Journal of the American Society of Echocardiography

Persistent Reduction in Left Ventricular Strain Using Two-Dimensional Speckle-Tracking Echocardiography after Balloon Valvuloplasty in Children with Congenital Valvular Aortic Stenosis

2012-02-20

Background: The aim of this study was to investige serial changes of myocardial deformation using two-dimensional speckle-tracking echocardiographic (2DSTE) imaging in children undergoing balloon valvuloplasty for congenital valvular aortic stenosis (VAS).Methods: Thirty-seven children with isolated congenital VAS were enrolled in this study prospectively. Patients underwent echocardiographic evaluation at three instances: before balloon valvuloplasty, 6 months after intervention, and 3 years after intervention. Longitudinal, circumferential, and radial peak systolic strain values were determined, as well as systolic strain rate and the time to peak global systolic strain. Linear mixed statistical models were used to assess changes in 2DSTE parameters after balloon intervention. Using one-way analysis of variance, 2DSTE results at 3-year follow-up were compared with 2DSTE measurements in 74 healthy age-matched children and 76 children with uncorrected VAS whose severity of stenosis corresponded to residual stenosis of study subjects at 3-year follow-up.Results: Global peak strain and strain rate measurements in all three directions were decreased before intervention compared with healthy children. Global peak strain and strain rate measurements increased significantly (P < .001) several months after balloon valvuloplasty and continued to increase at 3-year follow-up. However, at 3-year follow-up, global peak strain and strain rate in the longitudinal and circumferential directions were significantly lower (P < .001) compared with both control groups. Measurements of time to peak global systolic strain were significantly shorter at early follow-up compared with measurements before intervention (P < .05).Conclusions: Shortly after balloon valvuloplasty for severe congenital VAS, there is an improvement in systolic myocardial deformation. However, 2DSTE parameters do not return to normal at 3-year follow-up. These abnormalities in systolic deformation cannot be fully attributed to residual stenosis or aortic regurgitation.

Left Ventricular Systolic Dyssynchrony in Pediatric and Adolescent Patients with Congestive Heart Failure

2012-02-27

Background: Echocardiographic measures of left ventricular (LV) dyssynchrony in pediatric patients with heart failure (HF) have not been adequately evaluated. The aim of this study was to evaluate LV systolic dyssynchrony in pediatric patients with HF and normal children.Methods: Among a total of 68 patients, 22 had HF and 46 were normal. Doppler tissue imaging, M-mode echocardiography, and pulsed-wave Doppler echocardiography were performed. Intraventricular dyssynchrony using the maximal difference in time to peak myocardial systolic contraction (Ts), the standard deviation of Ts of 12 LV segments, septal–to–posterior wall motion delay, and interventricular dyssynchrony by measuring aortic and pulmonary pre-ejection delays were obtained.Results: The maximal difference in Ts (patients with HF, 91.27 ± 31.18 msec; controls, 45.93 ± 21.29 msec; P < .001), the standard deviation of Ts (patients with HF, 31.05 ± 10.68 msec; controls, 15.60 ± 7.70 msec; P 31 msec (+2 standard deviations of normal controls) and a maximal difference in Ts > 89 msec in normal controls and 18 patients with HF due to dilated cardiomyopathy was included for analysis of systolic dyssynchrony; it was present in three (6.5%) and two (4.3%) controls and in nine (50%) and 10 (55%) patients with HF due to dilated cardiomyopathy, respectively. Low ejection fraction, elevated LV end-diastolic volume, and elevated LV end-systolic volume had significant correlations with systolic dyssynchrony. QRS duration was not significantly correlated with measures of dyssynchrony.Conclusions: Systolic mechanical dyssynchrony is common in pediatric patients with HF. QRS duration is not a determinant of systolic dyssynchrony in pediatric patients. Echocardiographic measurements of systolic dyssynchrony are feasible in pediatric patients.

