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 Echocardiography0894-7317238August 2010 © 2010 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.onlinejase.com/article/PIIS0894731710004578/abstract?rss=yesLeft ventricular hypertrophy is a nonspecific physiologic or maladaptive cardiac response to a large array of stimuli mediated by exercise and numerous cardiac and systemic diseases. Hypertrophy, however, is not uniform. Rather, depending on the underlying pathologic mechanism, it may display unique morphologic and functional characteristics. The precise characterization and quantification of left ventricular hypertrophy may therefore allow a more timely diagnosis of the underlying condition. The clinical reference standard to assess left ventricular hypertrophy is echocardiography, but a comprehensive description of how to approach this frequent finding in clinical practice is lacking. The current review systematically describes the typical echocardiographic patterns of important types of cardiac hypertrophy using both established and advanced imaging modalities, thus guiding clinicians' path to early diagnosis.The Different Faces of Echocardiographic Left Ventricular Hypertrophy: Clues to the EtiologyFrank Weidemann, Markus Niemann, Georg Ertl, Stefan Störk10.1016/j.echo.2010.05.020Journal of the American Society of Echocardiography 23, 8 (2010)2010-06-30Journal of the American Society of Echocardiography2010-06-30238S0894-7317(10)X0008-6Review Article793801http://www.onlinejase.com/article/PIIS0894731710004736/abstract?rss=yesBackground: Worldwide, cardiovascular (CV) disease remains the most common cause of morbidity and mortality. Although effective in predicting CV risk in select populations, the Framingham risk score (FRS) fails to identify many young individuals who experience premature CV events. Accordingly, the aim of this study was to determine the prevalence of high-risk carotid intima-media thickness (CIMT) or plaque, a marker of atherosclerosis and predictor of CV events, in young asymptomatic individuals with low and intermediate FRS (<2% annualized event rate) using the carotid ultrasound protocol recommended by the American Society of Echocardiography and the Society of Vascular Medicine.Methods: Individuals aged ≤ 65 years not taking statins and without diabetes mellitus or histories of coronary artery disease underwent CIMT and plaque examination for primary prevention. Clinical variables including lipid values, family history of premature coronary artery disease, and FRS and subsequent pharmacotherapy recommendations were retrospectively collected for statistical analysis.Results: Of 441 subjects (mean age, 49.7 ± 7.9 years), 184 (42%; 95% confidence interval, 37.3%-46.5%) had high-risk carotid ultrasound findings (CIMT ≥ 75th percentile adjusted for age, gender, and race or presence of plaque). Of those with the lowest FRS of ≤5% (n = 336) (mean age, 48.0 ± 7.6 years; mean FRS, 2.5 ± 1.5%), 127 (38%; 95% confidence interval, 32.6%-43.0%) had high-risk carotid ultrasound findings. For individuals with FRS ≤ 5% and high-risk carotid ultrasound findings (n = 127; mean age, 47.3 ± 8.1 years; mean FRS, 2.5 ± 1.5%), lipid-lowering therapy was recommended by their treating physicians in 77 (61%).Conclusions: Thirty-eight percent of asymptomatic young to middle-aged individuals with FRS ≤ 5% have abnormal carotid ultrasound findings associated with increased risk for CV events. Pharmacologic therapy for CV prevention was recommended in the majority of these individuals. The lack of radiation exposure, relatively low cost, and ability to detect early-stage atherosclerosis suggest that carotid ultrasound for CIMT and plaque detection should continue to be explored as a primary tool for CV risk stratification in young to middle-aged adults with low FRS.Carotid Ultrasound Identifies High Risk Subclinical Atherosclerosis in Adults with Low Framingham Risk ScoresMackram F. Eleid, Steven J. Lester, Troy L. Wiedenbeck, Sharad D. Patel, Christopher P. Appleton, Matthew R. Nelson, Julie Humphries, R. Todd Hurst10.1016/j.echo.2010.06.003Journal of the American Society of Echocardiography 23, 8 (2010)2010-06-30Journal of the American Society of Echocardiography2010-06-30238S0894-7317(10)X0008-6Cardiovascular Risk Assessment by Cardiovascular Ultrasound802808http://www.onlinejase.com/article/PIIS0894731710003676/abstract?rss=yesBackground: The cardiovascular (CV) risk assigned by the Framingham risk score (FRS) misses many subjects destined for CV events. Coronary artery calcification (CAC) as measured by computed tomography and carotid intima-media thickness (CIMT) and plaque assessment using B-mode ultrasound can identify subclinical atherosclerosis. The comparative