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Pan JA, Patel AR. The Role of Multimodality Imaging in Cardiomyopathy. Curr Cardiol Rep 2024; 26:689-703. [PMID: 38753290 PMCID: PMC11236518 DOI: 10.1007/s11886-024-02068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW There has been increasing use of multimodality imaging in the evaluation of cardiomyopathies. RECENT FINDINGS Echocardiography, cardiac magnetic resonance (CMR), cardiac nuclear imaging, and cardiac computed tomography (CCT) play an important role in the diagnosis, risk stratification, and management of patients with cardiomyopathies. Echocardiography is essential in the initial assessment of suspected cardiomyopathy, but a multimodality approach can improve diagnostics and management. CMR allows for accurate measurement of volumes and function, and can easily detect unique pathologic structures. In addition, contrast imaging and parametric mapping enable the characterization of tissue features such as scar, edema, infiltration, and deposition. In non-ischemic cardiomyopathies, metabolic and molecular nuclear imaging is used to diagnose rare but life-threatening conditions such amyloidosis and sarcoidosis. There is an expanding use of CCT for planning electrophysiology procedures such as cardioversion, ablations, and device placement. Furthermore, CCT can evaluate for complications associated with advanced heart failure therapies such as cardiac transplant and mechanical support devices. Innovations in multimodality cardiac imaging should lead to increased volumes and better outcomes.
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Affiliation(s)
- Jonathan A Pan
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA
| | - Amit R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA.
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2
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Zoghbi WA, Jone PN, Chamsi-Pasha MA, Chen T, Collins KA, Desai MY, Grayburn P, Groves DW, Hahn RT, Little SH, Kruse E, Sanborn D, Shah SB, Sugeng L, Swaminathan M, Thaden J, Thavendiranathan P, Tsang W, Weir-McCall JR, Gill E. Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2024; 37:2-63. [PMID: 38182282 DOI: 10.1016/j.echo.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation. It replaces the 2009 American Society of Echocardiography guideline on prosthetic valves and complements the 2019 guideline on the evaluation of valvular regurgitation after percutaneous valve repair or replacement.
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Affiliation(s)
- William A Zoghbi
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas.
| | - Pei-Ni Jone
- Lurie Children's Hospital, Northwestern University, Chicago, Illinois
| | | | - Tiffany Chen
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Grayburn
- Baylor Scott & White Health, University of Texas Southwestern, Dallas, Texas
| | - Daniel W Groves
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York
| | - Stephen H Little
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas
| | - Eric Kruse
- University of Chicago Medical Center, Chicago, Illinois
| | | | - Sangeeta B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lissa Sugeng
- North Shore University Hospital, Manhasset, New York
| | - Madhav Swaminathan
- Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University, Durham, North Carolina
| | | | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
| | | | - Edward Gill
- University of Colorado School of Medicine, Aurora, Colorado
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3
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Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 1-imaging before and during device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e1-e32. [PMID: 37861372 DOI: 10.1093/ehjci/jead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).
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Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- Department of Cardiology, University of Baskent, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine Karolinska Institutet AND Cardiovascular Division, Karolinska University Hospital, StockholmSweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
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Hagendorff A, Kandels J, Metze M, Tayal B, Stöbe S. Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases-Possible or Wishful Thinking? Diagnostics (Basel) 2023; 13:1359. [PMID: 37046577 PMCID: PMC10093440 DOI: 10.3390/diagnostics13071359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Joscha Kandels
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Bhupendar Tayal
- Harrington Heart and Vascular Center, Department of Cardiology, University Hospitals, Cleveland, OH 44106, USA;
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
