Left ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim... Show moreLeft ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim of the present study was to evaluate the morphology and dynamics of LV diastolic vortex ring formation early after acute myocardial infarction (AMI), in relation to LV diastolic function and infarct size. A total of 94 patients with a first ST-segment elevation AMI (59 +/- 11 years; 78% men) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, the following examinations were performed: 2-dimensional echocardiography with speckle-tracking analysis to assess the LV systolic and diastolic function, the vortex formation time (VFT, a dimensionless index for characterizing vortex formation), and the LV untwisting rate; contrast echocardiography to assess LV vortex morphology; and myocardial contrast echocardiography to identify the infarct size. Patients with a large infarct size LV segments) had a significantly lower VFT (p < 0.001) and vortex sphericity index (p <0.001). On univariate analysis, several variables were significantly related to the VFT, including anterior AMI, LV end-systolic volume, LV ejection fraction, grade of diastolic dysfunction, LV untwisting rate, and infarct size. On multivariate analysis, the LV untwisting rate (beta = -0.43, p <0.001) and infarct size (beta = -0.33, p = 0.005) were independently associated with VFT. In conclusion, early in AMI, both the LV infarct size and the mechanical sequence of diastolic restoration play key roles in modulating the morphology and dynamics of early diastolic vortex ring formation. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:1404-1409) Show less
Shanks, M.; Bertini, M.; Delgado, V.; Ng, A.C.T.; Nucifora, G.; Bommel, R.J. van; ... ; Bax, J.J. 2010
Objectives This study sought to examine the changes in diastolic dyssynchrony with cardiac resynchronization therapy (CRT). Background Little is known about the effect of CRT on diastolic... Show moreObjectives This study sought to examine the changes in diastolic dyssynchrony with cardiac resynchronization therapy (CRT). Background Little is known about the effect of CRT on diastolic dyssynchrony. Methods Consecutive heart failure patients (n = 266, age 65.7 +/- 10.0 years) underwent color-coded tissue Doppler imaging at baseline, 48 h, and 6 months after CRT. Systolic and diastolic dyssynchrony were defined as maximal time delay in peak systolic and early diastolic velocities, respectively, in 4 basal LV segments. CRT responders were defined as those with >= 15% decrease in LV end-systolic volume at 6 months. Results Baseline LVEF was 25.2 +/- 8.1%; 63.5% patients were CRT responders. Baseline incidence of systolic and diastolic dyssynchrony, and a combination of both was 46.2%, 51.9%, and 28.6%, respectively. Compared to nonresponders, responders had longer baseline systolic (79.2 +/- 43.4 ms vs. 45.4 +/- 30.4 ms; p < 0.001) and diastolic (78.5 +/- 52.0 ms vs. 50.1 +/- 38.2 ms; p < 0.001) delays. In follow-up, systolic delays (45.4 +/- 31.6 ms at 48 h; 38.9 +/- 26.2 ms at 6 months; p < 0.001) and diastolic delays (49.4 +/- 36.3 ms at 48 h; 37.7 +/- 26.0 ms at 6 months; p < 0.001) improved only in responders. Conclusions At baseline: 1) diastolic dyssynchrony was more common than systolic dyssynchrony in HF patients; 2) nonresponders had less baseline diastolic dyssynchrony compared to responders. After CRT: 1) diastolic dyssynchrony improved only in responders. Further insight into the pathophysiology of diastolic dyssynchrony and its changes with CRT may provide incremental information on patient-specific treatments. (J Am Coll Cardiol 2010;56:1567-75) (C) 2010 by the American College of Cardiology Foundation Show less