relation of CAC and CIMT and carotid plaque after integration into the FRS is not established. The aim of this study was to develop a CV screening approach incorporating FRS, CAC, and CIMT.Methods: The prevalence of subclinical atherosclerosis, defined as CAC score > 0, CIMT ≥ 75th percentile, or plaque ≥ 1.5 mm, was determined in the groups with low, intermediate, and high FRS among 136 asymptomatic subjects. The CIMT and CAC values were used to determine “vascular age” and “coronary calcium” age, respectively, with established nomograms.Results: In the 103 low-risk (FRS < 10%) subjects, 41%, 50%, 59%, and 66% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. In the 33 subjects with intermediate (n = 14) or high (n = 19) FRS, 70%, 81%, 87%, and 87% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. Fifty-two percent of subjects with coronary calcium scores of zero had carotid plaque. Adjusted for FRS, body mass index was an independent predictor of abnormal CIMT in the low-FRS group, but not of abnormal CAC. Mean vascular CIMT age was significantly higher than coronary calcium age (61.6 ± 11.4 vs 58.3 ± 11.1 years, P = .001), and both were significantly higher than chronologic age (56.9 ± 10.1 years) (P < .0001 and P  5% in more cases than CAC (42% vs 17%).Conclusion: In asymptomatic patients without CV disease, CIMT and plaque assessment are more likely to revise FRS than CAC. Body mass index predicts increased CIMT in low-FRS subjects. These findings may have broad implications for screening in low-FRS subjects.High Prevalence of Ultrasound Detected Carotid Atherosclerosis in Subjects with Low Framingham Risk Score: Potential Implications for Screening for Subclinical AtherosclerosisTasneem Z. Naqvi, Fernando Mendoza, Farhad Rafii, Heidi Gransar, Maria Guerra, Norman Lepor, Daniel S. Berman, Prediman K. Shah10.1016/j.echo.2010.05.005Journal of the American Society of Echocardiography 23, 8 (2010)2010-05-31Journal of the American Society of Echocardiography2010-05-31238S0894-7317(10)X0008-6Cardiovascular Risk Assessment by Cardiovascular Ultrasound809815http://www.onlinejase.com/article/PIIS0894731710004608/abstract?rss=yesBackground: Echocardiographic measures of left ventricular (LV) mass and relative wall thickness and left atrial (LA) size predict future cardiovascular morbidity and mortality. The aim of this study was to compare young adults with low cardiovascular risk (body mass index, 18.5–24.9 kg/m2; blood pressure < 120/80 mmHg; no tobacco use, no diabetes, and physical fitness) with those without these characteristics with regard to LV mass and relative wall thickness and LA size, to determine the protective effect of a healthy lifestyle on the development of these characteristics.Methods: Cross-sectional assessment of 4059 black and white men and women aged 23 to 35 years in the Coronary Artery Risk Development in Young Adults (CARDIA) study at the year 5-examination, when risk factors were measured, and echocardiography to assess LV mass and relative wall thickness were performed. Physical fitness was measured at baseline using a symptom-limited maximal treadmill test. All other covariates were measured concurrently with echocardiography.Results: Gender, body mass index, and systolic blood pressure were associated with LV mass and relative wall thickness and LA size in multivariate models. Additional correlates of LV mass/height2.7 ratio were tobacco use, resting heart rate (inverse), self-reported physical activity, gender (male higher), and age. Age was associated with LV relative wall thickness but not other measures of LV size. Additional correlates of LA diameter/height ratio were tobacco use, resting heart rate (inverse), serum glucose, and self-reported physical activity. Seven hundred ninety of 4059 subjects (19%) were classified as having low risk; black race was less likely in the low-risk group. Those with low risk had lower LV mass/height2.7 ratios (32.0 vs 34.6 g/m2.7, P < .0001), better LV relative wall thickness (0.33 vs 0.35, P < .0001), and lower LA diameter/height ratios (2.02 vs 2.08 cm/m, P < .01).Conclusions: A low cardiovascular risk profile in young adulthood is associated with more favorable LV mass, LV relative wall thickness, and LA size. This may be one mechanism of lifestyle protection against cardiovascular morbidity and mortality.Low Cardiovascular Risk Is Associated with Favorable Left Ventricular Mass, Left Ventricular Relative Wall Thickness, and Left Atrial Size: The CARDIA StudySamuel S. Gidding, Mercedes R. Carnethon, Stephen Daniels, Kiang Liu, David R. Jacobs, Steve Sidney, Julius Gardin10.1016/j.echo.2010.05.023Journal of the American Society of Echocardiography 23, 8 (2010)2010-07-02Journal of the American