Conclusions: In most cases, the conus artery can be visualized in cardiac CT. A description of the conus artery should be a part of the standard clinical coronary CT angiography description.,Objectives: To examine whether it is possible to visualize the conus artery in multi-slice computed tomography (CT).,Patients and Methods: In 79 consecutive patients (aged 56 ± 12.9 years; 13 women), 64-slice CT was performed due to a suspicion of coronary artery disease. The standard protocol for scanning with retrospective gating was used for all the patients.,Results: It was possible to visualize the conus artery in coronary CT angiography in 64 (81%) patients. The course of the conus artery in the right ventricle was commonly in the outflow tract direction. The conus artery was visualized at a distance of 33.2 ± 16.3 mm. The average diameter of the conus artery was 2.3 ± 0.8 mm. The conus artery most frequently originated from the first segment of the right coronary artery (53%) and directly from the aorta (37.9%). In the rest of the cases, there was a common trunk for both vessels (CA/RCA).,Background: The conus artery is usually the first branch of the right coronary artery (RCA) and passes around the right ventricular outflow tract.

A New Sonographic Phantom for Quality Control and Training Purposes

Thu, 15 May 2023 00:00:00 +0430

Background: Evaluation of the accuracy and performance of sonography units needs tissue-mimicking phantoms. These phantoms play an important role by simulating soft tissues, obviating the need to experiment on humans or animals.,Objectives: To present a simple sonographic phantom for quality control and training purposes.,Materials and Methods: The presented phantom consists of a two-part Plexiglas box. The larger part is filled with a mixture of ethanol (9.5 ± 0.25%) in distilled water and a solution of sodium nitrite (0.1 M) to prevent rusting. The second part is filled with a combination of 3.85% by wt. % agar, and 50 g/L of powdered graphite as the background material. In this study, chrome-plated electric guitar strings, 0.52 mm in diameter, were used. Several objects were considered as tissue-equivalent material, and their images were obtained at different times. Criteria for the selection of suitable objects comprised similarity between the obtained image and the corresponding tissues in the human body, minimal shrinkage, and change in brightness level at different times. In addition to quantitative analysis obtained from image processing, a blind qualitative study was done by a radiologist.,Results: Both results of quantitative analysis using MATLAB software and independent qualitative analysis showed that the commercial rubber and agar were appropriate as solid and cystic objects, respectively. Moreover, quantitative analysis done with MATLAB on images obtained from the phantom showed that the commercial rubber and agar had a 5% and 2% change in image pixel intensity (brightness) after 2 months, respectively.,Conclusions: The presented phantom not only has lower cost and complexity, which make it suitable for educational centers, but also is capable of providing good images of cystic and solid objects for quality control and training purposes. Furthermore, it confers reliable stability for at least 2 months, as was assessed in the present study.

ECG Abnormalities After Transcatheter Aortic Valve Implantation

Sun, 13 Apr 2023 00:00:00 +0430

: Transcatheteraortic valve implantation, first introduced in 2002, has been established as an alternative modality for patients deemed not suitable for open-heart surgery. The anatomical vicinity of the atrioventricular node and the His bundle to the non-coronary and rightcoronary aortic cusps predisposes patients to conduction abnormalities in case of severe calcification or mechanical trauma during valve implantation. However, the two evaluated valves (CoreValve and Edwards SAPIEN valve) have different rates of these complications, mainly driven by their respective geometry.,: Currently, there is ongoing evaluation of the true rate of conduction disorders and their clinical relevance or durability. The initial experience of fatal outcomes with conduction disorders such as complete atrioventricular block has increased the rate of subsequent pacemaker implantation up to 50%. However, prophylactic pacemaker implantation is associated with several possible complications. Thus, there is a need for further data from large-scale series taking into account the true rate of clinically relevant conduction disorders.