Erratum

2012-05-01

In the article entitled “Assessment of transmitral vortex formation in patients with diastolic dysfunction” by Kheradvar et al (J Am Soc Echocardiogr 2012;25:220-7), there was an error in the text on page 221 and equation on page 222. The corrected text and equation is as follows:

Impaired Left Ventricular Myocardial Mechanics and Their Relation to Pulmonary Regurgitation, Right Ventricular Enlargement and Exercise Capacity in Asymptomatic Children after Repair of Tetralogy of Fallot

2012-02-13

Background: Left ventricular (LV) dysfunction is common in adults late after repair of tetralogy of Fallot (TOF). The early detection of myocardial dysfunction may be important, but LV myocardial strain and dyssynchrony are not well studied in children with TOF. The objective of this study was to investigate LV strain and dyssynchrony in asymptomatic children and adolescents after contemporary repair of TOF. The hypothesis was that impaired LV myocardial mechanics are related to pulmonary regurgitation, right ventricular (RV) enlargement, and exercise capacity.Methods: Children and adolescents were prospectively studied after TOF repair. LV regional strain and dyssynchrony were assessed using two-dimensional speckle-tracking echocardiography. Ventricular volumes, ejection fraction, and pulmonary regurgitation were assessed using magnetic resonance imaging. Exercise capacity was determined using metabolic exercise testing.Results: One hundred twenty-four subjects (53 patients with TOF and 71 controls) were studied. Regional circumferential (e.g., basal lateral wall, −15.0 ± 7.0% vs −19.0 ± 7.0%, P = .02) and radial (e.g., basal posterior wall, 32.0 ± 18.0% vs 48.0 ± 21.0%, P < .001) LV strain and longitudinal septal strain (−18.5 ± 3.5% vs −20.2 ± 2.8%, P = .01) were significantly reduced in patients with TOF compared with controls. LV mechanical dyssynchrony indices were not significantly different between groups (e.g., standard deviation of time to peak circumferential strain, 52.5 ± 40.4 vs 50.5 ± 27.1 msec, P = .81). Higher pulmonary regurgitation volume and larger RV end-diastolic volume were associated with decreased LV radial strain (P = .09). There was no association between LV longitudinal, radial, or circumferential dyssynchrony and indexed pulmonary regurgitation flow volume, RV end-diastolic volume, or RV ejection fraction.Conclusions: LV circumferential and radial strain are significantly reduced in children and adolescents after TOF repair and are associated with pulmonary regurgitation and RV dilatation. Resting LV mechanical dyssynchrony does not appear to contribute to early impaired LV strain in this population.

Value of Tissue Doppler Echocardiography in Children with Pulmonary Hypertension

2012-02-27

Background: The impact of pulmonary hypertension (PHT) on right ventricular and left ventricular (LV) function in children with PHT is unknown, and echocardiographic data combining conventional and Doppler tissue imaging (DTI) on PHT in children are sparse.Methods: Forty-one children (18 male; mean age, 7.9 ± 5.6 years) with PHT and structurally normal hearts (27 with idiopathic PHT, 14 with associated PHT) and 44 age-matched healthy controls were assessed using conventional echocardiography and DTI.Results: Children with PHT had enlarged tricuspid valve diameters, right atrial areas, pulmonary artery dimensions, and LV eccentricity indices. In addition, pulmonary acceleration time and tricuspid annular plane systolic excursion were significantly reduced in patients compared with controls. DTI revealed that children with PHT had significantly lower systolic (S) and early diastolic (E) velocities at the tricuspid and septal levels. Despite preserved LV ejection fractions, left lateral free wall systolic velocities were significantly reduced in patients with PHT. Significantly reduced LV rapid filling velocities (E) suggested an underloaded left ventricle or LV diastolic dysfunction in children with PHT compared with controls. Pulmonary acceleration time and tricuspid annular plane systolic excursion correlated best with DTI systolic tricuspid and septal velocities.Conclusions: Despite not being evident on conventional two-dimensional echocardiography, LV systolic performance appears to be impaired in children with PHT. Quantitative DTI assessment of ventricular function and ventricular-ventricular interactions in this setting might provide further insights into the mechanisms leading to end-stage PHT and may guide clinicians to optimize antifailure treatment.

