bluuebunny/crossref_metadata_2025 huggingface dataset:
Diastolic Blood Pressure‐Estimated Left Ventricular dp/dt
Authors: Yılmaz Hüseyin , Minareci Kenan , Kabukçu Mehmet , Sancaktar Oktay
Published: July 2003

Background: Peak dp/dt is one of the best isovolumic phase indexes of the myocardial contractile state requiring invasive procedures or presence of mitral regurgitation severe enough to measure in clinical practice by Doppler echocardiography. In this study, we sought the correlation between two noninvasive methods of measurements for left ventricular dp/dt‐diastolic blood pressure‐ (DBP) estimated and continuous‐wave Doppler‐derived dp/dt‐min electrocardiographic/echocardiographic study to emphasize the clinical feasibility of the DBP‐estimated method. Method: Thirty‐six randomized patients (27 male, 9 female; 58 ± 8 years) with mild mitral regurgitation were enrolled in this study. DBP‐estimated dp/dt was calculated from DBP minus the left ventricular end‐diastolic pressure (LVEDP) over the isovolumetric contraction time (IVCT). LVEDP was assumed to be 10 mmHg for all patients. Doppler‐determined left ventricular dp/dt was derived from the continuous‐wave Doppler spectrum of mitral regurgitation jet by dividing the magnitude of the left ventricular atrial pressure gradient rise between 1 mm/sec–3 mm/sec of mitral regurgitant velocity signal by the time taken for this change. Results: Left ventricular dp/dt by Doppler was 1122 ± 303 mmHg/sec and blood pressure‐estimated dp/dt was 1063 ± 294 mmHg/sec. There was a high correlation (r = 0.97, P < 0.001) of dp/dt between the two techniques. Conclusions: DBP and IVCT can generate left ventricular dp/dt without invasive procedures, even in the absence of mitral regurgitation in clinical practice.
Noninvasive Estimation of Pulmonary Capillary Wedge Pressure By Color M‐Mode Doppler Echocardiography in Patients with Acute Myocardial Infarction
Authors: Ueno Yoshiki , Nakamura Yasuyuki , Kinoshita Masahiko , Fujita Tamotsu , Sakamoto Taizou , Okamura Hiroshi
Published: July 2003

The peak early diastolic filling velocity/flow propagation velocity (E/FPV) by color M‐mode Doppler provides a better estimate of pulmonary capillary wedge pressure (PCWP) than transmitral or pulmonary venous flow. However, the value of E/FPV for the assessment of PCWP has not been evaluated in patients with acute myocardial infarction. We investigated the correlation between E/FPV and PCWP and whether PCWP can be estimated from E/FPV in patients with acute myocardial infarction. One hundred and two patients with acute myocardial infarction were divided into two groups. The first 60 patients were used to generate an equation to estimate PCWP (retrospective group). This equation was then assessed prospectively in the remaining 42 patients (prospective group). We measured the transmitral flow velocity indices and the deceleration time of diastolic pulmonary venous flow and E/FPV by Doppler echocardiography and compared these variables with PCWP measured using a pulmonary artery catheter. E/FPV was strongly correlated with PCWP (r = 0.89) in the retrospective group. The sensitivity of an E/FPV of ≥ 2.0 for predicting a PCWP of ≥ 18 mmHg was 95%, and the specificity was 98%. The estimated PCWP showed a strong correlation with the measured PCWP (r = 0.84, P < 0.0001) in the prospective group. The mean difference between the measured and estimated PCWP was −0.4 ± 3.6 mmHg. In patients with acute myocardial infarction, E/FPV by color M‐mode Doppler during early left ventricular filling provides a better estimate of PCWP than transmitral or pulmonary venous flow.
False Positive ST Segment Elevation During Dobutamine Stress Echocardiography Due to Left Ventricular Hypertrophy
Authors: Burger Andrew J. , Al‐Sergani Hani , Wrobleski David
Published: July 2003

The significance of ST segment elevation in dobutamine stress echocardiography (DSE) remains controversial. In patients with prior Q wave myocardial infarction (MI), it may reflect myocardial ischemia, contractile reserve in the infarct‐related area, or dyskinesia of the infarcted areas of myocardium. In the nonpost‐MI population, it has been attributed to vasospasm or strongly associated with coronary artery disease and ischemia. We hypothesized that ST segment elevation in the absence of inducible ischemia or prior MI is related to the presence of left ventricular hypertrophy (LVH). During DSE, dobutamine was infused from 5 μg/kg/min up to a maximum of 50 μg/kg/min. Echocardiographic images were obtained at baseline, low dose, peak dose, and recovery. Ischemia was defined as either the development of a new wall‐motion abnormality or worsening wall motion at peak dose. We reviewed 682 consecutive DSE tests and found ST elevation in 42 patients (incidence = 6.1%). After excluding two patients for > 10% uninterpretable echocardiographic segments, the study population consisted of 40 patients. In 25 patients with ST elevation and without echocardiographic evidence for dobutamine‐induced ischemia, 21 (84%) patients had LVH (P = 0.001). In 15 patients with inducible ischemia, only 4 (27%) patients had LVH. No other significant differences were found except that prior MI was more common in the inducible ischemia group. In the subgroup of 18 patients without prior MI, no inducible ischemia was found in 15 (83%). LVH was present in 14 (93%) of these 15 patients (P < 0.005), and all 14 had a normal baseline left ventricular ejection fraction. None of the three patients in the nonpost‐MI subgroup with inducible ischemia had LVH. The 22 patients with prior MI had no significant association with LVH (P = 0.39). We conclude that ST segment elevation during DSE can occur without echocardiographic evidence for ischemia and is associated with LVH in the nonpost‐MI population. This ST elevation may be related to transient electrocardiographic repolarization changes in the hypertrophied ventricle in the presence of altered loading conditions and/or altered catecholamine influences rather than true ischemia.
Endocardial Border Delineation during Dobutamine Infusion Using Contrast Echocardiography
Authors: Mathias Wilson , Arruda Ana L. M. , Andrade José L. , Filho Orlando C. , Porter Thomas R.
Published: July 2003