Comparison of Left Atrial Function between Hypertensive Patients with Normal Atrial Size and Normotensive Subjects Using Strain Rate Imaging Technique

Sun, 16 Feb 2023 00:00:00 +0330

Conclusions: In our subjects, with a normal value of LA size, the effect of hypertension on LA reservoir function was independent of age, sex, heart rate, left ventricular mass index, and left ventricular ejection fraction. Additionally, heart rate independently correlated with reduced TVI and SRI parameters in the patients with hypertension.,Background: Patients with hypertension are at risk of structural and functional changes in the left atrium (LA). There are only a few studies on the impact of hypertension on LA function, especially in hypertensive patients with a normal LA size. We, therefore, designed this study to evaluate LA function in patients with a normal LA size via deformation imaging.,Objectives: We assessed regional longitudinal strain rate imaging (SRI) profiles along with tissue velocity imaging (TVI) in the LA walls to quantify LA reservoir function and explore changes in LA function in hypertensive patients with a normal value of LA size.,Patients and Methods: One hundred twenty-four subjects with normal angiography (mean age = 56.28 ± 8.91 years, 46% male), who were referred to the Echocardiography Laboratory of our institution, were enrolled in this study. These subjects were categorized into two groups: hypertensive (75 cases) and age-matched normotensive (49 cases) groups. All the cases of the patient and control groups had a normal LA size. SRI parameters included strain (ST, %) and strain rate (SR, s-1), and tissue imaging parameters such as peak systolic velocity (Sm, m/s) were measured in four septal, lateral, anterior, and inferior LA walls at the mid-level.,Results: Compared with the controls, the patients with a history of hypertension showed significantly lower values of Sm, ST, and SR in each segment of the LA. There was no effect of age on these indices. Also, no differences regarding Sm, ST, and SR were found between the septal, lateral, anterior, and inferior LA walls in each group. By multivariate linear regression analysis, a history of hypertension was the only independent determinant of average LA strain rate in the all the individuals (P < 0.001). When this analysis was repeated in the patients with a history of hypertension, the only independent determinant of average LA strain rate was heart rate (P = 0.026).

Tissue Doppler Imaging Findings Including Prominent S Wave in Patients With Mitral Valve Prolapse Syndrome

Fri, 07 Feb 2023 00:00:00 +0330

Conclusions: Sm wave in TDI is prominent and significantly high in MVP syndrome. Also, our study showed some degree of diastolic dysfunction in MVP patients.,Results: Seventy-five patients (48 females) at a mean age of 26.5 ± 9.4 years and 50 individuals (32 females) at a mean age of 27.1 ± 8.3 years were enrolled in the study. As the important results of our study, Sm wave was much more prominent and much higher in the MVP group (P = 0.00); Em was lower (P = 0.00) and Am was slightly higher (P = 0.12). Furthermore, the E waves of MV inflow for the MVP and control groups were similar and E/Em was significantly higher in the MVP group (P = 0.00); taken together with a higher left atrial volume in this group, this finding revealed a relatively higher left ventricular end-diastolic pressure.,Objectives: We aimed to evaluate the findings of TDI in MVP syndrome.,Patients and Methods: Seventy-five patients with MVP syndrome and 50 normal individuals as the control group were evaluated. The general characteristics and echocardiographic findings, especially TDI results, were evaluated and compared between the two groups. Mitral annular TDI velocities (Sm, Em, and Am) were measured at the lateral corner of the MV in the apical four-chamber view of transthoracic echocardiography.,Background: Mitral valve prolapse (MVP) is allied to a variety of echocardiographic and pathologic findings, not least courtesy of the advent of novel and stringent echocardiographic criteria. MVP enjoys definite and clear-cut characteristics and is, as such, a fertile ground for research. Tissue Doppler imaging (TDI) is a relatively new imaging technique, and there is currently a dearth of information on this modality in patients with MVP syndrome.

Tuberculous Effusive-Constrictive Pericarditis

Sat, 25 Jan 2023 00:00:00 +0330

Discussion: Transthoracic echocardiography disclosed massive pericardial effusion, respiratory variation in mitral and tricuspid inflow E velocity, increased diastolic flow reversal with expiration in the hepatic vein, septum deviation in inspiration toward the left ventricle (LV), preserved LV function, and inferior vena caval (IVC) dilation without any collapse in inspiration. Chest computed tomography (CT) revealed a large amount of pericardial effusion and bilateral pleural effusion.,Introduction: Tuberculosis (TB) is a serious disease in developing countries. Tuberculous pericarditis is a rare but life-threatening condition and may lead to cardiac tamponade and constrictive pericarditis.,Case Presentation: An 82-year-old man was referred for cardiac consultation. He was suffering from dyspnea, malaise, weight loss, night sweat, and fever for four months duration.