Right Ventricular Systolic Strain Is Altered in Children with Sickle Cell Disease

2012-02-20

Background: Several adult studies have shown that sickle cell disease is associated with cardiac abnormalities and premature death. The aim of this study was to use speckle-tracking strain, a relatively load independent parameter, to evaluate systolic left ventricular (LV) and right ventricular (RV) function in a pediatric sickle cell disease population.Methods: Twenty-eight patients with sickle cell disease (mean age, 10.0 ± 3.6 years; mean body surface area, 1.14 ± 0.27 m2) and 29 controls matched for age and body surface area were compared. Cardiac output, LV dimension, wall thickness and circumferential strain, LV and RV longitudinal systolic strain, conventional and tissue Doppler parameters, and pulmonary pressure were assessed.Results: LV cardiac output was significantly higher in patients, as were indexed LV systolic diameter, indexed LV mass, and E/E′ septal ratio. Indexed LV diastolic diameter, wall thickness, LV shortening fraction, and global LV longitudinal and circumferential strains were similar in patients and controls. However, their global RV longitudinal strain was significantly lower, although tricuspid annular plane systolic excursion and color-coded tricuspid S-wave velocity were similar. Among patients, 21% had tricuspid regurgitation velocities > 2.5 m/sec, but none had tricuspid regurgitation velocities > 3 m/sec. Indexed LV diastolic dimension and systolic pulmonary artery pressure were significantly higher in patients whose hemoglobin was <80 g/L, but parameters of systolic and diastolic LV function were similar.Conclusions: In children with sickle cell disease, LV diastolic function is significantly altered, although LV systolic function, evaluated by global longitudinal strain, is normal. In addition, cardiac output is increased, and elevated tricuspid regurgitation velocity is common, whereas it is never found in controls. Most importantly, global RV longitudinal systolic strain is significantly altered.

Can Simple Echocardiographic Measures Reduce the Number of Cardiac Magnetic Resonance Imaging Studies to Diagnose Right Ventricular Enlargement in Congenital Heart Disease?

2012-02-27

Background: Right ventricular (RV) enlargement is used as a criterion for the treatment of RV outflow tract dysfunction in patients with congenital heart disease. Although RV volumes are most accurately measured by cardiac magnetic resonance (CMR), CMR is a limited resource. The aim of this study was to investigate whether simple echocardiographic measurements can adequately predict RV volumes below clinical thresholds, thereby reducing the need for CMR in some patients.Methods: Children with repaired tetralogy of Fallot, double-outlet right ventricle, or truncus arteriosus who underwent CMR and echocardiography within a 4-week interval were retrospectively studied. From the four-chamber view, indexed RV lateral wall length, indexed RV end-diastolic perimeter length, and indexed RV end-diastolic area (RVEDAi), were measured. Results were compared with CMR indexed RV volume. The sensitivity and specifity of echocardiographic threshold values predicting RV volumes < 170 mL/m2 were determined.Results: Fifty-one children (mean age, 12.7 ± 3.5 years; 25 male, 26 female) were reviewed. RVEDAi was correlated with CMR indexed RV volume (r = 0.60, P < .0001). Indexed RV end-diastolic perimeter length and indexed RV lateral wall length were not correlated with CMR. RVEDAi < 20 cm2/m2 had 100% specificity to predict indexed RV volume ≤ 170 mL/m2 (area under the curve, 0.79), reducing the need for CMR in 15 of 51 patients (29%). A threshold RVEDAi of 22 cm2/m2 would reduce the need for CMR in 21 of 51 patients (41%) at the expense of one false-negative result. The coefficients of variation were 14.7% for intraobserver variability and 9.6% for interobserver variability.Conclusions: The specificity of echocardiography-measured RVEDAi can be set to predict RV volumes below a 170 mL/m2 threshold in 100% of cases. This may reduce the need for CMR to determine RV volumes in ≥25% of patients with congenital heart disease, potentially reducing patient burden and costs.