Background: A significant percentage of pharmacologic stress echocardiograms produce suboptimal images despite the use of second harmonic imaging. Intravenous continuous infusion of myocardial ultrasound contrast may enhance endocardial border delineation during dobutamine‐atropine stress echocardiography (DASE), improving wall‐motion analysis. Patients and Methods: We prospectively studied 68 patients (41 males and 27 females), mean age 58 years, with DASE during intravenous infusion of contrast using second harmonic imaging. Dobutamine was infused in scalar doses of 5 μg/kg/min to 40 μg/kg/min, and atropine was administered in doses of up to 1 mg. We diluted 0.1 mL of perfluorocarbon‐exposed sonicated dextrose albumin (PESDA) microbubbles into 80 mL of saline solution, which was used for continuous intravenous infusion. Blinded reviewers used a 16‐segment model at rest and peak DASE to analyze segmental wall delineation in two sets of images for each patient, with and without contrast. An endocardial delineation score of 0–3 (nondelineated to excellent delineation) was given to each segment. An endocardial delineation score index (EDSI), the number of endocardial delineation scores for each set of images divided by 16, was created. Results: The analysis of the mean EDSI for the 2176 segments was 1.46 (± 0.43) at rest and 1.30 (± 0.48) at peak for noncontrast images and 2.22 (± 0.52) and 2.29 (± 0.52) for contrast images. Complete left ventricle opacification was obtained in all patients, with a mean dose of 4 mL/min, although in 15 (22%) patients, signs of apical bubble destruction occurred. There were 1768 (81%) of 2176 segments delineated without contrast enhancement and 2057 (95%) of 2176 with enhancement (P < 0.05). Conclusion: Continuous infusion of myocardial ultrasound contrast improves endocardial border delineation using second harmonic imaging in patients undergoing DASE.
Effect of Left Ventricular Global Systolic Function, Mitral Regurgitation, and Left Ventricular Inflow Pattern on Exercise Echocardiography Results
Authors: Peteiro Jesús , Monserrat Lorenzo , Bouzas Beatriz , Castro‐Beiras Alfonso
Published: July 2003

Diagnosis of coronary artery disease (CAD) by exercise echocardiography is usually based on rest or exercise‐induced regional wall‐motion abnormalities. Mitral regurgitation (MR), left ventricular (LV) global systolic function, and LV inflow measurements can be assessed during exercise echocardiography; however, their diagnostic value has not been analyzed consistently. Treadmill exercise echocardiography and coronary angiography were performed in 120 patients (94 male, 26 female; mean age 61 ± 10 years [± 1 SD]) to evaluate known or suspected CAD. Positive exercise echocardiography was defined either as a rest‐ or exercise‐induced regional wall‐motion abnormalities. An abnormal response of LV ejection fraction (EF), LV volumes, MR (as assessed by color Doppler), and LV inflow pattern was defined as a fall in LVEF, a LV end‐diastolic volume increase, a LV end‐systolic volume increase, a new or increased MR, or a change from an impaired relaxation pattern (E < A) to a “pseudonormalized” pattern (E > A) from rest to exercise, respectively. CAD (≥ 50% luminal narrowing in at least one vessel) was found in 89 (74%) patients. EE‐based regional wall‐motion abnormality analysis was positive in 95 (79%) patients and negative in 25 (21%) patients. Feasible images for regional wall‐motion abnormalities, LVEF and volumes, LV inflow, and MR measurements were acquired in 90% of patients. Regional wall‐motion abnormality analysis and LVEF decrease provided the greatest sensitivities for CAD (94% and 75%, respectively), while the highest specificity was given by a new or increased MR (90%), the development of a pseudonormalized pattern (88%), and the appearance of angina (87%). A positive electrocardiogram (ECG) finding in patients with interpretable ECGs provided good sensitivity and specificity (67% and 85%, respectively). In conclusion, a complete rest and exercise Doppler echocardiography approach is feasible in most patients. Regional wall‐motion abnormalities are the most accurate exercise echocardiography variable for diagnosing CAD, whereas exercise ECG remains a good test in patients with interpretable ECGs. Exercise echocardiography, exercise ECG, newly developed or increased MR, and change to a pseudonormalized LV inflow pattern are highly specific.
Does Rapid Volume Loading During Transesophageal Echocardiography Differentiate Constrictive Pericarditis from Restrictive Cardiomyopathy?
Authors: Abdalla Ibrahim A. , Murray R. Daniel , Lee Jar Chi , White Richard D. , Thomas James D. , Klein Allan L.
Published: July 2003