Left Atrial and Left Atrial Appendage Mass Diagnosed by Cardiac Imaging: A Case Report

Wed, 22 Jan 2023 00:00:00 +0330

Introduction: Left atrial thrombi are present in one third of patients with severe rheumatic mitral stenosis and atrial fibrillation. A left atrial mass can be diagnosed as a thrombus by transthoracic echocardiography in the presence of the predisposing factors for a thrombus such as mitral stenosis and atrial fibrillation. The sensitivity of transthoracic echocardiography for detecting left atrial appendage thrombi is low, and only a few case reports have been described in the literature.,Conclusions: Transthoracic echocardiography was sufficient to establish the diagnosis and to decide its management.,Case Presentation: This report describes the case of a 65-year-old female with severe rheumatic mitral stenosis and chronic atrial fibrillation presenting with congestive heart failure. This patient was shown, by means of transthoracic echocardiography, to have a large immobile left atrium cavity mass (6.5 × 3.4 × 2.3 cm) and a large left atrial appendage mass (1.7 cm) identified as a thrombus. Contrast computed tomography of the chest confirmed the diagnosis.

Echocardiographic Abnormalities in Patients with Sleep Apnea Syndrome

Sun, 12 Jan 2023 00:00:00 +0330

Background: Obstructive sleep apnea (OSA) is a common sleep disease. It is associated not only with hypertension but also with other cardiac complications. Thus, the early detection of cardiac disorders is very useful.,Objectives: We sought to evaluate different echocardiographic parameters.,Patients and Methods: This cross-sectional study was done on 55 patients with OSA. The patients were divided into three groups: mild, moderate, and severe according to the apnea hypopnea index (AHI) and all underwent echocardiography. Analysis was done by SPSS 18 as well as the chi-squared and one-way ANOVA tests.,Results: The mean age of the study population was 51.16 ± 12.88 years old and 36 (65.5%) patients were male. Right Tei index mean was 0.383 ± 0.213, which was abnormal in 19.1% of the patients. Left Tei index mean was 0.378 ± 0.230 and was abnormal in 52.9% of the patients. Pulmonary artery pressure mean was 18.32 ± 8.91 and was normal in 39 (70.9%) patients. Only basal septum strain (P = 0.015) and basal septum strain rate (P = 0.005) changes were associated with OSA severity.,Conclusions: The main findings of this study were relative left ventricular systolic and diastolic dysfunction as well as dysfunction in some parameters of the right ventricle. The prevalence of these disorders and what constitutes the best echocardiographic parameter for their diagnosis are controversial and require further research.

Assessment of Right Ventricular Function by Tissue Doppler, Strain and Strain Rate Imaging in Patients with Left-Sided Valvular Heart Disease and Pulmonary Hypertension