Society of Echocardiography2010-07-02238S0894-7317(10)X0008-6Cardiovascular Risk Assessment by Cardiovascular Ultrasound816822http://www.onlinejase.com/article/PIIS0894731710004219/abstract?rss=yesBackground: The aim of this study was to evaluate the timing and magnitude of global and regional right ventricular (RV) function by means of speckle tracking–derived strain in normal subjects and patients with RV dysfunction.Methods: Peak longitudinal systolic strain (PLSS) and time to PLSS in 6 RV segments (the basal, mid, and apical segments of the RV free wall and septum) were obtained in 100 healthy volunteers and 76 patients with RV dysfunction by tracking speckles inside the myocardium using grayscale images. Global PLSS and time to PLSS were based on the average of the 6 regional values.Results: There was a significant and close correlation between RV contractility as measured by PLSS and tricuspid annular plane systolic excursion (r = −0.83, P < .001). In normal subjects, PLSS was significantly greater in the free wall than in the septum (−28.7 ± 4.1% vs −19.8 ± 3.4%, P < .001), whereas time to PLSS was similar in the different regions of the right ventricle. In patients with RV dysfunction, global and regional PLSS was significantly less than in normal subjects (−13.7 ± 3.6% vs −24.2 ± 2.9%, P < .001), and a global PLSS cutoff value of −19% was helpful in distinguishing the two groups. Furthermore, time to PLSS in all of the RV septal segments and dispersion in RV contraction timing were significantly longer. Global PLSS in the patients with RV dysfunction was also significantly less in the presence of moderate to severe pulmonary hypertension (−12.7 ± 3.6% vs −14.4 ± 3.4%, P = .038).Conclusions: Speckle tracking not only makes it possible to quantify global RV function but also illustrates the physiology of RV contraction and the pattern of activation at regional level. Speckle tracking–derived strain could become an important new means of assessing and following up patients with impaired RV function and increased pulmonary pressure.Timing and Magnitude of Regional Right Ventricular Function: A Speckle Tracking-Derived Strain Study of Normal Subjects and Patients with Right Ventricular DysfunctionAlessandra Meris, Francesco Faletra, Cristina Conca, Catherine Klersy, François Regoli, Julia Klimusina, Maria Penco, Elena Pasotti, Giovanni B. Pedrazzini, Tiziano Moccetti, Angelo Auricchio10.1016/j.echo.2010.05.009Journal of the American Society of Echocardiography 23, 8 (2010)2010-06-21Journal of the American Society of Echocardiography2010-06-21238S0894-7317(10)X0008-6Right Ventricular Function823831http://www.onlinejase.com/article/PIIS0894731710003664/abstract?rss=yesBackground: Stress echocardiography is an established technique for diagnosis, risk stratification, and prognosis in patients with known or suspected coronary artery disease. The ability of stress echocardiography to predict clinical outcomes, such as coronary angiography and revascularization, has not been reported previously. The purpose of this study was to evaluate the clinical outcomes of coronary angiography, revascularization, and cardiac events in patients undergoing stress echocardiography.Methods: A total of 3121 patients (mean age, 60 ± 13 years; 48% men) undergoing stress echocardiography (41% treadmill, 59% dobutamine) were assessed. Follow-up (mean, 2.8 ± 1.1 years) for subsequent coronary angiography, revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]), and confirmed hard events (nonfatal myocardial infarction or cardiac death) was obtained.Results: Stress echocardiographic results were normal (peak wall motion score index [pWMSI], 1.0) in 66% and abnormal (pWMSI > 1.0) in 34% of patients. The pWMSI effectively risk-stratified patients into low-risk (pWMSI, 1.0; 0.8% per year), intermediate-risk (pWMSI, 1.1-1.7; 2.6% per year), and high-risk (pWMSI >1.7; 5.5% per year) groups for future cardiac events (P < .0001). Early coronary angiography (30 days following stress echocardiography) was performed in only 35 patients (1.7%) with normal stress echocardiographic results and 267 patients (25.5%) with abnormal stress echocardiographic results (P < .0001). Late coronary revascularization (2 years following stress echocardiography) occurred in 80 patients (PCI, 2.8%; CABG, 1.1%) with pWMSI values of 1.0, 123 patients (PCI, 13.5%; CABG, 7.3%) with pWMSI values of 1.1 to 1.7, and 102 patients (PCI, 12.7%; CABG, 9.6%) with pWMSI values > 1.7. Multivariate logistic regression analysis identified pWMSI as a predictor of coronary angiography (relative risk, 2.04; 95% confidence interval, 1.67-2.5), revascularization (relative risk, 1.91; 95% confidence interval, 1.68-2.17), and cardiac events (relative