Comparison of Biventricular Function between Pregnant and Non-Pregnant Women by Conventional and Newer Echocardiographic Indices

Introduction: Pregnancy is a physiological process associated with increased cardiac output, blood volume, decreased systemic vascular resistance and other metabolic changes. The purpose of this study was to evaluate biventricular function between pregnant and non-pregnant women by conventional and newer echocardiographic indices.Methods: Echocardiography was done at the beginning of the second and third trimester for 51 (18-24 GW) pregnant women and age-matched 50 non-pregnant women were included in this study. Patients were assesses based on their sex, age, detailed history, and anthropometric values. Moreover, cardiac investigations including echocardiography and tissue Doppler imaging were performed.Results: The mean age of pregnant women was 27 ± 3, and the non-pregnant woman was 24 ± 4 years. When compared with control during pregnancy left ventricular (LV) end-diastolic volume was increased, and LV ejection fraction was decreased for women in second to third trimester. Right ventricular (RV) function increased significantly (P < 0.05) in the third trimester when compared with control. RV tissue Doppler early diastolic filling wave E’ gradually decreased during pregnancy.Conclusions: During pregnancy, left ventricular ejection fraction & contractility is reduced. The myocardial peak velocity changes occurred throughout pregnancy. Echocardiographic indices of ventricular function were used to detect the changes in cardiac function during both normal and high-risk pregnancy

A TBX5 NONSENSE MUTATION IN SIBLINGS WITH DIVERGENT PHENOTYPES ASSOCIATED WITH ISOLATED SEPTAL DEFECTS

  Objective: Heart septal defects (HSD) account for 50% of the congenital heart malformations and are characterized by the hole in the wall of tissue which separates the heart chambers. The known causes of the SD are multifactorial and complex inheritance.Methods: Isolated 15 subjects with ostium secundum atrial SD (OS-ASD) and one subject with perimembranous ventricular SD (VSD) among 125 clinically diagnosed SD were included in the study. Sanger sequencing was performed for all the exons of TBX5 genes using genomic DNA of these patients.Results: Sequence variation c.444 G>A substitution, leads to the alteration of tryptophan residue into premature stop codon at codon 148. We observed a divergent phenotype within a family of four, where one sibling and the mother had OS-ASD, another sibling had phenotype of perimembranous VSD, and the father had normal genotype.Conclusion: We believe that this novel sequence variant in TBX5 gene is one of the factors in the SD and may hold a key determining the role of TBX5 gene in the heart development

Left Ventricular Torsion Deformation in Atrial Septal Defect Patients Undergoing Transcatheter Device Closure

Introduction: Atrial septal defects (ASD) considered being one of the known congenital heart diseases. ASD causes increased volume overload of the right heart. The purpose of this study was to evaluate left ventricular (LV) torsion deformation in ASD patients undergoing transcatheter device closure.Methods: All adult patients who underwent transcatheter device closure with ostium secundum ASD were included in the study. We assessed LV torsion in ostium secundum ASD patient’s pre and post device closure by using speckle tracking echocardiography.Results: A total of 37 patients (22 females and 15 males) were included in this study. The average age was 28 ± 19 years. LV peak basal rotation improved significantly (P = 0.028) in post transcatheter closure. LV torsion (2.88 ± 0.99˚/cm before vs. 3.40 ± 1.41˚/cm after closure, P = 0.009) and twisting (15.12 ± 4.69˚ before vs. 17.95 ± 6.21˚ after closure, P = 0.005) were statistically significant in post transcatheter closure. Volumetric assessment of LV including end-diastolic volume and systolic volume showed significant improvement (P = 0.02, P < 0.01) post device closure.Conclusions: The increased peak LV twisting and torsion was mainly attributed to the improved peak systolic clockwise rotation after ASD device closure. The LV twisting at a younger age was improved after the closure of ASD