Sat, 04 Jan 2024 00:00:00 +0330

Background: Pulmonary artery hypertension is the presentation of various types of cardiovascular and systematic diseases. There are different kinds of noninvasive methods to determine right ventricular function, pulmonary artery pressure, and effect of pulmonary hypertension on right ventricular function. These methods include the tissue Doppler imaging (TDI) of the tricuspid annulus and the longitudinal deformation indices of the right ventricular free wall.,Objectives: In some patients, the echocardiogram cannot help estimate pulmonary artery pressure. In this study, we evaluated the effect of pulmonary hypertension on the TDI of the tricuspid annulus and the longitudinal strain and strain rate of the basal segment of the right ventricular free wall in patients with left-sided valvular heart disease and pulmonary hypertension. Indeed, we sought to investigate whether we can guess the presence of pulmonary hypertension through the measurement of the TDI of the tricuspid annulus and the deformity indices of the basal segment of the right ventricular free wall.,Patients and Methods: Eighty consecutive patients with left-sided valvular disease and pulmonary artery hypertension (V/PH Group) and 80 healthy matched controls (H Group) were enrolled in this research. The TDI parameters were obtained in the tissue velocity imaging mode during systole (S, S VTI), early relaxation (E), atrial systole (A), and isovolemic relaxation time (IVRT). The deformation indices included peak systolic longitudinal strain and strain rate measured from the basal segment of the right ventricular free wall and were calculated as the relative magnitude of segmental deformation.,Results: S, E, and S VTI were reduced significantly in the V/PH Group, and there was a significant negative correlation between S velocity, S VTI with pulmonary artery systolic pressure (PASP), and right ventricular diameter (RVD). According to the ROC curve, S velocity ˂ 10.5 cm/s had 65% sensitivity and 40% specificity for the prediction of pulmonary hypertension. E velocity had only a negative significant correlation with RVD and no significant correlation with tricuspid annular plane systolic excursion (TAPSE) and PASP. There was no significant difference in A velocity and E/A ratio between the two groups (P = 0.455 and P = 0.070, respectively), and these parameters had no significant correlation with RVD and TAPSE. IVRT was significantly increased in the V/PH Group versus the H Group, and IVRT > 40 ms had 78% sensitivity and 67% specificity for the prediction of pulmonary hypertension. In comparison with the H Group, RV longitudinal peak systolic strain (-14/35 ± 4%) and strain rate (-0.65 ± 0.12) at the basal segment of the right ventricular free wall were significantly lower in the V/PH Group (P < 0.001 and P < 0.001). ,Conclusions: We observed a significant reduction in S, E velocity, and S VTI of the tricuspid annulus. Moreover, the strain/strain rate of the basal segment of the right ventricular free wall had a marked decrease in the V/PH Group in comparison with the healthy subjects.

Absent Pulmonary Valve Associated With Tetralogy of Fallot and Double Chamber Right Ventricle

Tue, 12 Nov 2023 00:00:00 +0330

Introduction: Tetralogy of Fallot (TOF) in the absent of pulmonary valve is a rare congenital anomaly (3%of TOF patients).,Case Presentation: We are presenting an 18- year-old male with history of dyspnea on exertion and cyanosis since childhood. Despite the diagnosis of congenital heart disease, no intervention was done due to his poor socioeconomic culture. At age of 18, he referred to our center for further evaluation of heart problem. After physical examination and other diagnostic tests, our final diagnosis was tetralogy of fallot, absent pulmonary valve and double-chamber right ventricle. The absence of mature PV tissue leads to severe pulmonary regurgitation, which is often associated with significant dilatation of the pulmonary arteries. After further evaluation of main pulmonary artery, its branches and other abnormalities of the heart, total correction of tetralogy and pulmonary valve replacement was done. His post operation period was uneventful without any complication and he discharged after 10 days.,Conclusions: We believe that the prognosis for those patients in this era is good and complete surgical treatment is tolerated well by them.

Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods

Tue, 12 Nov 2023 00:00:00 +0330

Conclusions: Results suggest that these methods cannot be interchanged, and VVI showed significantly lower LV peak twist, peak twisting rate and peak untwisting rate. However, when LV twist and LV twisting rates were normalized to LV length, values were comparable for both imaging techniques.,Results: Twist degree was significantly lower in the VVI group than in the TDI group (P = 0.008, r = 0.56). LV torsion was lower in the VVI group but was not significant. (P = 0.13, r = 0.38). Twisting rate (P = 0.004, r = 0.66) and untwisting rate (P = 0.0001, r = 0.61) were lower in the VVI group, but when timing of untwisting rate was normalized by systolic duration, there was no significant difference between the two groups (P = 0.41, r = 0.59). Similarly, when peak untwisting rate was normalized by LV length, there was a significant decline in normalized peak untwisting rate in the VVI group (P = 0.004, r = 0.62), but not in peak twisting rate normalized by LV length (P = 0.12, r = 0.42). Peak untwisting rate normalized by LV torsion was not statistically different between the two groups (P = 0.05, r = 0.53).,Objectives: Recent advances in echocardiography techniques have allowed for quantification of LV mechanics. The aim of the present study was to compare various LV twisting and untwisting parameters in healthy human subjects determined by velocity vector imaging (VVI) and tissue Doppler imaging (TDI) at rest.,Patients and Methods: All volunteers (47 healthy subjects in two groups: 24 subjects in VVI group and 23 subjects in TDI group) underwent complete echocardiographic study, and LV torsional parameters were assessed by VVI or TDI methods. In addition, LV torsion and LV twisting/untwisting rate profiles were calculated throughout cardiac cycle.,Background: The torsional parameters of the left ventricle (LV) are sensitive indicators of the cardiac performance. The torsion/twist of the LV is the wringing motion of the heart around its long axis created by oppositely directed apical and basal rotations and is determined by contracting myofibers in the LV wall which are arranged in opposite directions between the subendocardial and subepicardial layers. This motion is essential for regulating the LV systolic and diastolic functions.

