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Kandels J, Pawluczuk J, Stöbe S, Hagendorff A. Echocardiographic monitoring of myocardial function in a female patient with right heart Loeffler endocarditis at thrombotic stage after Epstein-Barr-virus infection. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03147-2. [PMID: 38780708 DOI: 10.1007/s10554-024-03147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Transthoracic echocardiography is usually the first non-invasive imaging modality for the detection of Loeffler endocarditis at thrombotic stage. In the recent decade 3D echocardiography and deformation imaging already proved as a helpful tool for the monitoring of left and right ventricular heart disease. CASE PRESENTATION The present case illustrates the diagnostic role of 3D echocardiography and deformation imaging in the acute stage of right sided Loeffler endocarditis in a 70-year-old Western European (German) woman. This case proves that myocardial involvement due to inflammation can be detected at subclinical stages by speckle tracking echocardiography. Acute deterioration of left and right ventricular function and the early response to prednisolone therapy can objectively be monitored. In addition, alterations of effective stroke volume can quantitatively be assessed by 3D right ventricular volumetry with exclusion of thrombus formation in the volume measurements. CONCLUSION This case underlines the importance of 3D echocardiography and deformation imaging as a helpful diagnostic tool in disease management in the acute phase of Loeffler endocarditis at thrombotic stage.
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Affiliation(s)
- Joscha Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, Leipzig, 04103, Germany.
| | - J Pawluczuk
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
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Brandt RR, Stöbe S, Ewers A, Helfen A. Erratum zu: Echokardiographie in der Rhythmologie. Herzschrittmacherther Elektrophysiol 2024; 35:94. [PMID: 38099945 DOI: 10.1007/s00399-023-00984-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Roland R Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Aydan Ewers
- Medizinische Universitätsklinik II - Kardiologie und Angiologie, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland
| | - Andreas Helfen
- Abteilung für Kardiologie, Katholische St. Paulus Gesellschaft, St.-Marien-Hospital Lünen, Altstadtstr. 23, 44534, Lünen, Deutschland
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Hagendorff A, Helfen A, Brandt R, Knebel F, Altiok E, Ewers A, Haghi D, Knierim J, Merke N, Romero-Dorta E, Ruf T, Sinning C, Stöbe S, Ewen S. Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography. Clin Res Cardiol 2024; 113:393-411. [PMID: 37212864 PMCID: PMC10881739 DOI: 10.1007/s00392-023-02227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
The assessment of valvular pathologies in multiple valvular heart disease by echocardiography remains challenging. Data on echocardiographic assessment-especially in patients with combined aortic and mitral regurgitation-are rare in the literature. The proposed integrative approach using semi-quantitative parameters to grade the severity of regurgitation often yields inconsistent findings and results in misinterpretation. Therefore, this proposal aims to focus on a practical systematic echocardiographic analysis to understand the pathophysiology and hemodynamics in patients with combined aortic and mitral regurgitation. The quantitative approach of grading the regurgitant severity of each compound might be helpful in elucidating the scenario in combined aortic and mitral regurgitation. To this end, both the individual regurgitant fraction of each valve and the total regurgitant fraction of both valves must be determined. This work also outlines the methodological issues and limitations of the quantitative approach by echocardiography. Finally, we present a proposal that enables verifiable assessment of regurgitant fractions. The overall interpretation of echocardiographic results includes the symptomatology of patients with combined aortic and mitral regurgitation and the individual treatment options with respect to their individual risk. In summary, a reproducible, verifiable, and transparent in-depth echocardiographic investigation might ensure consistent hemodynamic plausibility of the quantitative results in patients with combined aortic and mitral regurgitation.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - A Helfen
- Department of Cardiology, Kath. St. Paulus Gesellschaft, St-Marien-Hospital Lunen, Altstadtstrasse 23, 44534, Lünen, Germany
| | - R Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2‑8, 61231, Bad Nauheim, Germany
| | - F Knebel
- Klinik Für Innere Medizin II, Kardiologie, Sana Klinikum Lichtenberg, Fanningerstrasse 32, 10365, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Berlin, German Heart Center Charité Berlin, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany
| | - E Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Ewers
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, de La Camp-Platz 1, 44789, Bochum, Germany
| | - D Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis der Universitat Mannheim-Ludwig-Guttmann, Strasse 11, 67071, Ludwigshafen, Germany
| | - J Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Paulinenkrankenhaus Berlin, Klinik Für Innere Medizin Und Kardiologie, Dickensweg 25‑39, 14055, Berlin, Germany
| | - N Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Romero-Dorta
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Berlin, German Heart Center Charité Berlin, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany
| | - T Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - C Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lubeck, Martinistrasse 52, 20251, Hamburg, Germany
| | - S Stöbe
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - S Ewen
- Zentrale Notaufnahme and Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Homburg, Germany
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Kandels J, Richter S, Hagendorff A, Kragholm K, Tayal B, Laufs U, Denecke T, Stöbe S. Comparison of left ventricular deformation abnormalities by echocardiography with cardiac magnetic resonance imaging in patients with acute myocarditis and preserved left ventricular ejection fraction. Front Cardiovasc Med 2024; 10:1322145. [PMID: 38264261 PMCID: PMC10803407 DOI: 10.3389/fcvm.2023.1322145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
Purpose Cardiac magnetic resonance imaging (cMRI) represents the gold standard to detect myocarditis. Left ventricular (LV) deformation imaging provides additional diagnostic options presumably exceeding conventional transthoracic echocardiography (TTE). The present study aimed to analyze the feasibility to detect myocarditis in patients (pts) with preserved LV ejection fraction (LVEF) by TTE compared to cMRI. It has been hypothesized that the number of pathological findings by deformation imaging correspond to findings in cMRI. Methods and results Between January 2018 and February 2020 102 pts with acute myocarditis according to the modified Lake Louise criteria and early gadolinium enhancement (EGE) by cMRI were identified at the department of cardiology at the University Hospital Leipzig. Twenty-six pts were included in this retrospective comparative study based on specific selection criteria. Twelve pts with normal cMRI served as a control group. LV deformation was analyzed by global and regional longitudinal strain (GLS, rLS), global and regional circumferential and radial strain (GCS, rCS, GRS, rRS), and LV rotation (including layer strain analysis). All parameters were compared to findings of edema, inflammation, and fibrosis by cMRI according to Lake Louise criteria. All pts with acute myocarditis diagnosed by cMRI showed pathological findings in TTE. Especially rCS and LV rotation analyzed by regional layer strain exhibit a high concordance with pathological findings in cMRI. In controls no LV deformation abnormalities were documented. Mean values of GLS, GRS, and GCS were not significantly different between pts with acute myocarditis and controls. Conclusion This retrospective analysis documents the feasibility of detecting regional deformation abnormalities by echocardiography in patients with acute myocarditis confirmed by cMRI. The detection of pathological findings due to myocarditis requires the determination of regional deformation parameters, particularly rCS and LV rotation. The assessment of global strain values does not appear to be of critical value.
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Affiliation(s)
- Joscha Kandels
- Department of Cardiology, Leipzig University Hospital, Leipzig, Germany
| | - Sarah Richter
- Department of Internal Medicine I, Martha-Maria Hospital Halle-Dölau, Halle (Saale), Germany
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Ulrich Laufs
- Department of Cardiology, Leipzig University Hospital, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, Leipzig University Hospital, Leipzig, Germany
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Kandels J, Metze M, Hagendorff A, Stöbe S. Prognostic Relevance of Global Myocardial Work Index in Patients with Moderate Aortic Valve Stenosis. J Clin Med 2023; 12:7694. [PMID: 38137763 PMCID: PMC10743712 DOI: 10.3390/jcm12247694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND A reduced global myocardial work index (GWI) ≤ 1951 mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS). However, parameters predicting the outcome in patients with moderate AS are limited. Therefore, the aim of this study was to evaluate the prognostic value of the GWI in patients with moderate AS. METHODS AND RESULTS In this prospective study, 103 patients with moderate AS (mean age 72 ± 10 years; male: 69%) underwent standardized transthoracic echocardiography. The primary endpoint was survival without an aortic valve replacement (AVR). After a median follow-up of 30 ± 5 months, 37 patients (36%) were referred for an AVR. Survival without an AVR was 96% at 12 months and 80% at 30 months (>1951 mmHg%) versus 96% and 68% (≤1951 mmHg%). A GWI ≤ 1951 mmHg% did not predict the need for an AVR (hazard ratio 1.31 (95% CI, 0.63-2.72), p = 0.49). Furthermore, there was no significant correlation between the mean GWI (1644 ± 448 mmHg%) and mean aortic valve pressure gradient (24.2 mmHg ± 6.2, p = 0.615) or effective aortic orifice area (1.24 cm2 ± 0.11, p = 0.678). There was no difference between the AVR and non-AVR groups in the occurrence of clinical symptoms. CONCLUSION In contrast to patients with severe AS, a GWI ≤ 1951 mmHg% did not predict the need for an AVR. Further research is needed to improve the risk stratification in patients with moderate AS.
