Abstract only Background: The purpose of the present study was to assess whether systemic arterial hypertension is associated with abnormal right ventricular (RV) structure and function as assessed ...by three-dimensional speckle tracking echocardiography and how those changes are related to left ventricular (LV) strain, left ventricular hypertrophy (LVH) and aortic (Ao) function. Methods: We examined 115 hypertensive (mean age, 65±16 years; 52% male) and 115 healthy adults (mean age, 68±13 years; 54% male). Patients were divided into two groups: patients with LVH (Group I, LVMI>115g/m 2 men, LVMI>95g/m 2 women) and patients without LVH (group II). LV longitudinal (LS), circumferential, radial and area (GAS) strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). RV free-wall longitudinal strain (LS) was determined by 3DSTE. Aortic (Ao) distensibility and stiffness index (SI) were calculated using accepted formulae. The corrected aortic strain (Ao-S) by two-dimensional speckle tracking echocardiography was calculated as the global aortic strain /pulse pressure. Data analysis was performed offline (GE EchoPAC). Results: Overall, Ao-SI was increased (r=0.74, p=0.003) and Ao-S was decreased (r=0.79, p=0.002) in hypertensive patients compared with controls. Ao-SI had a negative correlation with Ao-S (r=-0.76, p<0.001). Ao-S correlated with LV and RV longitudinal strain (r=0.62,p=0.02, and r=0.58,p<0.05, respectively) and LV and RV area strain (r=0.66,p=<0.01, and r=0.53,p<0.05, respectively). RV-LS and LV-GAS were lower in Group 1 patients compared to Group 2 (r=0.81, p<0.001), and lower in Group 2 patients compared to controls (r=0.59, p=0.02). There was a positive correlation between LV and RV LS (r=0.52, p<0.05). RV-LS was independently associated with Ao-S (β=0.37, p=0.01), LV-GAS (β=0.32, p=0.027) and LV-LS (β=0.26, p=0.034) in the whole hypertensive population. Conclusions: In systemic hypertension there is a complex interaction between LV strain, RV strain and Ao strain. Reduced RV strain can occur even in the absence of LV hypertrophy.
Fracture of the penis, a relatively uncommon emergency in Urology, consists in the traumatic rupture of the tunica albuginea of the corpus cavernosum. Examination and clinical history can be highly ...suspicious of penile fracture in the majority of cases and ultrasonography (USS) can be useful to identify the exact location of the tunical rupture, which is proximal in 2/3 of cases and therefore manageable through a penoscrotal approach. Although expensive and not readily available in the acute setting, Magnetic Resonance Imaging (MRI) may play a role in the differential diagnosis with rupture of a circumflex or dorsal vein of the penis or when the tunical rupture is not associated with tear of the overlying Buck's fascia. This form of imaging is more sensitive than USS at identifying the presence of a tunical tear. The treatment of choice is immediate surgical repair, which allows preserving erectile function and minimizing corporeal fibrosis.
Increased arterial stiffness may participate in the genesis of hypertension and increase of left ventricular (LV) mass after surgical correction of coarctation of the aorta. The purpose of the ...current study was to assess the aortic elastic properties using Doppler tissue imaging and strain rate imaging in patients after coarctoplasty.
Echocardiography with Doppler tissue/strain rate imaging capabilities was performed in 26 adult normotensive patients who had successful repair of coarctation of the aorta in infancy and in 24 control subjects. Transesophageal aortic transverse sections were imaged at the level of the proximal and distal segments to the repair site. Doppler tissue imaging wall velocities during systole (S(w)), early relaxation (E(w)), and atrial systole (A(w)) and peak systolic strain (ps epsilon) were measured in both groups. Transthoracic ascending aorta (AAo) measurements were also obtained.
In the patients with coarctoplasty, S(w) velocities and ps epsilon were significantly decreased in the proximal segments compared with control subjects. Both peak systolic blood pressure after exercise (P < .001) and pulse pressure after exercise (P < .001) were directly related to AAo wall strain. LV annular early diastolic velocity was significantly reduced compared with control subjects in patients with decreased AAo wall strain and exercise-induced hypertension (P < .001) and related to AAo wall velocity (P < .005) and strain (P < .001). In multiple linear regression analysis, only weight, study group, and AAo wall strain were correlated to LV mass index.
Patients with coarctation of the aorta have reduced proximal aortic wall velocities and strain and increased stiffness even after successful repair. This amplifies stress-induced hypertension and increases LV burden.