Evaluation of Left Atrial Two-Dimensional Strain in Patients with Systolic Heart Failure using Velocity Vector Imaging

Sun, 10 Nov 2023 03:30:00 +0330

Background: Two-dimensional (2D) Strain is a new reproducible technique for assessing regional myocardial function; however, its application for evaluation of left atrium (LA) function is less studied. ,Objectives: We sought to assess LA function in heart failure patients using velocity vector imaging (VVI).,Patients and Methods: Thirty five patients (mean age: 43.34 ± 18.1 years, 59.3% male) with systolic dysfunction [left ventricle ejection fraction (LVEF) < 35%] enrolled. Standard Doppler echocardiography and 2D strain were performed on all subjects. Strain measurements were obtained from apical views. ,Results: A significant differences in LA volume index (LAVI) and strain were found in patients with systolic heart failure (SHF) versus normal subjects (23.8 ± 4.1 versus 57.8 ± 19.7 ml/m2, P < 0.001 and 39.6 ± 10.6 versus 8.2 ± 5.3%, P < 0.001). Multivariate analysis of separate walls revealed significant inverse relationship between LA size and volume with total and regional (2-ch view) 2D strains of LA. Significant inverse relationship were also detected between pulmonary artery systolic pressure and both total LA strain (22 ± 8 versus 42 ± 10 mmHg, r = -0.4, P < 0.001) and LA strain in 2-chamber (r = -0.5, P < 0.001). A cutoff value of total average LA strain (≥ 23.28%) can differentiate normal and abnormal LA function with a sensitivity of 93% and specificity of 100% and a cutoff value of total LA strain (in average) of 17.2% can differentiate mild and moderate and severe diastolic dysfunction with a sensitivity of 100% and a specificity of 97%.,Conclusions: LA strain seems to be a better determinant for diagnosis of abnormal LA function and the degree of diastolic dysfunction in SHF.

Prenatal Diagnosis of Tuberous Sclerosis by Fetal Echocardiography With an Unusual Clinical Course After Birth

Sun, 10 Nov 2023 00:00:00 +0330

Conclusions: This case report underscores the role of fetal echocardiography in the prenatal diagnosis of cardiac disease and illustrates rhabdomyomas in a tuberous sclerosis patient. Rhabdomyomas are histologically benign; however, they may cause severe arrhythmia even when they are regressing.,Case Presentation: Our tuberous sclerosis patient developed arrhythmia unexpectedly while his tumors were in regression, presenting a challenge to us as to whether or not opt for surgery.,Introduction: The cardiac outcome in tuberous sclerosis patients is usually favorable, and cerebral manifestations determine the ultimate prognosis in these patients.