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Affiliation(s)
- Joscha Kandels
- Correspondence: ; Tel.: +49-341-97-12389; Fax: +49-341-97-12659
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Kandels J, Stöbe S, Kogel A, Hepp P, Riepenhof H, Droste JN, Stoeggl T, Marshall RP, Rudolph U, Laufs U, Fikenzer S, Hagendorff A. Effect of maximum exercise on left ventricular deformation and its correlation with cardiopulmonary exercise capacity in competitive athletes. Echo Res Pract 2023; 10:17. [PMID: 37789500 PMCID: PMC10548575 DOI: 10.1186/s44156-023-00029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Global longitudinal strain (GLS) and global myocardial work index (GWI) allow early detection of subclinical changes in left ventricular (LV) systolic function. The aim of the study was to investigate the immediate effects of maximum physical exercise by different exercise testing methods on early post exercise LV deformation parameters in competitive athletes and to analyze their correlation with cardiopulmonary exercise capacity. METHODS To reach maximum physical exercise, cardiopulmonary exercise testing (CPET) was performed by semi-recumbent ergometer in competitive handball players (n = 13) and by treadmill testing in competitive football players (n = 19). Maximum oxygen uptake (VO2max) indexed to body weight (relative VO2max) was measured in all athletes. Transthoracic echocardiography and blood pressure measurements were performed at rest and 5 min after CPET in all athletes. GLS, GWI and their changes before and after CPET (ΔGLS, ΔGWI) were correlated with (relative) VO2max. RESULTS In handball and football players, GLS and GWI did not differ significantly before and after CPET. There were no significant correlations between GLS and relative VO2max, but moderate correlations were found between ΔGWI and relative VO2max in handball (r = 0.631; P = 0.021) and football players (r = 0.592; P = 0.008). Furthermore, handball (46.7 ml/min*kg ± 4.7 ml/min*kg vs. 37.4 ml/min*kg ± 4.2; P = 0.004) and football players (58.3 ml/min*kg ± 3.7 ml/min*kg vs. 49.7 ml/min*kg ± 6.8; P = 0.002) with an increased ΔGWI after CPET showed a significant higher relative VO2max. CONCLUSION Maximum physical exercise has an immediate effect on LV deformation, irrespective of the used testing method. The correlation of relative VO2max with ΔGWI in the early post exercise period, identifies ΔGWI as an echocardiographic parameter for characterizing the current individual training status of athletes.
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Affiliation(s)
- J Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - A Kogel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - P Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie Und Plastische Chirurgie, Universitätsklinikum, 04103, Leipzig, Germany
| | - H Riepenhof
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Center for Rehabilitation and Sports Medicine, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | - J N Droste
- Center for Rehabilitation and Sports Medicine, BG Klinikum Hamburg, 21033, Hamburg, Germany
- Red Bull Athlete Performance Center, 5303, Salzburg, Austria
| | - T Stoeggl
- Red Bull Athlete Performance Center, 5303, Salzburg, Austria
- Department of Sport and Exercise Science, Universität Salzburg, 5020, Salzburg, Austria
| | - R P Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120, Halle, Germany
| | - U Rudolph
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - U Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - S Fikenzer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Brandt RR, Stöbe S, Ewers A, Helfen A. [Echocardiography in cardiac arrhythmias]. Herzschrittmacherther Elektrophysiol 2023; 34:256-264. [PMID: 37584761 DOI: 10.1007/s00399-023-00956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
Echocardiography plays a key role in planning and guidance of electrophysiological procedures. After exclusion of structural heart disease, echocardiography provides insight into the extent of left atrial remodeling by determining left atrial metrics. This "biomarker" is associated with the risk of new-onset atrial fibrillation and predictive of atrial fibrillation recurrence after ablation. Transesophageal echocardiography is necessary to exclude left atrial thrombi and is able to guide a transseptal puncture. In case of a rare but life-threatening cardiac tamponade, an echocardiographic-guided pericardiocentesis ensures quick and effective treatment. Left ventricular ejection fraction and deformation analysis determined by echocardiography are established methods for risk stratification in patients with systolic dysfunction and used to guide pharmacological and device therapy.
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Affiliation(s)
- Roland R Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Aydan Ewers
- Medizinische Universitätsklinik II - Kardiologie und Angiologie, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland
| | - Andreas Helfen
- Abteilung für Kardiologie, Katholische St. Paulus Gesellschaft, St.-Marien-Hospital Lünen, Altstadtstr. 23, 44534, Lünen, Deutschland
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Kandels J, Metze M, Hagendorff A, Stöbe S. Impact of Aortic Valve Regurgitation on Doppler Echocardiographic Parameters in Patients with Severe Aortic Valve Stenosis. Diagnostics (Basel) 2023; 13:diagnostics13111828. [PMID: 37296679 DOI: 10.3390/diagnostics13111828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/06/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Diagnosing severe aortic stenosis (AS) depends on flow and pressure conditions. It is suspected that concomitant aortic regurgitation (AR) has an impact on the assessment of AS severity. The aim of this study was to analyze the impact of concomitant AR on Doppler-derived guideline criteria. We hypothesized that both transvalvular flow velocity (maxVAV) and the mean pressure gradient (mPGAV) will be affected by AR, whereas the effective orifice area (EOA) and the ratio between maximum velocity of the left ventricular outflow tract and transvalvular flow velocity (maxVLVOT/maxVAV) will not. Furthermore, we hypothesized that EOA (by continuity equation), and the geometric orifice area (GOA) (by planimetry using 3D transesophageal echocardiography, TEE), will not be affected by AR. METHODS AND RESULTS In this retrospective study, 335 patients (mean age 75.9 ± 9.8 years, 44% male) with severe AS (defined by EOA < 1.0 cm2) who underwent a transthoracic and transesophageal echocardiography were analyzed. Patients with a reduced left ventricular ejection fraction (LVEF < 53%) were excluded (n = 97). The remaining 238 patients were divided into four subgroups depending on AR severity, and they were assessed using pressure half time (PHT) method: no, trace, mild (PHT 500-750 ms), and moderate AR (PHT 250-500 ms). maxVAV, mPGAV and maxVLVOT/maxVAV were assessed in all subgroups. Among the four subgroups (no (n = 101), trace (n = 49), mild (n = 61) and moderate AR (n = 27)), no differences were obtained for EOA (no AR: 0.75 cm2 ± 0.15; trace AR: 0.74 cm2 ± 0.14; mild AR: 0.75 cm2 ± 0.14; moderate AR: 0.75 cm2 ± 0.15, p = 0.998) and GOA (no AR: 0.78 cm2 ± 0.20; trace AR: 0.79 cm2 ± 0.15; mild AR: 0.82 cm2 ± 0.19; moderate AR: 0.83 cm2 ± 0.14, p = 0.424). In severe AS with moderate AR, compared with patients without AR, maxVAV (p = 0.005) and mPGAV (p = 0.022) were higher, whereas EOA (p = 0.998) and maxVLVOT/maxVAV (p = 0.243) did not differ. The EOA was smaller than the GOA in AS patients with trace (0.74 cm2 ± 0.14 vs. 0.79 cm2 ± 0.15, p = 0.024), mild (0.75 cm2 ± 0.14 vs. 0.82 cm2 ± 0.19, p = 0.021), and moderate AR (0.75 cm2 ± 0.15 vs. 0.83 cm2 ± 0.14, p = 0.024). In 40 (17%) patients with severe AS, according to an EOA < 1.0 cm2, the GOA was ≥ 1.0 cm2. CONCLUSION In severe AS with moderate AR, the maxVAV and mPGAV are significantly affected by AR, whereas the EOA and maxVLVOT/maxVAV are not. These results highlight the potential risk of overestimating AS severity in combined aortic valve disease by only assessing transvalvular flow velocity and the mean pressure gradient. Furthermore, in cases of borderline EOA, of approximately 1.0 cm2, AS severity should be verified by determining the GOA.
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Affiliation(s)
- Joscha Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Metze M, Stöbe S, Pfeiffer D, Hagendorff A, Laufs U, Lenk K. First case report of the use of two stents following coronary artery obstruction during indirect mitral annuloplasty. ESC Heart Fail 2023. [PMID: 37080951 PMCID: PMC10375092 DOI: 10.1002/ehf2.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
The case of a 71-year-old male with end stage heart failure and severe mitral regurgitation is presented, where percutaneous indirect mitral annuloplasty was performed. During device implantation in the coronary sinus the circumflex artery was compromised at two anatomic locations, while the mitral regurgitation was efficiently reduced. After weighing risks and alternative therapeutic options, stent implantation was chosen as bailout strategy to leave the device in place and retain the efficient MR reduction. The anatomical proximity of Cx and coronary sinus in the mitral valve plane bears the risk of circumflex artery damage during surgical and interventional mitral repair. Usually, a device exchange solves the problem of arterial flow limitation in most cases. While stent implantation remains off label use in this setting and should not be performed without critical evaluation, it has been performed successfully in similar clinical settings as well (e.g. artery stenosis by surgical suture).
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Affiliation(s)
- Michael Metze
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | | | - Andreas Hagendorff
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Karsten Lenk
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Kandels J, Metze M, Hagendorff A, Marshall RP, Hepp P, Laufs U, Stöbe S. The impact of upright posture on left ventricular deformation in athletes. Int J Cardiovasc Imaging 2023; 39:1123-1131. [PMID: 36869240 DOI: 10.1007/s10554-023-02820-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/16/2023] [Indexed: 03/05/2023]
Abstract
Besides LV ejection fraction (LVEF), global longitudinal strain (GLS) and global myocardial work index (GWI) are increasingly important for the echocardiographic assessment of left ventricular (LV) function in athletes. Since exercise testing is frequently performed on a treadmill, we investigated the impact of upright posture on GLS and GWI. In 50 male athletes (mean age 25.7 ± 7.3 years) transthoracic echocardiography (TTE) and simultaneous blood pressure measurements were performed in upright and left lateral position. LVEF (59.7 ± 5.3% vs. 61.1 ± 5.5%; P = 0.197) was not affected by athletes' position, whereas GLS (- 11.9 ± 2.3% vs. - 18.1 ± 2.1%; P < 0.001) and GWI (1284 ± 283 mmHg% vs. 1882 ± 247 mmHg%; P < 0.001) were lower in upright posture. Longitudinal strain was most frequently reduced in upright posture in the mid-basal inferior, and/or posterolateral segments. Upright posture has a significant impact on LV deformation with lower GLS, GWI and regional LV strain in upright position. These findings need to be considered when performing echocardiography in athletes.
