Advantages of Real-Time Three-Dimensional Echocardiography Over Two-Dimensional Echocardiography

Over the last fifty-years conventional two-dimensional (2D) echocardiography has served as a valuable clinical adjunct for the diagnosis and management of cardiovascular disease. However, the echocardiologist was expected to mentally reconstruct the complex structure of myocardium, resulting in geometrical assumptions which in turn could underestimate the validity of clinical findings

The Pivotal Role of Three-Dimensional Transesophageal Echocardiography in Non-Coronary Intervention Procedures

The recent availability of real-time 3-dimensional (3D) transesophageal echocardiography (TEE) can drive forward the diagnostic capability of ultrasound imaging. Real time 3D TEE has evolved into the imaging modality of choice when it comes to percutaneous interventions, as in many cases it serves as the ‘eyes of the operator’ to evaluate, guide, and assess the results of the procedures in the catheterization laboratory. Moreover, it has been shown to provide additional insight into the anatomical, morphological and hemodynamic status. Up to date, real time 3D TEE has been integrated into the following percutaneous non-coronary procedures: closure of atrial or ventricular defects, aortic valve replacement, paravalvular leak occlusion, mitral valve repair with clips, and more recently left atrial appendage occlusion with use of closure devices. Further technological advancements will lead to more accurate and wider use of this imaging technique

Late Tricuspid Regurgitation as a Result of Rheumatic Tricuspid Disease in a Patient With Prosthetic Mitral Valve. Combined Two-Dimensional and Real-Time Three-Dimensional Transthoracic Echocardiographic Assessment

We herein present the case of a 65-year-old lady with late tricuspid regurgitation 15 years after successful mitral valve replacement due to severe mitral stenosis of rheumatic origin. She presented to our department complaining of fatigue which worsened over the last 6 months. Transthoracic echocardiographic examination including both 2D and real time 3D modalities revealed severe tricuspid regurgitation and the patient was scheduled for tricuspid annuloplasty. A propos with this case, a brief review of the literature is provided highlighting the key points of this topic

Echocardiographic imaging of tricuspid and pulmonary valve abnormalities in primary ovarian carcinoid tumor

Carcinoid is a rare malignancy originating from enterochromaffin cells and is clinically characterized by flushing, diarrhea and bronchospasm, due to secretion of vasoactive substances. A dreaded complication is carcinoid heart disease, which mainly affects right cardiac chambers, resulting in thickened, immobile and retracted tricuspid and pulmonary valves. In the current report, a case of a 60-year old female presenting with symptoms of right heart failure is described. Transthoracic two-dimensional and real-time three-dimensional echocardiography findings, as well as biochemical markers, including pro-BNP and NT-pro-BNP, were consistent with carcinoid syndrome. The histological diagnosis of carcinoid was confirmed after surgical resection of an ovarian mass

Quantitative analysis of left atrial function in asymptomatic patients with b-thalassemia major using real-time three-dimensional echocardiography

<p>Abstract</p> <p>Background</p> <p>There is strong evidence that left atrial (LA) size is a prognostic marker in a variety of heart diseases. Recently, real-time three-dimensional echocardiography (RT3DE) has been reported as a useful tool for studying the phasic changes of the left atrial volumes. The aim of this study was to investigate the performance of the left atrium in beta-thalassemic patients with preserved left ventricular ejection fraction (EF) and no iron overload, using RT3DE.</p> <p>Methods</p> <p>Twenty-eight asymptomatic b-thalassemic patients (32.2 ± 4.3 years old, 17 men) who were on iron chelating therapy, as well as 20 age- and sex-matched healthy controls underwent transthoracic RT3DE. The patient group had normal echocardiographic systolic and diastolic indices, while there was no myocardial iron disposition according to MRI. Apical full volume data sets were obtained and LA volumes were measured at 3 time points of the cardiac cycle: (1) maximum volume (LAmax) at end-systole, just before mitral valve opening; (2) minimum volume (LAmin) at end-diastole, just before mitral valve closure; and (3) volume before atrial active contraction (LApreA) obtained from the last frame before mitral valve reopening or at time of the P wave on the surface electrocardiogram. From the derived values, left atrial active and passive emptying volumes, as well as the respective emptying fractions were calculated.</p> <p>Results</p> <p>Left ventricular EF (59.2 ± 2.5% patients vs. 60.1 ± 2.1% controls), E/A, E/E' were similar between the two groups. Differences in the LAmax, LAmin and LApreA between b-thalassemic patients and controls were non-significant, LAmax:(35.5 ± 13.4 vs 31.8 ± 9.8)cm³, LAmin:(16.0 ± 6.0 vs. 13.5 ±4.2)cm³, and LApreA:(25.4 ± 9.8 vs. 24.3 ± 7.2)cm³. However, left atrial active emptying fraction was reduced in the patient group as compared to the healthy population (34.3 ± 16.4% vs. 43.2 ± 11.4%, p < 0.05).</p> <p>Conclusion</p> <p>RT3DE may be a novel technique for the evaluation of LA function in asymptomatic patients with b-Thalassemia Major. Among three-dimensional volumes and indices, left atrial active emptying fraction may be an early index of LA dysfunction in the specific patient population.</p

Value of real-time 3D adenosine stress contrast echocardiography in patients with known or suspected coronary artery disease