Background: Respiratory variation of the pulmonary venous (PV) peak flow velocities can be used to distinguish constrictive pericarditis (constriction) from restrictive cardiomyopathy (restriction). Rapid volume expansion has been used successfully to enhance diastolic pressure equalization in occult constriction. The effect of volume on the respiratory variation in constriction has not been studied previously. This study assessed the utility of volume in enhancing the PV respiratory variation of constriction to further separate it from restriction. Methods: The study population consisted of 15 patients referred to the echocardiography laboratory for further evaluation of clinically suspected diastolic dysfunction. Pulsed‐Doppler transesophageal echocardiography (TEE) of the left or right upper pulmonary vein and mitral inflow was performed with respiratory monitoring before and after infusion of 1 liter of normal saline over 5 to 10 minutes. The classification of patients as constriction (n = 8) or restriction (n = 7) was confirmed independently by cardiac catheterization or surgery. Peak velocities of the PV systolic and diastolic waves and the mitral inflow E were measured during inspiration and expiration. A mean of 3–6 respiratory cycles was obtained for each value before and after volume loading. The percent change from expiration to inspiration (%E) was calculated using the formula %E = expiration ‐ inspiration / expiration. Results: At baseline, patients with constrictive pericarditis can be separated reliably from those with restrictive cardiomyopathy based on a higher systolic/diastolic ratio and greater respiratory variation of their PV diastolic flow velocity. There were no complications in any patient due to volume expansion. Although the change from baseline to volume expansion was not statistically significant in either constriction or restriction, the %E of the PV diastolic wave became significantly higher in constriction than in restriction (P < 0.05). Conclusions: Rapid volume expansion is relatively safe during TEE and can be used for further separation of constrictive pericarditis from restrictive cardiomyopathy by significantly enhancing the respiratory variation of the PV diastolic flow velocity in constrictive pericarditis.
Free‐Hand Four‐Dimensional Echocardiography: A Diagnostic Tool in Coronary Artery Disease
Authors: Bock Alexander P. , Genov Angela , Zotz Rainer J.
Published: July 2003

Direct echocardiographic visualization of coronary arteries has been difficult due to the inherent problems involved in obtaining ultrasound access. We used freehand four‐dimensional echocardiography in a 79‐year‐old patient with a trifurcational stenosis. We were able to identify a 6 × 11 mm possibly subintimal atheromathous plaque and to measure the diameters of the left descending coronary artery before, in, and behind the stenosis. There was good agreement with the angiographic measurements. This successful approach may be an argument to motivate further research in this area.
Embolic Cerebral Infarction and Gastrointestinal Hemorrhage Following Thrombolytic Therapy for Acute Myocardial Infarction
Authors: Chang Michael Chich‐Kuang , Lee Andrew Ying‐Siu , Chang Wen‐Fung , Chen Tien‐Jen
Published: July 2003

We report an unusual case of cerebral embolization that occurred after intravenous thrombolytic therapy for myocardial infarction. Direct observation by serial echocardiograms in this patient confirmed that the thrombolytic treatment induced lysis and fragmentation of thrombus, and the subsequent dislodging and embolization of preexisting cardiac thrombi, which caused the cerebral infarction. It is suggested that an echocardiogram, if instantly available, be performed before considering thrombolytic therapy whenever acute anterior wall myocardial infarction is impressed.
Anterolateral Papillary Muscle Rupture: Diagnosis and Successful Treatment (A Case Report)
Authors: Apetrei Eduard , Rugina Mihaela , Iliescu Vlad , Deleanu Dan , Miclea Ion , Filipescu Daniela , Chioncel Ovidiu , Mereuta Adrian
Published: July 2003

We report the case of a young man presenting with chest pain, dyspnea, and syncope in whom transthoracic and transesophageal echocardiography helped to diagnose anterolateral papillary muscle rupture. After cardiac catheterization (which confirmed the severe mitral regurgitation and showed two vessel coronary disease), mitral valve replacement was performed together with coronary bypass grafting.
Transesophageal Echocardiographic Evidence of Atrial Fibrillation with Systolic Flow in the Right Atrial Appendage and Systolic Reversal Pulmonary Flow in a Patient with DDD Permanent Pacing
Authors: Oneglia Carlo , Rusconi Cesare
Published: July 2003

We report the case of a patient with atrial fibrillation on standard electrocardiogram who underwent transesophageal echocardiography to rule out presence of thrombi in heart cavities. Pulsed‐wave Doppler investigation revealed multiphasic waves consistent with atrial fibrillation in the left atrial appendage, while in the right atrial appendage, a biphasic flow was registered after QRS depolarization. Some hypotheses are made about the origin of this signal.
Renal Cell Carcinoma Presenting as Right Atrial Mass
Authors: Crouch Eron D. , Tak Tahir
Published: July 2003

Approximately 190 new cases of renal cell carcinoma infiltrate into the inferior vena cava and right atrium every year. Echocardiography often plays a major role in establishing the diagnosis and in guiding surgical therapy. This report describes a patient who presented with shortness of breath but had no classic signs or symptoms of renal cell carcinoma other than chronic anemia. Transthoracic two‐dimensional echocardiography and transesophageal echocardiography established the diagnosis of a right atrial mass extending from the inferior vena cava that was later discovered to be renal cell carcinoma.
Isolated Noncompaction of the Ventricular Myocardium: Contrast Echocardiographic Findings and Review of the Literature
Authors: Koo Bon Kwon , Choi Donghoon , Ha Jong‐Won , Kang Seok‐Min , Chung Namsik , Cho Seung‐Yun
Published: July 2003

Isolated noncompaction of the ventricular myocardium (INVM) is a rare congenital anomaly. We report a case of INVM in an adult, which was diagnosed using contrast echocardiography.
Proximal Isovelocity Surface Area (PISA) in the Evaluation of Fixed Membranous Subaortic Stenosis
Authors: Goodkin Gregory M. , Tunick Paul A. , Kronzon Itzhak
Published: July 2003

The evaluation of the severity of subaortic stenosis is usually expressed by the magnitude of the subvalvular gradient. Calculation of the membrane orifice area noninvasively is difficult by the standard means. We present a patient in whom the area was calculated using the proximal isovelocity surface area (PISA) method. This method should have clinical applicability because it is not flow dependent and can be used in patients with normal, reduced, or increased stroke volume.
Transesophageal Three‐Dimensional Echocardiographic Assessment of Left Ventricular Pseudoaneurysm
Authors: Nekkanti Rajasekhar , Nanda Navin C. , Ansingkar Kamlesh G. , McGiffin David C.
Published: July 2003