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Affiliation(s)
- J Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - R P Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120, Halle, Germany
| | - P Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - U Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Lavall D, Vosshage NH, Geßner R, Stöbe S, Ebel S, Denecke T, Hagendorff A, Laufs U. Native T1 mapping for the diagnosis of cardiac amyloidosis in patients with left ventricular hypertrophy. Clin Res Cardiol 2023; 112:334-342. [PMID: 35355115 PMCID: PMC9998594 DOI: 10.1007/s00392-022-02005-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/03/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) with parametric mapping can improve the characterization of myocardial tissue. We studied the diagnostic value of native T1 mapping to detect cardiac amyloidosis in patients with left ventricular (LV) hypertrophy. METHODS One hundred twenty-five patients with increased LV wall thickness (≥ 12 mm end-diastole) who received clinical CMR in a 3 T scanner between 2017 and 2020 were included. 31 subjects without structural heart disease served as controls. Native T1 was measured as global mean value from 3 LV short axis slices. The study was registered at German clinical trial registry (DRKS00022048). RESULTS Mean age of the patients was 66 ± 14 years, 83% were males. CA was present in 24 patients, 21 patients had hypertrophic cardiomyopathy (HCM), 80 patients suffered from hypertensive heart disease (HHD). Native T1 times were higher in patients with CA (1409 ± 59 ms, p < 0.0001) compared to healthy controls (1225 ± 21 ms), HCM (1266 ± 44 ms) and HHD (1257 ± 41 ms). HCM and HHD patients did not differ in their native T1 times but were increased compared to control (p < 0.01). ROC analysis of native T1 demonstrated an area under the curve for the detection of CA vs. HCM and HHD of 0.9938 (p < 0.0001), which was higher than that of extracellular volume (0.9876) or quantitative late gadolinium enhancement (0.9406; both p < 0.0001). The optimal cut-off value of native T1 to diagnose CA was 1341 ms (sensitivity 100%, specificity 97%). CONCLUSION Non-contrast CMR imaging with native T1 mapping provides high diagnostic accuracy to diagnose cardiac amyloidosis in patients with left ventricular hypertrophy.
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Affiliation(s)
- Daniel Lavall
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Nicola H Vosshage
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Romy Geßner
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian Ebel
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Timm Denecke
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Stöbe S, Kandels J, Metze M, Tayal B, Laufs U, Hagendorff A. Left ventricular hypertrophy, diastolic dysfunction and right ventricular load predict outcome in moderate aortic stenosis. Front Cardiovasc Med 2023; 9:1101493. [PMID: 36704453 PMCID: PMC9871769 DOI: 10.3389/fcvm.2022.1101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Aims Predictors of progression of moderate aortic valve stenosis (AS) are incompletely understood. The objective of this study was to evaluate the prognostic value of left ventricular hypertrophy (LVH), diastolic dysfunction, and right ventricular (RV) load in moderate AS. Methods and results Moderate AS was defined by aortic valve area (AVA), peak transvalvular velocity (Vmax) or mean pressure gradient (PGmean). A total of 131 Patients were divided into two groups according to the number of pathophysiological changes (LVH, diastolic dysfunction with increased LV filling pressures and/or RV load): <2 (group 1); ≥2 (group 2). The primary outcome was survival without aortic valve replacement (AVR). After follow-up of 30 months, the reduction of AVA (-0.06 ± 0.16 vs. -0.24 ± 0.19 cm2, P < 0.001), the increase of PGmean (2.89 ± 6.35 vs 6.29 ± 7.13 mmHg, P < 0.001) and the decrease of the global longitudinal strain (0.8 ± 2.56 vs. 1.57 ± 3.42%, P < 0.001) from baseline to follow-up were significantly more pronounced in group 2. Survival without AVR was 82% (group 1) and 56% (group 2) [HR 3.94 (1.74-8.94), P < 0.001]. Survival without AVR or progression of AS was 77% (group 1) and 46% (group 2) [HR 3.80 (1.84-7.86), P < 0.001]. The presence of ≥2 pathophysiological changes predicted outcome whereas age, comorbidities, LDL-cholesterol did not. Conclusion The presence of ≥2 pathophysiological changes is a strong predictor of outcome in moderate AS and may be useful for risk stratification, particularly for scheduling follow-up time intervals and deciding the timing of AVR.
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Affiliation(s)
- Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany,*Correspondence: Stephan Stöbe,
| | - Joscha Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Bhupendar Tayal
- Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Hagendorff A, Helfen A, Brandt R, Altiok E, Breithardt O, Haghi D, Knierim J, Lavall D, Merke N, Sinning C, Stöbe S, Tschöpe C, Knebel F, Ewen S. Expert proposal to characterize cardiac diseases with normal or preserved left ventricular ejection fraction and symptoms of heart failure by comprehensive echocardiography. Clin Res Cardiol 2023; 112:1-38. [PMID: 35660948 PMCID: PMC9849322 DOI: 10.1007/s00392-022-02041-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/10/2022] [Indexed: 01/22/2023]
Abstract
Currently, the term "heart failure with preserved left ventricular ejection fraction (HFpEF)" is based on echocardiographic parameters and clinical symptoms combined with elevated or normal levels of natriuretic peptides. Thus, "HFpEF" as a diagnosis subsumes multiple pathophysiological entities making a uniform management plan for "HFpEF" impossible. Therefore, a more specific characterization of the underlying cardiac pathologies in patients with preserved ejection fraction and symptoms of heart failure is mandatory. The present proposal seeks to offer practical support by a standardized echocardiographic workflow to characterize specific diagnostic entities associated with "HFpEF". It focuses on morphological and functional cardiac phenotypes characterized by echocardiography in patients with normal or preserved left ventricular ejection fraction (LVEF). The proposal discusses methodological issues to clarify why and when echocardiography is helpful to improve the diagnosis. Thus, the proposal addresses a systematic echocardiographic approach using a feasible algorithm with weighting criteria for interpretation of echocardiographic parameters related to patients with preserved ejection fraction and symptoms of heart failure. The authors consciously do not use the diagnosis "HFpEF" to avoid misunderstandings. Central illustration: Scheme illustrating the characteristic echocardiographic phenotypes and their combinations in patients with "HFpEF" symptoms with respect to the respective cardiac pathology and pathophysiology as well as the underlying typical disease.
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Affiliation(s)
- A. Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - A. Helfen
- Department of Cardiology, Kath. St. Paulus Gesellschaft, St-Marien-Hospital Lünen, Altstadtstrasse 23, 44534 Lünen, Germany
| | - R. Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - E. Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - O. Breithardt
- Klinik für Innere Medizin-Kardiologie and Rhythmologie, Agaplesion Diakonie Kliniken Kassel, Herkulesstrasse 34, 34119 Kassel, Germany
| | - D. Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis der Universität Mannheim-Ludwig-Guttmann, Strasse 11, 67071 Ludwigshafen, Germany
| | - J. Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Paulinenkrankenhaus Berlin, Klinik Für Innere Medizin Und Kardiologie, Dickensweg 25-39, 14055 Berlin, Germany
| | - D. Lavall
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - N. Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20251 Hamburg, Germany
| | - S. Stöbe
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - C. Tschöpe
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,BIH Center for Regenerative Therapies (BCRT), Augustenburger Platz 1, 13353 Berlin, Germany ,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Knebel
- Klinik Für Innere Medizin II, Kardiologie, Sana Klinikum Lichtenberg, Fanningerstrasse 32, 10365 Berlin, Germany ,Department of Cardiology, University of Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - S. Ewen
- Zentrale Notaufnahme and Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse, 66421 Homburg, Germany
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Metze M, Siegemund A, Siegemund T, Klöter T, Stöbe S, Laufs U, Petros S, Pfrepper C. The dose–response of direct oral anticoagulants is non‐linear at plasma levels below 100 ng/ml. Int J Lab Hematol 2022; 45:e60-e63. [PMID: 36539973 DOI: 10.1111/ijlh.14004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Michael Metze
- Department of Cardiology, Medical Department IV University Hospital Leipzig Leipzig Germany
| | | | | | - Tristan Klöter
- Department of Cardiology, Medical Department IV University Hospital Leipzig Leipzig Germany
| | - Stephan Stöbe
- Department of Cardiology, Medical Department IV University Hospital Leipzig Leipzig Germany
| | - Ulrich Laufs
- Department of Cardiology, Medical Department IV University Hospital Leipzig Leipzig Germany
| | - Sirak Petros
- Medical ICU University Hospital Leipzig Leipzig Germany
- Division of Hemostaseology, Medical Department I University Hospital Leipzig Leipzig Germany
| | - Christian Pfrepper
- Division of Hemostaseology, Medical Department I University Hospital Leipzig Leipzig Germany
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16
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Metze M, Ussat M, Stöbe S. [Clinical exam of the unconscious patient]. Dtsch Med Wochenschr 2022; 147:1062-1068. [PMID: 35970188 DOI: 10.1055/a-1804-9420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
In the setting of emergency medicine, the unconscious patient requires a special approach of clinical examination. The patient is mostly unable to communicate and cannot express any complaints. The early identification of life-threatening conditions is of utmost importance. Following the well established ABCDE scheme, we present a short algorithm, which allows the emergency physician to identify the most conditions within a few minutes.
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Bewarder Y, Lauder L, Kulenthiran S, Schäfer O, Ukena C, Percy Marshall R, Hepp P, Laufs U, Stöbe S, Hagendorff A, Böhm M, Mahfoud F, Ewen S. Global longitudinal strain differentiates physiological hypertrophy from maladaptive remodeling. IJC Heart & Vasculature 2022; 40:101044. [PMID: 35573652 PMCID: PMC9096142 DOI: 10.1016/j.ijcha.2022.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/27/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
Aims Differentiation of left ventricular (LV) hypertrophy in healthy athletes from pathological LV hypertrophy in heart disease is often difficult. We explored whether extended echocardiographic measurements such as E/e’ and global longitudinal strain (GLS) distinguish physiologic from maladaptive hypertrophy in hypertrophic cardiomyopathy, excessively trained athletes’ hearts and normal hearts. Methods Seventy-eight professional athletes (cyclists n = 37, soccer players n = 29, handball players n = 21) were compared with patients (n = 88) with pathological LV hypertrophy (hypertrophic obstructive cardiomyopathy (HOCM, n = 17), hypertensive heart disease (HHD, n = 36), severe aortic valve stenosis (AVS, n = 35) and with sedentary healthy individuals as controls (n = 37). Results LV ejection fraction (LVEF) was ≥50% in all patients, athletes (median age 26 years, all male) and the controls (97% male, median age 32 years). LV mass index (LVMI) and septal wall thickness was in normal range in controls, but elevated in cyclists and patients with pathological hypertrophy (p < 0.001 for both). E/e’ was elevated in all patients with maladaptive hypertrophy but normal in controls and athletes (p < 0.001 vs. pathological hypertrophy). Furthermore GLS was reduced in patients with pathological hypertrophy compared with athletes and controls (for both p < 0.001). In subjects with septal wall thickness >11 mm, GLS (≥−18%) has a specificity of 79% to distinguish between physiological and pathological hypertrophy. Conclusion GLS and E/e’ are reliable parameters unlike left ventricular mass or LV ejection fraction to distinguish pathological and physiological hypertrophy.
