Journal of the American Society of Echocardiography RSS feed: Current Issue. The Journal of the American Society of Echocardiography brings physicians and sonographers the very latest clinical, scientific, legal, and economic information regarding the use of cardiac ultrasound. The Journal's original, peer-reviewed articles cover conventional procedures as well as newer clinical techniques, such as transesophageal echocardiography, intraoperative echocardiography, and intravascular ultrasound.http://www.onlinejase.com/?rss=yesElsevier Inc.en © 2010 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. Journal of the American Society of Echocardiography0894-7317232February 2010 © 2010 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.onlinejase.com/article/PIIS0894731709011092/abstract?rss=yesBackground: The quantification of right ventricular (RV) size and function is of diagnostic and prognostic importance. Recently, new software for the analysis of RV geometry using three-dimensional (3D) echocardiographic images has been validated. The aim of this study was to provide normal reference values for RV volumes and function using this technique.Methods: A total of 245 subjects, including 15 to 20 subjects for each gender and age decile, were studied. Dedicated 3D acquisitions of the right ventricle were obtained in all subjects.Results: The mean RV end-diastolic and end-systolic volumes were 49 ± 10 and 16 ± 6 mL/m2 respectively, and the mean RV ejection fraction was 67 ± 8%. Significant correlations were observed between RV parameters and body surface area. Normalized RV volumes were significantly correlated with age and gender. RV ejection fractions were lower in men, but differences across age deciles were not evident.Conclusion: The current study provides normal reference values for RV volumes and function that may be useful for the identification of clinical abnormalities.Reference Values for Right Ventricular Volumes and Ejection Fraction With Real-Time Three-Dimensional Echocardiography: Evaluation in a Large Series of Normal SubjectsGloria Tamborini, Nina Ajmone Marsan, Paola Gripari, Francesco Maffessanti, Denise Brusoni, Manuela Muratori, Enrico G. Caiani, Cesare Fiorentini, Mauro Pepi10.1016/j.echo.2009.11.026Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Focus Topic: Right Ventricular Volume and Function109115http://www.onlinejase.com/article/PIIS0894731709010980/abstract?rss=yesBackground: The aim of this study was to validate a novel real-time three-dimensional echocardiographic (RT3DE) analysis tool for the determination of right ventricular volumes and function in unselected adult patients.Methods: A total of 100 consecutive adult patients with normal or pathologic right ventricles were enrolled in the study. A dynamic polyhedron model of the right ventricle was generated using dedicated RT3DE software. Volumes and ejection fractions were determined and compared with results obtained on magnetic resonance imaging (MRI) in 88 patients with adequate acquisitions.Results: End-diastolic, end-systolic, and stroke volumes were slightly lower on RT3DE imaging than on MRI (124.0 ± 34.4 vs 134.2 ± 39.2 mL, P < .001; 65.2 ± 23.5 vs 69.7 ± 25.5 mL, P = .02; and 58.8 ± 18.4 vs 64.5 ± 24.1 mL, P < .01, respectively), while no significant difference was observed for ejection fraction (47.8 ± 8.5% vs 48.2 ± 10.8%, P = .57). Correlation coefficients on Bland-Altman analysis were r = 0.84 (mean difference, 10.2 mL; 95% confidence interval [CI], −31.3 to 51.7 mL) for end-diastolic volume, r = 0.83 (mean difference, 4.5 mL; 95% CI, −23.8 to 32.9 mL) for end-systolic volume, r = 0.77 (mean difference, 5.7 mL; 95% CI, −24.6 to 36.0 mL) for stroke volume, and r = 0.72 (mean difference, 0.4%; 95% CI, −14.2% to 15.1%) for ejection fraction.Conclusion: Right ventricular volumes and ejection fractions as assessed using RT3DE imaging compare well with MRI measurements. RT3DE imaging may become a time-saving and cost-saving alternative to MRI for the quantitative assessment of right ventricular size and function.Dynamic Assessment of Right Ventricular Volumes and Function by Real-Time Three-Dimensional Echocardiography: A Comparison Study With Magnetic Resonance Imaging in 100 Adult PatientsGregor Leibundgut, Andreas Rohner, Leticia Grize, Alain Bernheim, Arnheid Kessel-Schaefer, Jens Bremerich, Michael Zellweger, Peter Buser, Michael Handke10.1016/j.echo.2009.11.016Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Focus Topic: Right Ventricular Volume and Function116126http://www.onlinejase.com/article/PIIS0894731709010013/abstract?rss=yesBackground: The aim of this study was to evaluate the accuracy of three-dimensional (3D) ultrasound compared with the standard magnetic resonance imaging method in determining right ventricular (RV) volumes and function in adult patients with congenital heart disease and chronic, severe pulmonary regurgitation (PR).Methods: Twenty-five patients with severe PR secondary