Appraisal of different ultrasonography indices in patients with carotid artery atherosclerosis

In this study a semi-automated image-processing based method was designed in which the parameters such as intima-media thickness (IMT), resistive index (RI), pulsatility index (PI), dicrotic notch index (DNI), and mean wavelet entropy (MWE) were evaluated in B-mode and Doppler ultrasound in patients presenting with carotid artery atherosclerosis. In a cross-sectional design, 144 men were divided into four groups of control, mild, moderate and severe stenosis subjects. In all individuals, far wall IMT, RI, PI, DNI, and MWE of the left common carotid artery (CCA) were extracted using the proposed method. Our findings showed that the maximum far wall IMT, RI, PI, DNI in the CCA were significantly different in the patients with mild, moderate, and severe stenosis compared to control group (p-value 0.05). The proposed method can help physicians to better identify patients at risk of cardiovascular diseases

Predicting the outcome in patients with unexplained syncope and suspected cardiac cause: Role of electrophysiologic studies Kalp nedenli oldu�undan ��phe edilen ve a�ıklanamayan senkoplu bir hastada sonucun kestirilmesi

Objective: Unexplained syncope is a challenge facing electrophysiologists. The prognosis varies widely depending on underlying causes, specially, cardiac ones. We sought to determine the abnormal electrophysiolgic (EP) study results as predictors of prognosis in syncope patients with suspected cardiac cause and risk factors associated with mortality. Methods: A total of 227 consecutive patients with unexplained syncope were prospectively enrolled in this study. EP study was performed in 177 patients in base of inclusion criteria. These patients, in whom a cardiac cause of syncope was suspected, underwent EP study and if negative, head-up tilts test (HUTT). Complete follow-up was obtained for 132 patients for 20.0�10.8 months. Results: A cardiac cause of syncope was established in 35, a neurally mediated syncope in 35.6, and in the rest 29.4 the cause of syncope remained unexplained despite a throughout neurologic and cardiologic evaluation. Logistic analysis revealed that the significant predictors of a cardiac cause of syncope were the absence of prodromal symptoms, left bundle branch block (LBBB), sever left ventricle (LV) dysfunction and male gender. At logistic analysis, the presence of LBBB (OR=6.63; 95 CI: 1.09-40) was significantly associated with outcome of death. Conclusion: The present study provides evidence that presence of LBBB, abnormal EP study result and structural heart disease (SHD) have prognostic value in patients with suspected cardiac cause of syncope. The patients with SHD and unexplained syncope who had a negative EP study have a good long-term prognosis even in the presence of LV dysfunction. � 2015 by Turkish Society of Cardiology

Predicting the outcome in patients with unexplained syncope and suspected cardiac cause: Role of electrophysiologic studies

Objective: Unexplained syncope is a challenge facing electrophysiologists. The prognosis varies widely depending on underlying causes, specially, cardiac ones. We sought to determine the abnormal electrophysiolgic (EP) study results as predictors of prognosis in syncope patients with suspected cardiac cause and risk factors associated with mortality. Methods: A total of 227 consecutive patients with unexplained syncope were prospectively enrolled in this study. EP study was performed in 177 patients in base of inclusion criteria. These patients, in whom a cardiac cause of syncope was suspected, underwent EP study and if negative, head-up tilts test (HUTT). Complete follow-up was obtained for 132 patients for 20.0±10.8 months. Results: A cardiac cause of syncope was established in 35, a neurally mediated syncope in 35.6, and in the rest 29.4 the cause of syncope remained unexplained despite a throughout neurologic and cardiologic evaluation. Logistic analysis revealed that the significant predictors of a cardiac cause of syncope were the absence of prodromal symptoms, left bundle branch block (LBBB), sever left ventricle (LV) dysfunction and male gender. At logistic analysis, the presence of LBBB (OR=6.63; 95 CI: 1.09-40) was significantly associated with outcome of death. Conclusion: The present study provides evidence that presence of LBBB, abnormal EP study result and structural heart disease (SHD) have prognostic value in patients with suspected cardiac cause of syncope. The patients with SHD and unexplained syncope who had a negative EP study have a good long-term prognosis even in the presence of LV dysfunction. © 2015 by Turkish Society of Cardiology

Assessment of subclinical left ventricular dysfunction in patients with chronic mitral regurgitation using torsional parameters described by tissue doppler imaging

Background: Left ventricular (LV) twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR) on the torsional mechanics of the left human ventricle using tissue Doppler imaging. Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI). LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle. Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38 ° ± 4.04 ° vs. 13.95 ° ± 4.27 °; p value = 0.020; and 1.29 ± 0.54 °/cm vs. 1.76 ± 0.56 °/cm; p value = 0.021, respectively), both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (-79.74 ± 35.97 °/s vs.-110.96 ± 34.65 °/s; p value = 0.020), but there was statistically no significant difference in the LV twist rate. Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients