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Affiliation(s)
- Yvonne Bewarder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- Corresponding author at: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Geb. 41, 66421 Homburg/Saar, Germany.
| | - Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Saarraaken Kulenthiran
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ortwin Schäfer
- Cycling Team Israel Start-Up Nation, 4 Hanechoshet St., 6 Floor, Or Towers, 6971069 Tel Aviv, Israel
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Pierre Hepp
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Ulrich Laufs
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Hagendorff
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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18
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Hagendorff A, Stöbe S. [Functional Diagnostics by Rational Echocardiography]. Dtsch Med Wochenschr 2022; 147:518-527. [PMID: 35468633 DOI: 10.1055/a-1554-8329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Functional diagnostics by rational echocardiography are the base of a verifiable and reliable analysis of ventricular and valvular function. The most important functional parameters in echocardiography are cardiac volumes - especially total and effective left ventricular stroke volume -, global longitudinal strain, effective orifica areas in valvular stenoses and effective regurgitant volumes, regurgitant fraction and regurgitant orifice areas in valvular regurgitations. Standardized documentation and correct measurements are the prerequisites for accurate echocardiographic estimations. In addition, optimization of image quality supports the correctness of measurements to ensure plausibility of hemodynamics in each individual patient. However, measurements of cardiac volumes by planimetry are error-prone. In addition, calculation of the effective orifice areas using the continuity equation needs methodological accuracy and standardization. Finally, assessment of regurgitant volumes, regurgitant fraction, and regurgitant orifice is often inconsistent with stable hemodynamic conditions - especially by functional assessment the 2D-PISA method. Thus, functional diagnostics by echocardiography in valvular heart diseases should focus on a plausible hemodynamic assessment.
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Hagendorff A, Stöbe S. Plausible Functional Diagnostics by Rational Echocardiography in the Assessment of Valvular Heart Disease - Role of Quantitative Echocardiography in the Assessment of Mitral Regurgitation. Front Cardiovasc Med 2022; 9:819915. [PMID: 35433886 PMCID: PMC9008256 DOI: 10.3389/fcvm.2022.819915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/07/2022] [Indexed: 11/21/2022] Open
Abstract
The echocardiographic assessment of valvular heart diseases is the basic analysis of valvular defects next to clinical investigation and stethoscopy. Severity of mitral regurgitation (MR) is usually estimated by an integrated approach using semi quantitative parameters and is still one of the biggest challenges of echocardiography. Quantitative echocardiographic analysis of MR severity often fails to describe comprehensible hemodynamic conditions. However, comprehensive echocardiography based on standardized image acquisition and proper image quality is required to properly assess hemodynamic parameter comparable to cardiac magnetic resonance tomography. This review focuses on the uncertainty of MR severity assessed by echocardiography in recent trials of interventional MR treatment. In addition, the necessity to provide plausible echocardiographic data for individual decision making is highlighted. In conclusion, plausible functional diagnostics by rational echocardiography is a prerequisite in patients with valvular heart diseases.
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Lavall D, Stöbe S. Myocardial Function in Secondary Mitral Regurgitation: A Challenging Relationship. Circ Cardiovasc Imaging 2021; 14:e013350. [PMID: 34521218 DOI: 10.1161/circimaging.121.013350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Lavall
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Germany
| | - Stephan Stöbe
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Germany
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21
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Lavall D, Bruns J, Stegmann T, Hagendorff A, Stöbe S, Laufs U. Long-term clinical and haemodynamic results after transcatheter annuloplasty for secondary mitral regurgitation. ESC Heart Fail 2021; 8:2448-2457. [PMID: 33939295 PMCID: PMC8318490 DOI: 10.1002/ehf2.13383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 01/15/2023] Open
Abstract
AIMS The study sought to investigate the long-term outcome after transcatheter mitral valve annuloplasty for secondary mitral regurgitation (MR). METHODS AND RESULTS Consecutive patients with symptomatic secondary MR undergoing transcatheter mitral valve annuloplasty with the Carillon device at Leipzig University Hospital between 2012 and 2018 were studied prospectively. Left ventricular (LV) function and MR severity were quantified by standardized echocardiography. 33 patients were included. Mean age was 75 ± 10 years, and 20 patients were women. A Society of Thoracic Surgeons score of 8.1 ± 7.2% indicated high-risk status. In 24 patients, MR resulted from LV remodelling and dysfunction, eight suffered from left atrial dilatation, and one patient had MR due to combined primary and secondary aetiology. LV ejection fraction at baseline was (median) 38% [inter-quartile range (IQR) 30-49%]. During the mean follow-up time of 45 ± 20 months, 17 patients died, two patients withdraw consent, and four patients were lost. Of the remaining patients, four were hospitalized for decompensated heart failure. Two of these patients underwent additional transcatheter edge-to-edge mitral valve repair. At follow-up, New York Heart Association (NYHA) functional class improved from 95% in Class III/IV at baseline to 70% in Class I/II with no patients in NYHA Class IV (P < 0.0001). Mitral regurgitant volume was reduced from 27 mL (IQR 25-42 mL) to 8 mL (IQR 3-17 mL) (P = 0.018) and regurgitant fraction from 42% (IQR 34-54%) to 11% (IQR 8-24%) (P = 0.014). LV end-diastolic volume index [92 mL/m2 (IQR 74-107 mL/m2 ) vs. 67 mL/m2 (IQR 46-101 mL/m2 ), P = 0.065] and end-systolic volume index [50 mL/m2 (IQR 44-69 mL/m2 ) vs. 32 mL/m2 (IQR 20-53 mL/m2 ), P = 0.037] decreased. Total stroke volume remained unchanged [38 mL/m2 (IQR 33-43 mL/m2 ) vs. 33 mL/m2 (IQR 26-44 mL/m2 ), P = 0.695], while LV ejection fraction increased [43% (IQR 35-49%) vs. 54% (IQR 46-57%), P = 0.014]. Forward stroke volume, heart rate, and forward cardiac output were not significantly altered. CONCLUSIONS Among high-risk patients undergoing transcatheter mitral valve annuloplasty for symptomatic secondary MR, mortality was ~50% at 4 years. In the surviving patients, reduced MR severity was associated with reduced NYHA functional class, reverse LV remodelling, and improved LV function.
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Affiliation(s)
- Daniel Lavall
- Klinik und Poliklinik für KardiologieUniversitätsklinikum LeipzigLiebigstraße 20Leipzig04103Germany
| | - Julius Bruns
- Klinik und Poliklinik für KardiologieUniversitätsklinikum LeipzigLiebigstraße 20Leipzig04103Germany
| | - Tina Stegmann
- Klinik und Poliklinik für KardiologieUniversitätsklinikum LeipzigLiebigstraße 20Leipzig04103Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für KardiologieUniversitätsklinikum LeipzigLiebigstraße 20Leipzig04103Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für KardiologieUniversitätsklinikum LeipzigLiebigstraße 20Leipzig04103Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für KardiologieUniversitätsklinikum LeipzigLiebigstraße 20Leipzig04103Germany
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Metze M, Klöter T, Stöbe S, Rechenberger B, Siegemund R, Siegemund T, Laufs U, Petros S, Pfrepper C. Plasma levels do not predict thrombin generation in patients taking direct oral anticoagulants. Int J Lab Hematol 2021; 43:1539-1548. [PMID: 34097808 DOI: 10.1111/ijlh.13618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/04/2021] [Accepted: 05/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The antithrombotic effect of direct oral anticoagulants (DOAC) in specific clinical scenarios is difficult to assess. OBJECTIVE This study aimed to evaluate the effect of DOAC on thrombin generation (TG) in relation to their plasma level. METHODS Eighty patients newly started on anticoagulation were included, 20 patients for each DOAC-apixaban, edoxaban, rivaroxaban, and dabigatran. Plasma was sampled before DOAC (baseline), at plasma peak time, 6 and 12 hours after starting DOAC for quantification of drug levels and TG. RESULTS The baseline TG before DOAC intake showed inter-individual variability. All DOACs significantly prolonged lag time (LT) and time to peak (TTP), but did not change endogenous thrombin potential (ETP). Anti-Xa inhibitors but not dabigatran reduced thrombin peak, but the effect of apixaban at plasma peak was less pronounced (factor 1.6). LT and TTP prolongation of dabigatran was lower compared to anti-Xa inhibitors. All DOACs showed a nonlinear dose-response relationship, with the greatest antithrombotic effect at lower DOAC plasma levels. The inhibition of TG parameters between baseline and peak was parallel between individual patients but the coefficient of variation of TG was lower compared to drug levels. CONCLUSION The antithrombotic effect at DOAC peak plasma level measured by TG depends on the patient-specific baseline TG level and the drug-specific inhibition by the particular DOAC. Although peak plasma levels have a high variability, the variation of TG is lower compared to drug levels. Therefore, TG assays may be superior to plasma levels in the assessment of the intensity of anticoagulation.