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Muraru D, Baldea SM, Genovese D, Tomaselli M, Heilbron F, Gavazzoni M, Radu N, Sergio C, Baratto C, Perelli F, Curti E, Parati G, Badano LP. Association of outcome with left ventricular volumes and ejection fraction measured with two- and three-dimensional echocardiography in patients referred for routine, clinically indicated studies. Front Cardiovasc Med 2022; 9:1065131. [PMID: 36620642 PMCID: PMC9815115 DOI: 10.3389/fcvm.2022.1065131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives We sought to analyze if left ventricular (LV) volumes and ejection fraction (EF) measured by three-dimensional echocardiography (3DE) have incremental prognostic value over measurements obtained from two-dimensional echocardiography (2DE) in patients referred to a high-volume echocardiography laboratory for routine, clinically-indicated studies. Methods We measured LV volumes and EF using both 2DE and 3DE in 725 consecutive patients (67% men; 59 ± 18 years) with various clinical indications referred for a routine clinical study. Results LV volumes were significantly larger, and EF was lower when measured by 3DE than 2DE. During follow-up (3.6 ± 1.2 years), 111 (15.3%) all-cause deaths and 248 (34.2%) cardiac hospitalizations occurred. Larger LV volumes and lower EF were associated with worse outcome independent of age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart diseases). In stepwise Cox regression analyses, the associations of both death and cardiac hospitalization with clinical data (CD: age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart disease) whose Harrel's C-index (HC) was 0.775, were augmented more by the LV volumes and EF obtained by 3DE than by 2DE parameters. The association of CD with death was not affected by LV end-diastolic volume (EDV) either measured by 2DE or 3DE. Conversely, it was incremented by 3DE LVEF (HC = 0.84, p < 0.001) more than 2DE LVEF (HC = 0.814, p < 0.001). The association of CD with the composite endpoint (HC = 0.64, p = 0.002) was augmented more by 3DE LV EDV (HC = 0.786, p < 0.001), end-systolic volume (HC = 0.801, p < 0.001), and EF (HC = 0.84, p < 0.001) than by the correspondent 2DE parameters (HC = 0.786, HC = 0.796, and 0.84, all p < 0.001) In addition, partition values for mild, moderate and severe reduction of the LVEF measured by 3DE showed a higher discriminative power than those measured by 2DE for cardiac death (Log-Rank: χ2 = 98.3 vs. χ2 = 77.1; p < 0.001). Finally, LV dilation defined according to the 3DE threshold values showed higher discriminatory power and prognostic value for death than when using 2DE reference values (3DE LVEDV: χ2 = 15.9, p < 0.001 vs. χ2 = 10.8, p = 0.001; 3DE LVESV: χ2 = 24.4, p < 0.001 vs. χ2 = 17.4, p = 0.001). Conclusion In patients who underwent routine, clinically-indicated echocardiography, 3DE LVEF and ESV showed stronger association with outcome than the corresponding 2DE parameters.
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Affiliation(s)
- Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sorina Mihaila Baldea
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Davide Genovese
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca’ Foncello Hospital, Treviso, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Noela Radu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Caravita Sergio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Francesco Perelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Emanuele Curti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy,*Correspondence: Luigi P. Badano,
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6
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Muscogiuri G, Volpato V, Cau R, Chiesa M, Saba L, Guglielmo M, Senatieri A, Chierchia G, Pontone G, Dell’Aversana S, Schoepf UJ, Andrews MG, Basile P, Guaricci AI, Marra P, Muraru D, Badano LP, Sironi S. Application of AI in cardiovascular multimodality imaging. Heliyon 2022; 8:e10872. [PMID: 36267381 PMCID: PMC9576885 DOI: 10.1016/j.heliyon.2022.e10872] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/23/2022] [Accepted: 09/27/2022] [Indexed: 12/16/2022] Open
Abstract
Technical advances in artificial intelligence (AI) in cardiac imaging are rapidly improving the reproducibility of this approach and the possibility to reduce time necessary to generate a report. In cardiac computed tomography angiography (CCTA) the main application of AI in clinical practice is focused on detection of stenosis, characterization of coronary plaques, and detection of myocardial ischemia. In cardiac magnetic resonance (CMR) the application of AI is focused on post-processing and particularly on the segmentation of cardiac chambers during late gadolinium enhancement. In echocardiography, the application of AI is focused on segmentation of cardiac chambers and is helpful for valvular function and wall motion abnormalities. The common thread represented by all of these techniques aims to shorten the time of interpretation without loss of information compared to the standard approach. In this review we provide an overview of AI applications in multimodality cardiac imaging.
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Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Italy,School of Medicine, University of Milano-Bicocca, Milan, Italy,Corresponding author.