Normal Echocardiographic Values of 368 Iranian Healthy Subjects

Sun, 10 Nov 2023 00:00:00 +0330

Background: Echocardiography is widely used to diagnose or exclude cardiac disease. The reports on reference values based on an Asian population are limited.,Objectives: We conducted a study to determine normal values for two-dimensional, M-mode, and Doppler echocardiographic measurements and evaluate the relationship between these parameters and age and gender in a large, healthy Iranian population. ,Patients and Methods: Among a total of 400 volunteers in a cross-sectional study, 368 healthy individuals aged between 30 and 70 years [171 males at a mean age of 47.6 (9.9) and 197 females at a mean age of 47.6 (9.5)] were enrolled. Standard comprehensive transthoracic echocardiography (TTE) was performed based on the guidelines of the American Society of Echocardiography. The normal limits are presented as mean (SD) and are also indexed to body surface area (BSA).,Results: There was no significant difference between the men and women regarding left ventricular (LV) ejection fraction (57.97% vs. 57.99%). The mean of LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), interventricular septum (IVS), posterior wall (PW) thickness, and right ventricular diastolic diameter (RVDd) was significantly greater in the men than in the women. However, there was an inverse relationship when LVEDD, RVDd, and left atrial (LA) diameter and area were indexed to BSA. There was no significant difference in the mean of LA area between the males and females (14.28 vs. 13.6 cm2). The LV diastolic parameters correlated negatively with age. A peakE /A velocity ratio < 1 was found in the subjects over 50 years old. The mean of all the measurements in our study was less than the reference values in the published guidelines.,Conclusions: Our study, the first and largest investigation of its kind, provides reference values for the echocardiographic evaluation of the cardiac size and function of Iranian healthy individuals. The mean of our measurements was significantly less than that reported in the published guidelines.

Association Between Echocardiographic Indices and Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation

Sat, 09 Nov 2023 03:30:00 +0330

Results: The mean age of patients was 60 ± 9.9 years. Statistically significant relationship between the occurrence of AF with Mitral valve annulus, LA Volume Index (LAVI) , Right ventricle function, and type of surgery (off pump or on pump) were detected in our study (P < 0.05) . There was no statistically significant relationship between the occurrence of AF and time interval of P wave to A wave onset in conventional Doppler echocardiographic study (P-A), P-A′ onset and P-A’ peak in TDI examination (P > 0.05).,Conclusions: Based on our findings, MV annulus, LAVI, RV function and on pump CABGS were independent factors related to the occurrence of AF post CABGS. Echocardiographic study associated with clinical data could be helpful for risk stratification of occurrence of post-operative AF.,Background: Atrial fibrillation (AF) was recognized as a major cause of morbidity and mortality after coronary artery bypass graft surgery (CABGS). Finding an accurate method to identify patients with increased risk may prevent or lower the occurrence of the related complications.,Objectives: This study aimed to evaluate the association between interval of P-wave initiation in surface electrocardiogram, a-wave initiation in doppler study of mitral valve, MV annular velocity by TDI and compare them with conventional echocardiographic findings to investigate the associated factors related to the occurrence of AF in the first 72 hours after the CABGS.,Patients and Methods: Four hundred and four patients with sinus rhythm, who were candidate for CABGS between June 2010 and July 2012 were examined before the surgery by conventional echocardiography and Tissue Velocity Imaging Methods and were monitored for 72 hours after surgery. Data collection and analysis were done by SPSS statistical software.

Pericystic Fibrosis of a Cardiac Hydatid Cyst

Sat, 09 Nov 2023 03:30:00 +0330

Introduction: Cardiac hydatid cysts are rare and represent less than 2% of all hydatid cases. They can occur as part of a widespread systemic infection or an isolated event. ,Case Presentation: Here, we presented a case of cardiac hydatid cyst in interventricular septum.,Conclusions: The case presented had some findings that suggested the specific diagnosis of hydatid cyst.

Hypoplastic Right Ventricle with Multiple Associated Anomaly: A Challenging Case for Biventricular Repair or Univentricular Approach?

Sun, 30 Jun 2023 00:00:00 +0430

: Abstract,: Hypoplastic right ventricular is a rare congenital heart disease. A few cases have been reported. We presented a case with hypoplastic right ventricular and multiple associated anomaly (Ventricular septal defect, atrial septal defect and pulmonary stenosis) in whom the main concern was whether biventricular repair or Fontan type surgery would be the optimal management in this patient. Biventricular repair was done successfully using the multimodality cardiac imaging with intraoperative transesophageal echocardiography.