to either pulmonary valvotomy or tetralogy of Fallot repair were evaluated using 3D ultrasound and MRI.Results: The mean RV ejection fractions were 42 ± 8% on 3D ultrasound and 44 ± 7% on MRI (r = 0.89, P < .0001). The mean end-diastolic volumes were 249 ± 66 and 274 ± 82 mL and the mean end-systolic volumes 147 ± 50 and 159 ± 60 mL on 3D ultrasound and MRI, respectively. Similarly, there were strong correlations of both end-diastolic volume and end-systolic volume on 3D ultrasound and MRI (r = 0.88 and r = 0.89, respectively).Conclusions: Three-dimensional ultrasound was comparable with MRI in determining RV size and function in most patients with complex congenital heart disease. It will be important to study 3D US in a larger population of patients with TOF, which will be possible only through multi-center collaboration.Three-Dimensional Echocardiographic Assessment of Right Ventricular Volume and Function in Adult Patients With Congenital Heart Disease: Comparison With Magnetic Resonance ImagingJasmine Grewal, David Majdalany, Imran Syed, Patricia Pellikka, Carole A. Warnes10.1016/j.echo.2009.11.002Journal of the American Society of Echocardiography 23, 2 (2010)2009-12-04Journal of the American Society of Echocardiography2009-12-04232S0894-7317(10)X0002-5Focus Topic: Right Ventricular Volume and Function127133http://www.onlinejase.com/article/PIIS0894731709011110/abstract?rss=yesBackground: The objective of this study was to test the feasibility, accuracy, and reproducibility of the assessment of right ventricular (RV) volumes and ejection fraction (EF) using real-time three-dimensional echocardiographic (RT3DE) imaging in patients with congenital heart disease (CHD), using cardiac magnetic resonance (CMR) as a reference.Methods: RT3DE data sets and short-axis cine CMR images were obtained in 62 consecutive patients (mean age, 26.9 ± 10.4 years; 65% men) with various CHDs. RV volumetric quantification was done using semiautomated 3-dimensional border detection for RT3DE images and manual tracing of contours in multiple slices for CMR images.Results: Adequate RV RT3DE data sets could be analyzed in 50 of 62 patients (81%). The time needed for RV acquisition and analysis was less for RT3DE imaging than for CMR (P < .001). Compared with CMR, RT3DE imaging underestimated RV end-diastolic and end-systolic volumes and EF by 34 ± 65 mL, 11 ± 55 mL, and 4 ± 13% (P < .05) with 95% limits of agreement of ±131 mL, ±109 mL, and ±27%, as shown by Bland-Altman analyses, with highly significant correlations (r = 0.93, r = 0.91, and r = 0.74, respectively, P < .001). Interobserver variability was 1 ± 15%, 6 ± 17%, and 8 ± 13% for end-diastolic and end-systolic volumes and EF, respectively.Conclusion: In the majority of unselected patients with complex CHD, RT3DE imaging provides a fast and reproducible assessment of RV volumes and EF with fair to good accuracy compared with CMR reference data when using current commercially available hardware and software. Further studies are warranted to confirm our data in similar and other patient populations to establish its use in clinical practice.Clinical Value of Real-Time Three-Dimensional Echocardiography for Right Ventricular Quantification in Congenital Heart Disease: Validation With Cardiac Magnetic Resonance ImagingHeleen B. van der Zwaan, Willem A. Helbing, Jackie S. McGhie, Marcel L. Geleijnse, Saskia E. Luijnenburg, Jolien W. Roos-Hesselink, Folkert J. Meijboom10.1016/j.echo.2009.12.001Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Focus Topic: Right Ventricular Volume and Function134140http://www.onlinejase.com/article/PIIS0894731709012073/abstract?rss=yesIt is well known that the evaluation of right ventricular (RV) volume and function by two-dimensional echocardiography has long been hampered by the complex three-dimensional (3D) shape of this chamber, which has made its geometric modeling challenging and frequently inaccurate. Today, as real-time 3D echocardiographic (RT3DE) imaging is being embraced by echocardiographers around the world as a clinically useful imaging modality with a proven “track record” in the assessment of valvular pathology and left ventricular function, research and clinical applications focused on the right ventricle have been lagging behind. As a result, our progress in understanding how changes in RV size, shape, and dynamics may contribute to pathophysiology has also been relatively slow. The recognition that RT3DE imaging has the potential to overcome these difficulties has recently caused a resurgence of interest in the assessment of this “neglected” chamber. Similar to the technological advancements in the RT3DE evaluation of the left ventricle, an important milestone for the right ventricle was the development of analysis software that allows the semiautomated detection of the 3D RV endocardial surface, from which RV volume can be calculated throughout the cardiac cycle directly, without the need for geometric