Determination of instantaneous interventricular septum wall thickness by processing sequential 2D echocardiographic images

Non-invasive quantitative analysis of the heart walls thickness is a fundamental step in diagnosis and discrimination of heart disease. Thickness measurements in 2D echocardiographic images have many applications in research and clinic for assessing of wall stress, wall thickening and viability parameters. Regarding to interventricular septum wall thickness measurement by conventional manual method is more dependent on sonographer experiment; this encouraged these researchers to develop a semi-automatic computer algorithm in accessing to interventricular septum segments thickness. We proposed and carried out a computerized algorithm for wall thickness measurements in 2D echocardiographic image frames. In this program, wall thickness measurement is based of intensity profile function and adaptive bilateral thresholding operation. For validation, thicknesses of septum base and mid segments were estimated in constituent image frames with use of proposed method and then were compared with conventional manual results at same images of the cardiac cycle by statistical methods. In our sample image frames (240 corresponding segments; with different rang of image quality), a bias of 0.10 and 0.12 mm with SD differences of ±0.81 and ±0.72 mm and correlation coefficients of 0.87 and 0.89 were found in base and mid segments, respectively. Interobserver variability using the Computer-Assisted Method (CAM) and Conventional Manual Method (CMM) were 4.0 and 4.7 for the basal and 2.8 and 3.9 for the middle segments. The method introduced in the present study permits precise thickness assessment of base and mid segments of the interventricular septum wall and has high concordance with CMM. © 2007 Asian Network for Scientific Information

Assessment of left atrial reservoir function in mitral valve disease by tissue doppler, strain and strain rate imaging

Introduction: Mitral valve stenosis and mitral valve regurgitation still result in significant morbidity and mortality. It has been shown that atrial remodeling and atrial fibrillation may occur in these patients. We sought to investigate how pressure or volume overload in the left atrium could impact atrial deformation properties obtained via Doppler-derived velocity and strain/strain rate imaging. Methods: Thirty-six patients, comprising 17 patients with a diagnosis of moderate to severe mitral stenosis and 19 patients with a diagnosis of moderate to severe mitral regurgitation, were compared with 16 healthy subjects. Two-dimensional, pulse Doppler, and tissue Doppler transthoracic echocardiographic study was performed. Measurement of regional velocity, strain and SR profiles, peak systolic velocity, peak strain, and strain rate was performed in two segments of the four left atrial walls. Results: There was a significant decline in peak systolic velocity in the mitral stenosis patients in both annular and roof segments, but the difference was not statistically significant between the mitral regurgitation patients and the healthy subjects. Total velocity was significantly lower in the mitral stenosis patients than in the healthy subjects, but the difference was not statistically significant between the healthy subjects and the mitral regurgitation patients. Comparison of total strain showed significant differences between the three groups mainly due to a decline in strain in the mitral stenosis patients in comparison with the other two groups. Comparison of total peak systolic strain rate between the groups showed significant differences due to a significant decline in the mitral stenosis group and a non-significant decline in the mitral regurgitation group by comparison with the healthy group. Conclusion: This reduction, especially in strain and strain rate, shows that the reservoir function of the left atrium could be compromised more severely in asymptomatic mitral stenosis patients. © 2014 American Scientific Publishers All rights reserved

State diagrams of the heart – a new approach to describing cardiac mechanics

<p>Abstract</p> <p>Background</p> <p>Cardiac time intervals have been described as a measure of cardiac performance, where prolongation, shortening and delay of the different time intervals have been evaluated as markers of cardiac dysfunction. A relatively recently developed method with improved ability to measure cardiac events is Tissue Doppler Imaging (TDI), allowing accurate measurement of myocardial movements.</p> <p>Methods</p> <p>We propose the state diagram of the heart as a new visualization tool for cardiac time intervals, presenting comparative, normalized data of systolic and diastolic performance, providing a more complete overview of cardiac function. This study aimed to test the feasibility of the state diagram method by presenting examples demonstrating its potential use in the clinical setting and by performing a clinical study, which included a comparison of the state diagram method with established echocardiography methods (E/E' ratio, LVEF and WMSI). The population in the clinical study consisted of seven patients with non ST-elevation myocardial infarction (NSTEMI) and seven control subjects, individually matched according to age and gender. The state diagram of the heart was generated from TDI curves from seven positions in the myocardium, visualizing the inter- and intraventricular function of the heart by displaying the cardiac phases.</p> <p>Results</p> <p>The clinical examples demonstrated that the state diagram allows for an intuitive visualization of pathological patterns as ischemia and dyssynchrony. Further, significant differences in percentage duration between the control group and the NSTEMI group were found in eight of the totally twenty phases (10 phases for each ventricle), e.g. in the transition phases (Pre-Ejection and Post-Ejection). These phases were significantly longer (> 2.18%) for the NSTEMI group than for the control group (p < 0.05). No significant differences between the groups were found for the established echocardiography methods.</p> <p>Conclusion</p> <p>The test results clearly indicate that the state diagram has potential to be an efficient tool for visualization of cardiac dysfunction and for detection of NSTEMI.</p