Aim: The aim of this study was to evaluate the feasibility of myocardial wall-motion and perfusion assessment using contrast echocardiography during real-time three-dimensional (RT3D) adenosine stress test, and compare its diagnostic accuracy with the two-dimensional (2D) method using coronary angiography as reference.Methods and results: Patients with known or suspected coronary artery disease (CAD) have been submitted to adenosine stress contrast echocardiography and coronary angiography, within a one month-period. 2D apical four-, two- and three- chamber, as well as three-dimensional (3D) pyramidal full-volume datasets were acquired at rest and at peak stress. The 17-segment division of the left ventricle was used and each segment was evaluated based on wall motion and perfusion.Sixty patients (age 60.1±8.5 years, 38 men) were enrolled, i.e. 1020 segments were evaluated at rest and at peak stress. Wall motion analysis per patient revealed that the sensitivity and specificity of 2D to detect CAD were 80% and 82% and of RT3D echocardiography were 82% and 64%, respectively, while in the per patient perfusion analysis the respective percentages were 88%, 64% for 2D, and 90%, 73% for RT3D. Regarding left anterior descending artery and right coronary system, there seems to be no statistical significant difference in terms of wall motion and perfusion evaluation between the two modalities. Conclusions: Real-time 3D adenosine stress echocardiography is a feasible and valuable technique to evaluate myocardial wall-motion and perfusion in patients with suspected coronary artery disease, despite existing problems concerning lower spatial and temporal resolution as compared with 2D echocardiography.Σκοπός: Ο στόχος της παρούσας μελέτης ήταν να εκτιμηθεί η δυνατότητα αξιολόγησης των διαταραχών της συστολικής πάχυνσης και της αιμάτωσης των μυοκαρδιακών τοιχωμάτων κατά τη διενέργεια της τρισδιάστατης (RT3D) δυναμικής υπερηχοκαρδιογραφίας αντίθεσης με αδενοσίνη και να συγκριθεί η διαγνωστική της ακρίβεια με την κλασική δισδιάστατη (2D) τεχνική, χρησιμοποιώντας τη στεφανιαιογραφία ως μέθοδο αναφοράς.Μέθοδος: Εξήντα (60) ασθενείς με γνωστή ή πιθανή στεφανιαία νόσο (ΣΝ) υποβλήθηκαν σε δυναμική υπερηχοκαρδιογραφία αντίθεσης με αδενοσίνη και σε στεφανιαιογραφία σε διάστημα ενός μήνα. Ελήφθησαν 2D κορυφαίες λήψεις τεσσάρων, δύο και τριών καρδιακών κοιλοτήτων, καθώς και 3D πληροφορία υπό τη μορφή πυραμιδικού όγκου (full-volume dataset), τόσο σε ηρεμία όσο και στο μέγιστο της φόρτισης. Χρησιμοποιήθηκε το μοντέλο των 17 μυοκαρδιακών τμημάτων και το κάθε τμήμα εκτιμήθηκε με βάση τη συστολική πάχυνση και την αιμάτωση.Αποτελέσματα: Η μέση ηλικία του πληθυσμού της μελέτης ήταν (60,1 ± 8,5 έτη, 38 άνδρες). Εκτιμηθήκαν 1020 τμήματα σε ηρεμία και στο μέγιστο της φόρτισης. Η ανάλυση της συστολικής πάχυνση σε ηρεμία ήταν εφικτή στο 98% των τμημάτων με το 2D και 97% με το RT3D, ενώ στη μέγιστη φόρτιση τα ποσοστά ήταν 93% και 92% αντίστοιχα. Η εκτίμηση της αιμάτωσης σε ηρεμία ήταν εφικτή στο 97% των τμημάτων με το 2D και 96% με το RT3D. Στο μέγιστο έργο τα αντίστοιχα ποσοστά ήταν 92% και 90%. Αναφορικά με την εκτίμηση της συστολικής πάχυνσης η ευαισθησία και η ειδικότητα του 2D να διαγνώσει ΣΝ ήταν 80% και 82%, ενώ τα αντίστοιχα ποσοστά για το RT3D ήταν 82% και 64%. Σχετικά με την αξιολόγηση της αιμάτωσης, το 2D παρουσίασε 88% ευαισθησία και 64% ειδικότητα, ενώ το RT3D 90% και 73% αντίστοιχα. Η ανάλυση ανά περιοχή αγγείου δεν ανέδειξε στατιστικά σημαντικές διαφορές μεταξύ των δύο μεθόδων για τη μελέτη τόσο των διαταραχών της συστολικής πάχυνσης και όσο της αιμάτωσης των μυοκαρδιακών τοιχωμάτων.Συμπεράσματα: Η τρισδιάστατη δυναμική υπερηχοκαρδιογραφία αντίθεσης με αδενοσίνη είναι μια εφικτή και χρήσιμη τεχνική για την αξιολόγηση των διαταραχών της συστολικής πάχυνσης και της αιμάτωσης των μυοκαρδιακών τμημάτων σε ασθενείς με γνωστή ή πιθανή στεφανιαία νόσο, παρά τα όποια προβλήματα που αφορούν τη χωρική και χρονική διακριτική ικανότητα της μεθόδου

PCSK9 Inhibitors for the Management of Dyslipidemia in People with Type 2 Diabetes: How Low is Too Low?

Diabetic patients are considered to be at high risk for the development of atherosclerotic disease. Management of hypercholesterolemia is of paramount importance to optimize cardiovascular outcomes in this subset of patients and statins are regarded as the mainstay of treatment. However, the recent advent of PCSK-9 inhibitors has provided a useful alternative in the management of dyslipidemia, especially when statins cannot be tolerated or when hypolipidemic targets cannot be achieved. In this review, we discuss current trends in their use, and we focus on their role in the management of diabetic dyslipidemia

Contrast Echocardiography: An Update on Clinical Applications

Contrast echocardiography is considered by many as the Holy Grail for the assessment of heart disease, including coronary artery disease, structural abnormalities and cardiomyopathies. Although contrast agents have been severely criticized at times, they are now officially implemented into an extended variety of clinical applications, as illustrated by the American and European echocardiographic societies published consensus statements. The current review highlights contrast major clinical applications under the light of current literature data