We report an adult patient with a left ventricular pseudoaneurysm following an acute myocardial infarction in whom three‐dimensional (3‐D) transesophageal echocardiography (TEE) delineated clearly not only the location but also the size and shape of the rupture site. The size of the rupture site measured by 3‐D TEE correlated well with the surgical measurements. Three‐dimensional images also showed a localized superior distortion of the lateral aspect of the mitral annulus and left atrial wall produced by the pseudoaneurysm. The resulting severe mitral regurgitation practically disappeared after repair and decompression of the pseudoaneurysm.
Estimation of Global Left Ventricular Function from the Velocity of Longitudinal Shortening
Authors: Vinereanu Dragos , Khokhar Azhar , Tweddel Ann C. , Cinteza Mircea , Fraser Alan G.
Published: July 2003

Aims: To determine if global ventricular function can be assessed from the long‐axis contraction of the left ventricle, we compared pulsed‐wave Doppler myocardial imaging of mitral annular motion to radionuclide ventriculography. Methods and Results: We studied 51 patients (56 ± 10 years, 11 women) with a radionuclide ejection fraction of 52 ± 13% (15%–70%). Peak systolic velocities of medial and lateral mitral annular motion correlated with ejection fraction (0.55 and 0.54, respectively; P < 0.001), as did the time‐velocity integrals (0.57 and 0.58, respectively; P < 0.001). Correlations were higher in normal ventricles (0.62–0.69) than in patients with previous myocardial infarction (0.39–0.64). Patients with anterior myocardial infarction had the lowest correlations (0.39–0.46). The best differentiation of normal (≥ 50%) from abnormal (< 50%) ejection fraction was provided by peak systolic velocity ≥ 8 cm/sec for the medial (sensitivity 80%, specificity 89%) or lateral (sensitivity 80%, specificity 92%) mitral annulus. Conclusion: Global left ventricular function can be estimated by recording mitral annular velocity. The implementation of a cutoff limit of 8 cm/sec gave a simple guide for differentiating between normal and abnormal left ventricular systolic function that might be useful clinically in patients without regional wall‐motion abnormalities. However, in patients with important segmental wall‐motion abnormalities during systole, left ventricular longitudinal shortening is an imperfect surrogate for ejection fraction.
Ultrasonic Tissue Characterization and Doppler Tissue Imaging in the Analysis of Left Ventricular Function in Essential Arterial Hypertension: A Preliminary Study
Authors: Giorgi Davide , Di Bello Vitantonio , Pedrinelli Roberto , Bertini Alessio , Talini Enrica , Dell'Omo Giulia , Mengozzi Giovanna , Palagi Caterina , Dell'Anna Rita , Mariani Mario
Published: July 2003

It is not known if diastolic abnormalities are independent of systolic dysfunction in arterial hypertension. We studied three groups of 10 male subjects of comparable mean age (31.6 ± 3.5 years), weight, and height: Athletes (A) (cyclists), essential hypertensive patients (H), and controls (C). Ultrasonic myocardial integrated backscatter signals (IBS) of the septum and the posterior wall were analyzed, while the systo‐diastolic variation of the backscatter was considered as a cyclic variation index (CVIibs). Myocardial velocities across the left ventricular major axis were sampled at septum and lateral wall levels by pulsed‐wave Doppler tissue imaging (DTI). CVIibs at the septum and the posterior wall were significantly lower in the hypertensive group in comparison with athletes and controls, who were comparable. Early diastolic myocardial velocity (Em) of the lateral wall and of the septum were significantly lower in hypertensives, while the late diastolic myocardial velocity (Am) was significantly higher in hypertensives in comparison with athletes. The Em/Amat the septum level was significantly lower in hypertensives in comparison with athletes and controls. Significant correlations were found between CVI and DTI parameters: CVIibs and Em/Am septum(r = 0.50, P < 0.002). Furthermore, significant correlations were found between mean arterial pressure (MAP) and Em/Am septum (r =−0.65, P < 0.001). Ultrasonic tissue characterization with the intrinsic contractility study and the evaluation of the regional diastolic function should, therefore, represent a new integrated diagnostic modality for the evaluation of left ventricular hypertrophied intramyocardial function. This study demonstrated that diastolic abnormalities of left ventricular function, in arterial hypertension, are related and progress with systolic intrinsic dysfunction.
Assessment of Left Ventricular Mass in Mice: Comparison Between Two‐Dimensional and M‐Mode Echocardiography
Authors: Kiatchoosakun Songsak , Restivo Joseph , Kirkpatrick Darryl , Hoit Brian D.
Published: July 2003

Objective: M‐mode echocardiography has been used extensively for estimating left ventricular (LV) mass in mice, but accuracy is limited by its unidimensional nature. This study tested whether two‐dimensional (2‐D) echocardiographic measurement of LV mass using area‐length and truncated ellipsoid methods overcomes this limitation. Methods: Twenty‐five anesthetized FVB/N mice (Mus musculus) underwent high resolution (15 MHZ) two‐dimensionally directed M‐mode and 2‐D echocardiography. End‐diastolic epicardial and endocardial areas from short‐axis views and the LV orthogonal long‐axis views were measured, while LV mass was calculated by 2‐D area‐length and truncated ellipsoid methods. LV mass was calculated from M‐mode using the uncorrected cube equation. Hearts were removed and weighed after completing the echocardiographic studies. The correlation and agreement between echocardiographic‐determined LV mass and gravimetric LV weight were examined. Results: LV mass using the area‐length method correlated better with autopsy LV weight (r = 0.87, slope = 0.87, standard error of the estimate [SEE]= 12.4 mg, P < 0.001) than M‐mode echocardiography (r = 0.85, slope = 0.71, SEE = 11.1 mg, P < 0.001), and the degree of agreement (bias ± 2 SD) was better (10.2 ± 25.1 mg vs 13.1 ± 25.8 mg, P NS). Although 2‐D truncated ellipsoid LV mass showed a good correlation with necropsy LV weight (r = 0.87, slope = 0.78, SEE = 11.0 mg, P < 0.001), the agreement between the truncated ellipsoid estimates and LV weight was less than that between M‐mode and gravimetric LV mass. Conclusions: The 2‐D area‐length method is an accurate method of LV mass determination in symmetrical ventricles and can be used as an alternative for in vivo measurement of LV mass in mice.
Doppler Flow Velocity Measurement to Assess Changes in Inotropy and Afterload: A Study in Healthy Dogs
Authors: Sohn Sejung , Kim Hae Soon , Han Jae Jin
Published: July 2003