risk, 2.45; 95% confidence interval, 2.09-2.88) (all P values < .0001). Patients with markedly abnormal stress echocardiographic results (pWMSI > 1.7) had a significantly higher cardiac event rate in those who did not undergo coronary revascularization (9.6% per year vs 2.9% per year, P < .05).Conclusions: Stress echocardiography is an effective gatekeeper for coronary angiography and revascularization. Stress echocardiographic results influence clinical decision making in higher risk patients with significantly increased referral to coronary angiography and revascularization. Patients with markedly abnormal stress echocardiographic results (pWMSI > 1.7) were most likely to benefit from coronary revascularization.Prognostic Implications of Stress Echocardiography and Impact on Patient Outcomes: An Effective Gatekeeper for Coronary Angiography and RevascularizationSiu-Sun Yao, Sripal Bangalore, Farooq A. Chaudhry10.1016/j.echo.2010.05.004Journal of the American Society of Echocardiography 23, 8 (2010)2010-05-31Journal of the American Society of Echocardiography2010-05-31238S0894-7317(10)X0008-6Coronary Heart Disease832839http://www.onlinejase.com/article/PIIS0894731710004761/abstract?rss=yesBackground: Single photon-emission computed tomography (SPECT) is widely used for the assessment of hibernating myocardium (HM). The aim of this study was to test the hypothesis that myocardial contrast echocardiography (MCE), because of its better spatial and temporal resolution, would be superior to SPECT for the detection of HM.Methods: Thirty-nine consecutive patients with symptomatic ischemic cardiomyopathy underwent rest and vasodilator SPECT and MCE. Of these, 23 survived to undergo assessment 3 months after revascularization for the recovery of left ventricular (LV) function (spontaneous recovery or dobutamine induced), which is the definition of HM.Results: Of the 214 dysfunctional segments, 156 segments demonstrated HM in the 23 patients, of whom 16 showed significant improvement in LV function. Logistic regression analysis showed that both qualitative and quantitative MCE were independent predictors for the detection of HM (P < .0001 vs P = .06 for qualitative MCE vs qualitative SPECT, respectively, and P < .01 vs P = .25 for all quantitative myocardial contrast echocardiographic parameters vs quantitative SPECT, respectively). Using clinical and LV functional data, SPECT, and MCE for predicting the recovery of LV function, MCE was the only independent predictor (P = .03).Conclusion: MCE was superior to SPECT for the assessment of HM in ischemic cardiomyopathy.Myocardial Contrast Echocardiography Versus Single Photon Emission Computed Tomography for Assessment of Hibernating Myocardium in Ischemic Cardiomyopathy: Preliminary Qualitative and Quantitative ResultsRajesh K. Chelliah, Michael Hickman, Christopher Kinsey, Leah Burden, Roxy Senior10.1016/j.echo.2010.06.004Journal of the American Society of Echocardiography 23, 8 (2010)2010-07-02Journal of the American Society of Echocardiography2010-07-02238S0894-7317(10)X0008-6Coronary Heart Disease840847http://www.onlinejase.com/article/PIIS0894731710004190/abstract?rss=yesBackground: Mutations in the X-linked gene encoding dystrophin cause skeletal and cardiac muscle diseases in men. Female “carriers” also can develop overt disease. The purpose of this study was to ascertain the prevalence of cardiac contractile abnormalities in dystrophinopathy carriers.Methods: Twenty-four dystrophinopathy heterozygotes and 24 normal women each underwent standard exercise stress echocardiography.Results: Heterozygotes demonstrated mildly lower left ventricular ejection fractions (LVEFs) at rest compared with controls (0.56 ± 0.10 vs 0.62 ± 0.07, P = .02). After exercise, the mean LVEF fell to 0.53 ± 0.14 in heterozygotes but rose to 0.73 ± 0.07 in controls (P < .001). Twenty-one of 24 dystrophinopathy heterozygotes demonstrated ≥1 of the following: abnormal resting LVEF, abnormal LVEF response to exercise, or exercise-induced wall motion abnormality.Conclusions: Women heterozygous for dystrophinopathy demonstrate significant left ventricular systolic dysfunction, which is unmasked by exercise. This finding has mechanistic implications for both inherited and acquired cardiac disease states.Exercise-Induced Left Ventricular Systolic Dysfunction in Women Heterozygous for DystrophinopathyRobert M. Weiss, Richard E. Kerber, Jane K. Jones, Carrie M. Stephan, Christina J. Trout, Paul D. Lindower, Kimberly S. Staffey, Kevin P. Campbell, Katherine D. Mathews10.1016/j.echo.2010.05.007Journal of the American Society of Echocardiography 23, 8 (2010)2010-06-21Journal of the American Society of