Background Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim... Show moreBackground Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of the infarct, periinfarct, and remote zones and monomorphic ventricular tachycardia (VT) inducibility on electrophysiologic (EP) study. Methods A total of 134 patients with chronic ischemic cardiomyopathy scheduled for EP study were included. The protocol consisted of clinical, electrocardiographic, and echocardiographic evaluation, including LV longitudinal strain analysis using speckle-tracking echocardiography, immediately before EP study. An infarct segment was defined as a longitudinal strain value of greater than -5%, and a periinfarct segment was defined as immediately adjacent to an infarct segment. Results The infarct zone had the most impaired longitudinal strain (-0.5% +/- 3.0%), whereas the periinfarct and remote zones had more preserved longitudinal strain (-10.8% +/- 1.9% and -14.5% +/- 3.0%, respectively; analysis of variance, P < .001). Seventy-two (54%) patients had inducible monomorphic VT on EP study. There was no significant difference in LV ejection fraction (31% +/- 9% vs 32% +/- 11%, P = .29) between inducible and noninducible patients. Longitudinal peak systolic strain of the periinfarct zone was more impaired in inducible patients (-9.8% +/- 1.5% vs -11.0% +/- 2.1%, P = .001), but no differences in LPSS of the infarct (-0.5% +/- 3.2% vs -0.4% +/- 2.7%, P = .75) and remote (-14.6% +/- 2.8% vs -14.5% +/- 3.4%, P = .92) zones were observed. Only LPSS of the periinfarct zone (OR 1.43, 95% CI 1.15-1.78, P = .001) was independently related to monomorphic VT inducibility on multiple logistic regression. Conclusions Longitudinal strain analysis may be a useful imaging tool to risk stratify ischemic patients for malignant ventricular arrhythmia. (Am Heart J 2010; 160: 729-36.) Show less
Shanks, M.; Delgado, V.; Bertini, M.; Ng, A.C.T.; Nucifora, G.; Bommel, R.J. van; ... ; Bax, J.J. 2010
The analysis of left ventricular (LV) mechanics provides novel insights into the effects of cardiac resynchronization therapy (CRT) on LV performance. Currently, advances in speckle-tracking... Show moreThe analysis of left ventricular (LV) mechanics provides novel insights into the effects of cardiac resynchronization therapy (CRT) on LV performance. Currently, advances in speckle-tracking echocardiographic analysis have permitted the characterization of subendocardial and subepicardial LV twist. The aim of this study was to investigate the role of the acute changes in subendocardial and subepicardial LV twist for the prediction of midterm beneficial effects of CRT. A total of 84 patients with heart failure scheduled for CRT were recruited. All patients underwent echocardiography before and <48 hours after CRT implantation and at 6-month follow-up. The assessment of LV volumes, ejection fractions, and mechanical dyssynchrony (systolic dyssynchrony index) was performed with real-time 3-dimensional echocardiography. The assessment of subendocardial and subepicardial LV twist was performed with 2-dimensional speckle-tracking echocardiography. A favorable outcome was defined as the occurrence of a reduction -15% in LV end-systolic volume associated with an improvement of >= 1 New York Heart Association functional class at 6-month follow-up. At 6-month follow-up, 53% of the patients showed favorable outcomes. Ischemic cause of heart failure, baseline systolic dyssynchrony index, immediate improvement in the LV ejection fraction, immediate improvement in systolic dyssynchrony index, and immediate improvement in subendocardial and subepicardial LV twist were significantly related to favorable outcomes. However, in multivariate logistic regression analysis, only the immediate improvement of subepicardial LV twist was independently related to favorable outcomes (odds ratio 2.31, 95% confidence interval 1.29 to 4.15, p = 0.005). Furthermore, the immediate improvement of subepicardial LV twist had incremental value over established parameters. In conclusion, the immediate improvement of subepicardial LV twist (but not subendocardial LV twist) is independently related to favorable outcomes after CRT. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:682-687) Show less