Myocardial contractility and afterload are important factors for adequate circulation. To noninvasively assess changes in inotropy and afterload, ascending aortic blood flow was measured by continuous‐wave Doppler echocardiography before and after the administration of an inotrope and a vasodilator in eight open chest dogs. Data were collected in the baseline, at three different doses of epinephrine (0.1, 0.5, and 1 μg/kg/min) and nitroprusside (1, 4, and 8 μg/kg/min) administration, and after a simultaneous infusion of both drugs in various combinations. Epinephrine infusion caused increases in peak velocity (PV), mean acceleration (MA), velocity time integral (VTI), and minute distance without a significant change in afterload. Acceleration time (AT) and ejection time (ET) showed a slight tendency to decrease with an increase in inotropy, but with no significance. Nitroprusside infusion produced dose‐dependent decreases in blood pressure and index of systemic vascular resistance (ISVR), which was associated with increases in PV, MA, and minute distance, and with a decrease in AT. The combined infusion of nitroprusside and epinephrine, unless ISVR was elevated, produced synergistic effects on PV, MA, VTI, and minute distance. However, these Doppler parameters tended to diminish with an elevation in afterload. ISVR obtained during nitroprusside infusion had a better correlation with both PV and MA than with VTI or the Doppler time intervals. Our study suggests that Doppler measurement of aortic blood flow velocity and acceleration can be used for the noninvasive assessment of changes in inotropy and afterload.
Echocardiographic Features of Primary Cardiac Sarcoma
Authors: Hsieh Pu‐Lin , Lee Doyal , Chiou Kuan‐Rau , Kung Ming‐Ho , Lin Shoa‐Lin , Liu Chun‐Peng , Chiang Hung‐Ting
Published: July 2003

Primary cardiac sarcoma is extremely rare and seldom causes symptoms until late in its course. Discomfort may occur only when the mass causes obstruction to the intracardiac flow. Early diagnosis is vital because it allows prompt and relevant management. We describe the history and echocardiographic features in four patients with primary cardiac sarcoma and review the current literature.
Three‐Dimensional Color Doppler Transpharyngeal Echocardiographic Reconstruction of the Left Common, Internal, and External Carotid Arteries
Authors: Miller Andrew P. , Aaluri Srinivasa R. , Mukhtar Osman M. , Nanda Navin C.
Published: July 2003

To our knowledge, we report the first cases of successful three‐dimensional reconstruction of the left common, internal, and external carotid arteries using color Doppler transpharyngeal echocardiography.
Basic Acoustic Properties of Microbubbles
Authors: De Jong Nico , Bouakaz Ayache , Frinking Peter
Published: July 2003

Small (encapsulated) gas bubbles in a contrast medium react to an external oscillating pressure field with volume pulsations. Depending on the magnitude of the ultrasound wave, the vibrations will be related either linearly or nonlinearly to the applied acoustic pressure. For low acoustic pressures, the instantaneous radius oscillates linearly in relation to the amplitude of the applied external pressure field. The oscillation of the bubble is governed by parameters such as resonance frequency, damping coefficients, and shell properties. For higher amplitudes of the external field, the pulsation of the bubbles becomes nonlinear. The spectrum of the scattered ultrasound wave also contains higher harmonics of the emitted frequency in addition to the fundamental frequency. The emitted frequency, bubble size, and nonlinear propagation effects have significant influence on the harmonic generation. For encapsulated bubbles exposed to even higher acoustic amplitudes, their scattering effectiveness increases dramatically and becomes transient. The scattered frequency spectrum broadens, containing higher harmonics. This consequence is due to rupture, disappearance, change of gas content, etc. Using these specific characteristics of the contrast bubbles will open new perspectives in imaging and analysis for medical diagnosis.
Instrumentation for Contrast Echocardiography
Authors: Burns Peter N.
Published: July 2003

A number of new imaging methods have been developed specifically for use with ultrasound contrast agents. These methods rely on the peculiar behavior of microbubbles in an ultrasound field. At low incident acoustic pressures (reflected by the mechanical index, MI) microbubbles emit harmonics. These can be detected using harmonic or pulse inversion imaging. At higher MI, bubbles are disrupted, emitting a strong, nonlinear echo. Harmonic power Doppler methods are able to detect this echo, offering the most sensitive method for the detection of microbubble at the perfusion level. Although the first images of myocardial perfusion were made using this disruption method, it requires intermittent imaging with interframe intervals of up to 6 heart beats. Pulse inversion Doppler imaging is a newer method that is able to detect the nonlinear component of bubble echoes at a very low MI, thereby making possible real‐time myocardial perfusion imaging. An understanding of the behavior of bubbles during an imaging examination is an essential prerequisite to its success in clinical practice.
Current and Future Contrast Agents
Authors: Grayburn Paul A.
Published: July 2003