modeling. Assuming that this analysis is accurate and reproducible, one may see the possibilities for gaining new insights into RV dynamics that will expand the understanding of a spectrum of cardiovascular pathology and facilitate its implementation into routine clinical practice.Imaging the Forgotten Chamber: Is the Devil in the Boundary?Victor Mor-Avi, Lissa Sugeng, Jonathan R. Lindner10.1016/j.echo.2009.12.021Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Editorial Comment141143http://www.onlinejase.com/article/PIIS0894731709011572/abstract?rss=yesThis article reviews the main clinical aspects of patent foramen ovale (PFO), such as its prevalence in the population, the diagnostic techniques to detect its presence, its role as a risk factor for ischemic stroke of otherwise unexplained origin, and its controversial association with migraine. Some cofactors possibly involved in the association between PFO and stroke are discussed, along with the various therapeutic options to prevent recurrent cerebral ischemic events in stroke patients with a PFO.Patent Foramen Ovale: Echocardiographic Detection and Clinical Relevance in StrokeMarco R. Di Tullio10.1016/j.echo.2009.12.008Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5State of the Art Review Article144155http://www.onlinejase.com/article/PIIS0894731709010979/abstract?rss=yesBackground: There are few data on adding left atrial volume index (LAVi) or pulmonary artery systolic pressure (PAP) to the ratio of early mitral inflow to mitral annular velocity (E/e′) for the estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fractions (LVEFs) (>50%).Methods: Patients underwent echocardiography within 20 minutes of cardiac catheterization. Echocardiographic variables were compared with invasively measured LV preatrial contraction pressure (pre-A).Results: Of the 122 patients studied (mean age, 55 ± 9 years; mean LVEF, 61 ± 6%), 67 (55%) were women, 108 (88%) had hypertension, and 79 (65%) had significant coronary artery disease at catheterization. E/e′ was significantly correlated with pre-A (R = 0.63, P < .0001) compared with LAVi (R = 0.49, P < .001) and PAP (R = 0.48, P  13 had sensitivity of 70% and specificity of 93% (area under the curve [AUC], 0.82; P < .0001), LAVi > 31 mL/m2 had sensitivity of 78% and specificity of 76% (AUC, 0.80, P < .001), and PAP > 28 mm Hg had sensitivity of 80% and specificity of 64% for pre-A > 15 mm Hg (AUC, 0.77, P < .001). Adding LAVi >31 mL/m2 for E/e′ = 8 to 13 significantly increased the accuracy of E/e′ > 13 alone (sensitivity, 87%; specificity, 88%; AUC, 0.89; P = .01 for comparison). However, adding PAP > 28 mm Hg for E/e′ = 8 to 13 did not significantly increase the accuracy of E/e′ > 13 alone (AUC, 0.82; sensitivity, 82%; specificity, 72%; P = NS for comparison).Conclusions: In patients with preserved LVEFs, adding LAVi > 31 mL/m2 to E/e′ (when E/e′ was in the gray zone, but not when E/e′ was >13) significantly increased the accuracy of E/e′ alone for the estimation of LV filling pressure. These data support the notion of using several, rather than any single, Doppler echocardiographic parameter for the accurate assessment of LV diastolic function.Do Additional Echocardiographic Variables Increase the Accuracy of E/e′ for Predicting Left Ventricular Filling Pressure in Normal Ejection Fraction? An Echocardiographic and Invasive Hemodynamic StudyHisham Dokainish, John S. Nguyen, Ranjita Sengupta, Manu Pillai, Mahboob Alam, Jaromir Bobek, Nasser Lakkis10.1016/j.echo.2009.11.015Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5LV Diastolic Function and LA Function156161http://www.onlinejase.com/article/PIIS089473170901181X/abstract?rss=yesIn recent years, the importance of heart failure with preserved ejection fraction has been increasingly recognized, and the demand for a simple, noninvasive, bedside test for validating this diagnosis has dramatically increased. Echocardiography is the natural candidate technique for this task, but the echocardiographic detection of left ventricular (LV) diastolic dysfunction has been fraught with differing concepts and confusing terminology, including the question of what exactly constitutes diastolic dysfunction. At the bottom of this problem lies the inability to obtain noninvasively the LV diastolic pressure-volume relationship, because echocardiography cannot measure absolute pressures. Many echocardiographic signs and patterns of diastolic dysfunction have been described over the years, but the multifactorial nature, in particular the load dependency, of echocardiographically obtainable parameters of diastolic LV physiology has dogged efforts to find a simple way to assess diastolic function. The problem therefore has been restated in a simpler, although perhaps simplistic, way: how can we diagnose elevated filling pressures by echocardiography, regardless of the complex pathophysiology (which involves the respective roles of active relaxation, chamber compliance, interventricular