| | - Valentina Volpato
- Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy,IRCCS Ospedale Galeazzi - Sant'Ambrogio, University Cardiology Department, Milan, Italy
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Cagliari, Italy
| | | | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Cagliari, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, the Netherlands
| | | | | | | | - Serena Dell’Aversana
- Department of Radiology, Ospedale S. Maria Delle Grazie - ASL Napoli 2 Nord, Pozzuoli, Italy
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr., Charleston, SC, USA
| | - Mason G. Andrews
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr., Charleston, SC, USA
| | - Paolo Basile
- University Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Denisa Muraru
- School of Medicine, University of Milano-Bicocca, Milan, Italy,Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luigi P. Badano
- School of Medicine, University of Milano-Bicocca, Milan, Italy,Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Italy,Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
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7
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Barbieri A, Pepi M. Three-Dimensional Echocardiography Based on Automation and Machine Learning Principles and the Renaissance of Cardiac Morphometry. J Clin Med 2022; 11:jcm11154357. [PMID: 35955974 PMCID: PMC9369091 DOI: 10.3390/jcm11154357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Correspondence:
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
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8
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Tomaselli M, Badano LP, Menè R, Gavazzoni M, Heilbron F, Radu N, Caravita S, Baratto C, Oliverio G, Florescu DR, Parati G, Muraru D. Impact of correcting the 2D PISA method on the quantification of functional tricuspid regurgitation severity. Eur Heart J Cardiovasc Imaging 2022; 23:1459-1470. [PMID: 35734964 DOI: 10.1093/ehjci/jeac104] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS In functional tricuspid regurgitation (FTR) patients, tricuspid leaflet tethering and relatively low jet velocity could result in proximal flow geometry distortions that lead to underestimation of TR. Application of correction factors on two-dimensional (2D) proximal isovelocity surface area (PISA) equation may increase its reliability. This study sought to evaluate the impact of the corrected 2D PISA method in quantifying FTR severity. METHODS AND RESULTS In 102 patients with FTR, we compared both conventional and corrected 2D PISA measurements of effective regurgitant orifice area [EROA vs. corrected (EROAc)] and regurgitant volume (RegVol vs. RegVolc) with those obtained by volumetric method (VM) using three-dimensional echocardiography (3DE), as reference. Both EROAc and RegVolc were larger than EROA (0.29 ± 0.26 vs. 0.22 ± 0.21 cm2; P < 0.001) and RegVol (24.5 ± 20 vs. 18.5 ± 14.25 mL; P < 0.001), respectively. Compared with VM, both EROAc and RegVolc resulted more accurate than EROA [bias = -0.04 cm2, limits of agreement (LOA) ± 0.02 cm2 vs. bias = -0.15 cm2, LOA ± 0.31 cm2] and RegVol (bias = -3.29 mL, LOA ± 2.19 mL vs. bias = -10.9 mL, LOA ± 13.5 mL). Using EROAc and RegVolc, 37% of patients were reclassified in higher grades of FTR severity. Corrected 2D PISA method led to a higher concordance of TR severity grade with the VM method (ĸ = 0.84 vs. ĸ = 0.33 for uncorrected PISA, P < 0.001). CONCLUSION Compared with VM by 3DE, the conventional PISA underestimated FTR severity in about 50% of patients. Correction for TV leaflets tethering angle and lower velocity of FTR jet improved 2D PISA accuracy and reclassified more than one-third of the patients.
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Affiliation(s)
- Michele Tomaselli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesca Heilbron
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Noela Radu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giorgio Oliverio
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Diana R Florescu
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy.,University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, P.le Brescia 20, 20149 Milan, Italy
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9
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Christensen J, Landler NE, Olsen FJ, Feldt-Rasmussen B, Hansen D, Kamper AL, Christoffersen C, Ballegaard ELF, Sørensen IMH, Bjergfelt SS, Seidelin E, Bro S, Biering-Sørensen T. Left ventricular structure and function in patients with chronic kidney disease assessed by 3D echocardiography: the CPH-CKD ECHO study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1233-1244. [PMID: 34971417 DOI: 10.1007/s10554-021-02507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease is the leading cause of mortality amongst patients with chronic kidney disease (CKD). This is the first study using 3-dimensional echocardiography (3DE) to investigate associations between adverse changes of the left ventricle, and different stages of CKD. Participants were recruited from the Copenhagen CKD cohort study and the Herlev-Gentofte CKD cohort study. Patients were stratified according to GFR category (G1 + 2: eGFR ≥ 60 mL/min/1.73 m2, G3: eGFR = 30-59 mL/min/1.73 m2, and G4 + 5: eGFR ≤ 29 mL/min/1.73 m2), and according to albuminuria (A1: UACR < 30 mg/g, A2: 30-300 mg/g, A3: > 300 mg/g). Echocardiograms were analysed for left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), and global strain measures. In adjusted analysis, eGFR groups were adjusted for confounders and albuminuria category, while albuminuria groups were adjusted for confounders and GFR category. The study population consisted of 662 outpatients with CKD and 169 controls. Mean age was 57 ± 13 years, and 61% were males. Mean LVEF and global longitudinal strain (GLS) were increasingly impaired across eGFR groups: LVEF = 60.1%, 58.4%, and 57.8% (p = 0.013), GLS = - 16.1%, - 14.8%, and - 14.6% (p < 0.0001) for G1 + 2, G3, and G4 + 5. LVMi and prevalence of LV hypertrophy increased with albuminuria severity: mean LVMi = 87.9 g/m2, 88.1 g/m2, and 92.1 g/m2 (p = 0.007) from A1-3. Adjusted analysis confirmed reduced LVEF in G3 compared with G1 + 2, and increased LVMi in A3 compared with A1. Increasingly impaired eGFR was associated with adverse changes in LV systolic function, while albuminuria was associated with adverse changes in LV mass assessed by 3DE. Their associations were independent of each other.