Echocardiography2010-06-21238S0894-7317(10)X0008-6Cardiomyopathy848853http://www.onlinejase.com/article/PIIS0894731710005456/abstract?rss=yesDuchenne muscular dystrophy (DMD) is an X-linked recessive myopathy that occurs in 1 in 3500 live-born male infants. DMD results from a mutation in chromosome Xp21.1, leading to a deficiency in the cytoskeletal protein dystrophin. Dystrophin is critical for sarcolemmal membrane stability, and its absence results in membrane disruption, altered intracellular calcium metabolism, and eventual myocyte necrosis and fibrosis. Clinically, this results in a myopathy, most notably of skeletal and cardiac muscle.Identifying Abnormalities of Left Ventricular Systolic Function in Asymptomatic “Carriers” of Dystrophin Mutations: Getting Better…but Not There YetBenjamin W. Eidem10.1016/j.echo.2010.06.025Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6Editorial Comment854856http://www.onlinejase.com/article/PIIS0894731710003615/abstract?rss=yesBackground: Doppler echocardiography of mitral inflow or aortic outflow or both has been validated and advocated to guide biventricular (Biv) pacemaker optimization. A comprehensive and tailored Doppler echocardiographic evaluation may be required in patients with heart failure to assist with Biv pacemaker optimization. The third heart sound (S3), an acoustic cardiographic parameter, has been demonstrated to be a highly specific finding for hemodynamic evaluation in patients with heart failure. The aims of this study were to evaluate the use of comprehensive Doppler echocardiography as a guide during Biv pacemaker optimization in patients after cardiac resynchronization therapy and to evaluate the feasibility of S3 intensity to be a cost-efficient parameter for Biv pacemaker optimization compared with Doppler echocardiography.Methods: Comprehensive Doppler echocardiographic evaluations were performed during Biv pacemaker optimization in 44 patients referred for pacemaker optimization (mean age, 71 ± 12 years; mean left ventricular ejection fraction, 34 ± 11%). Blinded assessment of S3 intensity was performed simultaneously using acoustic cardiography. The correlation and improvement in cardiac hemodynamics were analyzed between the methods.Results: Echocardiographically guided optimization resulted in significant improvements in the left ventricular outflow velocity-time integral (15.92 ± 4.77 to 18.51 ± 5.19 cm, P < .001), ejection time (278 ± 40 to 293 ± 40 ms, P < .001), myocardial performance index (0.57 ± 0.19 to 0.44 ± 0.14, P < .002), and peak pulmonary artery systolic pressure (42 ± 13 to 36 ± 11 mm Hg, P < .04) and decreased S3 intensity from 4.81 ± 1.84 at baseline to 3.96 ± 1.22 after optimization (P < .02) for the overall study group and from 6.63 ± 1.37 to 4.85 ± 1.13 (P  5.0. The correlation between echocardiographic and acoustic cardiographic S3 intensity for optimal atrioventricular delay was 0.86 (P < .001) and for optimal interventricular delay was 0.64 (P < .001). Optimal atrioventricular delay was identical by echocardiographic and acoustic cardiographic S3 intensity in 56%, and optimal interventricular delay was identical in 75% of patients. Pacemakers were permanently programmed on the basis of echocardiographic evaluation. In 35 patients available for follow up, the mean New York Heart Association class reduced from 2.55 ± 0.81 to 1.77 ± 0.90 (P < .001) and the mean quality-of-life score as assessed by Minnesota Living With Heart Failure Questionnaire improved from 45 ± 28 to 32 ± 28 (P = .08) at 2.5 ± 2.1 months.Conclusion: Comprehensive echocardiographically guided Biv pacemaker optimization produces significant improvement in Doppler echocardiographic hemodynamics, a reduction in S3 intensity, and an improvement in functional class in patients after cardiac resynchronization therapy.Biventricular Pacemaker Optimization Guided by Comprehensive Echocardiography—Preliminary Observations Regarding the Effects on Systolic and Diastolic Ventricular Function and Third Heart SoundNima Taha, Jing Zhang, Rupesh Ranjan, Samuel Daneshvar, Edilzar Castillo, Elizabeth Guillen, Martha C. Montoya, Giovanna Velasquez, Tasneem Z. Naqvi10.1016/j.echo.2010.04.022Journal of the American Society of Echocardiography 23, 8 (2010)2010-05-31Journal of the American Society of Echocardiography2010-05-31238S0894-7317(10)X0008-6Cardiac Resynchronization Therapy857866http://www.onlinejase.com/article/PIIS0894731710005407/abstract?rss=yesDespite the established clinical and survival benefits of cardiac resynchronization therapy (CRT) in advanced heart failure, 20% to 30% of patients in randomized trials have been “nonresponders.” The definition of this term is still under debate; experts disagree as to whether clinical parameters (symptoms and exercise capacity) and/or