dependence, etc)? The group of Nagueh et al, in which the senior author of the article by Dokainish et al in this issue of the Journal was a coworker, has pioneered the use of a novel parameter to estimate “filling pressure,” namely, the ratio of peak early transmitral blood flow velocity (E) and peak early diastolic tissue velocity at the base of the left ventricle (e′). They studied the correlation of E/e′ with LV filling pressures in several clinical scenarios and found reasonable correlations in patients with a wide range of ejection fractions. However, the reported relations have always been far from perfect and too weak to base clinical decisions solely on this parameter. Moreover, a recent study in patients who in a substantial proportion had wide QRS complexes and mechanical dyssynchrony indicated that the correlation is further degraded in such circumstances.Diagnosing Left Ventricular Diastolic Dysfunction by Echocardiography: Reverend Bayes Lends a HandChristian Rost, Frank A. Flachskampf10.1016/j.echo.2009.12.013Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Editorial Comment162163http://www.onlinejase.com/article/PIIS0894731709011043/abstract?rss=yesBackground: Hypertrophic cardiomyopathy (HCM) is characterized by myocardial hypertrophy, fiber disarray, and fibrosis interfering with myocardial force generation and relaxation. Because conventional Doppler echocardiographic methods inadequately assess diastolic function in HCM, the aim of this study was to determine local and global left ventricular (LV) relaxation mechanics in patients with HCM.Methods: Seventy-two patients with HCM and 32 normal controls were studied. Using Velocity Vector Imaging, longitudinal and circumferential strain, strain rate, and rotation at the base, middle, and apex of the septal and lateral LV walls were measured. Differences between patients' functional class subgroups were assessed using analysis of variance, and Tukey's post hoc analysis was used to compare patients in HCM clinical subgroups with normal controls.Results: Longitudinal strain and systolic and early diastolic strain rates were lower than normal in patients with HCM, whereas their circumferential values were higher. This suggests that shortening and relaxation orientation in HCM was more circumferential. The ratio of peak early diastolic to peak systolic strain rate decreased longitudinally and circumferentially in moderately to severely symptomatic (New York Heart Association class III or IV) patients (0.95 ± 0.35 vs 0.89 ± 0.35, P < .001). LV untwist was similarly prolonged in all HCM subgroups. LV relaxation assessed using the early apical reverse rotation fraction was significantly lower in patients with worse functional status (34 ± 14% vs 18 ± 4% in class I or II vs class III or IV). Left atrial volume increased, paralleling the severity of symptoms and the degree of diastolic dysfunction.Conclusions: The evaluation of biplane myocardial mechanics offers new insights into the evaluation of diastolic function and its relationship to clinical status.Diastolic Myocardial Mechanics in Hypertrophic CardiomyopathyShemy Carasso, Hua Yang, Anna Woo, Michal Jamorski, E. Douglas Wigle, Harry Rakowski10.1016/j.echo.2009.11.022Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Clinical Investigations164171http://www.onlinejase.com/article/PIIS0894731709010414/abstract?rss=yesBackground: Left atrial (LA) strain (ε) and ε rate (SR) analysis by two-dimensional speckle tracking can represent a new tool to evaluate LA function. To assess its potential value, the authors addressed whether LA ε and SR measured in normal subjects correlates with other Doppler echocardiographic parameters that evaluate LA function and left ventricular function.Methods: Sixty-four healthy subjects were studied. LA ε and SR were calculated with the reference point set at the P wave, which enabled the recognition of peak negative ε (εneg peak), peak positive ε (εpos peak), and the sum of those values, total LA ε (εtot), corresponding to LA contractile, conduit, and reservoir function, respectively. Similarly, peak negative SR (LA SRlate neg peak) during LA contraction, peak positive SR (LA SRpos peak) at the beginning of LV systole, and peak negative SR (LA SRearly neg peak) at the beginning of LV diastole were identified.Results: Global LA εpos peak, εneg peak, and εtot were 23.2 ± 6.7%, −14.6 ± 3.5%, and 37.9 ± 7.6%, respectively. Global LA SRpos peak, SRearly neg peak , and SRlate neg peak were 2.0 ± 0.6 s−1, −2.0 ± 0.6 s−1, and −2.3 ± 0.5 s−1, respectively. The above-described variables derived from analysis of global LA ε and LA SR correlated significantly with Doppler echocardiographic indexes that evaluated the same phase of the cardiac cycle or the same component of the LA function, including indexes derived from mitral inflow, pulmonary vein velocities, tissue Doppler, and LA volumes. Global LA εpos peak, LA εtot, and LA SRearly neg peak also correlated