This article focuses on current and new contrast agents for opacification of left‐sided cardiac chambers and myocardium after intravenous injection. The first generation of contrast agents, such as agitated saline, hydrogen peroxide, indocyanine green dye, and iodinated contrast, required aortic or intracoronary injection to opacify the left heart. Second generation agents, such as sonicated 5% human albumin‐containing air bubbles, were capable of transpulmonary passage but often failed to produce adequate imaging of the left heart. Newer agents containing fluorocarbon gases within albumin, surfactant, lipid, or polymer shells hold great promise to achieve myocardial perfusion via intravenous injection. The characteristics of these agents and the results of early clinical trials will be discussed.
The Myocardial Performance Index in Patients with Aortic Stenosis
Authors: Mugerwa Jude A. , Kiatchoosakun Songsak , Restivo Joseph , Hoit Brian D.
Published: July 2003

Objectives: This study was designed to determine the effect of chronic afterload on a Doppler‐derived myocardial performance index (MPI) combining both systolic and diastolic left ventricular dysfunction. Methods: The study included 36 patients with a diagnosis of aortic stenosis and 36 normal subjects. Doppler‐derived myocardial performance index (MPI), defined as the sum of the isovolumic contraction time and isovolumic relaxation time divided by ejection time, was measured from the mitral valve inflow and left ventricular outflow velocity patterns and was then related to the aortic valve area, valve gradient, and other echocardiographic variables. Results: The values of the Doppler‐derived MPI in the patients with aortic stenosis were significantly higher than those in the controls (0.54 ± 0.20 vs 0.38 ± 0.04, respectively; P < 0.001). Transmitral deceleration time and the E/A ratio (r = 0.47 and r = 0.35, respectively; P < 0.05) were significant univariate correlates, and mitral deceleration time was the only significant correlate of MPI. However the index did not correlate with aortic valve area, peak and mean valve gradients, left ventricular mass, or age. Conclusions: Doppler‐derived MPI reflects severity of global left ventricular dysfunction in patients with aortic stenosis and may be of clinical value in this patient population.
Importance of the Index of Myocardial Performance in Evaluation of Left Ventricular Function
Authors: Dagdelen Sinan , Eren Nevnihal , Karabulut Hasan , Caglar Nuri
Published: July 2003

The index of myocardial performance (MPI) has been used as an easily obtainable parameter that reflects both systolic and diastolic functions of the myocardium and correlates closely with invasive measurements. This study investigated the importance of MPI on assessment of left ventricular function in patients with critical coronary artery disease. Methods: We studied 82 patients who had coronary angiography and echocardiography. Patients in Group A were without critical coronary stenosis (n = 37, 17 females, 20 males, mean age 54 ± 11 years) and patients in Group B had critical coronary stenosis (> 70%) without previous myocardial infarction (n = 45, 18 female, 27 male, mean age 57 ± 10 years). Using echocardiographic parameters, left ventricular isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), ejection time (ET), ratio of velocity time integrals (vti) of early and late diastolic mitral flow (E/Avti), E deceleration time (EDT), MPI [(IRT − ICT) / ET], ejection fraction (EF), and fractional shortening (FS) were calculated. During cardiac catheterization, Dp/Dt [(diastolic blood pressure left ventricular end diastolic pressure) / ICT] was calculated. Results: There were significant differences in IRT, EDT, E/Avti, and the MPI between Groups A and B (95.9 ± 14.7 and 113.4 ± 14.3 msec, P < 0.001; 164.5 ± 44.8 and 186.2 ± 33.6 msec, P < 0.05; 1.51 ± 0.45 and 1.24 ± 0.80 msec, P < 0.05; and 0.45 ± 0.08 and 0.53 ± 0.07 msec, P < 0.001, respectively), but there were no significant differences in ICT, ET, EF, FS, and Dp/Dt between the two groups. Both groups showed a close correlation between MPI and Dp/Dt (r =−0.78 for Group A and r =−0.82 for Group B). There were no significant differences in heart rate and systolic and diastolic blood pressure between the two groups. Conclusion: These data suggest that MPI may be a useful parameter and an early indicator of left ventricular dysfunction in patients with critical coronary artery disease and normal systolic function.
Ventricular Interdependence in Patients with Dual‐Chamber Pacing: A Doppler Tissue Imaging Study
Authors: D'Andrea Antonello , Caso Pio , Galderisi Maurizio , Ducceschi Valentino , Scherillo Marino , Sarubbi Berardo , Mininni Nicola , Calabro' Raffaele
Published: July 2003

Purpose: To analyze pulsed‐Doppler tissue imaging (DTI) of the right ventricular (RV) tricuspid annulus and left ventricular (LV) mitral annulus in patients paced in the DDD mode at three different pacing modes as compared with healthy subjects, and to investigate possible physiologic interaction between the RV and LV in this subgroup of patients. Methods: We selected a population of 22 subjects with pacemakers (PM) for atrioventricular (AV) block and/or sick sinus syndrome and compared them to 20 healthy subjects. Standard echo Doppler and DTI parameters were measured at baseline (heart rate [HR] 70 beats/min; AV delay 125 msec) and after at least 5 minutes of constant stimulation at two different pacing modes: (1) HR 70 beats/min, AV delay 188 msec, and (2) HR 89 beats/min, AV delay 125 msec. LV stroke volume was obtained by LV outflow Doppler method. Results: In the PM group, RV and LV annulus exhibited significantly higher peak systolic (Sm) and early (Em) diastolic wall velocities than controls. In the PM population, LV stroke volume was strongly associated to RV Em peak velocity (r = 0.83; P < 0.00001) and RV Sm peak velocity (r = 0.81; P < 0.0001). These associations between LV stroke volume and RV DTI parameters remained significant even after increase of HR and AV delay in the pacing modalities. Moreover, univariate relations were found in the PM group between DTI indexes of RV tricuspid annulus and the homologous indexes of LV mitral annulus. In a multiple linear regression analysis, both RV Em (P < 0.001) and RV Sm (P < 0.001) were related independently to LV stroke volume (cumulative R2= 0.85, P < 0.00001). Conclusions: Our findings suggest the usefulness of pulsed‐DTI to display physiologic ventricular interaction in patients with PM. Therefore, DTI may be taken into account as a valuable supporting tool to predict LV systolic performance and to select the most appropriate pacing mode in individual PM patients.
Prognostic Value of Dobutamine Echocardiography in Elderly Patients with Suspected Coronary Artery Disease and an Abnormal Resting Electrocardiogram
Authors: Ciaroni Stefano , Bloch Antoine , Albrecht Laurette
Published: July 2003