Effect of Mitral Valve Repair on Mitral-Aortic Coupling: A Real-Time Three-Dimensional Transesophageal Echocardiography Study

2012-03-12

Background: The aortic valve and the mitral valve (MV) are coupled via fibrous tissue. Simultaneous dynamic analysis of the two valves' annuli has demonstrated that they have synchronous and reciprocal behavior. Accordingly, the aims of this study were to characterize mitral-aortic coupling (MAC) in three-dimensional space before and after MV repair and to identify the untoward effects of annuloplasty rings on MAC compared with normal valvular function.Methods: Real-time three-dimensional transesophageal echocardiography was performed on 28 consecutive patients with degenerative MV disease and severe mitral regurgitation before and after MV repair and in 25 age-matched control subjects. Custom software was used to semiautomatically identify the mitral and aortic annuli throughout the cardiac cycle and to measure parameters describing valvular dynamics.Results: Patients with mitral regurgitation before MV repair were characterized by altered morphology and function of the MV but preserved MAC because of the maintained ability of the mitral annulus to change size and position. MV repair together with annuloplasty ring implantation forced the mitral annulus to be smaller and less pulsatile, with decreased displacement ability compared with normal mitral annuli. Because of this alteration in MAC, the “unaffected” aortic annulus became less pulsatile and less mobile.Conclusions: This study shows unwanted and unexpected changes in aortic annular function secondary to mitral valve repair with an annuloplasty ring due to altered MAC mechanisms. These changes may alter the dynamic mechanism of the aortic root that facilitates blood ejection, so MAC should be considered and evaluated from diagnosis to treatment in MV disease.

Towards an Integrated Echocardiographic Assessment of Valvular Mechanics by Three-Dimensional Volumetric Imaging

Luigi P. Badano, Denisa Muraru — 2012-05-01

Echocardiography is the most useful imaging modality for the noninvasive assessment of patients with valvular diseases, by integrating a thorough morphologic characterization with real-time dynamics in the beating heart. The routine use of conventional two-dimensional (2D) and Doppler echocardiography has greatly expanded our understanding of cardiac physiology and pathophysiology, and has improved our ability to assess the optimal timing for interventions and the prognosis of our patients. However, conventional 2D echocardiography is a tomographic imaging technique, basically providing the visualization of only one thin slice of the heart at a time. The assessment of the size and function of a particular cardiac structure taken as a whole can only be performed by making geometric assumptions about its shape and by applying specific formulas to calculate global indexes from measurements performed in multiple predefined tomographic views. In addition, the displacement and cyclic deformation of the moving cardiac structures displayed in these fixed predefined views can be fully captured only if occurring within the corresponding scan planes. Yet, cardiac valves lie in different planes, move in three-dimensional (3D) space and change in orientation and reciprocal spatial relationship continuously during the cardiac cycle; therefore there is no single 2D plane able to image en face two valves simultaneously. Consequently, the cardiac chambers and valves have been studied individually by 2D echocardiography, as if the function of one were independent from the other, and so clinicians have almost lost the ability to consider the heart as a whole and to assess the fascinating functional interplay among its components.

Mechanisms and Predictors of Mitral Regurgitation after High-Risk Myocardial Infarction

2012-02-10

Background: Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate the mechanistic components of MR after high-risk MI and to identify predictors of MR progression during follow-up.Methods: The Valsartan in Acute Myocardial Infarction Echo substudy prospectively enrolled 610 patients with LV dysfunction, heart failure, or both after MI. MR at baseline, 1 month, and 20 months was quantified by mapping jet expansion in the left atrium in 341 patients with good-quality echocardiograms. Indices of LV remodeling, left atrial size, and diastolic function and parameters of mitral valve deformation, including tenting area, coaptation depth, anterior leaflet concavity, annular diameters, and contractility, were assessed and related to baseline MR. The progression of MR was further analyzed, and predictors of worsening among the baseline characteristics were identified.Results: Tenting area, coaptation depth, annular dilatation, and left atrial size were all associated with the degree of baseline MR. Tenting area was the only significant and independent predictor of worsening MR; a tenting area of 4 cm2 was a useful cutoff to identify worsening of MR after MI and moderate to severe MR after 20 months.Conclusions: Increased mitral tenting and larger mitral annular area are determinants of MR degree at baseline, and tenting area is an independent predictor of progression of MR after MI. Although LV remodeling itself contributes to ischemic MR, this influence is directly dependent on alterations in mitral geometry.