significantly with age or body mass index. Global LA SRlate neg peak also correlated significantly with age.Conclusions: LA ε analysis is a new tool that can be used to evaluate LA function. Further studies are warranted to determine the utility of LA ε in disease states.Left Atrial Strain Measured by Two-Dimensional Speckle Tracking Represents a New Tool to Evaluate Left Atrial FunctionRoberto M. Saraiva, Sayit Demirkol, Adisai Buakhamsri, Neil Greenberg, Zoran B. Popović, James D. Thomas, Allan L. Klein10.1016/j.echo.2009.11.003Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Clinical Investigations172180http://www.onlinejase.com/article/PIIS0894731709010992/abstract?rss=yesBackground: The aim of this study was to test the impact of posterolateral myocardial systolic function on response to cardiac resynchronization therapy (CRT).Methods: Forty patients were studied before and 4 ± 2 months after CRT. Dyssynchrony was defined as anteroseptal wall–to–posterior wall delay (≥130 ms) caused by speckle-tracking radial strain. The average longitudinal strain in 4 posterior and lateral segments (ε-pl) in which the left ventricular pacing lead was positioned was calculated by automated functional imaging. Response to CRT was defined as a ≥15% decrease in end-systolic volume.Results: The negative value of ε-pl in responders was significantly higher than that in nonresponders at baseline (−7.8 ± 6.9% vs −2.1 ± 4.9%, P < .01). Combining dyssynchrony with ε-pl < −7.8% was more effective for predicting response to CRT than dyssynchrony parameters alone (92% vs 75%).Conclusion: The addition of posterolateral myocardial systolic function to the measurement of dyssynchrony appears to be of value for predicting response to CRT.Myocardial Contractile Function in the Region of the Left Ventricular Pacing Lead Predicts the Response to Cardiac Resynchronization Therapy Assessed by Two-Dimensional Speckle Tracking EchocardiographyKazuko Norisada, Hiroya Kawai, Hidekazu Tanaka, Kazuhiro Tatsumi, Tetsuari Onishi, Koji Fukuzawa, Akihiro Yoshida, Ken-ichi Hirata10.1016/j.echo.2009.11.017Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Left Ventricular Dyssynchrony181189http://www.onlinejase.com/article/PIIS0894731709012115/abstract?rss=yesOver the past decade, cardiac resynchronization therapy (CRT) has changed the treatment of patients with end-stage heart failure. Currently, on the basis of the guidelines of the American Heart Association, American College of Cardiology, and Heart Rhythm Society, CRT is considered a class I indication in patients with drug-refractory heart failure (New York Heart Association functional class III or ambulatory class IV) with left ventricular (LV) ejection fraction ≤ 35%, broad QRS complex (≥120 ms), and sinus rhythm. However, when patients are selected according to the aforementioned criteria, approximately 30% do not have beneficial responses on the basis of clinical outcomes or echocardiographic indicators of reverse remodeling, indicating that currently used guidelines are not perfect at identifying patients with heart failure most likely to benefit from CRT. This is a major issue because CRT is a costly procedure and may potentially expose patients to periprocedural or device-related complications; therefore, it should be reserved for patients with heart failure for whom positive responses can be anticipated, to optimize the allocation of organizational and financial resources and also to avoid unjustified risk exposure. Hence, a question arises: can cardiac imaging techniques, specifically echocardiography, be applied to better identify CRT responders among the cohort of candidates for biventricular pacemaker implantation on the basis of conventional electrocardiographic and clinical criteria?Speckle Tracking Echocardiography for Cardiac Resynchronization Therapy: Has the Right Ultrasound Technique Finally Been Found?Donato Mele10.1016/j.echo.2009.12.025Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Editorial Comment190194http://www.onlinejase.com/article/PIIS0894731709009985/abstract?rss=yesObjective: The study objective was to compare the left ventricular (LV) dyssynchrony and torsional behavior between right ventricular apical (RVA) and right ventricular septal (RVS) pacing.Methods: Forty-six patients with symptomatic sick sinus syndrome and preserved LV function were assigned to 2 groups: RVA (n = 23) and RVS (n = 23). Echocardiographic study including two-dimensional speckle tracking imaging was performed in the AAI and DDD modes.Results: Mean QRS width during DDD mode was significantly longer with RVA pacing than with RVS pacing. Dyssynchrony, torsion, and untwisting rate during DDD mode were significantly worse with RVA than with RVS pacing. In patients with RVA pacing, there was an increase in longitudinal dyssynchrony from AAI to DDD mode that significantly correlated with the deterioration of untwisting rate.Conclusion: In bradyarrhythmic patients with preserved