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Affiliation(s)
- Jacob Christensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark.
| | - Nino Emanuel Landler
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Bo Feldt-Rasmussen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Hansen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Linnea Freese Ballegaard
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ida Maria Hjelm Sørensen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sasha Saurbrey Bjergfelt
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eline Seidelin
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Susanne Bro
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Raftopoulos L, Aggeli C, Dimitroglou Y, Kakiouzi V, Tsartsalis D, Patsourakos D, Tsioufis C. The fundamental role of stress echo in evaluating coronary artery disease in specific patient populations. Curr Vasc Pharmacol 2021; 20:156-167. [PMID: 34931964 DOI: 10.2174/1570161120666211220104156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
Abstract
Stress echocardiography (SE) was initially used for assessing patients with known or suspected coronary heart disease by detecting and evaluating myocardial ischemia and viability. The implementation of SE has gradually been extended to several cardiovascular diseases beyond coronary artery disease, and SE protocols have been modified and adapted for the detection of coronary artery disease (CAD) or other cardiovascular diseases in specific patient populations. This review attempts to summarize current data concerning SE implementation and clinical value in these specific and diverse populations: patients with an intramural course of a coronary artery - known as a myocardial bridge, chronic severe or end-stage hepatic disease, chronic severe or end-stage kidney disease, cardiac allograft vasculopathy, patients scheduled for solid-organ transplantation and other intermediate and high-risk surgery and, finally, patients treated with anticancer drugs or radiotherapy.
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Affiliation(s)
- Leonidas Raftopoulos
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Yannis Dimitroglou
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Vasiliki Kakiouzi
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Tsartsalis
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Patsourakos
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
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11
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Addetia K, Miyoshi T, Amuthan V, Citro R, Daimon M, Fajardo PG, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Zhang Y, Hitschrich N, Blankenhagen M, Degel M, Schreckenberg M, Mor-Avi V, Asch FM, Lang RM. Normal Values of Left Ventricular Size and Function on 3D Echocardiography: Results of the World Alliance of Societies of Echocardiography Study. J Am Soc Echocardiogr 2021; 35:449-459. [PMID: 34920112 DOI: 10.1016/j.echo.2021.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using 2D echocardiography (2DE). Yet, 3D echocardiography (3DE) has been shown to be more accurate and reproducible than 2DE. Current normative reference values for 3D LV analysis are predominantly based on data from North America and Europe. The World Alliance of Societies of Echocardiography (WASE) study was a designed to sample normal subjects from around the world to provide more universal global reference ranges. In this study we sought to assess the world-wide feasibility of LV 3DE and report on size and function measurements. METHODS 2262 healthy subjects were prospectively enrolled from 19 centers in 15 countries. 3D LV full-volume datasets were obtained and analyzed offline with vendor-neutral software. Measurements included end-diastolic and end-systolic volumes (EDV, ESV), ejection fraction (EF), global longitudinal and circumferential strain (GLS and GCS). Results were categorized by age (18-40, 41-65 and >65 years), sex and race. RESULTS 1589 subjects (feasibility 70%) had adequate LV datasets for analysis. Mean normal values for indexed EDV, ESV and EF in men and women were 70 ± 15 and 65 ± 12 mL, 28 ± 7 and 25 ± 6 mL and 60 ± 5, 62 ± 5% respectively. Men had larger LV volumes and lower EF than women. GLS and GCS were higher in magnitude in women. In both sexes, LV volumes were lower and EF tended to be higher with increasing age, especially considering the differences between the youngest and oldest age groups. While GLS was similar across age groups in men, in women, the youngest and middle-age cohorts revealed higher magnitudes of GLS when compared to the oldest age group. GCS was higher in magnitude at older age in both men and women. Finally, Asians had smaller chamber sizes and higher EF and absolute strain values than both blacks and whites. CONCLUSIONS Age, sex, and race should be considered when defining normal reference values for LV dimension and function parameters obtained by 3DE.