Velocity Vector Imaging: Standard Tissue-Tracking Results Acquired in Normals—The VVI-STRAIN Study

2012-02-13

Background: Echocardiographic imaging assessment of left ventricular mechanics is a new technology that is offered by various vendors. Different software algorithms have at times yielded conflicting results. The aim of this study was to determine normal myocardial mechanical parameters in a healthy population using Velocity Vector Imaging.Methods: One hundred twenty subjects were selected for this study, including healthy subjects referred for echocardiography to evaluate minor symptoms or murmurs, who had normal echocardiographic findings and healthy volunteers. Study subjects were recruited in Haifa, Israel and Toronto, Canada. Echocardiography was performed using commercially available systems to analyze archived studies. Endocardial and epicardial longitudinal and circumferential strain and strain rate were calculated as well as rotational mechanical parameters. Age and gender differences were evaluated.Results: Average endocardial longitudinal, circumferential, and radial strains and twist were −19.6 ± 2.0%, −27.6 ± 3.9%, +30.1 ± 7.5%, and 9.6 ± 3.9°, respectively. Epicardial circumferential strain and twist were −11.3 ± 2.2% and 4.0 ± 1.9°, respectively. Shortening increased from base to apex longitudinally (10%) and circumferentially (33%). Thickening at the apex was 16% lower than at the base. Men and older subjects had increased endocardial circumferential strain and apical rotation.Conclusions: Mechanical parameters differ with location (endocardial vs epicardial, basal vs apical strain gradients), age, and gender. Care should be taken when comparing regional strain measurements between systems, and gender and age should be matched between and within two-dimensional strain systems.

Prevalence of Non-Cardiac Pathology on Clinical Transthoracic Echocardiography

2012-03-12

Background: Non-cardiac findings (NCFs) are seen in more than a third of cardiac computed tomographic and cardiac magnetic resonance imaging studies. The prevalence and importance of NCFs in transthoracic echocardiographic (TTE) imaging is unknown. The aim of this study was to determine the prevalence of NCFs on TTE imaging.Methods: The subcostal images of all comprehensive adult TTE studies performed at one institution in December 2008 were retrospectively reviewed for NCFs by a radiologist with fellowship training in cardiovascular and abdominal radiology and blinded to the TTE report findings and clinical histories. Additional TTE image orientations were assessed in a subset of 300 studies. NCFs were categorized as benign (e.g., simple hepatic cyst), indeterminate (e.g., ascites), or worrisome (e.g., liver metastases). If an indeterminate or worrisome NCF was identified, the patient's electronic medical record was reviewed to determine if the NCF was previously known.Results: Of 1,008 TTE studies (443 inpatient, 565 outpatient) in 922 patients, 77 NCFs were identified in 69 patients (7.5%). These included 20 benign (26%), 52 indeterminate (67%), and five worrisome (7%) NCFs. Intermediate and worrisome NCFs were more common in inpatient TTE studies (9% vs 3% outpatient, P = .002). The additional views demonstrated 2% more NCFs. Record review demonstrated that 60% of worrisome and 67% of indeterminate NCFs were previously known. No unknown NCF ultimately led to a change in patient management.Conclusions: Clinical TTE studies demonstrate NCFs in 7.5% of all patients, with an increased prevalence on inpatient studies. Although 75% of NCFs were potentially management changing, the majority of these were previously known and very unlikely to lead to management changes. Further study is needed to validate these findings in other populations and to assess their clinical impact.

Non-Cardiac Findings: Now You See Them…

James N. Kirkpatrick, Martin G. St. John Sutton — 2012-05-01

The prevalence of non-cardiac findings (NCFs) identified during routine diagnostic cardiac imaging with computed tomography (CT), magnetic resonance imaging (MRI), and nuclear perfusion scanning has been described to be as high as 23% to 43%. However, in spite of transthoracic echocardiography (TTE) being by far the most commonly used cardiac imaging modality worldwide, the prevalence of NCFs with TTE remains poorly defined. Khosa et al. set out to assess the prevalence and significance of NCFs on clinically indicated TTEs from a single institution.