LV function, RVS pacing resulted in a reduced LV dyssynchrony and better torsional behavior than RVA pacing.Right Ventricular Pacing from the Septum Avoids the Acute Exacerbation in Left Ventricular Dyssynchrony and Torsional Behavior Seen with Pacing from the ApexKatsuji Inoue, Hideki Okayama, Kazuhisa Nishimura, Akiyoshi Ogimoto, Tomoaki Ohtsuka, Makoto Saito, Go Hiasa, Toyofumi Yoshii, Takumi Sumimoto, Junichi Funada, Jitsuo Higaki10.1016/j.echo.2009.10.015Journal of the American Society of Echocardiography 23, 2 (2010)2009-12-04Journal of the American Society of Echocardiography2009-12-04232S0894-7317(10)X0002-5Clinical Investigations195200http://www.onlinejase.com/article/PIIS0894731709010426/abstract?rss=yesBackground: Using speckle-tracking imaging (STI), the aims of this study were to assess dyssynchrony and quantify the myocardial energy wasted by contractility in delayed segments by determining the longitudinal strain delay index (LSDi) in patients with heart failure with preserved ejection fraction (HFpEF).Method: Thirty-eight patients with HFpEF and 33 matched controls were recruited. All subjects underwent clinical examinations, 12-lead electrocardiography, pulmonary function tests, echocardiography, and metabolic exercise tests. LSDi was determined, the magnitude of which is a measure of the amount of wasted energy. Global and segmental systolic and diastolic dyssynchrony was assessed by STI.Results: LSDi was significantly higher in patients with HFpEF than controls (−14.36 ± 8.24% vs −10.73 ± 5.62%, P < .05). Patients with HFpEF exhibited left ventricular (LV) systolic and diastolic dyssynchrony, with the LV anterior wall displaying the most delayed motion.Conclusion: Patients with HFpEF exhibited increased myocardial contractile inefficiency. They also exhibited LV systolic and diastolic dyssynchrony, with the LV anterior wall displaying the most delayed motion.Myocardial Contractile Inefficiency and Dyssynchrony in Heart Failure With Preserved Ejection Fraction and Narrow QRS ComplexThanh T. Phan, Khalid Abozguia, Ganesh Nallur Shivu, Ibrar Ahmed, Kiran Patel, Francisco Leyva, Michael Frenneaux10.1016/j.echo.2009.11.004Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Clinical Investigations201206http://www.onlinejase.com/article/PIIS0894731709011067/abstract?rss=yesBackground: Abnormal cardiac stress imaging findings are not always associated with angiographically significant coronary artery disease. The outcomes of patients with such false-positive findings have not been extensively examined. The aim of this retrospective study was to describe the characteristics and outcomes of patients with abnormal stress echocardiographic findings who had false-positive results compared with those who had true-positive results.Methods: Of 1,477 consecutive patients (mean age, 66 ± 12 years; 61% men) with abnormal stress echocardiographic findings who underwent coronary arteriography within 30 days, death from any cause was ascertained.Results: At coronary arteriography, 997 patients (67.5%) had true-positive results, defined by the presence of angiographically significant coronary artery disease (≥50% stenoses), and 480 (32.5%) had false-positive results, defined by <50% stenoses or normal coronary arteries. Of the subgroup of patients with markedly abnormal stress echocardiographic findings (n = 605), 28% had <50% stenoses or normal coronary arteries. During an average follow-up period of 2.4 ± 1.0 years, there were 140 deaths. The adjusted likelihood of subsequent death for patients with <50% stenoses compared to patients with ≥50% stenoses after abnormal stress echocardiography was 1.05 (95% confidence interval, 0.86-1.31; P = .62).Conclusions: A sizable proportion of patients with abnormal stress echocardiographic results who are referred for coronary angiography have false-positive findings. The outcomes of patients with false-positive results were similar to those of patients with true-positive results. This finding suggests that patients with false-positive results on stress echocardiography should still receive intensive risk factor management and careful clinical follow-up.Characteristics and Outcomes of Patients With Abnormal Stress Echocardiograms and Angiographically Mild Coronary Artery Disease (<50% Stenoses) or Normal Coronary ArteriesAaron M. From, Garvan Kane, Charles Bruce, Patricia A. Pellikka, Christopher Scott, Robert B. McCully10.1016/j.echo.2009.11.023Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Coronary Artery Disease207214http://www.onlinejase.com/article/PIIS0894731709012048/abstract?rss=yesIt has been more than 25 years since the first reports of the use of echocardiographic imaging in conjunction with stress testing for the diagnosis of coronary artery disease. Since that time, both radionuclide and echocardiographic stress testing have become a routine part of the evaluation of patients with known or suspected coronary artery disease. Previous studies