Blood speckle imaging: A new echocardiographic approach to study fluid dynamics in congenital heart disease

Introduction: Blood speckle imaging (BSI) is a new speckle-tracking-based technique for blood flow study. Flows assessment is particularly challenging in Congenital heart diseases (CHDs), where a profound distortion in cardiac anatomy gives reason of alteration in fluid mechanics. Up until now doppler methods were the only ones used for the analysis of fluid. Overcoming standard Doppler limits, BSI is becoming a promising new approach for the study of fluid dynamics.The aim of the study was to assess fluid-dynamics of different CHDs by using BSI. Methods and results: Ten children (7 with suspected CHDs and 3 controls) were enrolled for the purpose between January and June 2019. All of them underwent a complete 2D and Doppler echocardiographic assessment plus a further BSI study. We studied: one complex transposition of great arteries, one coarctation of aorta, one tetralogy of Fallot, one complete atrio-ventricular septal defect, one suspicious flow in pulmonary artery, one aortic stenosis, one hypertrophic cardiomyopathy and three normal controls. Conclusion: Compared to conventional Doppler methods, BSI was able to better describe fluid dynamics and hemodynamics of these CHDs by showing laminar and turbulent flows and vortices. In our experience, it helped to define the diagnosis and, in some cases, drove the management

Different trajectories and significance of B-type natriuretic peptide, congestion and acute kidney injury in patients with heart failure

The exact relationship existing among congestion status, brain natriuretic peptide (BNP) changes and acute kidney injury (AKI) has not been elucidated in patients with acute heart failure (AHF). The aims of this study are: to investigate the relation and prognostic role of BNP, AKI and clinical congestion after discharge; to define the exact BNP cut off value or a BNP in-hospital reduction to identify patients with higher risk during vulnerable post-discharge phase. We consecutively enrolled 157 patients with a diagnosis of AHF. BNP and creatinine were measured in all patients, and degree of failure was assessed. AKI was defined as a creatinine increase ≥0.3 mg/dL or eGFR reduction ≥20% during hospitalization. All patients were followed for 1 and 3 months. Of 146 included patients, 110 patients (75%) displayed effective decongestion, 116 (79%) showed a BNP decrease ≥30%, and 28 (19%) developed in-hospital AKI. BNP in-hospital decrease ≥30% was found more often in patients who showed good decongestion in comparison to patients in persistent failure (63 vs 22%; p < 0.001). The ROC curve analyses at 3 months show that both BNP reduction of 30% between admission and discharge and decongestion at discharge identifies patients with a reduced incidence of cardiovascular events (AUC = 0.79, confidence interval 0.68–0.90, sensibility 90%, sensitivity 50% p < 0.001). Kaplan–Meier survival plots show a better outcome in patients with a BNP decrease ≥30% and good decongestion at discharge (p = 0.03). BNP reduction in AHF is associated with decongestion. BNP reduction associated with decongestion at discharge is a favorable prognostic indicator at 90-day survival irrespective of the AKI occurrence

Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of Fallot: New insights in cardiac mechanics and exercise capacity

Background: Pulmonary regurgitation (PR) and right ventricular (RV) dilatation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF).Aims: To compare Echo datawith the gold standard CMR in a paediatric population of r-TOFwith significant PR, to assess the reliability of standard and advanced echo parameters. In addition, to evaluate their correlation with peak oxygen consumption (VO2).Methods and results: All patients underwent standard echo-Doppler study, speckle tracking analysis, and CMR to assess PR and RV size and function. Thirty-six patients underwent also cardiopulmonary exercise test. Fourty-six patients (aged 13.7 +/- 3.0) were included. Echo derived RV areas correlated with CMR RV volumes (p = 150 ml/m(2). RVEF was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. Flow-reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify CMRpulmonary regurgitant fraction (RF) = 35%. None of the CMRparameters correlated with peak VO2. Among the Echo data only right atrial strain (RAS) correlated with peak VO2.Conclusion: In children, flow-reversal in pulmonary branches identifies hemodynamically significant RF with a good sensitivity but poor specificity. RV area by echocardiogramis a valid first-line parameter to screen RV dilation. RV longitudinal systolic dysfunction coexistswith a still preserved EF. RAS correlates stronglywith peak VO2 and should be added in their follow up. (C) 2020 Elsevier B.V. All rights reserved

Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of Fallot: New insights in cardiac mechanics and exercise capacity

Background: Pulmonary regurgitation (PR) and right ventricular (RV) dilatation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF).Aims: To compare Echo datawith the gold standard CMR in a paediatric population of r-TOFwith significant PR, to assess the reliability of standard and advanced echo parameters. In addition, to evaluate their correlation with peak oxygen consumption (VO2).Methods and results: All patients underwent standard echo-Doppler study, speckle tracking analysis, and CMR to assess PR and RV size and function. Thirty-six patients underwent also cardiopulmonary exercise test. Fourty-six patients (aged 13.7 +/- 3.0) were included. Echo derived RV areas correlated with CMR RV volumes (p = 150 ml/m(2). RVEF was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. Flow-reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify CMRpulmonary regurgitant fraction (RF) = 35%. None of the CMRparameters correlated with peak VO2. Among the Echo data only right atrial strain (RAS) correlated with peak VO2.Conclusion: In children, flow-reversal in pulmonary branches identifies hemodynamically significant RF with a good sensitivity but poor specificity. RV area by echocardiogramis a valid first-line parameter to screen RV dilation. RV longitudinal systolic dysfunction coexistswith a still preserved EF. RAS correlates stronglywith peak VO2 and should be added in their follow up. (C) 2020 Elsevier B.V. All rights reserved