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Affiliation(s)
- Michael Metze
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Tristan Klöter
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | | | | | | | - Ulrich Laufs
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Sirak Petros
- Medical ICU, University Hospital Leipzig, Leipzig, Germany.,Division of Hemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany
| | - Christian Pfrepper
- Division of Hemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany
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Hagendorff A, Knebel F, Helfen A, Stöbe S, Haghi D, Ruf T, Lavall D, Knierim J, Altiok E, Brandt R, Merke N, Ewen S. Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness. Clin Res Cardiol 2021; 110:1704-1733. [PMID: 33839933 PMCID: PMC8563569 DOI: 10.1007/s00392-021-01841-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/08/2021] [Indexed: 12/28/2022]
Abstract
The echocardiographic assessment of mitral valve regurgitation (MR) by characterizing specific morphological features and grading its severity is still challenging. Analysis of MR etiology is necessary to clarify the underlying pathological mechanism of the valvular defect. Severity of mitral regurgitation is often quantified based on semi-quantitative parameters. However, incongruent findings and/or interpretations of regurgitation severity are frequently observed. This proposal seeks to offer practical support to overcome these obstacles by offering a standardized workflow, an easy means to identify non-severe mitral regurgitation, and by focusing on the quantitative approach with calculation of the individual regurgitant fraction. This work also indicates main methodological problems of semi-quantitative parameters when evaluating MR severity and offers appropriateness criteria for their use. It addresses the diagnostic importance of left-ventricular wall thickness, left-ventricular and left atrial volumes in relation to disease progression, and disease-related complaints to improve interpretation of echocardiographic findings. Finally, it highlights the conditions influencing the MR dynamics during echocardiographic examination. These considerations allow a reproducible, verifiable, and transparent in-depth echocardiographic evaluation of MR patients ensuring consistent haemodynamic plausibility of echocardiographic results.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology, University of Berlin, Charité Universitätsmedizin Berlin, Campus Mitte, Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Helfen
- Department of Cardiology, Katholisches Klinikum Lünen Werne GmbH, St-Marien-Hospital Lünen, Altstadtstrasse 23, 44534, Lünen, Germany
| | - Stephan Stöbe
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Dariush Haghi
- Kardiologische Praxisklinik Ludwigshafen, Akademische Lehrpraxis der Universität Mannheim, Ludwig-Guttmann-Strasse 11, 67071, Ludwigshafen, Germany
| | - Tobias Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Daniel Lavall
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Ertunc Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Roland Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Nicolas Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str, IMED, 66421, Homburg, Germany
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Stöbe S, Tayal B, Tünnemann-Tarr A, Hagendorff A. Dynamics in myocardial deformation as an indirect marker of myocardial involvement in acute myocarditis due to HIV infection: a case report. Eur Heart J Case Rep 2021; 5:ytaa511. [PMID: 33598608 PMCID: PMC7873785 DOI: 10.1093/ehjcr/ytaa511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
Background The diagnosis of acute myocarditis (AM) is often challenging and mainly performed by cardiac magnetic resonance (CMR). Case summary The present case describes echocardiographic findings of a 38-year-old male patient with exertional dyspnoea probably due to myocardial involvement of previously undiagnosed acute human immunodeficiency virus (HIV) infection. Myocardial deformation imaging might be helpful to detect early stages of myocardial dysfunction in patients with AM and/or systemic infectious diseases by documentation of patchy abnormalities of longitudinal, circumferential and rotational left ventricular (LV) deformation. Discussion CMR still represents the gold standard to diagnose AM, which has been confirmed by myocardial oedema and hyperaemia in the present case. However, speckle tracking echocardiography seems to be useful to detect myocardial involvement in HIV infection by dynamic alterations of different components of LV deformation. This was documented by comparing echocardiographic findings at the acute stage of HIV infection to findings at follow-ups during antiviral treatment. The diagnostic option to detect myocardial involvement by deformation imaging in a patient with HIV infection is described for the first time.
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Affiliation(s)
- Stephan Stöbe
- Department of Cardiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Adrienn Tünnemann-Tarr
- Department of Cardiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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25
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Stöbe S, Hagendorff A, Gutberlet M, Tayal B. Myocardial Work: A Modern Tool to Detect Possible Compensation Mechanism of Deformation in Acute Myocarditis with Preserved Left Ventricular Function. J Cardiovasc Echogr 2021; 30:206-210. [PMID: 33828942 PMCID: PMC8021083 DOI: 10.4103/jcecho.jcecho_48_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/14/2020] [Accepted: 10/18/2020] [Indexed: 01/22/2023] Open
Abstract
The architecture of the myocardial fibers defines the different components of left ventricular (LV) contraction. Subendocardial layers are primarily responsible for longitudinal LV deformation and subepicardial layers for circumferential LV deformation. The specific analysis of the different components of LV deformation by echocardiography might offer new diagnostic options in patients with acute myocarditis (?IM). This case report focuses on specific pathological findings of regional LV deformation in a patient with IM and preserved LV systolic function.
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Affiliation(s)
- Stephan Stöbe
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | | | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Platz MR, Stöbe S, Baum P, Metze M. Case report: isolated pulmonary valve endocarditis in a 39-year-old patient with intravenous drug abuse. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33442654 PMCID: PMC7793195 DOI: 10.1093/ehjcr/ytaa442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/23/2020] [Accepted: 10/30/2020] [Indexed: 12/05/2022]
Abstract
Background Isolated pulmonary valve endocarditis is a very rare form of right-sided infective endocarditis. Due to the anatomy, in most cases, just the tricuspid valve is involved. Diagnosis can be challenging because of non-specific symptoms (fever, dyspnoea, haemoptysis, and pleuritic chest pain) and difficulty of detection by echocardiography. Risk factors include intravenous drug abuse, congenital heart disorders, alcohol abuse, male sex and central venous catheters, or pacemaker leads. Case summary A 39-year-old homeless male patient, who was a current intravenous drug user, presented with fever, dyspnoea, and haemoptysis. The chest X-ray showed bilateral infiltrates. Empiric antibiotic treatment was initiated. Blood cultures showed the presence of Streptococcus dysgalactiae. Atypical causes of pneumonia were excluded. Systemic embolism was suspected, and a computed tomography scan of brain, thorax, and abdomen was performed. Multiple septic embolic lesions were detected in both lungs. Echocardiography revealed an isolated pulmonary valve endocarditis. Penicillin G and gentamycin were administered intravenously for a duration of 6 and 2 weeks, respectively. The patient was discharged in stable condition but did not return for outpatient clinical appointments. Discussion To detect rare causes of right-sided infective endocarditis, repeated echocardiograms with special focus on the pulmonary valve may be required. Usually, antibiotic treatment alone leads to recovery. In special situations (heart failure, septic shock, or large vegetation size) surgery is required. Due to the high risk of postoperative complications, surgery in intravenous drug users should be avoided if possible.
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Affiliation(s)
- Martin Richard Platz
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Paul Baum
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Polito MV, Hagendorff A, Citro R, Prota C, Silverio A, De Angelis E, Klingel K, Metze M, Stöbe S, Hoffmann KT, Sabri O, Piscione F, Galasso G. Loeffler's Endocarditis: An Integrated Multimodality Approach. J Am Soc Echocardiogr 2020; 33:1427-1441. [PMID: 33129649 DOI: 10.1016/j.echo.2020.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/09/2023]
Abstract
Loeffler's endocarditis (LE) is the cardiac manifestation of hypereosinophilic syndrome, a rare systemic disease characterized by the sustained production of eosinophils leading to organ damage. Few data, principally by case reports, are available regarding the diagnostic workup in patients with suspected LE. Thus, we have performed a systematic search of the literature dealing with imaging in LE and propose an integrated multimodality imaging approach in the cardiac diagnostics of LE patients. The aim is to provide an updated state-of-the-art review focused on noninvasive and invasive imaging modalities for this rare and underdiagnosed disease. Standard and advanced echocardiography are typically the first cardiac imaging examinations when LE is suspected and they are also used later in follow-up for prognostic stratification and assessing response to treatment. Cardiac magnetic resonance provides a more detailed anatomical and functional evaluation of cardiac chambers, tissue characterization for the presence and extension of myocardial edema and fibrosis, and ventricular thrombi identification. Computed tomography scan and [18F]-fluoro-deoxy-glucose positron emission tomography may be helpful in selected cases to evaluate the cardiac involvement of LE as well as the other noncardiac manifestations of hypereosinophilic syndrome. Endomyocardial biopsy may be considered in patients with high clinical suspicion of LE if noninvasive imaging findings are confusing or not conclusive. The appropriate use of invasive and noninvasive imaging modalities, combining the available techniques with the patients' clinical features, will hopefully lead to early diagnosis, more accurate staging of disease, and timely treatment of LE that may prevent the irreversible myocardial damage of LE and adverse cardiovascular events.
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Affiliation(s)
- Maria Vincenza Polito
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
| | | | - Rodolfo Citro
- Department of Cardiology, A.O.U. "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Costantina Prota
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Elena De Angelis
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Federico Piscione
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Gennaro Galasso
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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Döbel T, Stöbe S, Marshall RP, Hepp P, Fikenzer S, Fikenzer K, Tautenhahn S, Laufs U, Hagendorff A. Possible new options and benefits to detect myocarditis, right ventricular remodeling and coronary anomalies by echocardiography in systematic preparticipation screening of athletes. Int J Cardiovasc Imaging 2020; 36:1855-1885. [PMID: 32462448 PMCID: PMC7497512 DOI: 10.1007/s10554-020-01899-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/21/2020] [Indexed: 01/27/2023]
Abstract
Exclusion of cardiac abnormalities should be performed at the beginning of the athlete's career. Myocarditis, right ventricular remodeling and coronary anomalies are well-known causes of life-threatening events of athletes, major cardiovascular events and sudden cardiac death. The feasibility of an extended comprehensive echocardiographic protocol for the detection of structural cardiac abnormalities in athletes should be tested. This standardized protocol of transthoracic echocardiography includes two- and three-dimensional imaging, tissue Doppler imaging, and coronary artery scanning. Post processing was performed for deformation analysis of all compounds including layer strain. During 2017 and 2018, the feasibility of successful image acquisition and post processing analysis was retrospectively analyzed in 54 male elite athletes. In addition, noticeable findings inside the analyzed cohort are described. The extended image acquisition and data analyzing was feasible from 74 to 100%, depending on the used modalities. One case of myocarditis was detected in the present cohort. Coronary anomalies were not found. Right ventricular size and function were within normal ranges. Isovolumetric right ventricular relaxation time showed significant regional differences. One case of hypertrophic cardiomyopathy and two subjects with bicuspid aortic valves were found. Due to the excessive cardiac stress in highly competitive sports, high-quality and precise screening modalities are necessary, especially with respect to acquired cardiac diseases like acute myocarditis and pathological changes of left ventricular and RV geometry. The documented feasibility of the proposed extended protocol underlines the suitability to detect distinct morphological and functional cardiac alterations and documents the potential added value of a comprehensive echocardiography.