Background-Left ventricular (LV) torsion is emerging as a sensitive parameter of LV systolic myocardial performance. The aim of the present study was to explore the effects of acute myocardial... Show moreBackground-Left ventricular (LV) torsion is emerging as a sensitive parameter of LV systolic myocardial performance. The aim of the present study was to explore the effects of acute myocardial infarction (AMI) on LV torsion and to determine the value of LV torsion early after AMI in predicting LV remodeling at 6-month follow-up. Methods and Results-A total of 120 patients with a first ST-segment elevation AMI (mean +/- SD age, 59 +/- 10 years; 73% male) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, speckle-tracking echocardiography was performed to assess LV torsion; infarct size was assessed by myocardial contrast echocardiography. At 6-month follow-up, LV volumes and LV ejection fraction were reassessed to identity patients with LV remodeling (defined as a >= 15% increase in LV end-systolic volume). Compared with control subjects, peak LV torsion in AMI patients was significantly impaired (1.54 +/- 0.64 degrees/cm vs 2.07 +/- 0.27 degrees/cm, P < 0.001). By multivariate analysis, only LV ejection fraction (beta = 0.36, P < 0.001) and infarct size (beta = -0.47, P < 0.001) were independently associated with peak LV torsion. At 6-month follow-up, 19 patients showed LV remodeling. By multivariate analysis, only peak LV torsion (odds ratio = 0.77; 95% CI, 0.65-0.92; P = 0.003) and infarct size (odds ratio = 1.04; 95% CI, 1.01-1.07; P = 0.021) were independently related to LV remodeling. Peak LV torsion provided modest but significant incremental value over clinical, echocardiographic, and myocardial contrast echocardiography variables in predicting LV remodeling. By receiver-operating characteristics curve analysis, peak LV torsion <= 1.44 degrees/cm provided the highest sensitivity (95%) and specificity (77%) to predict LV remodeling. Conclusions-LV torsion is significantly impaired early after AMI. The amount of impairment of LV torsion predicts LV remodeling at 6-month follow-up. (Circ Cardiovasc Imaging. 2010; 3: 433-442.) Show less
Multidetector computed tomography (MDCT) has been demonstrated as a feasible imaging modality for noninvasive assessment of coronary artery disease and left ventricular (LV) function. Recently, 320... Show moreMultidetector computed tomography (MDCT) has been demonstrated as a feasible imaging modality for noninvasive assessment of coronary artery disease and left ventricular (LV) function. Recently, 320-row systems have become available with 16 cm anatomical coverage allowing image acquisition of the entire heart within a single heartbeat. The purpose of this study was to evaluate the accuracy of 320-row MDCT in the assessment of global LV function compared to two-dimensional (2D) echocardiography as the standard of reference. A head-to-head comparison between 320-row MDCT and 2D-echocardiography was performed in 114 patients (68 men; mean age 62 +/- A 13 years) who were clinically referred for MDCT coronary angiography. The entire heart was imaged in a single heartbeat, using prospective dose modulation. LV end-diastolic volumes (LVEDV) and LV end-systolic volumes (LVESV) were determined and the LV ejection fraction (LVEF) was derived. Average LVEF was 60 +/- A 10% (range 26-78%) as determined on MDCT, compared with 59 +/- A 10% (range 25-77%) on 2D-echocardiography. Evaluation of LVEF by linear regression analysis showed a good correlation between MDCT and 2D-echocardiography (r (2) = .87; P < .001). Good correlations between MDCT and 2D-echocardiography were demonstrated for the assessment of LVEDV (r (2) = .91; P < .001) and LVESV (r (2) = .94; P < .001). At Bland-Altman analysis, mean differences (+/- SD) of 7.3 +/- A 12.1 mL (P < .05) and 1.8 +/- A 7.4 mL (P < .05) were observed between MDCT and 2D-echocardiography for LVEDV and LVESV, respectively. LVEF was slightly overestimated with MDCT (.9 +/- A 3.6%; P < .05). Accurate assessment of LV function and volumes is feasible with single heartbeat 320-row MDCT in patients referred for MDCT coronary angiography. Show less