echocardiographic parameters (ejection fraction, mitral regurgitation [MR], ventricular dimensions and volumes) adequately define a “CRT responder.” Further complicating the characterization of CRT response is the repeated lack of concordance between echocardiographic and clinical parameters after implantation.How Should Echocardiography Be Used in CRT Optimization?Ayesha Hasan10.1016/j.echo.2010.06.020Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6Editorial Comment867871http://www.onlinejase.com/article/PIIS0894731710004621/abstract?rss=yesBackground: Real-time three-dimensional (3D) echocardiography and unique software permit mitral annular (MA) tracking throughout systole to assess MA remodeling and function. Whether MA structure and function are altered differently depending on the etiology of mitral regurgitation (MR) is currently not known.Methods: We evaluated dynamic MA characteristics in patients with significant MR secondary to mitral valve prolapse and functional MR and compared them with normal controls. Novel 3D tracking software (based on 3D optical flow combined with block matching) was used to identify 16 circumferential equidistant MA points and to track changes in MA area and apical descent from end-diastole to end-systole. Twenty-eight patients with at least moderate MR and 15 normal controls underwent complete transthoracic two-dimensional and quantitative Doppler studies with 3D full-volume MA imaging from the apical 4-chamber view.Results: For each group studied, left ventricular size, systolic function, and dynamic MA characteristics were characterized. Patients with functional MR demonstrated end-diastolic MA area enlargement with reduced systolic area change and reduced apical descent (11.1 ± 2.7 cm2, 13 ± 5%, and 6 ± 2 mm, respectively) compared with normal controls (9 ± 2 cm2, 26 ± 8%, 11 ± 2 mm, respectively) (P < .05). In comparison, patients with prolapse MR demonstrated the largest end-diastolic MA areas with preserved annular area change and only mild reduction of apical descent (16.1 ± 3.5 cm2, 21 ± 6%, and 9 ± 3 mm; P < .05 for area change and apical descent compared with normal). This finding suggests that the pathophysiology of mitral leaflet prolapse may involve significant MA remodeling without deterioration of dynamic MA function.Conclusion: Patients with MR have significant MA enlargement, irrespective of MR etiology. In contrast to functional MR, patients with MR secondary to leaflet prolapse have the largest annular remodeling—almost 80% increase in area—and yet have preserved annular function and dynamicity. These findings may influence surgical repair technique.Dynamic Annular Geometry and Function in Patients with Mitral Regurgitation: Insight From Three-Dimensional Annular TrackingStephen H. Little, Sagit Ben Zekry, Gerald M. Lawrie, William A. Zoghbi10.1016/j.echo.2010.06.001Journal of the American Society of Echocardiography 23, 8 (2010)2010-07-02Journal of the American Society of Echocardiography2010-07-02238S0894-7317(10)X0008-6Valvular Disorders872879http://www.onlinejase.com/article/PIIS0894731710004566/abstract?rss=yesBackground: The grading of pulmonary regurgitation (PR) severity by two-dimensional (2D) and Doppler echocardiography is not standardized. Cardiovascular magnetic resonance imaging is the clinical gold standard for PR quantification. The purpose of this study was to determine the best 2D and Doppler echocardiographic predictors of severe PR.Methods: Thirty-six patients with tetralogy of Fallot or pulmonary valve stenosis with prior pulmonary valvuloplasty or transannular or subannular patch repair underwent 2D and Doppler echocardiography and cardiovascular magnetic resonance. Two-dimensional and Doppler echocardiographic measurements used to predict severe PR included diastolic flow reversal in the main or branch pulmonary arteries, PR jet width ≥ 50% of the pulmonary annulus, PR pressure half-time < 100 ms, and PR index < 0.77.Results: With the exception of PR index, all indices were significant independent predictors of severe PR. The best univariate predictor of severe PR was branch pulmonary artery diastolic flow reversal.Conclusion: Two-dimensional and Doppler echocardiography reliably identified severe PR in this cohort.Two-Dimensional and Doppler Echocardiography Reliably Predict Severe Pulmonary Regurgitation as Quantified by Cardiac Magnetic ResonancePierangelo Renella, Jamil Aboulhosn, Derek G. Lohan, Praveen Jonnala, J. Paul Finn, Gary M. Satou, Ryan J. Williams, John S. Child10.1016/j.echo.2010.05.019Journal of the American Society of Echocardiography 23, 8 (2010)2010-07-02Journal of the American Society of Echocardiography2010-07-02238S0894-7317(10)X0008-6Congenital Heart