Myocardial Deformation Indices in Patients with Significant Aortic Regurgitation: A Strain Rate Imaging Study

Thu, 20 Jun 2023 00:00:00 +0430

Conclusions: Our results demonstrated the ability of PW-TDI and S/SR modalities in detection of the early subclinical abnormalities in asymptomatic patients with significant chronic AR. ,Results: AR group had significantly increased LV end systolic and end diastolic volumes, interventricular septum and posterior wall thickness compared to controls. In AR, Sm and Em of septal wall, Sm of lateral wall; S and SR of both septal and lateral walls were significantly decreased while MPI were significantly increased compared to healthy participants.,Objective: Our aim was to study the subclinical left ventricular (LV) dysfunction, by novel echocardiographic methods, myocardial deformation indices in patients with asymptomatic, and significant aortic regurgitation (AR).,Patients and Methods: Standard echocardiogram and complementary tissue Doppler imaging (TDI) and Doppler based strain and strain rate (S/SR) imaging were performed in 44 asymptomatic patients with pure and significant AR and ejection fraction (EF) more than 50% (mean age:49.9 ± 17.2 years, 50% male) and 20 healthy participants (mean age: 47.3 ± 13.8 years, 65% male). In addition to TDI velocities to investigate the LV longitudinal deformation, peak systolic S and SR were measured at septal, lateral and posterior walls. The LV modified myocardial performance index (MPI) or Tie index also were calculated via TDI study. ,Background: Early detection of myocardial contractility disturbances in patients with asymptomatic moderate to severe aortic regurgitation (AR) leads to the early operative intervention early enough to prevent from poor postoperative heart failure (HF) prognosis.

Echocardiographic Assessment of Right Atrium Deformation Indices in Healthy Young Subjects

Thu, 20 Jun 2023 00:00:00 +0430

Background: Recently, assessment of the atrial motion and deformation indices obtained via Doppler myocardial imaging (DMI) has been proposed as a new method of exploring the atrial function.,Objective: Our aim was to assess the right atrial (RA) regional function using myocardial velocities, strain, and strain rate imaging (SRI) and compare it with the function of the inter-atrial septum (IAS) and left atrial (LA) lateral wall in healthy young adults.,Patients and Methods: A total of 75 healthy young individuals (35 women and 40 men) underwent standard transthoracic echocardiography and DMI at rest. Myocardial velocities, strain, and SRI profiles from the RA free wall, IAS, and LA lateral wall were calculated throughout the three cardiac cycles. Peak systolic, diastolic and time to peak were derived, and the average of the three cardiac cycles was taken into account for analysis in this study.,Results: The RA peak systolic, peak of early, and late diastolic velocities were 9.2 ± 1.6 cm/s, -9.5 ± 1.8 cm/s, and -8.3 ± 2.1 cm/s, respectively. The RA peak systolic strain was 152% ± 51%. The RA systolic strain was significantly higher than that of the IAS (87% ± 21%, P = 0.001) and the LA lateral wall (89% ± 15%, P = 0.001). The RA peak systolic, peak early and late diastolic SR were 6.3 ± 3.0 s-1, -5.4 ± 1.7 s-1, and -4.5 ± 2.2 s-1, respectively.,Conclusions: DMI proved to be a feasible and reproducible method for the assessment of the RA function in healthy young subjects. Study of myocardial properties showed that the RA free wall myocardial motion and deformation were significantly higher than those of the IAS and the LA lateral wall, but the rate of the RA free wall deformation was not significantly higher than that of the IAS and the LA lateral wall.

Echocardiographic Evaluation of Effects of Different Training Regimens on Left Ventricle Structure and Function in Female Athletes

Thu, 20 Jun 2023 00:00:00 +0430

Patients and Methods: Forty five young female volunteer athletes were included and received different training regimens (endurance-training, strength training and concurrent groups) for a 10 week period as study intervention. Standard color Doppler echocardiography was performed for assessment of the left ventricular activity.,Results: As a result, 45 athletes ended the study training regimens. Mean of cardiac parameters was not significantly different among athletes under study before the beginning of the study training regiments. Mean of end diastolic diameter among athletes of strength-trained group had been significantly increased after receiving the study training regiments. Mean of posterior wall thickness had been significantly increased in athletes of strength and concurrent groups. Mean of posterior wall thickness had been decreased in athletes of endurance-training group. Mean of heart rate was significantly decreased among the athletes of endurance-training and concurrent-training groups.,Background: Professional training regimens are accompanied with morphologic alteration and cardiac function which is known as “athlete’s heart” which is defined by left ventricular hypertrophy and other echocardiographic features.,Conclusion: The combination of both endurance-training and strength training protocols caused largest increases in left ventricular internal dimension and left ventricular wall thickness among the trial participants.,Objectives: The present study aims to evaluate the effect of different training protocols such as endurance-training, strength training protocols and concurrent protocols on heart structures.