The prognostic value of dobutamine stress echocardiography (DE) in elderly patients over 70 years of age with suspected coronary artery disease (CAD) and an abnormal electrocardiogram (ECG) at rest has not been well documented. We investigated 158 consecutive outpatients (97 men) aged 76 ± 4 years presenting with right bundle branch block with or without a left anterior hemiblock (41%), left bundle branch block (23%), or repolarization abnormalities (36%). The basic clinical and echocardiographic data were analyzed and correlated with the DE results. The patients were followed for a mean of 24 ± 13 months. Twenty‐three (14.5%) patients presented with a nonfatal cardiac event (CE). According to univariate analysis, the parameters associated with the onset of a CE included arterial hypertension, angina pectoris, anti‐angina therapy, the presence of calcifications on the aortic valve and the ascending walls of the aorta, and the presence of segmentalcontraction abnormalities of the left ventricle (LV) at rest during echocardiography. According to a Cox regression model, the only independent predictive parameter for the onset of a CE was the appearance of segmental‐contraction abnormalities of the LV and their severity during peak dose administration during DE (odds ratio [OR]= 2.58, P < 0.001). This parameter remains independent when spontaneous CEs (myocardial infarction and unstable angina) were considered as endpoints (OR = 2.31, P < 0.001). Conclusions: DE is a safe and reliable method for investigating CAD in patients over 70 years of age with an abnormal resting ECG. In our study, the most predictive independent parameter for the onset of a CE was the appearance of segmental‐contraction abnormalities of the LV and their severity during DE.
Prevalence and Clinical Significance of Left Atrial Spontaneous Echo Contrast Detected by Transesophageal Echocardiography
Authors: Vincelj Josip , Sokol Ivan , Jakšić Ozren
Published: July 2003

The prevalence and clinical significance of left atrial spontaneous echo contrast (SEC) were studied in patients undergoing transesophageal echocardiography (TEE). The study group included 290 consecutive patients (186 male and 104 female, aged 17–86 years, mean age 56.1 ± 12.8 years). Left atrial SEC was found in 50 (17.2%) patients, and was significantly associated with atrial fibrillation, mitral stenosis, absence of mitral regurgitation, and left atrial dimension. Atrial fibrillation was recorded in 44 (88%) patients, mitral stenosis or mitral valve replacement in 21 (42%) patients, and left atrial thrombus or previous embolism in 23 (46%) patients with SEC. Univariate analysis showed a significant association between the presence of SEC and atrial fibrillation, mitral stenosis or mitral valve replacement, and left atrial size. Multivariate analysis showed the presence of left atrial SEC and atrial fibrillation to be independent factors for thrombus formation and/or thromboembolism. Since left atrial SEC associated with atrial fibrillation, left atrial enlargement, mitral stenosis, or mitral valve prosthesis was found in 17.2% of patients undergoing TEE, it might be considered a marker of left atrial thrombus or previous thromboembolism.
Continuous Ultrasonic Monitoring of Balloon Valvuloplasty
Authors: Vahdat Arash , Vijayasekaran Srihdar , Durairaj Alex , Mehra Anil , Chandraratna P.A.N.
Published: July 2003

A novel ultrasound transducer developed in our laboratory (CONTISON) was used for monitoring catheter balloon commissurotomy (CBC). The transducer was placed at the cardiac apex to obtain an apical four‐chamber view and attached to the chest wall using an adhesive ring. During the procedure, the tip of the needle was imaged first in the right atrium and was seen to traverse the interatrial septum and enter the left atrium. Mitral valve gradients were measured before and after CBC.
Constrictive Pericarditis Localized To Left Ventricle Presented with Left Pleural Effusion: A Case Report
Authors: Akdemir Ilyas , Davutoglu Vedat , Aksoy Mehmet
Published: July 2003

An 18‐year old woman presented with progressive dyspnea and cough. Physical examination revealed decreased breath sounds at the left hemithorax and distant heart sounds with no murmurs or rub. Electrocardiogram revealed low voltage. Chest X‐ray showed unilateral left‐sided pleural effusion with no cardiomegaly. Transthoracic echocardiogram showed thickened pericardium localized throughout the left ventricle impairing the diastolic filling. Doppler waveforms were suggestive of localized constrictive pericarditis. A computerized tomographic scan of the chest confirmed the presence of unilateral pleural effusion with thickened pericardium surrounding the left ventricle. The patient's symptoms and signs were related to localized constrictive pericarditis and improved following surgery.
Cardiac Echinococcosis Causing Acute Dissection of the Left Ventricular Free Wall
Authors: Ahmed Tamzeed , Al‐Zaibag Muayed , Allan Andrew , Gabriel Christina , Widaa Hassan , Hulaimi Naji , Saileek Ahmad , Pai Ramdas G.
Published: July 2003

Cardiac echinococcosis is a rare condition, and its manifestations are protean depending upon its site of infestation. We report a case of hydatid heart disease presenting like an acute cardiac ischemic episode associated with a rise in serum cardiac enzymes secondary to left ventricular free wall dissection caused by ruptured intramyocardial echinococcal cyst. The resultant complex cardiac anatomy was characterized fully by echocardiographic examination.
Three‐Dimensional Reconstruction of Heart Defects Associated with Williams‐Beurer Syndrome
Authors: Roldán Francisco‐Javier , Vargas‐Barrón Jesús , Romero‐Cárdenas Angel , Keirns Candace , Espinola‐Zavaleta Nilda , Vázquez‐Antona Clara , Martinez‐Ríos Marco‐Antonio
Published: July 2003