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Affiliation(s)
- Tom Döbel
- University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany.
| | - Stephan Stöbe
- University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | | | - Pierre Hepp
- Department of Orthopedics, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Sven Fikenzer
- University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Kati Fikenzer
- University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Sandra Tautenhahn
- University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Ulrich Laufs
- University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Andreas Hagendorff
- University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
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Hagendorff A, Knebel F, Helfen A, Stöbe S, Doenst T, Falk V. Disproportionate mitral regurgitation: another myth? A critical appraisal of echocardiographic assessment of functional mitral regurgitation. Int J Cardiovasc Imaging 2020; 37:183-196. [PMID: 32851501 PMCID: PMC7878255 DOI: 10.1007/s10554-020-01975-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
The contradictory findings of recent prospective randomized controlled trials assessing the impact of percutaneous edge-to-edge repair in patients with functional or secondary mitral regurgitation have triggered a lively discussion about an “integrated” echocardiographic approach for grading severity of mitral regurgitation. In the MITRA-FR trial, the COAPT trial and the REDUCE-FMR trial echocardiographic assessment of the severity of mitral regurgitation was consistent with principles set forth by the current echocardiographic guidelines and analysed in its best settings by expert international leaders in the field of echocardiography. However, serious inconsistencies appeared in the presented echocardiographic assessments regarding cardiac output and regurgitant fraction. A new term “disproportionate functional mitral regurgitation” was introduced describing a situation where the increase of effective regurgitant orifice area exceeds the enlargement of the left ventricular end-diastolic volumes. Further discussion resulted in the idea of a “new conceptional framework” for distinguishing “proportionate” and “disproportionate” functional mitral regurgitation. The aim of this viewpoint is to dispute conclusions based on the term “disproportionate” mitral regurgitation. A “disproportionate” FMR is highly questionable because disproportionateness of flow in communication vessels cannot exist. In addition, a proposal of echocardiographic assessment based on a conventional comprehensive transthoracic echocardiography is given to avoid obvious hemodynamic contradictions.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Leipzig, Germany.
- Department of Cardiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology, University of Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Speaker of the Working Group "Cardiovascular Ultrasound" of the German Society of Cardiology, Düsseldorf, Germany
| | - Andreas Helfen
- Department of Cardiology, St. Marien Hospital Lünen, Lünen, Germany
- Co-Speaker of the Working Group "Cardiovascular Ultrasound" of the German Society of Cardiology, Düsseldorf, Germany
| | - Stephan Stöbe
- Department of Cardiology, University of Leipzig, Leipzig, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, University of Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Health Science and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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30
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Stöbe S, Richter S, Seige M, Stehr S, Laufs U, Hagendorff A. Echocardiographic characteristics of patients with SARS-CoV-2 infection. Clin Res Cardiol 2020; 109:1549-1566. [PMID: 32803387 PMCID: PMC7428201 DOI: 10.1007/s00392-020-01727-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 12/25/2022]
Abstract
Background Myocardial involvement induced by SARS-CoV-2 infection might be important for long-term prognosis. The aim of this observational study was to characterize the myocardial effects during SARS-CoV-2 infections by echocardiography. Results and methods An extended echocardiographic image acquisition protocol was performed in 18 patients with SARS-CoV-2 infection assessing LV longitudinal, radial, and circumferential deformation including rotation, twist, and untwisting. Furthermore, LV deformation was analyzed in an age-matched control group of healthy individuals (n = 20). The most prevalent finding was a reduced longitudinal strain observed predominantly in more than one basal LV segment (n = 10/14 patients, 71%). This pattern reminded of a “reverse tako-tsubo” morphology that is not typical for other viral myocarditis. Additional findings included a biphasic pattern with maximum post-systolic or negative regional radial strain predominantly basal (n = 5/14 patients, 36%); the absence or dispersion of basal LV rotation (n = 6/14 patients, 43%); a reduced or positive regional circumferential strain in more than one segment (n = 7/14 patients, 50%); a net rotation showing late post-systolic twist or biphasic pattern (n = 8/14 patients, 57%); a net rotation showing polyphasic pattern and/or higher maximum net values during diastole (n = 8/14 patients, 57%). Conclusion Myocardial involvement due to SARS-CoV-2-infection was highly prevalent in the present cohort—even in patients with mild symptoms. It appears to be characterized by specific speckle tracking deformation abnormalities in the basal LV segments. These data set the stage to prospectively test whether these parameters are helpful for risk stratification and for the long-term follow-up of these patients.
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Affiliation(s)
- Stephan Stöbe
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Sarah Richter
- Department of Internal Medicine I, Martha-Maria Hospital Halle-Dölau, Röntgenstr. 1, 06129, Halle (Saale), Germany
| | - Markus Seige
- Department of Internal Medicine I, Martha-Maria Hospital Halle-Dölau, Röntgenstr. 1, 06129, Halle (Saale), Germany
| | - Sebastian Stehr
- Department of Anesthesiology and Intensive Care, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Ulrich Laufs
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
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Tünnemann-Tarr A, Stöbe S, Laufs U, Hagendorff A, Tayal B. Speckle tracking echocardiography in a patient with viral myocarditis and acute myocardial infarction. J Cardiol Cases 2020; 22:184-191. [PMID: 33014202 DOI: 10.1016/j.jccase.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022] Open
Abstract
The present case of a patient with acute myocarditis with preserved left ventricular (LV) ejection fraction at the acute stage illustrates the obvious impairment of circumferential and rotational deformation, which can be documented by speckle tracking echocardiography. Thus, qualitative patterns of LV twist, radial strain, and circumferential layer strain, might be a new approach to detect acute myocarditis. The early diagnosis of acute myocarditis by echocardiography is important because of the considerable risk of cardiovascular morbidity as documented by the occurrence of an acute myocardial infarction presumably induced by inflammatory process in this case. <Learning objective: The compound of myocardial deformations caused by left ventricular subendomyocardial and subepimyocardial fibers may be a crucial diagnostic target in cardiac diseases. The predominant involvement of viral myocarditis of the outer myocardial layers might induce impairment of circumferential and rotational deformation, which can potentially serve as a new diagnostic key by echocardiography. In contrast, left ventricular ejection fraction and longitudinal deformation are often observed within normal ranges in patients with acute myocarditis. Acute myocardial infarction as a major cardiac event in acute stage of myocarditis causes completely different deformation patterns, mainly by the predominant involvement of the inner myocardial layers inducing severe pathologies of territorial longitudinal deformation. Patients with suspected acute myocarditis and abnormal findings of circumferential and rotational deformation should undergo additional diagnostic procedures as cardiac magnetic resonance and myocardial biopsy to confirm the diagnosis.>.
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Affiliation(s)
| | - Stephan Stöbe
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Stöbe S, Kreyer K, Jurisch D, Pfeiffer D, Lavall D, Farese G, Laufs U, Hagendorff A. Echocardiographic analysis of acute effects of percutaneous mitral annuloplasty on severity of secondary mitral regurgitation. ESC Heart Fail 2020; 7:1645-1652. [PMID: 32358886 PMCID: PMC7373905 DOI: 10.1002/ehf2.12719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/27/2020] [Accepted: 03/31/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Percutaneous mitral annuloplasty (PMA) represents a new treatment option for secondary mitral regurgitation (SMR) being associated with higher morbidity and mortality. The present study was aimed to evaluate whether or not acute effects on SMR severity can quantitatively be assessed after PMA. METHODS AND RESULTS PMA was performed in 30 patients (mean age 76 ± 9; 37% males) with moderate (n = 14) or severe (n = 16) SMR. Vena contracta (VC), left ventricular (LV) velocity-time-integral ratio (VTIMV/LVOT ), effective regurgitant orifice area (EROA) by two-dimensional proximal isovelocity surface area (PISA), regurgitant volume (RVolPISA ) and regurgitant fraction (RFPISA ) by PISA, RVolvolume and RFvolume by LV volume analyses, and parameters describing LV morphology, function, and cardiac performance were assessed by transthoracic echocardiography prior to and after PMA. According to RFPISA /RFvolume , 14 patients showed mild, 15 moderate, and 1 severe SMR after PMA. Mean RF, RVol, EROA, VC, and VTIMV/LVOT were lower directly after PMA (RFPISA : 49% ± 11 vs. 34% ± 13, P < 0.001; RFvolume : 46% ± 10 vs. 34% ± 13, P < 0.001; RVolPISA : 33 mL ± 13 vs. 25 mL ± 12, P < 0.001; RVolvolume : 28 mL ± 17 vs. 20 mL ± 14, P < 0.05; EROAPISA : 0.24 cm2 ± 0.1 vs. 0.19 cm2 ± 0.1, P < 0.05; VC: 5.2 ± 0.1 vs. 4.1 ± 0.2, P < 0.001; VTIMV/LVOT : 1.9 ± 0.4 vs. 1.6 ± 0.5, P < 0.05). Parameters of LV morphology, function, and cardiac performance did not change directly after PMA. CONCLUSIONS PMA leads to a reduction of MR severity in >80% of SMR patients. Acute effects of PMA can quantitatively be assessed by transthoracic echocardiography.