This study examined the prognostic value of novel diastolic indexes in ST-elevation acute myocardial infarction (AMI), derived from strain and strain rate analysis using 2-dimensional speckle... Show moreThis study examined the prognostic value of novel diastolic indexes in ST-elevation acute myocardial infarction (AMI), derived from strain and strain rate analysis using 2-dimensional speckle tracking imaging. Echocardiograms were obtained within 48 hours of admission in 371 consecutive patients with first ST-elevation AMI (59.7 +/- 11.6 years old). Indexes of diastolic function including mean strain rate during isovolumic relaxation (SRIVR), mean early diastolic strain rate (SRE) and mean diastolic strain at peak transmitral E wave (E) were obtained from 3 apical views. Mean early diastolic velocity from 4 basal segments by color-coded tissue Doppler imaging was measured. Indexes of diastolic filling including E/SRIVR, E/SRE, E/diastolic strain at E, and E/early diastolic velocity were calculated. The primary end point (composite of death, hospitalization for heart failure, repeat MI, and repeat revascularization) occurred in 84 patients (22.6%) during a mean follow-up of 17.3 +/- 12.2 months. Mean SRIVR (p < 0.001), multivessel disease (p < 0.001), Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention (p = 0.004), and left ventricular ejection fraction (p = 0.008) were independent predictors of the combined end point on Cox regression analysis. Mean SRIVR showed incremental prognostic value over baseline clinical and echocardiographic variables (global chi-square increase from 41.0 to 51.6, p < 0.001). After dividing patient population based on median SRIVR, patients with SRIVR <= 0.24/second had significantly higher event rates than others (hazard ratio 2.74, 95% confidence interval 1.61 to 4.67, p < 0.001). In conclusion, SRIVR was incremental to left ventricular ejection fraction, Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention, and multivessel disease and superior to other diastolic indexes in predicting future cardiovascular events after AMI. SRIVR may be useful in identifying high-risk patients soon after AMI. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:592-597) Show less
Data evaluating gender- and age-specific differences in plaque observations on multislice computed tomography (MSCT) are scarce. Accordingly, the aim of this study was to evaluate coronary plaque... Show moreData evaluating gender- and age-specific differences in plaque observations on multislice computed tomography (MSCT) are scarce. Accordingly, the aim of this study was to evaluate coronary plaque patterns in men and women in relation to age using MSCT. The findings were compared to observations on grayscale intravascular ultrasound (IVUS) and virtual histology (VH) IVUS. In total, 93 patients (59 men, 34 women) underwent 64-slice MSCT followed by conventional coronary angiography with IVUS. Plaque extent and composition were assessed on MSCT, grayscale IVUS, and VH IVUS. Coronary plaque patterns were compared between men and women in 2 age groups (<65 and >or=65 years old). In patients aged <65 years, more plaques were observed on MSCT in men (6 +/- 4 vs 2 +/- 2 in women, p <0.001). Also, a larger plaque burden was observed on grayscale IVUS in men (45.7 +/- 11.4% vs 36.3 +/- 11.6% in women, p <0.001). Similarly, more mixed plaques were observed in men (3 +/- 3 vs 1 +/- 1 in women, p = 0.003), whereas a larger arc of calcium was detected on grayscale IVUS in men (91.7 +/- 93.5 degrees vs 25.7 +/- 51.0 degrees in women, p <0.001). On VH IVUS, the prevalence of thin-cap fibroatheroma was higher in men (31% vs 0%) compared to women. In patients aged >or=65 years old, no important differences in plaque patterns were observed between men and women. In conclusion, more extensive atherosclerosis and more calcified lesions were observed in men than in women. These differences were predominantly present in patients aged <65 years and were lost in those aged >or=65 years. Show less