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Almeida AG, Carpenter JP, Cameli M, Donal E, Dweck MR, Flachskampf FA, Maceira AM, Muraru D, Neglia D, Pasquet A, Plein S, Gerber BL. Multimodality imaging of myocardial viability: an expert consensus document from the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2021; 22:e97-e125. [PMID: 34097006 DOI: 10.1093/ehjci/jeab053] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
In clinical decision making, myocardial viability is defined as myocardium in acute or chronic coronary artery disease and other conditions with contractile dysfunction but maintained metabolic and electrical function, having the potential to improve dysfunction upon revascularization or other therapy. Several pathophysiological conditions may coexist to explain this phenomenon. Cardiac imaging may allow identification of myocardial viability through different principles, with the purpose of prediction of therapeutic response and selection for treatment. This expert consensus document reviews current insight into the underlying pathophysiology and available methods for assessing viability. In particular the document reviews contemporary viability imaging techniques, including stress echocardiography, single photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and computed tomography and provides clinical recommendations for how to standardize these methods in terms of acquisition and interpretation. Finally, it presents clinical scenarios where viability assessment is clinically useful.
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Affiliation(s)
- Ana G Almeida
- Faculty of Medicine, Lisbon University, University Hospital Santa Maria/CHLN, Portugal
| | - John-Paul Carpenter
- Cardiology Department, University Hospitals Dorset, NHS Foundation Trust, Poole Hospital, Longfleet Road, Poole, Dorset BH15 2JB, United Kingdom
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Erwan Donal
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes 1, Rennes F-35000, France
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, The University of Edinburgh & Edinburgh Heart Centre, Chancellors Building Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Frank A Flachskampf
- Dept. of Med. Sciences, Uppsala University, and Cardiology and Clinical Physiology, Uppsala University Hospital, Akademiska, 751 85 Uppsala, Sweden
| | - Alicia M Maceira
- Cardiovascular Imaging Unit, Ascires Biomedical Group Colon St, 1, Valencia 46004, Spain; Department of Medicine, Health Sciences School, CEU Cardenal Herrera University, Lluís Vives St. 1, 46115 Alfara del Patriarca, Valencia, Spain
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Piazzale Brescia 20, 20149, Milan, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio-Via G. Moruzzi 1, Pisa, Italy
| | - Agnès Pasquet
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, and Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvain, Av Hippocrate 10, B-1200 Brussels, Belgium
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds, Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom
| | - Bernhard L Gerber
- Department of Biomedical Imaging Science, Leeds, Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom
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13
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Abstract
Advanced chronic heart failure (ACHF) is the last phase in the evolution of heart failure and is characterized by high hospitalization and mortality rates and is refractory to medical therapy, therefore requiring more aggressive therapies, such as mechanical circulatory support or heart transplantation. Over the last years, the incidence of ACHF was continuously growing, together with the increase in population survival rates. Therefore, the early recognition of the transition to ACHF is of crucial importance in HF patients, which also helps in prognostication of such patients, since advanced therapeutic options are limited to selected patients and they also have some important risk implications. Echocardiography is the gold standard tool for the evaluation of patients with HF; moreover, the recent technological advances provided new structural and functional indices of the four cardiac chambers that showed to be comparable to advanced imaging or invasive hemodynamic parameters. This allows us to operate an accurate study of ACHF with first- and second-level echocardiographic techniques, which are now being integrated in daily clinical practice. The present review presents an overview of the currently available tools for the echocardiographic examination of patients with ACHF, with its advantages and limitations, based on the latest supporting evidences.
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14
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Dobson R, Ghosh AK, Ky B, Marwick T, Stout M, Harkness A, Steeds R, Robinson S, Oxborough D, Adlam D, Stanway S, Rana B, Ingram T, Ring L, Rosen S, Plummer C, Manisty C, Harbinson M, Sharma V, Pearce K, Lyon AR, Augustine DX. British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab. Echo Res Pract 2021; 8:G1-G18. [PMID: 34106116 PMCID: PMC8052569 DOI: 10.1530/erp-21-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022] Open
Abstract
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor (EGF) receptor (HER) 2-positive targeted treatment (e.g. trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.
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Affiliation(s)
- Rebecca Dobson
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Martin Stout
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Rick Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - David Adlam
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Susannah Stanway
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | - Thomas Ingram
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Liam Ring
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Stuart Rosen
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Chris Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Charlotte Manisty
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Alexander R Lyon
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Daniel X Augustine
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - the British Society of Echocardiography (BSE) and the British Society of Cardio-Oncology (BCOS)
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Baker Heart and Diabetes Institute, Melbourne, Australia
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- North West Anglia Foundation Trust, UK
- Liverpool John Moores University, Liverpool, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Belfast Health and Social Care Trust, Belfast, UK
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
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15
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Dobson R, Ghosh AK, Ky B, Marwick T, Stout M, Harkness A, Steeds R, Robinson S, Oxborough D, Adlam D, Stanway S, Rana B, Ingram T, Ring L, Rosen S, Plummer C, Manisty C, Harbinson M, Sharma V, Pearce K, Lyon AR, Augustine DX. BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab. JACC CardioOncol 2021; 3:1-16. [PMID: 34396303 PMCID: PMC8352267 DOI: 10.1016/j.jaccao.2021.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/06/2023] Open
Abstract
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor receptor (HER) 2-positive targeted treatment (e.g., trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.