Aortic Stiffness and Distensibility in Top-Level Athletes

2012-01-16

Background: Although cardiac adaptation to different sports has been extensively described, the potential relationship of training with aortic root (AR) elastic properties and diameters in top-level athletes remains not fully investigated. The aims of this study were to compare AR morphology and stiffness between highly trained athletes and sedentary subjects and to assess the independent determinants of AR stiffness and distensibility in athletes.Methods: Four hundred ten elite athletes (220 endurance-trained athletes [ATE] and 190 strength-trained athletes [ATS]; 290 men; mean age, 28.3 ± 13.6 years; age range, 18–40 years) and 240 healthy controls underwent standardized comprehensive transthoracic echocardiography, including Doppler studies. End-diastolic AR diameters were measured at four locations: the aortic annulus, the sinuses of Valsalva, the sinotubular junction, and the maximal diameter of the proximal ascending aorta. The aortic distensibility index was calculated as 2 × (systolic proximal ascending aortic diameter − diastolic proximal ascending aortic diameter)/(diastolic proximal ascending aortic diameter) × (pulse pressure) (cm−2 · dyn−1 · 10−6). AR stiffness index was defined as (systolic blood pressure/diastolic blood pressure)/(systolic proximal ascending aortic diameter − diastolic proximal ascending aortic diameter)/diastolic proximal ascending aortic diameter. Analysis of variance was performed to evaluate differences among groups.Results: Left ventricular (LV) mass index did not significantly differ between the two groups of athletes but was lower in controls. ATS showed higher body surface area, sum of wall thickness (septum plus LV posterior wall), and circumferential end-systolic stress, while LV stroke volume and LV end-diastolic volume were greater in ATE. AR diameters at all levels and AR stiffness were significantly greater in ATS than in ATE and controls, while AR distensibility was significantly higher in ATE. However, AR dilatation was observed only in four male power athletes (1%). By multivariate analyses, in the overall population of athletes, age, LV stroke volume, endurance training, and duration of training were the only independent determinant of higher AR distensibility. On the other hand, age, circumferential end-systolic stress, strength training, and duration of training were independently associated with AR stiffness in ATS.Conclusions: AR diameters and stiffness were significantly greater in strength-trained athletes, while aortic distensibility was higher in endurance athletes compared with age- and sex-matched healthy controls.

The Feasibility, Diagnostic Yield, and Learning Curve of Portable Echocardiography for Out-of-Hospital Cardiovascular Disease Screening

2012-02-13

Background: The reduction in the size of full-capability echocardiographic machines facilitates “out-of-hospital” transthoracic echocardiography (TTE). Data documenting the feasibility, yield, and logistical considerations of out-of-hospital TTE for preparticipation evaluation of athletes are sparse.Methods: A multiyear study was conducted to examine the role of 12-lead electrocardiography for athlete screening in which TTE was used to document or exclude underlying structural heart disease. Using a commercially available portable transthoracic echocardiographic system, the rate of technically adequate imaging, diagnostic yield, and the time required for the completion of TTE (including setup, performance, and interpretation) were examined. TTE was performed in university medical offices and at “out-of-office” athletic facilities. Measurements were recorded during each year of the study to determine the impact of targeted attempts to improve efficiency.Results: Four hundred sixty-seven of 510 participants had transthoracic echocardiographic images that were technically adequate for complete interpretation (imaging success rate, 92%). Echocardiographic evidence of physiologic, exercise-induced cardiac remodeling was observed in 110 of 510 (22%). Cardiac abnormalities with relevance to sports participation risk were detected in 11 of 508 participants (2.2%). Over 3 years, the average time for the completion of TTE (including setup, imaging, and interpretation) decreased (year 1, 17.4 ± 3 min; year 2, 14.0 ± 2.1 min; year 3, 11.0 ± 1.8 min; P < .001). This was driven by a significant decrease in the time required for TTE at out-of-office athletic facilities.Conclusions: Community-based TTE in athletes is feasible and is associated with a high rate of technically adequate imaging. Importantly, there appears to be a significant learning curve associated with out-of-hospital TTE.