Disease880886http://www.onlinejase.com/article/PIIS0894731710004542/abstract?rss=yesWith the continued development of genetically engineered mouse models of cardiac disease, further advancement of noninvasive techniques for evaluating cardiac diastolic dysfunction in these models would be valuable. Therefore, we performed comprehensive transmitral and pulmonary venous Doppler echocardiographic studies to devise novel indices of diastolic function in a mouse model with cardiac hypertrophy, which were validated against invasively measured hemodynamic parameters. We examined 10 HopXTg transgenic mice with diastolic dysfunction and 10 age-matched controls sedated with 1% to 2% isoflurane (male, age 14–18 weeks). These studies revealed that the acceleration time of the transmitral Doppler E-wave was the best Doppler parameter for unmasking LV diastolic dysfunction in HopXTg mice. This is the first study to assess the utility of the acceleration time of the E-wave and pulmonary venous Doppler echocardiography as a primary diagnostic modality for assessing murine diastolic function.An Evaluation of Transmitral and Pulmonary Venous Doppler Indices for Assessing Murine Left Ventricular Diastolic FunctionLijun Yuan, Tao Wang, Fang Liu, Ethan D. Cohen, Vickas V. Patel10.1016/j.echo.2010.05.017Journal of the American Society of Echocardiography 23, 8 (2010)2010-06-30Journal of the American Society of Echocardiography2010-06-30238S0894-7317(10)X0008-6Pre-Clinical Investigations887897http://www.onlinejase.com/article/PIIS0894731710005572/abstract?rss=yes In this Editors' Page, I would like to share several experiences that I had quite recently, during the American Society of Echocardiography (ASE) Annual Scientific Sessions (held earlier this year in San Diego). These re-emphasized to me that in 2010, the field of echocardiography has perhaps never had more exciting opportunities, and more threatening challenges, than it does today.Echocardiography 2020: Opportunities and ChallengesAlan S. Pearlman10.1016/j.echo.2010.07.004Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6Editor's Page898900http://www.onlinejase.com/article/PIIS0894731710005560/abstract?rss=yesCME Test for The Different Faces of Echocardiographic Left Ventricular Hypertrophy: Clues to the Etiology10.1016/j.echo.2010.07.003Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6Continuing Medical Education901902http://www.onlinejase.com/article/PIIS0894731709011523/abstract?rss=yesA 19-year-old man was admitted for severe traumatic tricuspid regurgitation (TR) 4 months after a traffic accident. Transthoracic echocardiography revealed severe TR, with an abnormal chordal structure. Three-dimensional echocardiography showed widely lacerated right ventricular endocardium involving many subvalvular components. In this case of traumatic TR, three-dimensional echocardiography was useful not only for its diagnosis but also in providing important information for surgical decision making.Traumatic Tricuspid Regurgitation Caused by Myocardial Laceration: A Three-Dimensional Echocardiographic StudyChizuko Kamiya, Takahiro Ohara, Satoshi Nakatani, Yukiko Oe, Kazuo Niwaya, Akio Ogawa, Hideaki Kanzaki, Kazuhiko Hashimura, Masafumi Kitakaze10.1016/j.echo.2009.12.003Journal of the American Society of Echocardiography 23, 8 (2010)2010-02-11Journal of the American Society of Echocardiography2010-02-11238S0894-7317(10)X0008-6Case Reports903.e1903.e3http://www.onlinejase.com/article/PIIS0894731709011596/abstract?rss=yesThe role of echocardiography, including three-dimensional (3D) echocardiography, during interventional procedures in the cardiac catheterization laboratory is continuing to expand as interventional cardiologists perform more catheter-based interventions. Echocardiography often complements angiographic imaging of cardiac structures and sometimes provides additional information not available by angiography and fluoroscopy. The closure of perivalvular leaks using catheter-based techniques is one of the areas in which 3D echocardiography can be helpful. This case report describes the use of 3D real-time and color flow imaging during the closure of a mitral perivalvular leak. Three-dimensional echocardiography was used to assess the leak prior to intervention and the success of the intervention at the completion of the case.Percutaneous Closure of a Mitral Perivalvular Leak Using Three Dimensional Real Time and Color Flow ImagingKenneth D. Horton, Brian Whisenant, Steve Horton10.1016/j.echo.2009.12.010Journal of the American Society of Echocardiography 23, 8 (2010)2010-02-12Journal of the American Society of Echocardiography2010-02-12238S0894-7317(10)X0008-6Case Reports903.e5903.e7http://www.onlinejase.com/article/PIIS0894731709012012/abstract?rss=yesUntil