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Affiliation(s)
- Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Kristin Kreyer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Daniel Jurisch
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Dietrich Pfeiffer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Daniel Lavall
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Gerardo Farese
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzsig, Liebigstr. 20, Leipzig, 04103, Germany
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Metze M, Pfrepper C, Klöter T, Stöbe S, Siegemund R, Siegemund T, Edel E, Laufs U, Petros S. Inhibition of thrombin generation 12 hours after intake of direct oral anticoagulants. Res Pract Thromb Haemost 2020; 4:610-618. [PMID: 32548560 PMCID: PMC7292666 DOI: 10.1002/rth2.12332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/12/2020] [Accepted: 02/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The residual antithrombotic activity 12 hours after intake of direct oral anticoagulants (DOACs) is of clinical relevance in the setting of bleeding or urgent surgery. OBJECTIVE To evaluate the effects of DOACs on thrombin generation 12 hours after DOAC intake in comparison to baseline and a healthy control group. METHODS Eighty patients were recruited, 20 patients for each approved DOAC: apixaban, edoxaban, rivaroxaban, and dabigatran. The patients were either to be put on anticoagulation for the first time or had stopped taking oral anticoagulation for at least 48 hours. Blood plasma was sampled before (baseline) and 12 hours after starting DOAC for quantification of drug levels and thrombin generation assayed using an automated system (ST Genesia). Sixty-one blood donors served as control group. RESULTS The factor Xa inhibitors significantly increased lag time (137%-219%) and reduced thrombin peak (47%-76%) and velocity index (17%-44%) after 12 hours compared to baseline. Dabigatran showed prolongation of lag time to 133% and time to peak to 119%. All patients had residual antithrombotic activity, with reduced thrombin generation parameters 12 hours after DOAC intake compared to baseline and to the healthy control group. This effect remained significant in patients with low residual DOAC plasma levels <50 ng/mL. CONCLUSION Thrombin generation remains reduced 12 hours after DOAC intake. While thrombin peak is particularly modified by factor Xa inhibitors, all DOACs prolong the lag time and time to thrombin peak. In the setting of bleeding or urgent surgery, the automated thrombin generation assay may assist in decision making and antidote administration.
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Affiliation(s)
- Michael Metze
- Department of CardiologyMedical Department IVUniversity Hospital LeipzigLeipzigGermany
| | - Christian Pfrepper
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
| | - Tristan Klöter
- Department of CardiologyMedical Department IVUniversity Hospital LeipzigLeipzigGermany
| | - Stephan Stöbe
- Department of CardiologyMedical Department IVUniversity Hospital LeipzigLeipzigGermany
| | - Roland Siegemund
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
| | - Thomas Siegemund
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
| | - Elvira Edel
- Institute of Transfusion MedicineUniversity Hospital LeipzigLeipzigGermany
| | - Ulrich Laufs
- Department of CardiologyMedical Department IVUniversity Hospital LeipzigLeipzigGermany
| | - Sirak Petros
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
- Medical ICUUniversity Hospital LeipzigLeipzigGermany
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Abstract
ZusammenfassungDie Stress-Echokardiografie ist wegen der verschiedenen Modalitäten (dynamische und pharmakologische Stress-Echokardiografie) eine komplexe Thematik. Bei der Auswahl der besten diagnostischen Möglichkeit spielen vor allem Schallbarkeit und Komorbiditäten des Patienten/der Patientin eine wesentliche Rolle. Für die Durchführung einer Stress-Echokardiografie müssen, neben einer adäquaten Ultraschall-Geräteausstattung, die technischen und personellen Anforderungen zur Behandlung von Akutkomplikationen bis hin zur Reanimation berücksichtigt werden. Der Untersucher muss in allen Bereichen der transthorakalen Echokardiografie ausgebildet sein und ein ausreichendes Training im Bereich der Stress-Echokardiografie absolviert haben. Dies umfasst Kenntnisse über Indikationen, Kontraindikationen und Abbruchkriterien einer Stress-Echokardiografie, die Bildakquisition unter erschwerten Bedingungen sowie die Optimierung und Auswertung des akquirierten Bildmaterials. Hauptindikationen stellen die Ischämie- und Vitalitätsdiagnostik dar, gefolgt von Indikationen zur spezifischen Abklärung von Kardiomyopathien und Herzklappenerkrankungen. Grundvoraussetzung für eine zielführende kardiologische Diagnostik stellt dabei die Planung der zu verwendenden Stressprotokolle in Abhängigkeit der jeweiligen klinischen Fragestellung dar. Die diagnostische und prognostische Aussagekraft der Stress-Echokardiografie ist hoch, wobei gerade in der Stress-Echokardiografie hohe Anforderungen an die praktischen Fähigkeiten und klinische Erfahrung des Untersuchers gestellt werden.
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Affiliation(s)
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig
| | - Martin Neef
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig
| | - Daniel Jurisch
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig
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Lavall D, Kuprat LK, Kandels J, Stöbe S, Hagendorff A, Laufs U. Left ventricular mechanical dispersion in flow-gradient patterns of severe aortic stenosis with narrow QRS complex. Int J Cardiovasc Imaging 2020; 36:605-614. [PMID: 31933102 PMCID: PMC7125243 DOI: 10.1007/s10554-019-01754-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/17/2019] [Indexed: 01/10/2023]
Abstract
Patients with severe aortic stenosis are classified according to flow-gradient patterns. We investigated whether left ventricular (LV) mechanical dispersion, a marker of dyssynchrony and predictor of mortality, is associated with low-flow status in aortic stenosis. 316 consecutive patients with aortic stenosis and QRS duration < 120 ms were included in the retrospective analysis. Patients with severe aortic stenosis (aortic valve area ≤ 1.0 cm2) were classified as normal-flow (NF; stroke volume index > 35 ml/m2) high-gradient (HG; mean transvalvular gradient ≥ 40 mmHg) (n = 79), NF low-gradient (LG) (n = 62), low-flow (LF) LG ejection fraction (EF) ≥ 50% (n = 57), and LF LG EF < 50% (n = 23). Patients with moderate aortic stenosis (aortic valve area 1.5–1.0 cm2; n = 95) served as comparison group. Mechanical dispersion (calculated as standard deviation of time from Q/S onset on electrocardiogram to peak longitudinal strain in 17 left ventricular segments) was similar in patients with NF HG (49.4 ± 14.7 ms), NF LG (43.5 ± 12.9 ms), LF LG EF ≥ 50% (47.2 ± 16.3 ms) and moderate aortic stenosis (44.2 ± 15.7 ms). In patients with LF LG EF < 50%, mechanical dispersion was increased (60.8 ± 20.7 ms, p < 0.05 vs. NF HG, NF LG, LF LG EF ≥ 50% and moderate AS). Mechanical dispersion correlated with global longitudinal strain (r = 0.1354, p = 0.0160) and heart rate (r = 0.1587, p = 0.0047), but not with parameters of aortic stenosis. Mechanical dispersion was similar among flow-gradient subgroups of severe aortic stenosis with preserved LVEF, but increased in patients with low-flow low-gradient and reduced LVEF. These findings indicate that mechanical dispersion is rather a marker of systolic myocardial dysfunction than of aortic stenosis.
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Affiliation(s)
- Daniel Lavall
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Linn Kristin Kuprat
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Joscha Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Spies C, Metze M, Stöbe S, Hagendorff A. [Echocardiographic emergency diagnostics]. Herz 2019; 44:267-286. [PMID: 31020335 DOI: 10.1007/s00059-019-4799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Echocardiography is a non-invasive, versatile imaging modality for the diagnostics and monitoring of life-threatening cardiac diseases. This article summarizes the currently valid recommendations on emergency echocardiography of the German Cardiac Society and the European Association of Cardiovascular Imaging and provides practical guidance for their implementation in emergency medicine. Echocardiography is especially important for the diagnostics of acute coronary syndrome and its potential complications, of pulmonary embolism and endocarditis as well as the differential diagnosis of patients in shock and in emergencies. A domain of increasing importance in echocardiography is the treatment monitoring of patients supported by modern cardiac assist devices.
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Affiliation(s)
- C Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
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Kavalerchyk V, Stöbe S, Hagendorff A, Augustyniak J, Staudt A. [Right Atrial Thrombus Formation as Complications in the Presence of Hemodialysis Catheter and Central Venous Catheter]. Dtsch Med Wochenschr 2019; 144:1349-1353. [PMID: 31559616 DOI: 10.1055/a-0891-4955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HISTORY Case 1: admission to hospital of a 65-year-old female patient with multiple cerebral infarctions after surgery due to a benign tumor for detection of cardiac source of embolism by echocardiography. During surgery a central venous catheter has been placed into the internal jugular vein.Case 2: admission to hospital of a 59-year-old female with urosepsis due to infectious urinary stasis due to dislocated double J-catheter and suspected endocarditis. A chronic hemodialysis catheter has been placed 4 months ago. DIAGNOSIS/FINDINGS In both cases right atrial thrombotic formations could be detected by echocardiography. Further, morphological und functional changes of the right atrium and ventricle as well as the tricuspid valve could be observed. THERAPY AND COURSE In case 1 the patient was treated with therapeutic anticoagulation with phenprocoumon. In contrast, surgery (thrombectomy) was recommended in case 2 due to the increased risk of cardiac thromboembolism and the morphological und functional impairment of the tricuspid valve. CONCLUSION Echocardiography permits the detection of thrombotic formations in the right heart. Therapeutic procedures should be defined individually and interdisciplinarily.