ALTERED ARTERIAL DOPPLER FLOW PATTERN AND PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

ABSTRACTObjectives: Intrauterine growth restriction (IUGR) is one of the common conditions that interfere with the growth of the fetus accounting for 10-15%of pregnant woman. Literature explores a wide range of incidence of perinatal complication including mortality among IUGR pregnancies. Limiteddata available on these complications confined to coastal Karnataka and its association with abnormal arterial Doppler flow pattern. To study theperinatal complications associated with IUGR pregnancies and its prevalence in comparison to healthy controls of comparable gestational age.Methods: This cohort study screened 53 IUGR fetuses by an antenatal scan at gestational age of 27 weeks or more. The diagnosis of IUGR was madeaccording to established criteria from SOGC clinical practice guidelines August 2013. The data also included 48 appropriate for gestational age fetuseswith healthy mothers with the comparable gestational week. Experienced cardiac sonographer and gynecologist performed fetal echocardiography(ECHO) using Vivid 7, GE health-care system ECHO machine with the convex transducer of frequency 1.7-2.4 MHz. The study was conducted at southIndian tertiary care center.Results: This study included 53 IUGR cases and 48 non-IUGR controls. The mean age was 27±4.37 and 26.88±3.14 years in IUGR and non-IUGRgroups, respectively. Fetal Doppler study variables showed a significant decrease in peak aortic velocity and velocity time integral which was notevident on other valves, though mitral antegrade flow during atrial contraction was found to be lower among IUGR group. In two-dimensional chamberquantification of IUGR group revealed significant increase in pulmonary artery dimension, right ventricular (RV) dimension and RV thickness than thecontrol group (p<0.05). The anthropometric parameters such as weight and length; abdomen circumference was significantly lower in IUGR group,whereas head circumference found to be more in IUGR group (p<0.001). The gestational weeks at delivery was significantly different among twogroups with IUGR group depicting the early delivery group. p<0.001(35.58±2.92 and 38.5±0.96 in IUGR and non-IUGR groups, respectively). IUGRgroup also had prolonged neonatal intensive care unit stay when compared to controls (p<0.001).Conclusions: IUGR carries profound course in altered Doppler indices and cardiac function which explore its prediction on mortality and adverseperinatal outcome. This study showed significant perinatal mortality accounting for 5.6% among IUGR cases when compared to normal. Althoughtissue Doppler indices show normal variants, IUGR possesses significant adverse perinatal outcome, however with lesser incidence compared tosevere form of IUGR subsets who show altered tissue annular velocities.Keywords: Intrauterine growth restriction, Echocardiography, Doppler, Perinatal

USE OF TISSUE DOPPLER IMAGING TO DETECT RIGHT VENTRICULAR MYOCARDIAL DYSFUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objective: To determine the utility of tissue Doppler imaging (TDI) in detecting early right ventricle (RV) myocardial dysfunction, given its prognostic implications in patients with chronic obstructive pulmonary disease (COPD).Methods:  A prospective case-control study was carried out involving 36 COPD patients in an acute exacerbated state as cases and 34 healthy subjects serving as controls. Each subject underwent a baseline echocardiography using various methods ranging from m-mode and 2-dimensional measures for analyzing RV geometry to strain and strain rate using Tissue Doppler Imaging to measure RV deformation. The cases underwent a subsequent echocardiogram 1month later once the respiratory symptoms subsided.Results: A significant difference was observed in RV tissue annular velocities ( E', A', S) between cases and the controls at baseline. However no significant increase was observed in tissue annular velocities among cases during remission states from baseline. Peak systolic strain in COPD group was significantly reduced in comparison to controls, but not significantly increased during remission when compared to baseline in cases. FEV1/VC did not bear any significant correlation with RV strain. Tei index had a negative linear correlation with peak systolic strain of RV, which was statistically significant.Conclusion: TDI parameters revealed that RV dysfunction remains unaltered even in remission state of COPD, despite pulmonary arterial pressure normalizing. In light of it bearing a negative prognosis in COPD, RV dysfunction merits assessment in COPD patients, both in acute exacerbations as well as in remission. Â

Novel Hypertrophic Cardiomyopathy Diagnosis Index Using Deep Features and Local Directional Pattern Techniques

Hypertrophic cardiomyopathy (HCM) is a genetic disorder that exhibits a wide spectrum of clinical presentations, including sudden death. Early diagnosis and intervention may avert the latter. Left ventricular hypertrophy on heart imaging is an important diagnostic criterion for HCM, and the most common imaging modality is heart ultrasound (US). The US is operator-dependent, and its interpretation is subject to human error and variability. We proposed an automated computer-aided diagnostic tool to discriminate HCM from healthy subjects on US images. We used a local directional pattern and the ResNet-50 pretrained network to classify heart US images acquired from 62 known HCM patients and 101 healthy subjects. Deep features were ranked using Student's t-test, and the most significant feature (SigFea) was identified. An integrated index derived from the simulation was defined as 100.log(10 )(SigFea /root 2) in each subject, and a diagnostic threshold value was empirically calculated as the mean of the minimum and maximum integrated indices among HCM and healthy subjects, respectively. An integrated index above a threshold of 0.5 separated HCM from healthy subjects with 100% accuracy in our test dataset