Data evaluating gender- and age-specific differences in plaque observations on multislice computed tomography (MSCT) are scarce. Accordingly, the aim of this study was to evaluate coronary plaque... Show moreData evaluating gender- and age-specific differences in plaque observations on multislice computed tomography (MSCT) are scarce. Accordingly, the aim of this study was to evaluate coronary plaque patterns in men and women in relation to age using MSCT. The findings were compared to observations on grayscale intravascular ultrasound (IVUS) and virtual histology (VH) IVUS. In total, 93 patients (59 men, 34 women) underwent 64-slice MSCT followed by conventional coronary angiography with IVUS. Plaque extent and composition were assessed on MSCT, grayscale IVUS, and VH IVUS. Coronary plaque patterns were compared between men and women in 2 age groups (<65 and >= 65 years old). In patients aged <65 years, more plaques were observed on MSCT in men (6 4 vs 2 2 in women, p <0.001). Also, a larger plaque burden was observed on grayscale IVUS in men (45.7 +/- 11.4% vs 36.3 +/- 11.6% in women, p <0.001). Similarly, more mixed plaques were observed in men (3 +/- 3 vs 1 +/- 1 in women, p = 0.003), whereas a larger arc of calcium was detected on grayscale IVUS in men (91.7 +/- 93.5 vs 25.7 +/- 51.0 degrees in women, p <0.001). On VH IVUS, the prevalence of thin-cap fibroatheroma was higher in men (31% vs 0%) compared to women. In patients aged >= 65 years old, no important differences in plaque patterns were observed between men and women. In conclusion, more extensive atherosclerosis and more calcified lesions were observed in men than in women. These differences were predominantly present in patients aged <65 years and were lost in those aged >= 65 years. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105: 480-486) Show less
The impact of left ventricular (LV) dyssynchrony after acute myocardial infarction (AMI) on LV ejection fraction (EF) is unknown. One hundred twenty-nine patients with a first ST-elevation AMI (58 ... Show moreThe impact of left ventricular (LV) dyssynchrony after acute myocardial infarction (AMI) on LV ejection fraction (EF) is unknown. One hundred twenty-nine patients with a first ST-elevation AMI (58 +/- 11 years, 78% men) and QRS duration <120 ms were included. All patients underwent primary percutaneous coronary intervention. Real-time 3-dimensional echocardiography and myocardial contrast echocardiography were performed to assess LV function, LV dyssynchrony, and infarct size. LV dyssynchrony was defined as the SD of the time to reach the minimum systolic volume for 16 LV segments, expressed in percent cardiac cycle (systolic dyssynchrony index [SDI]). Myocardial perfusion at myocardial contrast echocardiography was scored (1 = normal/homogenous; 2 = decreased/patchy; 3 = minimal/absent) using a 16-segment model; a myocardial perfusion index, expressing infarct size, was derived by summing segmental contrast scores and dividing by the number of segments. SDI in patients with AM! was 5.24 +/- 2.23% compared to 2.02 +/- 0.70% of controls (p <0.001). Patients with AMI and LVEF <45% had significantly higher SDI compared to patients with LVEF >= 45% (4.29 +/- 1.44 vs 6.95 +/- 2.40, p <0.001). At multivariate analysis, SDI was independently related to LVEF; in addition, the impact of SDI on LV systolic function was incremental to infarct size and anterior location of AM! (F change 16.9, p <0.001). In conclusion, LV synchronicity is significantly impaired soon after AMI. LV dyssynchrony is related to LVEF and has an additional detrimental effect on LV function, beyond infarct size and the anterior location of AMI. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:306-311) Show less
Background Left ventricular (LV) diastolic dysfunction and subclinical systolic dysfunction may be markers of coronary artery disease (CAD). However, whether these markers are useful for prediction... Show moreBackground Left ventricular (LV) diastolic dysfunction and subclinical systolic dysfunction may be markers of coronary artery disease (CAD). However, whether these markers are useful for prediction of obstructive CAD is unknown. Methods A total of 182 consecutive outpatients (54 +/- 10 years, 59% males) without known CAD and overt LV systolic dysfunction underwent 64-slice multislice computed tomography (MSCT) coronary angiography and echocardiography. The MSCT angiograms showing atherosclerosis were classified as showing obstructive (>= 50% luminal narrowing) CAD or not. Conventional echocardiographic parameters of LV systolic and diastolic function