Williams‐Beurer syndrome is an unusual genetic alteration associated with congenital heart defects. We present the capabilities of three‐dimensional echocardiography in the study of the cardiopathy associated with this syndrome.
Is It Open or Is It Closed? Thrombosis of a St. Jude's Tricuspid Valve Prosthesis
Authors: Mehra Divya , Tunick Paul A. , Goodkin Gregory M. , Kahn Martin L. , Kronzon Itzhak
Published: July 2003

A 49‐year‐old woman with mitral and tricuspid mechanical valve prostheses developed marked weight gain with increasing abdominal girth and facial plethora 4 weeks after anticoagulation was temporarily interrupted for abdominal surgery. Transthoracic and transesophageal echocardiography documented severe tricuspid stenosis and regurgitation. The two discs of the tricuspid prosthesis were immobilized, half open and half closed. The prosthesis was replaced and the patient did well.
Transesophageal Two‐ and Three‐Dimensional Echocardiographic Diagnosis of Combined Left Ventricular Pseudoaneurysm and Ventricular Septal Rupture
Authors: Nekkanti Rajasekhar , Nanda Navin C. , Zoghbi Gilbert J. , Mukhtar Osman , McGiffin David C.
Published: July 2003

Two‐ (2‐D) and three‐dimensional (3‐D) transesophageal echocardiography (TEE) were useful in making the diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture in an elderly patient presenting with mediastinitis and worsening heart failure following coronary artery bypass graft surgery. The diagnosis was not suspected clinically. Three‐dimensional TEE served to increase the confidence level with which the diagnosis of this combined lesion was made. Additionally, 3‐D TEE proved superior to 2‐D TEE in assessing the size of the left ventricular rupture site.
Predictors for Maintenance of Sinus Rhythm after Cardioversion in Patients with Nonvalvular Atrial Fibrillation
Authors: Ökçün Bariş , Yigit Zerrin , Küçükoglu M. Serdar , Mutlu Haşim , Sansoy Vedat , Güzelsoy Deniz , Üner Sinan
Published: July 2003

Recurrence of atrial fibrillation (AF) after cardioversion (CV) to sinus rhythm (SR) is determined by various clinical and echocardiographic parameters. Transesophageal echocardiographic (TEE) parameters have been the focus of clinicians' interests for restoring and maintaining SR. This study determined the clinical, transthoracic, and TEE parameters that predict maintenance of SR in patients with nonvalvular AF after CV. We enrolled 173 patients with nonvalvular AF in the study. TEE could not be performed in 26 patients prior to CV. Twenty‐five patients had spontaneously CV prior to TEE. Six patients were excluded because of left atrial (LA) thrombus assessed by TEE. CV was unsuccessful in 6 patients. The remaining 110 consecutive patients (56 men, 54 women, mean age 69 ± 9 years), who had been successfully cardioverted to SR, were prospectively included in the study. Fifty‐seven (52%) patients were still in SR 6 months after CV. Age, gender, the configuration of the fibrillation wave on the electrocardiogram, pulmonary venous diastolic flow, and the presence of diabetes, hypertension, coronary artery disease, mitral annulus calcification, and mitral valve prolapse (MVP) did not predict recurrence. Duration of AF, presence of chronic obstructive pulmonary disease (COPD), LA diameter, left ventricular ejection fraction (EF), left atrial appendage peak flow (LAAPF), LAA ejection fraction (LAAEF), pulmonary venous systolic flow (PVSF), and the presence of LA spontaneous echo contrast (LASEC) predicted recurrence of AF 6 months after CV. In multivariate analysis, LAAEF < 30% was found to be the only independent variable (P < 0.0012) predicting recurrence at 6 months after CV in patients with nonvalvular AF. LAAEF more than 30% had a sensitivity of 75% and a specificity of 88% in predicting maintenance of SR 6 months after CV in patients with nonvalvular AF. In conclusion, TEE variables often used to determine thromboembolic risk also might be used to predict the outcome of CV.
Failure of Left Ventricular Hypertrophy to Regress after Surgery for Aortic Valve Stenosis
Authors: Lessick Jonathan , Mutlak Diab , Markiewicz Walter , Reisner Shimon A.
Published: July 2003

Background: Regression of left ventricular (LV) hypertrophy usually follows surgery for aortic stenosis (AS); however, a significant number of ventricles remain hypertrophied. The extent of this phenomenon, the reasons for failure to regress, and its significance are unclear. Methods: We investigated 43 patients before and after aortic valve surgery and divided them into two groups: 30 patients with regression of LV hypertrophy (Group A) and 13 patients without regression (Group B). Preoperative echocardiographic measurements, clinical status, and operative factors were compared between the two groups. The patients were followed up for 42 ± 22 months for the occurrence of hospitalization for congestive heart failure (CHF) or death. Results: Preoperatively, the two groups were similar except for an excess of patients in New York Heart Association (NYHA) functional Class IV and a greater incidence of old myocardial infarcts in Group B. Postoperatively, Group B patients had larger LVs with decreased systolic function. This was associated with a poor prognosis (23% mortality and 38% CHF vs 0% and 4% for Group A patients, P = 0.0002). Cox regression analysis showed previous myocardial infarction (P < 0.001) and percent mass reduction (P = 0.019) to be independent predictors of CHF or death. Conclusions: Successful regression of LV mass is difficult to predict before surgery; however, its absence is related strongly to a poor long‐term prognosis.