have indicated sensitivity and specificity of stress echocardiography in the range of 70% to 90%, compared with coronary angiography as a gold standard, for detecting hemodynamically significant obstructions. These differences have been explained by a variety of factors, including the extent of disease, reader experience, heart rate obtained during stress, concurrent medications, and other factors. Patients with abnormal results on stress exams (based on the development of new wall motion abnormalities), but with subsequent findings on coronary angiography indicating no significant coronary stenosis, are said to have had “false-positive” results. Echocardiography has been reported to have higher specificity and fewer “false-positive” results than other imaging modalities. Traditionally, these patients with “false-positive” examinations have been treated as if they had no significant coronary artery disease risk and are often dismissed from the care of cardiovascular specialists.The “Myth” of the False Positive Stress EchoArthur J. Labovitz10.1016/j.echo.2009.12.018Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Editorial Comment215216http://www.onlinejase.com/article/PIIS0894731710000027/abstract?rss=yes While it will be February 2010 by the time that you read this Editor's Page, I am writing it as 2009 winds down. It seems fitting to me, as I finish my second year as Editor-in-Chief of the Journal of the American Society of Echocardiography (JASE), to reflect back on what we have accomplished in the past year, and also to look forward in anticipation of implementing a few new “improvements” in JASE in the New Year.JASE 2010— A Progress ReportAlan S. Pearlman10.1016/j.echo.2010.01.001Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Editor's Page217218http://www.onlinejase.com/article/PIIS0894731709011808/abstract?rss=yesCME Test for Patent Foramen Ovale: Echocardiographic Detection and Clinical Relevance in Stoke10.1016/j.echo.2009.12.012Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Continuing Medical Education219220http://www.onlinejase.com/article/PIIS0894731709007627/abstract?rss=yesThe authors report two cases of unexplained active inflammatory endocarditis with totally different clinical presentations. The patients had undergone previous mitral repair surgery and were referred for multiple soft mobile masses on the mitral ring without clinical or laboratory signs of endocarditis. Serologic screening and blood culture results were negative, including those for specific fastidious bacteria, as well as immunologic tests to rule out “nonbacterial thrombotic endocarditis.” Before new surgery, both patients were treated with long-term antibiotic and anticoagulant therapy, with no significant changes in clinical setting and echocardiographic patterns. In neither case was it possible to characterize a specific microorganism: the intraoperative findings were highly evocative of active endocarditis with a macroscopic infiltration of the mitral ring, and culture results from surgical material and valvular tissue were negative.“Grey Zone” Patterns of Unexplained Endocarditis: Still a Challenge for Clinical Decision MakingAntonio Grimaldi, Maurizio Taramasso, Francesco Maisano, Giovanni La Canna, Maria Grazia Pala, Stefano Benussi, Giorgio Viganò, Ottavio Alfieri10.1016/j.echo.2009.08.010Journal of the American Society of Echocardiography 23, 2 (2010)2009-10-08Journal of the American Society of Echocardiography2009-10-08232S0894-7317(10)X0002-5Case Reports221.e1221.e4http://www.onlinejase.com/article/PIIS0894731709007640/abstract?rss=yesA right aortic arch with a left descending aorta and an aberrant left innominate artery is a rare but recognized vascular anomaly that can result in compression of the trachea and the esophagus. This vascular anomaly has been diagnosed using cardiac catheterization and angiography. Recently, computed tomography and magnetic resonance imaging have been used for noninvasive diagnosis. The aim of this report is to highlight the possibility of echocardiographic diagnosis.Aberrant Left Innominate Artery From the Left Descending Aorta in Right Aortic Arch: Echocardiographic DiagnosisSilvina Barcudi, Stephen P. Sanders, Roberto M. Di Donato, Andrea de Zorzi, Roberta Iacobelli, Antonio Amodeo, Maria G. Gagliardi, Francesco Borgia, Giacomo Pongiglione, Gabriele Rinelli10.1016/j.echo.2009.08.013Journal of the American Society of Echocardiography 23, 2 (2010)2009-10-08Journal of the American Society of Echocardiography2009-10-08232S0894-7317(10)X0002-5Case Reports221.e5221.e7http://www.onlinejase.com/article/PIIS0894731709007652/abstract?rss=yesA 22-month-old boy was referred to pediatric cardiology for evaluation of a heart murmur. He was asymptomatic except for occasional wheezing with activity. On evaluation, he was found to have both systolic and diastolic murmurs. Electrocardiography demonstrated possible left ventricular hypertrophy, with no evidence of ST-segment