Prognostic Value of Low Left Atrial Appendage Wall Velocity in Patients with Ischemic Stroke and Atrial Fibrillation

2012-02-13

Background: It is important to evaluate left atrial appendage (LAA) dysfunction for primary and secondary prevention of stroke in patients with atrial fibrillation (AF). LAA dysfunction can reportedly be evaluated by LAA wall velocity (LAWV) measured by transthoracic echocardiographic (TTE) imaging. The aim of this study was to examine whether TTE-LAWV can predict long-term cerebrovascular events in patients with ischemic stroke with AF.Methods: TTE imaging and transesophageal echocardiographic imaging were performed <7 days after onset in 179 consecutive patients with stroke with AF. TTE-LAWV was measured using Doppler tissue imaging at the LAA tip from the parasternal short-axis view on TTE imaging, as previously reported. All patients were followed up prospectively.Results: Cerebrovascular events were defined as cerebrovascular death and/or recurrent ischemic stroke requiring hospitalization. There were 32 cerebrovascular events during a median follow-up period of 397 days. TTE-LAWV was significantly lower in patients with cerebrovascular events than in patients without (8.3 ± 2.8 vs 11.3 ± 4.0 cm/sec, P < .01). Cox multivariate hazard analysis showed that low TTE-LAWV (<8.7 cm/sec) was an independent predictor of cerebrovascular events (hazard ratio, 3.460; P < .05). Kaplan-Meier analysis showed that cerebrovascular event rates were significantly higher in patients with low TTE-LAWV (<8.7 cm/sec) compared with those with high TTE-LAWV (34% vs 7%, P < .01).Conclusions: Impaired LAA function was associated with long-term cerebrovascular events in patients with stroke with AF. TTE-LAWV may be a feasible parameter for risk stratification in patients with AF.

The Effect of Definity on Systemic and Pulmonary Hemodynamics in Patients

2012-02-27

Background: The purpose of this study was to evaluate the pulmonary and systemic hemodynamic effects of Definity in patients with normal as well as those with elevated pulmonary artery pressure at baseline. Secondary objectives of the study were to evaluate safety and determine whether any potential immunologic reactions develop after Definity administration.Methods: Patients with normal and elevated pulmonary artery systolic pressure undergoing right-heart catheterization received Definity (10 μL/kg) as a slow bolus over 30 to 60 sec. Multiple sequential measurements of right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary artery pressure, cardiac output, and pulmonary capillary wedge pressure were made before and after Definity administration. Vital signs, electrocardiograms, and blood samples were taken at multiple time points. Patients were followed for the development of adverse events.Results: A total of 32 patients (16 with elevated pulmonary artery systolic pressure > 35 mm Hg) were enrolled. No significant changes in any pulmonary or systemic hemodynamic parameters, vital sign values, electrocardiographic data, or laboratory variables were found for data obtained before versus after receipt of Definity.Conclusions: The administration of Definity at the approved dosage does not change pulmonary or systemic hemodynamics in control patients or those with mild to moderate pulmonary hypertension. No significant changes were noted in a wide array of clinical and laboratory safety assessments after patients were exposed to Definity.

2012-05-01

Editorial Board

2012-05-01

Information for Authors

2012-05-01

Information for Readers

2012-05-01

Our Board: Charting a Path to the Future

2012-05-01

Remember the old Chinese curse, “May you live in interesting times”? I think you'll agree that it's never been more “interesting” for the echocardiography community than it is right now, what with reimbursement cuts, the development of accountable care organizations, decreasing educational funding from industry, increasing ultrasound use by nontraditional users, and competition for both health care dollars and for our brightest fellows, for whom we compete with alternative imaging modalities such as CT and MRI. How ASE responds to these challenges will determine whether the field that we love will thrive in the future or merely survive (or worse) in the years to come. Of course, the staff and leadership of ASE are always on guard to react to new issues as they arise (such as a recent effort by nurse anesthetists in South Carolina, who appealed to the medical board to be allowed to both perform and interpret intraoperative echoes, an effort countered by quick action from our Perioperative Council and Advocacy Committee). But navigating an optimal path to the future requires developing a multi-year strategic plan, where we declare our long-term goals and map specific approaches to achieving them.