Abstract only Purpose: Due to the high mortality and morbidity of patients with aortic endocarditis, careful monitoring is necessary to recognize an early failure of antibiotic and cardiokinetic ...therapy and avoid a possible cardiogenic or septic shock. The timing of surgery is crucial for patients in whom medical therapy fails. The aim of our study is to identify potential echocardiographic "markers" of adverse events in patients with aortic regurgitation from infective endocarditis. Methods: Seventeen patients with aortic regurgitation (AR) from infective endocarditis were studied by 3-dimensional transesophageal echocardiography (3D-TEE) and transthoracic speckle tracking echocardiography (STE). Fifteen healthy subjects were selected as controls. Vegetation size was assessed by 3D-TEE. Standard transthoracic echocardiographic parameters were determined. Global left ventricular (LV) longitudinal strain (LS), radial and circumferential strain were measured by STE. Averaged LV rotation and rotational velocities from the base and apex were obtained and used for calculation of LV torsion (LVtor). Results: Severe AR had decreased LS compared with control subjects. LVtor decreased significantly in severe AR compared to normals (p<.005) as a result of a predominant decrease in apical rotation. By multivariate analysis, LV-LS (p=0.005), LV-tor (p=0.006) and vegetation size (p=0.009) were predictive of adverse events. ROC curves suggested that thresholds offering an adequate compromise between sensitivity and specificity for adverse events detection were -18.2% for mean global LV-LS (AUC .79), 13mm for vegetation size (AUC .86), and 19.4degrees for LVtor (AUC .81). The combination of vegetation size and LV strain had the highest diagnostic accuracy for identifying adverse outcome, superior to vegetation size (p=.006) or LV strain alone (p=.002). Conclusions: The combined assessment of the characteristics of vegetating masses and LV function strain parameters improves the sensitivity of the echocardiographic indices in predicting cardiac morbidity and mortality of aortic regurgitation from infective endocarditis.
Dyslipidemia and obesity are considered strong risk factors for premature atherosclerotic cardiovascular disease and increased morbidity and mortality and may have a negative impact on myocardial ...function.Our purpose was to assess the presence of early myocardial deformation abnormalities in dyslipidemic children free from other cardiovascular risk factors, using 2-dimensional speckle tracking echocardiography (2DSTE) and 3-dimensional speckle tracking echocardiography (3DSTE).We studied 80 consecutive nonselected patients (6-18 years of age) with hypercholesterolemia (low-density lipoprotein LDL cholesterol levels >95th percentile for age and sex). Forty of them had normal weight and 40 were obese (body mass index >95th percentile for age and sex). Forty healthy age-matched children were selected as controls. Left ventricular (LV) global longitudinal, circumferential, and radial strains were calculated by 2DSTE and 3DSTE. Global area strain (GAS) was calculated by 3DSTE as percentage of variation in surface area defined by the longitudinal and circumferential strain vectors. Right ventricular (RV) global and free-wall longitudinal strain and LV and RV diastolic strain rate parameters were obtained. Data analysis was performed offline.LV global longitudinal strain and GAS were lower in normal-weight and obese dyslipidemic children compared with normal controls and reduced in obese patients compared with normal-weight dyslipidemic children. LV early diastolic strain rate was lower compared with normals. RV global and free-wall longitudinal strain was significantly reduced in obese patients when compared with the control group. A significant inverse correlation was found between LV strain, LDL cholesterol levels, and body mass index.2DSTE and 3DSTE show LV longitudinal strain and GAS changes in dyslipidemic children and adolescents free from other cardiovascular risk factors or structural cardiac abnormalities. Obesity causes an additive adverse effect on LV strain parameters and RV strain impairment.
Abstract only Introduction: Dyssynchrony indices based on two-dimensional speckle tracking echocardiography have demonstrated added value in identifying patients with mitral valve prolapse (MVP) with ...a higher prevalence of arrhythmic complications and the potential for sudden cardiac death, but measurements are restricted to a single plane, and complex left ventricular (LV) dyssynchrony patterns may be overlooked. Hypothesis: The purpose of this study was to investigate whether three-dimensional speckle-tracking echocardiography helps in detecting MVP at higher arrhythmic risk. Methods: We studied 21 arrhythmic MVP patients (group 1) with a history of complex ventricular ectopy on holter and/or event monitor (n=17) or defibrillator implant (n=2), 21 MVPs with no arrhythmic complications (group 2) and 21 healthy controls (group 3). 3D LV longitudinal strain (3DE-LVLS) and area strain (3DE-LVAS) were determined (17 segments). 3D LV dyssynchrony index (3DE-LVDI) was obtained as the standard deviation of the times to peak area strain in 17 segments, normalized to RR interval. Results: MVP patients had significantly higher LV dyssynchrony index compared to controls (9.4±3.9% vs 4.3±2.5%, p=0.002) although they had similar LV ejection fraction (64% vs 61%, p=0.51). Group 1 and group 2 had similar LV ejection fraction and clinical data (p>0.05). Bileaflet prolapse was more frequent in group 1 pts (52% vs 24%, p=0.03). Moderate mitral regurgitation was present in 9/21 group 1 pts and 3/21 group 2 pts (p=0.04). Group 1 pts had greater LV dyssynchrony index when compared with group 2 (10.7±4.1% vs 5.1±2.9%, p=0.0001). By ROC (receiver operating characteristics) curves, 3DE-LVDI and 3DE-LVAS cutoff values of 10.2% and -23.8%, respectively, had 89% and 85% sensitivity and 79% and 76% specificity in identifying the presence of significant arrhythmias with areas under the curve 0.87 and 0.84. Conclusions: Impairment of LV deformation parameters determined by three-dimensional speckle tracking echocardiography may help detect increased arrhythmic risk in patients with MVP.
PURPOSE OF REVIEWTo provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic ...platforms.
RECENT FINDINGThe technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients’ morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer.
SUMMARYOverall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.
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