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Key Words
- 2D, 2-dimensional
- 3D, 3-dimensional
- A2C, apical 2-chamber
- A3C, apical 3-chamber
- A4C, apical 4-chamber
- BSE, British Society of Echocardiography
- CMR, cardiac magnetic resonance
- CTRCD, cancer therapy–related cardiac dysfunction
- ECG, electrocardiogram
- GLS, global longitudinal strain
- HER2 therapy
- HER2, human epidermal growth factor receptor 2
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MV, mitral valve
- RH, right heart
- ROI, region of interest
- RV, right ventricular
- TDI, tissue Doppler imaging
- TRV, tricuspid regurgitant velocity
- anthracycline
- echocardiography
- guidelines
- imaging
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Affiliation(s)
- Rebecca Dobson
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, United Kingdom
| | - Arjun K. Ghosh
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Martin Stout
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Rick Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - David Adlam
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Susannah Stanway
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Thomas Ingram
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - Liam Ring
- West Suffolk NHS Foundation Trust, Bury St. Edmunds, United Kingdom
| | - Stuart Rosen
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Chris Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Charlotte Manisty
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mark Harbinson
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander R. Lyon
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Daniel X. Augustine
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - British Society of Echocardiography (BSE) and theBritish Society of Cardio-Oncology (BCOS)
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, United Kingdom
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Baker Heart and Diabetes Institute, Melbourne, Australia
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- North West Anglia Foundation Trust, United Kingdom
- Liverpool John Moores University, Liverpool, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
- West Suffolk NHS Foundation Trust, Bury St. Edmunds, United Kingdom
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
- Belfast Health and Social Care Trust, Belfast, United Kingdom
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
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16
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Kamińska H, Małek ŁA, Barczuk-Falęcka M, Werner B. Usefulness of three-dimensional echocardiography for assessment of left and right ventricular volumes in children, verified by cardiac magnetic resonance. Can we overcome the discrepancy? Arch Med Sci 2021; 17:71-83. [PMID: 33488858 PMCID: PMC7811329 DOI: 10.5114/aoms.2019.84215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/05/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The role of three-dimensional echocardiography (3D-ECHO) chamber quantification in children is still underestimated. MATERIAL AND METHODS In 43 children 3D-ECHO measurements of end-diastolic (EDV) and end-systolic ventricular volumes (ESV) were compared to cardiac magnetic resonance (CMR) using Bland-Altman analysis and linear regression. The values of left and right ventricular volumes calculated in 3D-ECHO were compared with each other and verified by CMR. RESULTS The values of LV-EDV and LV-ESV measured in 3D-ECHO showed highly significant correlations with CMR (for LV-EDV r = 0.892, p < 0.00001; for LV-ESV r = 0.896, p < 0.00001). In the case of the right ventricle the correlation of 3D-ECHO results with CMR was still high (RV-EDV r = 0.848, p < 0.00001, RV-ESV r = 0.914, p < 0.00001), although mean RV-EDV and RV-ESV in 3D-ECHO were underestimated compared to CMR (by 38% for RV-EDV and 45% for RV-ESV). Correction of 3D-ECHO results using the coefficient of 1.38 and 1.45 for RV-EDV and RV-ESV, respectively, significantly improved the consistency of the results with CMR. 3D-ECHO offered lower mean values of right ventricular volumes compared to the left ventricle. The discrepancy was again reduced by the calculated coefficients. CONCLUSIONS 3D-ECHO is a valuable tool for assessment of left ventricular volume, which strongly correlates and agrees with CMR. The right ventricular volumes calculated in 3D-ECHO tend to be significantly underestimated in comparison to CMR and corresponding left ventricular volumes obtained from 3D-ECHO. The use of coefficients developed by the study improves the consistency of right ventricular volumes measured by 3D-ECHO with results obtained by CMR and reduces the volumetric discrepancy between ventricles in 3D-ECHO.