Role of Four-Chamber Heart Ultrasound Images in Automatic Assessment of Fetal Heart: A Systematic Understanding

The fetal echocardiogram is useful for monitoring and diagnosing cardiovascular diseases in the fetus in utero. Importantly, it can be used for assessing prenatal congenital heart disease, for which timely intervention can improve the unborn child's outcomes. In this regard, artificial intelligence (AI) can be used for the automatic analysis of fetal heart ultrasound images. This study reviews nondeep and deep learning approaches for assessing the fetal heart using standard four-chamber ultrasound images. The state-of-the-art techniques in the field are described and discussed. The compendium demonstrates the capability of automatic assessment of the fetal heart using AI technology. This work can serve as a resource for research in the field

ANALYSIS OF GENE COPY NUMBER VARIATIONS IN PATIENTS WITH CARDIAC SEPTAL DEFECTS USING MULTIPLEX LIGATION-DEPENDENT PROBE AMPLIFICATION: CNVs analysis in CSDs

Objective: Cardiac septal defects (CSDs), the most common human congenital heart malformations are complex and heterogeneous. Progress in molecular biology has helped to identify many genes responsible for cardiac morphogenesis. However, etiologic factors in familial as well as isolated syndromes are being identified; the root genetic cause still needs to be resolved and its mechanism is yet to be revealed. The objective of this study is to identify DNA copy number variations (CNVs) and their possible association with septal defects. Methods: Multiplex ligation-dependent probe amplification (MLPA) was used to detect DNA copy number in non-syndromic CSDs using the P311-A1 Kit consisting of probes for the key genes, namely, NKX2-5 (NK2 transcription factor related, locus 5), GATA4 (GATA binding protein 4), TBX5 (T-box transcription factor), bone morphogenetic protein 4, and CRELD1 (cysteine rich with EGF-like domains 1). Results: We studied 124 clinically diagnosed CSD subjects, of which 111 (89.5%) had atrial septal defects and 13 (10.5%) had ventricular septal defects. MLPA assay was carried out in all these patients after a thorough clinical and cytogenetic screening. CNVs were identified in 16 (12.9%) cases, of which heterozygous deletions and heterozygous duplications were detected (8 patients each) with apparent phenotypes. Conclusion: MLPA could be a useful assay for the detection of CNVs and to be adopted as the first line of screening in patients with congenital heart diseases

Percutaneous left atrial appendage closure in AF using Amplatzer Cardiac Plug: First single center experience from India

Background: Atrial fibrillation (AF) is one of the most common arrhythmias accounting for significant mortality and morbidity, especially in elderly. Though oral anticoagulation (OAC) is an effective mode of prevention of stroke in patients of AF, bleeding complication remains a major concern. Because of these issues, a significant proportion of patients either does not receive or receive suboptimal doses of OAC. Methods: In such patients, percutaneous left atrial appendage (LAA) closure remains an interesting option. Experience and literature of this procedure from India have been sparse. We report the first single center experience, from India, of percutaneous LAA closure with Amplatzer Cardiac Plug in 10 patients of non-valvular AF. These patients had contraindications for OAC or had high risk of bleeding or labile international normalized ratio (INR) on therapy. Results: We successfully deployed the devices in all of the cases with no major complications perioperatively and on short-term follow-up. We also report a comprehensive review on the technique of percutaneous LAA closure using Amplatzer Cardiac Plug, including some novel modification with our experience of doing percutaneous mitral balloon valvuloplasty

Novel Hypertrophic Cardiomyopathy Diagnosis Index Using Deep Features and Local Directional Pattern Techniques

Hypertrophic cardiomyopathy (HCM) is a genetic disorder that exhibits a wide spectrum of clinical presentations, including sudden death. Early diagnosis and intervention may avert the latter. Left ventricular hypertrophy on heart imaging is an important diagnostic criterion for HCM, and the most common imaging modality is heart ultrasound (US). The US is operator-dependent, and its interpretation is subject to human error and variability. We proposed an automated computer-aided diagnostic tool to discriminate HCM from healthy subjects on US images. We used a local directional pattern and the ResNet-50 pretrained network to classify heart US images acquired from 62 known HCM patients and 101 healthy subjects. Deep features were ranked using Student’s t-test, and the most significant feature (SigFea) was identified. An integrated index derived from the simulation was defined as 100·log10(SigFea/2)  in each subject, and a diagnostic threshold value was empirically calculated as the mean of the minimum and maximum integrated indices among HCM and healthy subjects, respectively. An integrated index above a threshold of 0.5 separated HCM from healthy subjects with 100% accuracy in our test dataset