were obtained; in addition, (1) global longitudinal strain (GLS) and strain rate (indices of systolic function) and (2) global strain rate during the isovolumic relaxation period and during early diastolic filling (indices of diastolic function) were assessed using speckle-tracking echocardiography. In addition, the pretest likelihood of obstructive CAD was assessed using the Duke Clinical Score. Results Based on MSCT, 32% of patients were classified as having no CAD, whereas 33% showed nonobstructive CAD and the remaining 35% had obstructive CAD. Multivariate analysis of clinical and echocardiographic characteristics showed that only high pretest likelihood of CAD (odds ratio [OR] 3.21, 95% 1.02-10.09, P = .046), diastolic dysfunction (OR 3.72, 95% CI 1.44-9.57, P = .006), and GLS (OR 1.97, 95% CI 1.43-2.71, P < .001) were associated with obstructive CAD. A value of GLS >=-17.4 yielded high sensitivity and specificity in identifying patients with obstructive CAD (83% and 77%, respectively), providing a significant incremental value over pretest likelihood of CAD and diastolic dysfunction. Conclusions The GLS impairment aids detection of patients without overt LV systolic dysfunction having obstructive CAD. (Am Heart J 2010; 159: 148-57.) Show less
Ng, A.C.T.; Delgado, V.; Kley, F. van der; Shanks, M.; Veire, N.R.L. van de; Bertini, M.; ... ; Bax, J.J. 2010
BACKGROUND: 3D transesophageal echocardiography (TEE) may provide more accurate aortic annular and left ventricular outflow tract (LVOT) dimensions and geometries compared with 2D TEE. We assessed... Show moreBACKGROUND: 3D transesophageal echocardiography (TEE) may provide more accurate aortic annular and left ventricular outflow tract (LVOT) dimensions and geometries compared with 2D TEE. We assessed agreements between 2D and 3D TEE measurements with multislice computed tomography (MSCT) and changes in annular/LVOT areas and geometries after transcatheter aortic valve implantations (TAVI). METHODS AND RESULTS: Two-dimensional circular (pixr(2)), 3D circular, and 3D planimetered annular and LVOT areas by TEE were compared with "gold standard" MSCT planimetered areas before TAVI. Mean MSCT planimetered annular area was 4.65+/-0.82 cm(2) before TAVI. Annular areas were underestimated by 2D TEE circular (3.89+/-0.74 cm(2), P<0.001), 3D TEE circular (4.06+/-0.79 cm(2), P<0.001), and 3D TEE planimetered annular areas (4.22+/-0.77 cm(2), P<0.001). Mean MSCT planimetered LVOT area was 4.61+/-1.20 cm(2) before TAVI. LVOT areas were underestimated by 2D TEE circular (3.41+/-0.89 cm(2), P<0.001), 3D TEE circular (3.89+/-0.94 cm(2), P<0.001), and 3D TEE planimetered LVOT areas (4.31+/-1.15 cm(2), P<0.001). Three-dimensional TEE planimetered annular and LVOT areas had the best agreement with respective MSCT planimetered areas. After TAVI, MSCT planimetered (4.65+/-0.82 versus 4.20+/-0.46 cm(2), P<0.001) and 3D TEE planimetered (4.22+/-0.77 versus 3.62+/-0.43 cm(2), P<0.001) annular areas decreased, whereas MSCT planimetered (4.61+/-1.20 versus 4.84+/-1.17 cm(2), P=0.002) and 3D TEE planimetered (4.31+/-1.15 versus 4.55+/-1.21 cm(2), P<0.001) LVOT areas increased. Aortic annulus and LVOT became less elliptical after TAVI. CONCLUSIONS: Before TAVI, 2D and 3D TEE aortic annular/LVOT circular geometric assumption underestimated the respective MSCT planimetered areas. After TAVI, 3D TEE and MSCT planimetered annular areas decreased as it assumes the internal dimensions of the prosthetic valve. However, planimetered LVOT areas increased due to a more circular geometry. Show less
Ng, A.C.T.; Delgado, V.; Kley, F. van der; Shanks, M.; Veire, N.R.L. van de; Bertini, M.; ... ; Bax, J.J. 2010