abnormalities. Echocardiography and cardiac catheterization showed an anomalous origin of the patient's right coronary artery from his left ventricle, just inferior to his aortic valve annulus.Anomalous Origin of the Right Coronary Artery From the Left VentricleHolly M. Ippisch, Thomas R. Kimball10.1016/j.echo.2009.08.012Journal of the American Society of Echocardiography 23, 2 (2010)2009-10-08Journal of the American Society of Echocardiography2009-10-08232S0894-7317(10)X0002-5Case Reports222.e1222.e2http://www.onlinejase.com/article/PIIS0894731710000039/abstract?rss=yesAn error occurred in Figure 4 (D), in “Diastolic dysfunction and its histopathological correlation in obstructive hypertrophic cardiomyopathy in children and adolescents” by Menon SC, Eidem BW, Dearani JA, Ommen SR, Ackerman MJ, Miller D.; published in issue 22(12): 1331 of Journal of the American Society of Echocardiography.Corrigendum10.1016/j.echo.2010.01.002Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Case Reports222222http://www.onlinejase.com/article/PIIS0894731710000076/abstract?rss=yesTable of Contents10.1016/S0894-7317(10)00007-6Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5FrontmatterA4A4http://www.onlinejase.com/article/PIIS0894731710000088/abstract?rss=yesEditorial Board10.1016/S0894-7317(10)00008-8Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5FrontmatterA12A12http://www.onlinejase.com/article/PIIS089473171000009X/abstract?rss=yesInformation for Authors10.1016/S0894-7317(10)00009-XJournal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5FrontmatterA27A29http://www.onlinejase.com/article/PIIS0894731710000106/abstract?rss=yesInformation for Readers10.1016/S0894-7317(10)00010-6Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5FrontmatterA31A32http://www.onlinejase.com/article/PIIS0894731709011791/abstract?rss=yes21st Annual Scientific Sessions: Come for the Education, Stay for the Vacation!10.1016/j.echo.2009.12.011Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5American Society of Echocardiography NewsA33A33http://www.onlinejase.com/article/PIIS0894731709011559/abstract?rss=yesThe American Society of Echocardiography recognizes courses as supplements to formal training in an established echocardiographic laboratory. For more information about a course, please call the number listed. To list a course in the Continuing Education and Meeting Calendar, send the date(s), title, location, sponsor, course director(s), and contact information to ASE, Attn: Cheryl Williams, 2100 Gateway Centre Boulevard, Suite 310, Morrisville, NC 27560; Tel: 919-861-5574 x7160; E-mail: cwilliams@asecho.org.Continuing Education and Meeting Calendar10.1016/j.echo.2009.12.006Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5American Society of Echocardiography NewsA34A34http://www.onlinejase.com/article/PIIS0894731709011560/abstract?rss=yesPatient safety is such an important topic that when I received an e-mail from James Teixeira, a sonographer from Tennessee, asking to submit an editorial on the topic; I honestly wished I had thought of it myself. The truth is, many laboratories are working extensively to incorporate a culture that embraces the patients safety above all else. Please enjoy the following editorial by James Teixeira, BA, RDCS, (AE, PE), RCS.–Marti L. McCollough, BS, MBA, RDCS, FASELest we forget the patients!10.1016/j.echo.2009.12.007Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Sonographers' CommunicationA35A35http://www.onlinejase.com/article/PIIS0894731709011584/abstract?rss=yes As major debates continue regarding local and national health care legislation, including the Affordable Health Care for America Act, several issues affecting vascular imaging have arisen. As a medical community, we continue to “tighten our belts” as a result of the declining reimbursement from the Center for Medicare and Medicaid Services (CMS) for medical imaging— a consequence of the Balanced Budget Act of 1997. Vascular imagining has been particularly affected by dramatic reductions in reimbursement. In the face of these declining reimbursements, there continues to be more stringent requirements for payment for services provided. One such requirement is the need for laboratory accreditation (or technologist certification) for reimbursement in more than 30 states. The potential benefits of these requirements on the quality of care are readily acknowledged (and I support them, as a member of the board of directors for the Intersocietal Commission for the Accreditation for Vascular Laboratories). However, the primary motivating force for such requirements may be far less altruistic.Governmental Regulation and Impact on Reimbursement for Vascular Imaging: A Need for Active Participation10.1016/j.echo.2009.12.009Journal of the American Society of Echocardiography 23, 2 (2010)2010-02-01Journal of the American Society of Echocardiography2010-02-01232S0894-7317(10)X0002-5Vascular Ultrasound Council CommunicationA36A36