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Affiliation(s)
- Halszka Kamińska
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz A. Małek
- Faculty of Rehabilitation, University of Physical Education, Warsaw, Poland
| | | | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
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Hur DJ, Sugeng L. Integration of three-dimensional echocardiography into the modern-day echo laboratory. Echocardiography 2020; 39:985-1000. [PMID: 33305429 DOI: 10.1111/echo.14958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/03/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022] Open
Abstract
Three-dimensional echocardiography (3DE) has emerged in recent decades from a conceptual, research tool to an important, useful imaging technique that can informatively impact daily clinical practice. However, its adoption into the modern-day echo laboratory requires the acknowledgment of its value, coupled with proper leadership, education, and resources to implement and integrate its use with conventional echo techniques. 3DE integration involves important updates regarding equipment and patient selection, assimilation of 3D protocols into current clinical routine, laboratory workflow adaptation, storage, and reporting. This review will provide a practical blueprint and key points of how to integrate 3DE into today's echo laboratory, necessary resources to implement 3D workflow, logistical challenges that remain, and future directions to further improve assimilation of this relevant echo technique into the laboratory.
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Affiliation(s)
- David J Hur
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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18
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Tsuda T, Kernizan D, Del Grippo E, Thacker D, Kharouf R, Srivastava S. Echocardiographic assessment of ventricular function: Conventional and advanced technologies and their clinical applications. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Sawada SG. A Reappraisal of Dobutamine Echocardiography for Risk Stratification before Noncardiac Surgery. J Am Soc Echocardiogr 2020; 33:433-437. [PMID: 32111538 DOI: 10.1016/j.echo.2020.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Stephen G Sawada
- Krannert Institute of Cardiology, Indiana University School of Medicine, IU Health, Indianapolis, Indiana.
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20
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Guta AC, Badano LP, Ochoa-Jimenez RC, Genovese D, Previtero M, Civera S, Ruocco A, Bettella N, Parati G, Muraru D. Three-dimensional echocardiography to assess left ventricular geometry and function. Expert Rev Cardiovasc Ther 2020; 17:801-815. [PMID: 31770493 DOI: 10.1080/14779072.2019.1697234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Quantification of left ventricular (LV) size and function represents the most frequent indication for an echocardiographic study. New echocardiographic techniques have been developed over the last decades in an attempt to provide a more comprehensive, accurate, and reproducible assessment of LV function.Areas covered: Although two-dimensional echocardiography (2DE) is the recommended imaging modality to evaluate the LV, three-dimensional echocardiography (3DE) has proven to be more accurate, by avoiding geometric assumptions about LV geometry, and to have incremental value for outcome prediction in comparison to conventional 2DE. LV shape (sphericity) and mass are actually measured with 3DE. Myocardial deformation analysis using 3DE can early detect subclinical LV dysfunction, before any detectable change in LV ejection fraction.Expert opinion: 3DE eliminates the errors associated with foreshortening and geometric assumptions inherent to 2DE and 3DE measurements approach very closely those obtained by CMR (the current reference modality), while maintaining the unique clinical advantage of a safe, highly cost/effective, portable imaging technique, available to the cardiologist at bedside to translate immediately the echocardiography findings into the clinical decision-making process.
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Affiliation(s)
- Andrada C Guta
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Luigi P Badano
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberto C Ochoa-Jimenez
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Internal Medicine Department, Mount Sinai St Luke's and Mount Sinai West, New York, NY, USA
| | - Davide Genovese
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Marco Previtero
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Stefania Civera
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Alessandro Ruocco
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Natascia Bettella
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Gianfranco Parati
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
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21
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Lang RM, Addetia K, Narang A, Mor-Avi V. 3-Dimensional Echocardiography: Latest Developments and Future Directions. JACC Cardiovasc Imaging 2019; 11:1854-1878. [PMID: 30522687 DOI: 10.1016/j.jcmg.2018.06.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 01/03/2023]
Abstract
The ongoing refinements in 3-dimensional (3D) echocardiography technology continue to expand the scope of this imaging modality in clinical cardiology by offering new features that stem from the ability to image the heart in its complete dimensionality. Over the years, countless publications have described these benefits and tested new frontiers where 3D echocardiographic imaging seemed to offer promising ways to improve patients' care. These include improved techniques for chamber quantification and novel ways to visualize cardiac valves, including 3D printing, virtual reality, and holography. The aims of this review article are to focus on the most important developments in the field in the recent years, discuss the current utility of 3D echocardiography, and highlight several interesting future directions.