Background-3D transesophageal echocardiography ( TEE) may provide more accurate aortic annular and left ventricular outflow tract (LVOT) dimensions and geometries compared with 2D TEE. We assessed... Show moreBackground-3D transesophageal echocardiography ( TEE) may provide more accurate aortic annular and left ventricular outflow tract (LVOT) dimensions and geometries compared with 2D TEE. We assessed agreements between 2D and 3D TEE measurements with multislice computed tomography (MSCT) and changes in annular/LVOT areas and geometries after transcatheter aortic valve implantations (TAVI). Methods and Results-Two-dimensional circular (pi Xr(2)), 3D circular, and 3D planimetered annular and LVOT areas by TEE were compared with "gold standard" MSCT planimetered areas before TAVI. Mean MSCT planimetered annular area was 4.65 +/- 0.82 cm(2) before TAVI. Annular areas were underestimated by 2D TEE circular (3.89 +/- 0.74 cm(2), P<0.001), 3D TEE circular (4.06 +/- 0.79 cm(2), P<0.001), and 3D TEE planimetered annular areas (4.22 +/- 0.77 cm(2), P<0.001). Mean MSCT planimetered LVOT area was 4.61 +/- 1.20 cm(2) before TAVI. LVOT areas were underestimated by 2D TEE circular (3.41 +/- 0.89 cm(2), P<0.001), 3D TEE circular (3.89 +/- 0.94 cm(2), P<0.001), and 3D TEE planimetered LVOT areas (4.31 +/- 1.15 cm(2), P<0.001). Three-dimensional TEE planimetered annular and LVOT areas had the best agreement with respective MSCT planimetered areas. After TAVI, MSCT planimetered (4.65 +/- 0.82 versus 4.20 +/- 0.46 cm(2), P<0.001) and 3D TEE planimetered (4.22 +/- 0.77 versus 3.62 +/- 0.43 cm(2), P<0.001) annular areas decreased, whereas MSCT planimetered (4.61 +/- 1.20 versus 4.84 +/- 1.17 cm(2), P=0.002) and 3D TEE planimetered (4.31 +/- 1.15 versus 4.55 +/- 1.21 cm(2), P<0.001) LVOT areas increased. Aortic annulus and LVOT became less elliptical after TAVI. Conclusions-Before TAVI, 2D and 3D TEE aortic annular/LVOT circular geometric assumption underestimated the respective MSCT planimetered areas. After TAVI, 3D TEE and MSCT planimetered annular areas decreased as it assumes the internal dimensions of the prosthetic valve. However, planimetered LVOT areas increased due to a more circular geometry. (Circ Cardiovasc Imaging. 2010;3:94-102.) Show less
Background-Left ventricular (LV) fibrosis is important for the response to cardiac resynchronization therapy (CRT). Calibrated integrated backscatter derived by 2D echocardiography quantifies... Show moreBackground-Left ventricular (LV) fibrosis is important for the response to cardiac resynchronization therapy (CRT). Calibrated integrated backscatter derived by 2D echocardiography quantifies myocardial ultrasound reflectivity, which may provide a surrogate of LV fibrosis. The aim of the study was first, to investigate the relation of myocardial ultrasound reflectivity assessed with calibrated integrated backscatter on CRT response, and second, to explore the "myocardial ultrasound reflectivity-CRT response" relation in patients with ischemic and nonischemic heart failure (HF). Methods and Results-One hundred fifty-nine patients with HF referred for CRT underwent an extensive echocardiographic evaluation at baseline and at 6-month follow-up. LV dyssynchrony was derived from speckle-tracking analysis. Calibrated integrated backscatter was obtained from the parasternal long-axis view. The mean value of calibrated integrated backscatter of the anteroseptal and posterior wall was used to estimate myocardial ultrasound reflectivity. CRT response was defined as reduction >= 15% of LV end-systolic volume. At baseline, LV dyssynchrony was significantly larger in responders as compared with nonresponders (188 +/- 96 ms versus 115 +/- 68 ms, P<0.001), and CRT responders showed less myocardial ultrasound reflectivity as compared with nonresponders (-20.8 +/- 3.0 dB versus -17.0 +/- 3.0 dB, P<0.001). In multivariable logistic regression analysis, independent predictors for CRT response were LV dyssynchrony, renal function, and myocardial ultrasound reflectivity. Importantly, myocardial ultrasound reflectivity provided an incremental value to CRT response (chi(2) change=40, P<0.001). Considering patients with ischemic HF, the only independent predictor of CRT response was myocardial ultrasound reflectivity, whereas in patients with nonischemic HF, independent predictors of LV reverse remodeling were myocardial ultrasound reflectivity, LV dyssynchrony, and renal function. Conclusions-Assessment of myocardial ultrasound reflectivity is important in the prediction of CRT response in ischemic and nonischemic patients. (Circ Cardiovasc Imaging. 2010;3:86-93.) Show less