Vascular deformation in human atherosclerotic carotid artery evaluated by 2D analysis of ultrasonography

Objectives: Common carotid artery (CCA) remodelling in the atherosclerosis process is an inherent necessary element that decreases the progress of significant lumen compromise. The present study used a semi-automated method to assess relationships of intima-media thickness (IMT), lumen diameter (LD) and inter-adventitial diameter (IAD) using ultrasound B-mode images of atherosclerotic carotid artery. Methods: In the cross-sectional study, 120 male subjects (age range: 40�60 years) were classified into four research groups namely control, mild, moderate, and severe stenosis. The maximum near and far wall IMT, mean of both walls� IMT and IAD, and also LD of the left CCA were extracted for all participants. Pearson correlation coefficient was utilized to investigate relationships of IMT, LD, and IAD. Results: Results revealed that the maximum far and near wall IMT, mean of both walls� IMT and IAD in the CCA were significantly different in stenosis patients and the control group (p< 0.001). However, there were no significant differences among the four studied groups in terms of LD of CCA (p = 0.65). There was a stronger correlation between mean of both walls� IMT and IAD in comparison with mean far wall IMT and IAD (p < 0.001). Conclusions: Results indicated that changes of IAD in the left CCA were associated with carotid deformation, and thus it can be considered as a predictor of atherosclerosis process. © The Author(s) 2020

Comparing muscle thickness and function in healthy people and subjects with upper trapezius myofascial pain syndrome using ultrasonography

Background: The reliability of the muscle function using ultrasonography is not reported in patients with myofascial pain syndrome and healthy individuals. The main aim of this study was to compare muscle thickness and function of two matched healthy and patients groups with neck pain due to upper trapezius myofascial pain syndrome. Methods: 40 subjects (20 healthy and 20 patients) participated in this study. Two examiners measured the upper trapezius thickness and function 3 times by ultrasonography independently in the test and retest sessions. Results: There were not significant differences between two groups with respect to demographic characteristics. The ICC values were good to excellent for both measurements. There were no significant differences between the two groups, in terms of upper trapezius muscle thickness in rest (p = 0.63), fair (p = 0.75) and normal (p = 0.73) contractions. On the other hand, rest-thickness fair (p = 0.006), rest-thickness normal (p = 0.006), MVC-thickness (p = 0.02) showed significant differences between two healthy and myofascial pain syndrome groups. Conclusions: Ultrasonography is a reliable technique used to measure muscle thickness and function. Muscle thickness in rest, fair and normal contractions is not different between the matched groups of healthy people and myofascial pain syndrome subjects. Additionally, muscle function is less in myofascial pain syndrome subjects than healthy people specially MVC thickness. © 202

A new 2D-based method for carotid intima-media thickness quantification from ultrasound sequences

Background: Ultrasound measurement of carotid Intima-Media Thickness (IMT) is a suitable method to evaluate subclinical arteriosclerosis. Objectives: The current study aimed to present a new computerized algorithm to detect instantaneous changes of the IMT to Common Carotid Artery (CCA) of IMT in sequential ultrasound images by applying the maximum gradient and the dynamic programming. Patients and Methods: In a cross-sectional design, an examination was performed on thirty healthy human subjects with the mean age of 44 ± 6 years from April 2013 to June 2013 in Beheshti Hospital, Kashan, Iran. In all individuals, the instantaneous changes of the far wall IMT on the CCA were extracted. Local measurements of vessel intensity, intensity gradient, and boundary continuity were extracted for all of the sequential ultrasonic 2D-frames throughout three cardiac cycles. The Pearson correlation coefficients and Bland-Altman analysis were performed to assess the relationship and agreement between IMT measured by the proposed and conventional manual methods. Results: There was no significant difference between the proposed and manual methods with paired t-test analysis (in systole: 0.57 ± 0.10 vs. 0.56 ± 0.10 mm; P = 0.188 and in diastole: 0.63 ± 0.16 vs. 0.62 ± 0.10 mm; P = 0.122 for the manual and proposed methods, respectively). The Pearson correlation coefficients were r = 0.94 and r = 0.93 for IMTs and IMTd, respectively (both P < 0.001). Limit of agreements were narrow and considerable agreement was found between the two methods. Conclusions: The present study demonstrated that the proposed computerized analyzing method can provide accurate measurements of the IMT of the CCA in sequential 2D ultrasonic images. © 2015, Iranian Red Crescent Medical Journal