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Affiliation(s)
- Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Akhil Narang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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Kitano T, Nabeshima Y, Otsuji Y, Negishi K, Takeuchi M. Accuracy of Left Ventricular Volumes and Ejection Fraction Measurements by Contemporary Three-Dimensional Echocardiography with Semi- and Fully Automated Software: Systematic Review and Meta-Analysis of 1,881 Subjects. J Am Soc Echocardiogr 2019; 32:1105-1115.e5. [DOI: 10.1016/j.echo.2019.04.417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022]
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23
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3D Echo in Routine Clinical Practice – State of the Art in 2019. Heart Lung Circ 2019; 28:1400-1410. [DOI: 10.1016/j.hlc.2019.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/01/2019] [Indexed: 11/19/2022]
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24
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Nolan MT, Thavendiranathan P. Automated Quantification in Echocardiography. JACC Cardiovasc Imaging 2019; 12:1073-1092. [DOI: 10.1016/j.jcmg.2018.11.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
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25
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Aruta P, Muraru D, Guta AC, Mihaila S, Ruozi N, Palermo C, Elnagar B, Iliceto S, Badano LP. Comparison of mitral annulus geometry between patients with ischemic and non-ischemic functional mitral regurgitation: implications for transcatheter mitral valve implantation. Cardiovasc Ultrasound 2018; 16:27. [PMID: 30314517 PMCID: PMC6186037 DOI: 10.1186/s12947-018-0145-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022] Open
Abstract
Background Transcatheter mitral valve replacement (TMVR) is a new therapeutic option for high surgical risk patients with mitral regurgitation (MR). Mitral valve (MV) geometry quantification is of paramount importance for success of the procedure and transthoracic 3D echocardiography represents a useful screening tool. Accordingly, we sought to asses MV geometry in patients with functional MR (FMR) that would potentially benefit of TMVR, focusing on the comparison of mitral annulus (MA) geometry between patients with ischemic (IMR) and non ischemic mitral regurgitation (nIMR). Methods We retrospectively selected 94 patients with severe FMR: 41 (43,6%) with IMR and 53 (56,4%) with nIMR. 3D MA analysis was performed on dedicated transthoracic 3D data sets using a new, commercially-available software package in two moments of the cardiac cycle (early-diastole and mid-systole). We measured MA dimension and geometry parameters, left atrial and left ventricular volumes. Results Maximum (MA area 10.7 ± 2.5 cm2 vs 11.6 ± 2.7 cm2, p > 0.05) and the best fit plane MA area (9.9 ± 2.3 cm2 vs 10.7 ± 2.5 cm2, p > 0.05, respectively) were similar between IMR and nIMR. nIMR patients showed larger mid-systolic 3D area (9.8 ± 2.3 cm2 vs 10.8 ± 2.7 cm2, p < 0.05) and perimeter (11.2 ± 1.3 cm vs 11.8 ± 1.5 cm, p < 0.05) with longer and larger leaflets, and wider aorto-mitral angle (135 ± 10° vs 141 ± 11°, p < 0.05). Conversely, the area of MA at the best fit plane did not differ between IMR and nIMR patients (9 ± 1.1 cm2 vs 9.9 ± 1.5 cm2, p > 0.05). Conclusions Patients with ischemic and non-ischemic etiology of FMR have similar maximum dimension, yet systolic differences between the two groups should be taken into account to tailor prosthesis’s selection. Trial registration N.A.
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Affiliation(s)
- Patrizia Aruta
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Andrada Camelia Guta
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Sorina Mihaila
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Niccolò Ruozi
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Chiara Palermo
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | | | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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The Female Athlete's Heart: Comparison of Cardiac Changes Induced by Different Types of Exercise Training Using 3D Echocardiography. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3561962. [PMID: 29998132 PMCID: PMC5994567 DOI: 10.1155/2018/3561962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/24/2018] [Indexed: 01/01/2023]
Abstract
We aimed to characterize female athlete's heart in elite competitors in the International Federation of Bodybuilding and Fitness (IFBB) Bikini Fitness category and compare them to athletes of a more dynamic sport discipline and healthy, sedentary volunteers using 3D echocardiography. Fifteen elite female fitness athletes were recruited and compared to 15 elite, age-matched female water polo athletes and 15 age-matched healthy, nontrained controls. Using 3D echocardiography, left ventricular (LV) and right ventricular (RV) end-diastolic volume index (EDVi) and LV mass index (LVMi) were measured. Fitness athletes presented similar LV and RV EDVi compared to healthy, sedentary volunteers. Water polo athletes, however, had higher LV and also RV EDVi (fitness versus water polo versus control; LVEDVi: 76 ± 13 versus 84 ± 8 versus 73 ± 8 ml/m2, ANOVA p = 0.045; RVEDVi: 61 ± 12 versus 86 ± 14 versus 55 ± 9 ml/m2, p < 0.0001). LVMi was significantly higher in the athlete groups; the hypertrophy, however, was even more prominent in water polo athletes (78 ± 13 versus 91 ± 10 versus 57 ± 10 g/m2, p < 0.0001). To the best of our knowledge, this is the first study to characterize female athlete's heart of IFBB Bikini Fitness competitors. The predominantly static exercise regime induced a mild, concentric-type LV hypertrophy, while in water polo athletes higher ventricular volumes and eccentric LV hypertrophy developed.
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