Continuing Education and Meeting Calendar

2012-05-01

The 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.

Observations of Sonographer Participants on the ASE Global: Focus on India Outreach Trip

David Adams — 2012-05-01

In January a team of nine sonographers from the ASE travelled to India to provide cardiovascular ultrasound to an underserved population there. Organized by Dr. Partho Sengupta from Mount Sinai Hospital and Rhonda Price from the ASE, and supported by an educational grant from GE Healthcare, the sonographers and their physician counterparts scanned over 1,000 patients in two days.

Vascular Medicine in Singapore: An Infant that is Growing

2012-05-01

Vascular diseases are the leading cause of morbidity and mortality all over the world. Most of these disorders have common pathophysiology with similar mechanisms, irrespective of the site of the disease. Despite this, in most countries, the vascular diseases are managed differently by different specialties. In the U.S. and many European countries there is growing recognition of the need for dedicated vascular medical services. However, this is not yet true in most other countries. Although the specialty recognition of vascular medicine is yet far off in most Asian countries, we in Singapore have realized the importance of this specialty. The life expectancy of the Singapore population is one of the highest in the world, and, with an ageing population, the prevalence of vascular diseases is rapidly increasing. The need has arisen for implementing a comprehensive holistic approach to the management of these patients. Since different specialists with different skills are required, the evolving concept here is that the care of patients with vascular diseases should be coordinated, in close collaboration with other disciplines, by a dedicated physician such as a vascular medicine specialist.

Journal of the American Society of Echocardiography

Persistent Reduction in Left Ventricular Strain Using Two-Dimensional Speckle-Tracking Echocardiography after Balloon Valvuloplasty in Children with Congenital Valvular Aortic Stenosis

Left Ventricular Systolic Dyssynchrony in Pediatric and Adolescent Patients with Congestive Heart Failure

Erratum

Impaired Left Ventricular Myocardial Mechanics and Their Relation to Pulmonary Regurgitation, Right Ventricular Enlargement and Exercise Capacity in Asymptomatic Children after Repair of Tetralogy of Fallot

Value of Tissue Doppler Echocardiography in Children with Pulmonary Hypertension

Right Ventricular Systolic Strain Is Altered in Children with Sickle Cell Disease

Can Simple Echocardiographic Measures Reduce the Number of Cardiac Magnetic Resonance Imaging Studies to Diagnose Right Ventricular Enlargement in Congenital Heart Disease?

Effect of Mitral Valve Repair on Mitral-Aortic Coupling: A Real-Time Three-Dimensional Transesophageal Echocardiography Study

Towards an Integrated Echocardiographic Assessment of Valvular Mechanics by Three-Dimensional Volumetric Imaging

Mechanisms and Predictors of Mitral Regurgitation after High-Risk Myocardial Infarction

Velocity Vector Imaging: Standard Tissue-Tracking Results Acquired in Normals—The VVI-STRAIN Study

Prevalence of Non-Cardiac Pathology on Clinical Transthoracic Echocardiography

Non-Cardiac Findings: Now You See Them…

Aortic Stiffness and Distensibility in Top-Level Athletes

The Feasibility, Diagnostic Yield, and Learning Curve of Portable Echocardiography for Out-of-Hospital Cardiovascular Disease Screening

Prognostic Value of Low Left Atrial Appendage Wall Velocity in Patients with Ischemic Stroke and Atrial Fibrillation

The Effect of Definity on Systemic and Pulmonary Hemodynamics in Patients

Table of Contents

Editorial Board

Information for Authors

Information for Readers

Our Board: Charting a Path to the Future

Continuing Education and Meeting Calendar

Observations of Sonographer Participants on the ASE Global: Focus on India Outreach Trip

Vascular Medicine in Singapore: An Infant that is Growing