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Affiliation(s)
| | - Stephan Stöbe
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie
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Hagendorff A, Knebel F, Helfen A, Knierim J, Sinning C, Stöbe S, Fehske W, Ewen S. Expert consensus document on the assessment of the severity of aortic valve stenosis by echocardiography to provide diagnostic conclusiveness by standardized verifiable documentation. Clin Res Cardiol 2019; 109:271-288. [PMID: 31482241 DOI: 10.1007/s00392-019-01539-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
According to recent recommendations on echocardiographic assessment of aortic valve stenosis direct measurement of transvalvular peak jet velocity, calculation of transvalvular mean gradient from the velocities using the Bernoulli equation and calculation of the effective aortic valve area by continuity equation are the appropriate primary key instruments for grading severity of aortic valve stenosis. It is obvious that no gold standard can be declared for grading the severity of aortic stenosis. Thus, conclusions of the exclusive evaluation of aortic stenosis by Doppler echocardiography seem to be questionable due to the susceptibility to errors caused by methodological limitations, mathematical simplifications and inappropriate documentation. The present paper will address practical issues of echocardiographic documentation to satisfy the needs to analyze different scenarios of aortic stenosis due to various flow conditions and pressure gradients. Transesophageal and multidimensional echocardiography should be implemented for reliable measurement of geometric aortic valve area and of cardiac dimensions at an early stage of the diagnostic procedure to avoid misinterpretation due to inconsistent results.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology and Angiology, Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Helfen
- Department of Cardiology, St. Marien Hospital Lünen, Altstadtstraße 23, 44534, Lünen, Germany
| | - Jan Knierim
- Department of Cardiovascular Surgery, University of Berlin, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Sinning
- Department of Cardiology, University of Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Stephan Stöbe
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Wolfgang Fehske
- Department of Cardiology St, Vinzenz-Hospital Köln, Merheimer Straße 221, 50733, Köln, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Str., 66421, Homburg, Germany
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Farese GE, Tayal B, Stöbe S, Laufs U, Hagendorff A. Regional Disparities of Left Atrial Appendage Wall Contraction in Patients With Sinus Rhythm and Atrial Fibrillation. J Am Soc Echocardiogr 2019; 32:755-762. [PMID: 30904369 DOI: 10.1016/j.echo.2019.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) exhibit impaired left atrial appendage (LAA) function. However, regional characteristics of LAA function in patients with AF are not defined. METHODS Consecutive patients (n = 1,195) undergoing transesophageal echocardiography at a university hospital were included. Patients were divided into three groups on the basis of their rhythm: sinus rhythm (SR), paroxysmal AF, and permanent or persistent AF. Regional LAA wall velocities were determined using color Doppler tissue imaging, placing regions of interest at the lateral and medial wall of the LAA. RESULTS Of the 1,182 patients ultimately included, 691 (59%) were in SR, 371 (32%) had permanent or persistent AF, and 120 (10%) had paroxysmal AF with SR at the time of transesophageal echocardiography. Both lateral and medial LAA wall velocities were lower in patients with AF in comparison with those in SR. Nearly 90% of patients in both groups of patients with AF exhibited a pattern of medial LAA wall velocity greater than lateral LAA wall velocity, in comparison with 20% of patients with SR. The odds ratio for the association of this LAA contraction pattern with AF was 22.14 (95% CI, 12.06-40.64; P < .001). The movement of lateral LAA wall velocity showed the highest correlation with LAA emptying velocity compared with the medial LAA wall (r = 0.67, P < .001). CONCLUSIONS Lateral LAA wall velocity is higher than medial LAA wall velocity in patients in SR, which reverses in patients with AF. Assessment of LAA regional wall velocity using Doppler tissue imaging appears to be a promising approach to identify patients with paroxysmal AF.
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Affiliation(s)
- Gerardo E Farese
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Stephan Stöbe
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
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Stöbe S, Metze M, Spies C, Hagendorff A. [Transesophageal echocardiography in emergency and intensive care medicine : Indication and implementation]. Med Klin Intensivmed Notfmed 2019; 114:490-498. [PMID: 30830290 DOI: 10.1007/s00063-019-0549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
Transesophageal echocardiography (TEE) in emergency and intensive care medicine represents an additional semi-invasive method to confirm or rebut suspected diagnoses in critically ill patients. Three-dimensional (3D)-TEE investigations are established in the clinical workflow of emergency and intensive care units because 3D-TEE investigations permit a differentiation of artifacts due to oblique views by simultaneous documentation of sectional planes and en face views of characteristic cardiac structures. Thus, the level of diagnostic validity can be significantly increased by 3D-TEE investigation. The main indications of TEE investigation in emergency medicine are hemodynamic instability due to myocardial, pericardial or valvular heart diseases as well as suspected endocarditis and aortic dissection.
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Affiliation(s)
- S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - C Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Hobohm C, Hagendorff A, Schulz S, Fritzsch D, Budig S, Stöbe S, Michalski D. Clinical Presentation and Multi-Parametric Screening Surrogates of Ischemic Stroke Patients Suffering from Infective Endocarditis. Cerebrovasc Dis 2015; 41:60-7. [DOI: 10.1159/000442005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Infective endocarditis (IE) represents a life-threatening condition due to complications like cardiac failure and thromboembolism. In ischemic stroke, IE formally excludes patients from approaches addressing the recanalization of occluded vessels, challenging decision-making in the early phase of hospitalization. This study aimed at the rate and clinical course of stroke patients with IE and explored clinical, imaging-based and serum parameters, which would allow early identification. Methods: A hospital-based registry containing 1,531 ischemic stroke patients was screened for IE identified by echocardiography. In addition to clinical parameters, patterns of cerebral manifestation as well as a variety of inflammatory serum and myocardial markers were analyzed concerning their predictive impact for identifying affected patients. Results: IE was found in 26 patients (1.7%) and was associated with an increased body temperature and cardiac murmurs. Patients suffering from IE demonstrated a more severe clinical affection at hospital discharge and an impaired symptom decline during hospitalization, further deteriorated by the use of systemic thrombolysis. Distribution of cerebral infarction patterns did not differ between the groups. C-reactive protein (CRP) and leukocyte count as well as troponin and myoglobin, taken at hospital admission, were found to be significantly associated with IE. Conclusions: IE in stroke patients is associated with worse clinical outcome, complicated by intravenously applied thrombolysis, and therefore needs to be screened during the early phase of hospitalization. Increased serum levels of CRP and leukocyte count in combination with an increased body temperature or abnormal cardiac murmurs should entail rapid initiation of further diagnostics, that is, transoesophageal echocardiography.
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Trache T, Stöbe S, Tarr A, Pfeiffer D, Hagendorff A. The agreement between 3D, standard 2D and triplane 2D speckle tracking: effects of image quality and 3D volume rate. Echo Res Pract 2014; 1:71-83. [PMID: 26693303 PMCID: PMC4676467 DOI: 10.1530/erp-14-0025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 11/08/2022] Open
Abstract
Comparison of 3D and 2D speckle tracking performed on standard 2D and triplane 2D datasets of normal and pathological left ventricular (LV) wall-motion patterns with a focus on the effect that 3D volume rate (3DVR), image quality and tracking artifacts have on the agreement between 2D and 3D speckle tracking. 37 patients with normal LV function and 18 patients with ischaemic wall-motion abnormalities underwent 2D and 3D echocardiography, followed by offline speckle tracking measurements. The values of 3D global, regional and segmental strain were compared with the standard 2D and triplane 2D strain values. Correlation analysis with the LV ejection fraction (LVEF) was also performed. The 3D and 2D global strain values correlated good in both normally and abnormally contracting hearts, though systematic differences between the two methods were observed. Of the 3D strain parameters, the area strain showed the best correlation with the LVEF. The numerical agreement of 3D and 2D analyses varied significantly with the volume rate and image quality of the 3D datasets. The highest correlation between 2D and 3D peak systolic strain values was found between 3D area and standard 2D longitudinal strain. Regional wall-motion abnormalities were similarly detected by 2D and 3D speckle tracking. 2DST of triplane datasets showed similar results to those of conventional 2D datasets. 2D and 3D speckle tracking similarly detect normal and pathological wall-motion patterns. Limited image quality has a significant impact on the agreement between 3D and 2D numerical strain values.
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Affiliation(s)
- Tudor Trache
- Department for Cardiology and Angiology, Leipzig University Hospital , Liebigstrasse 2004103, Leipzig , Germany
| | - Stephan Stöbe
- Department for Cardiology and Angiology, Leipzig University Hospital , Liebigstrasse 2004103, Leipzig , Germany
| | - Adrienn Tarr
- Department for Cardiology and Angiology, Leipzig University Hospital , Liebigstrasse 2004103, Leipzig , Germany
| | - Dietrich Pfeiffer
- Department for Cardiology and Angiology, Leipzig University Hospital , Liebigstrasse 2004103, Leipzig , Germany
| | - Andreas Hagendorff
- Department for Cardiology and Angiology, Leipzig University Hospital , Liebigstrasse 2004103, Leipzig , Germany
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Tarr A, Stöbe S, Trache T, Kluge JG, Varga A, Pfeiffer D, Hagendorff A. The impact of foreshortening on regional strain--a comparison of regional strain evaluation between speckle tracking and tissue velocity imaging. Ultraschall Med 2013; 34:446-453. [PMID: 23371907 DOI: 10.1055/s-0032-1330521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The conventional parameter of systolic function is global left ventricular (LV) ejection fraction (EF), but this parameter will be replaced by global strain because it seems to be more robust. However, regional strain differences can have a significant impact on global strain. Thus, the aim of the present study was to evaluate the effect of non-standardized scanning on regional strain values determined by 2D speckle tracking and tissue velocity imaging (TVI). Regional longitudinal peak systolic strain (PSS) was measured in standardized data sets of the apical 4-chamber view (ChV) and in a standardized oblique foreshortened view in patients with normal wall motion patterns. MATERIALS AND METHODS A standardized 4ChV and a foreshortened 4ChV - defined by distinct cardiac structures - were acquired using a Vivid E9 system in 54 patients. All regional PSS values measured in monoplane 2D loops in lateral and septal regions were analyzed to detect the differences between regional strain measured in the standard and the foreshortened view. RESULTS Significant PSS differences due to FS were detected in patients using 2D speckle tracking for the basal septal regions (p < 0.001). No significant differences due to FS were detected in patients during the analysis of TVI-based strain values (p > 0.05, paired sample T-test). CONCLUSION To our knowledge this is the first study focusing on methodological aspects - especially standardization - using speckle tracking and TVI. Due to the lower accuracy of strain calculation based on TVI in basal regions, foreshortening has no significant impact on quantitative parameters of TVI-derived strain values in normal contracting hearts. Using speckle tracking, however, foreshortening induces significant differences of basal septal strain in normal contracting hearts. In the presence of regional wall motion defects, a lack of standardization of the views will cause inhomogeneous patterns of regional strain depending on the scan planes through the center of the infarction or its penumbra. Thus, non-standardization will have a significant impact on deformation parameters in 2D echocardiography.
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Affiliation(s)
- A Tarr
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged
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Hagendorff A, Stöbe S, Tarr A, Pfeiffer D. [Special echocardiographic diagnosis and specific problem constellations in patients with degenerative stenosis of the aortic valve]. Ultraschall Med 2013; 34:214-233. [PMID: 23229412 DOI: 10.1055/s-0032-1325510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- A Hagendorff
- Division of Cardiology and Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Germany
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