Quantitative Assessment of Right Atrial Function by Strain Imaging in Adult Patients with Totally Corrected Tetralogy of Fallot

Thu, 20 Jun 2023 00:00:00 +0430

Conclusions: In light of our findings, we concluded that RA function is severely diminished in adult patients with TOF. It would play an important role in pathophysiological process of the right sided heart failure in these patients.,Results: The myocardial velocities and deformational indices of RA free wall were significantly compromised in TOF patients compared with normal subjects. There was no correlation between RA function data measured by strain imaging and RV volume measured in CMR.,Patients and Method: Forty six adult patients with TOF who underwent total correction surgery in childhood and had severe pulmonary regurgitation and fulfilled the criteria of ACC/AHA guideline for PVR enrolled. The control group included 50 healthy adults with matched age and sex. Standard transthoracic echocardiography was performed on both groups which myocardial velocities and strain imaging indices were obtained from their RA free wall.,Objectives: We aimed to measure the right atrial function by this method in adult patients with surgically corrected Tetralogy of Fallot (TOF).,Background: Atrial function could be affected by many cardiac disorders. Recently Strain imaging has been employed for the assessment of atrial function in several disorders involving atria.

Cardiac Magnetic Resonance Imaging Findings in a Patient with Ebstein’s Anomaly and Left Ventricular Dysfunction

Thu, 20 Jun 2023 00:00:00 +0430

: Ebstein anomaly is characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialization of the right ventricle and could be diagnosed in a routine transthoracic echocardiography exam. We reported a young man with right sided heart failure symptoms who was found to have biventricular failure with suspected apical displacement of septal leaflet of tricuspid valve. For better evaluation, cardiac magnetic resonance imaging (CMR) was performed and nicely proved the diagnosis of Ebstein's anomaly with late intramyocardial enhancement of both left and right ventricles. CMR has the potential for providing information while echocardiography cannot, especially regarding the right ventricle and related myocardial problems, and Ebstein’s anomaly with decreased left ventricular (LV) systolic function.

Carotid Artery Intima-Media Thickness in Patients Undergoing Coronary Artery Bypass Graft Surgery

Wed, 19 Jun 2023 00:00:00 +0430

Conclusions: High prevalence of the increased CIMT in patients undergoing CABG highlights the significance of CIMT measurement in early diagnosis of the systemic atherosclerosis. Moreover, although Traditional cardiovascular risk factors were important they could not explain the extension and the severity of CIMT. It seems that some ultrasonographic features such as the associated carotid plaques and their characteristics provide promising clues to detect existing atherosclerosis. More importantly, avoiding the misinterpretation age-adjustment should be considered in all patients. ,Background: Coronary artery angiography is still the gold standard of choice for detection of coronary artery disease. Nevertheless, it is an invasive procedure and its complications are not uncommon. It also predisposes patients to the potential risks of contrast study and radiation,Objective: In the present report, we aimed to assess the significance of carotid intima-media thickness (CIMT) in patients undergoing coronary artery bypass grafting (CABG) by applying an imaging approach.,Patients and Methods: The carotid arteries were evaluated at baseline with high-resolution B-mode ultrasonography by a single trained physician. Measurements were performed on the far wall of the common carotid artery in a longitudinal view. Age-adjustment was done for the measured values before deciding regarding their appropriateness in each patient. Among 215 patients undergoing CABG, 70% had a higher CIMT above the expected normal range for their ages. ,Results: In our study sample, 2/3 of CAD patients requiring coronary revascularization were male. In 70% of cases carotid artery had intimal-medial thickness of above the presumed age-adjusted reference range. Traditional risk factors including hyperlipidemia, hypertension, smoking, diabetes mellitus and family history although important, but did not accurately reflect presence or extension of progression of the atherosclerotic process which could be determined by CIMT measurement. The CIMT in these patients were mostly dependent on the number and severity of the risk factors.