Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ...ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume LAV, and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives: Myocardial perfusion scintigraphy (MPS) is a well-established method for diagnosing coronary artery disease and risk stratification of individuals with chest pain. However, while MPS has ...high sensitivity and specificity for the detection of significant coronary artery disease, it has some drawbacks due to several technical difficulties. We suggest that aortic stiffness indexes measured by echocardiography, which is a well-known marker of atherosclerotic burden, may improve the equivocal test results obtained in MPS.
Materials and Methods: We prospectively enrolled 149 consecutive patients between the ages of 18 and 65 years without any previous cardiovascular disease with suspected coronary artery disease, who had undergone both SPECT MPS using Technetium-99m-sestamibi (99mTc MIBI) and transthoracic echocardiography between November 2013 and June 2014. Subjects were divided into three categories
according to MPS results as normal, equivocal and ischemic
groups.
Results: Aortic stiffness index (ASI) and aortic
distensibility (AD) of the normal and equivocal groups
were similar, and the ischemic group had higher ASI
values compared to the normal and equivocal groups. The
equivocal group had statistically lower ASI and higher
AD values compared to the ischemia group (p <0.001
and <0.001). Optimal threshold cut off point for ASI to
differentiate normal MPS result from MPS with ischemia in
any LV wall was calculated by ROC analysis. ASI value of
3.05 was found to be cut-off value with 98% sensitivity and
87% specificity to detect ischemia (AUC=0.953 with 95%
CI: 0.906 to 0.981 and p <0,001). If ASI value of >3.05 was
accepted as abnormal, the frequency of abnormal ASI in the
normal, equivocal, and ischemia groups were 11%, 19%,
and 98%, respectively. The equivocal group had similar
number of patients with abnormal ASI compared to the
normal group (p=0.262) while it had statistically a lower
number of patients with abnormal ASI than the ischemia
group (p<0.001)
Conclusion: However, aortic stiffness and aortic AD
indexes alone cannot diagnose coronary artery disease
(CAD), but may help to discriminate patients with CAD
from those without CAD whose MPS results are equivocal.
ACCREDITATION STATEMENT: The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for ...physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit.trade mark Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict-of-interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, have been indicated.
This activity is designed for all cardiovascular physicians, cardiac sonographers, and nurses with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, sonographers, and other medical professionals having a specific interest in contrast echocardiography may be included.
Upon completing this activity, participants will be able to: 1. Demonstrate an increased knowledge of the applications for contrast echocardiography and their impact on cardiac diagnosis. 2. Differentiate the available ultrasound contrast agents and ultrasound equipment imaging features to optimize their use. 3. Recognize the indications, benefits, and safety of ultrasound contrast agents, acknowledging the recent labeling changes by the US Food and Drug Administration (FDA) regarding contrast agent use and safety information. 4. Identify specific patient populations that represent potential candidates for the use of contrast agents, to enable cost-effective clinical diagnosis. 5. Incorporate effective teamwork strategies for the implementation of contrast agents in the echocardiography laboratory and establish guidelines for contrast use. 6. Use contrast enhancement for endocardial border delineation and left ventricular opacification in rest and stress echocardiography and unique patient care environments in which echocardiographic image acquisition is frequently challenging, including intensive care units (ICUs) and emergency departments. 7. Effectively use contrast echocardiography for the diagnosis of intracardiac and extracardiac abnormalities, including the identification of complications of acute myocardial infarction. 8. Assess the common pitfalls in contrast imaging and use stepwise, guideline-based contrast equipment setup and contrast agent administration techniques to optimize image acquisition.
Two‐dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame‐to‐frame tracking of ultrasonic speckles in ...gray scale 2D images. Two‐dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium. Two‐dimensional STE has been validated against hemodynamics, tissue Doppler, tagged magnetic resonance imaging, and sonomicrometry studies. Two‐dimensional STE has been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. A large number of studies have evaluated the role of 2D STE in predicting response to cardiac resynchronization therapy in patients with severe heart failure. However, the clinical utility of 2D STE in the above mentioned conditions remains controversial because of conflicting reports from different studies. Emerging areas of application include prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and effect of intracoronary injection of bone marrow stem cells on left ventricular function in patients with acute myocardial infarction. The emerging technique of three‐dimensional STE may further extend its clinical usefulness.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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