the last decade, acquired pulmonary vein (PV) stenosis in the adult population was a rare finding, caused by neoplasm or inflammatory conditions such as sarcoidosis or fibrosing mediastinitis. With the increased use of catheter-based ablation for the treatment of atrial fibrillation, PV stenosis is increasingly recognized as a complication of this procedure. Additionally, PV stenosis has been described as a rare complication of cardiac surgery. This report describes two cases of PV stenosis, one acquired as a result of multiple left atrial ablation procedures and the other after surgical cannulation of the right upper PV.Acquired Pulmonary Vein Stenosis: One Problem, Two MechanismsAnna M. Booher, David S. Bach10.1016/j.echo.2009.12.015Journal of the American Society of Echocardiography 23, 8 (2010)2010-02-08Journal of the American Society of Echocardiography2010-02-08238S0894-7317(10)X0008-6Case Reports904.e1904.e3http://www.onlinejase.com/article/PIIS0894731710005614/abstract?rss=yesTable of Contents10.1016/S0894-7317(10)00561-4Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6FrontmatterA4A4http://www.onlinejase.com/article/PIIS0894731710005626/abstract?rss=yesEditorial Board10.1016/S0894-7317(10)00562-6Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6FrontmatterA10A10http://www.onlinejase.com/article/PIIS0894731710005638/abstract?rss=yesInformation for Authors10.1016/S0894-7317(10)00563-8Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6FrontmatterA13A15http://www.onlinejase.com/article/PIIS089473171000564X/abstract?rss=yesInformation for Readers10.1016/S0894-7317(10)00564-XJournal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6FrontmatterA19A20http://www.onlinejase.com/article/PIIS089473171000547X/abstract?rss=yes As you can see in the pictures on this and the following pages, for 231 attendees, a highlight of the 2010 Scientific Sessions was the ASE Foundation Awards Gala, a festive, sold-out celebration honoring the winners of the 2010 association awards. The event raised nearly $20,000 in support of a research grant for cardiovascular ultrasound. A silent auction brought excitement to the President's Reception in San Diego and added another $9,000 to the support of this Foundation research grant. ASE members and friends, including Drs. Rakowski, Picard, Oh, Kronzon, Kaul, Ryan, Lang, Geiser, Madrazo, Hitchcock, Mor-Avi, Rose, Kendrick, and Lai; Peg Knoll; and generous vendors donated textbooks, professional items, and artwork to the auction.The ASE Foundation—Looking for Your SupportSanjiv Kaul10.1016/j.echo.2010.06.027Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6American Society of Echocardiography NewsA25A26http://www.onlinejase.com/article/PIIS0894731710005468/abstract?rss=yesThe American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ASE 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.2010.06.026Journal of the American Society of Echocardiography 23, 8 (2010)2010-07-12Journal of the American Society of Echocardiography2010-07-12238S0894-7317(10)X0008-6American Society of Echocardiography NewsA26A27http://www.onlinejase.com/article/PIIS0894731710005523/abstract?rss=yes “The intent of the accreditation process is two-fold. It is designed to recognize laboratories that provide quality echocardiography services. It is also designed to be used as an educational tool to improve overall quality of the laboratory.”2010 ICAEL STANDARDS FOR ACCREDITATION (pg. 4)2010 Accreditation Update10.1016/j.echo.2010.06.032Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6Sonographers' CommunicationA28A28http://www.onlinejase.com/article/PIIS0894731710005390/abstract?rss=yes The ASE strives to be the primary resource for education, knowledge exchange, and professional development in the field of cardiovascular ultrasound. As vascular ultrasound continues to grow in both scope and importance to the cardiovascular community, the Society has included education in vascular imaging as a key benchmark in its strategic plan. Offered from 2003–2006 as a joint offering with the Society for Vascular Medicine and Biology and co-sponsored by the ACC Foundation, The Vascular Imaging Symposium has evolved over the past two years into a unique educational tool: a smaller, specialized symposium that is geared toward a specific target audience of physicians, sonographers, fellows, medical students, and other allied healthcare providers interested in vascular ultrasound.Vascular Imaging Symposium Focuses on Developing Better Ultrasound Techniques10.1016/j.echo.2010.06.019Journal of the American Society of Echocardiography 23, 8 (2010)2010-08-01Journal of the American Society of Echocardiography2010-08-01238S0894-7317(10)X0008-6Sonographers' CommunicationA29A29