2,872 research outputs found

    Advanced Three-dimensional Echocardiography

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    Advanced Three-dimensional Echocardiography

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    Three-dimensional echocardiography and 2D-3D speckle tracking imaging in chronic pulmonary hypertension. diagnostic accuracy in detecting hemodynamic signs of RV failure

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    Background and objective. Our aim was to compare three-dimensional (3D) and 2D and 3D speckle tracking (2D-STE, 3D-STE) echocardiographic parameters with conventional right ventricular (RV) indexes in patients with chronic pulmonary hypertension (PH), and investigate whether these techniques could result in better correlation with hemodynamic variables indicative of heart failure. Methods. Seventy-three adult patients (mean age, 53±13 years; 44% male) with chronic PH of different etiologies were studied by echocardiography and cardiac catheterization (25 precapillary PH from pulmonary arterial hypertension, 23 obstructive pulmonary heart disease, and 23 postcapillary PH from mitral regurgitation). Thirty healthy subjects (mean age, 54±15 years; 43% male) served as controls. Standard 2D measurements (RV-FAC -fractional area change-, TAPSE -tricuspid annular plane systolic excursion-) and mitral and tricuspid tissue Doppler annular velocities were obtained. RV 3D volumes, and global and regional ejection fraction (3D-RVEF) were determined. RV strains were calculated by 2D-STE and 3D-STE. Results. RV 3D global-free-wall longitudinal strain (3DGFW-RVLS), 2D global-free-wall longitudinal strain (GFW-RVLS), apical-free-wall longitudinal strain (AFW-RVLS), basal-free-wall longitudinal strain (BFW-RVLS), and 3D-RVEF were lower in patients with pre-capillary PH (p<0.0001) and post-capillary PH (p<0.01) compared to controls. 3DGFW-RVLS (HR 4.6, 95% CI 2.79-8.38, p=0.004) and 3D-RVEF (HR 5.3, 95% CI 2.85-9.89, p=0.002) were independent predictors of mortality. ROC curves showed that the thresholds offering an adequate compromise between sensitivity and specificity for detecting hemodynamic signs of RV failure were 39% for 3D-RVEF (AUC 0.89), -17% for 3DGFW-RVLS (AUC 0.88), -18% for GFW-RVLS (AUC 0.88), -16% for AFW-RVLS (AUC 0.85), 16mm for TAPSE (AUC 0.67), and 38% for RV-FAC (AUC 0.62). Conclusions. In chronic PH, 3D, 2D-STE and 3D-STE parameters indicate global and regional RV dysfunction that is associated with RV failure hemodynamics better than conventional echo indices

    Role of Imaging in Left Atrial Appendage Occlusion

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    Percutaneous left atrial appendage (LAA) occlusion is now a valid alternative to long-term oral anticoagulation in patients with non-valvular atrial fibrillation at high thrombo-embolism risk, especially for patients who are considered ineligible for anticoagulation. The most frequently used occluders worldwide include the WATCHAMN (Boston Scientific, Natick, MA, USA) and the Amplatzer Cardiac Plug or Amulet (St. Jude Medical/Abbott, St Paul, MN, USA) devices. Multimodality imaging is key in the understanding of 3D aspects of the LAA and surrounding structures anatomy. Imaging is essential for procedural planning, during each step of the procedure and for device surveillance after implantation. Multimodality imaging, including 2D/3D echocardiography, fluoroscopy, and cardiac computed tomography can increase the safety and efficacy of the procedure

    Three-dimensional echocardiography for the assessment of congenital and acquired heart disease

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    Although conventional two-dimensional and Doppler blood-flow echocardiography are the standard imaging approaches in the assessment of heart disease they do not provide anatomic reconstructions in a form that resembles the cardiac morphology as visualized by the surgeon.The work presented in this thesis has explored the hypotheses that threedimensional echocardiography facilitates spatial recognition of intracardiac structures and therefore enhances the diagnostic confidence of echocardiography in congenital and acquired heart disease. The accuracy of three-dimensional reconstructions has been validated in vitro using two different phantoms and in vivo comparing the results with other established diagnostic techniques or surgical findings. Additionally, as the main limitation of transthoracic three-dimensional echocardiography is poor image quality in a substantial proportion of adult patients, Doppler myocardial imaging has been tested as a potentially superior method to conventional grey-scale imaging for transthoracic three-dimensional image acquisition.In vitro, using a virtual computer-generated phantom and a dynamic tissuemimicking phantom, the accuracy of both linear measurements and volume computation obtained from three-dimensional images was established. For both grey-scale and Doppler myocardial imaging, a detail of 1.0 mm dimension and two details separated from each other by a distance of 1.0 mm were the smallest structures and distances identified from a three-dimensional image. When testing the accuracy of volume measurements it appeared that both techniques marginally underestimated the true phantom volume (by approximately 1.0 ml for Doppler myocardial imaging and 4.0 ml for grey-scale imaging), but the systematic error was smaller and more constant in the case of Doppler myocardial imaging over the range of different true volumes.In vivo, the study was designed to compare the accuracy of grey-scale and Doppler myocardial imaging three-dimensional left ventricular volume measurements and cineventriculography. The differences were significantly smaller for the Doppler technique during both end-diastole and end-systole. A series of congenital heart lesions has also been studied. It has been shown that dynamic surgical reconstruction of the secundum atrial septal defect is feasible from the transthoracic approach in all patients. However, in adults, Doppler myocardial imaging proved more effective than grey-scale imaging in the accuracy of threedimensional defect reconstruction. In patients with sinus venosus atrial septal defect, transthoracic three-dimensional echocardiography was more accurate than standard echocardiography in diagnosing the defect including a detailed description of the abnormal pulmonary venous drainage. Finally, in children with atrio-ventricular septal defects, the 'unroofed' atrial reconstruction of the common valve accurately displayed dynamic valve morphology en face and the mechanism of valve reflux

    Hot Topics in Echocardiography

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    Echocardiography is still the most used imaging technique for the evaluation of cardiac anatomy and function and today it plays an essential role in daily decision making. The echocardiographic technology and its applications have widely developed in the last years leading to a better diagnostic accuracy. On the other hand echocardiography specialists have new clinical questions to answer. Echocardiography meets the growing need for non-invasive imaging in the expanding heart failure population and during structural heart interventions. The new percutaneous therapies need, a precise evaluation of cardiac dimensions and a complete understanding of the spatial relationships between cardiac structures. Echocardiography is of paramount importance both during the patient evaluation and guiding the procedure. This book tries to give an in depth evaluation about the specific issues that a modern cardiovascular imaging specialist is asked to answer nowadays
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