La revista, el nombre con el que está indexado en el medline( si lo está), los años online y la casa editorial
|European Journal of Echocardiography|
|Eur J Echocardiogr|
European Heart Journal - Cardiovascular Imaging - current issue
European Heart Journal - Cardiovascular Imaging - RSS feed of current issue
- Imaging-based right-atrial anatomy by computed tomography, magnetic resonance imaging, and three-dimensional transoesophageal echocardiography: correlations with anatomic specimens
Nowadays computed tomography, cardiac magnetic resonance imaging, and tridimensional transoesophageal echocardiography provide anatomic images of right-atrial structures with an impressive richness of anatomical details. It is therefore surprising that these techniques are not routinely used as complementary tools in teaching anatomy. This review aims to fill this gap showing the normal anatomy of right atrium as displayed by these sophisticated imaging techniques. A better understanding of right-atrial anatomy is crucial for the treatment of primary right-atrium electrical disorders as well as for catheter-based interventions for structural heart disease. The success of these procedures is, in fact, related to an accurate anatomical pre-procedural assessment. In this review, we describe the normal anatomy and variants of those right-atrial structures relevant for both ablationists and interventionalists.
- A rare cause of Bachmann interatrial block
- Pocket-size imaging device: effectiveness for ward-based transthoracic studies
Pocket-size imaging devices (PSID) are now available; their potential role in a hospital environment has been investigated but still remains undefined.
Methods and results
We evaluated the effectiveness of PSID in 92 patients referred for bedside transthoracic echocardiogram (TTE). Patients were included where there was a focused clinical question: quantification of left ventricular function (LVF); presence of regional wall motion abnormalities (RWMA); evidence of pericardial effusion, exclusion of significant valve pathology. Each patient underwent an echocardiography evaluation using PSID and TTE. In 83 patients [k = 90%, 95% CI (82.2–95.4)], it was possible to answer the clinical question by PSID examination alone. There was agreement between the findings of PSID and TTE in 86 cases [79%; k = 47%, 95% CI (12.8–82.0)], in three cases, the clinical question was not answered by both modalities. When the clinical question was focused on LVF, the agreement was excellent [k = 96%, 95% CI (95.3–97.9)], as was the agreement in the detection of RWMA [k = 94.57%, 95% CI (82.4–95.1)]. There was also good concordance in the detection of valve pathology and pericardial effusion. Using PSID, the reduction in the scanning and reporting time was 66%. The cost-effectiveness analysis produced very favourable results: with PSE, we obtained an overall cost saving per scan of 76%, compared with TTE.
This study demonstrates that PSID can provide a valuable alternative to TTE in the presence of focused clinical questions and can provide an efficient way of delivering a ward-based transthoracic echo service.
- Non-invasive indices of right ventricular function are markers of ventricular-arterial coupling rather than ventricular contractility: insights from a porcine model of chronic pressure overload
To investigate the physiological correlates of indices of RV function in a model of chronic pressure overload.
Methods and results
Chronic pulmonary hypertension (PH) was induced in piglets by ligation of the left pulmonary artery (PA) followed by weekly embolization of right lower lobe arteries for 5 weeks (the PH group, n = 11). These animals were compared with sham-operated animals (controls, n = 6). At 6 weeks, a subgroup of five PH pigs underwent surgical reperfusion of the left lung and four others were followed until 12 weeks without treatment. Right ventricular function was assessed using echocardiography and conductance catheter measurements. At 6 weeks, mean PA pressure was higher in PH group compared with controls (35 ± 9 vs. 14 ± 2 mmHg, P < 0.01). Although RV elastance (Ees) increased at 6 weeks in the PH group (0.55 ± 0.09 vs. 0.38 ± 0.05mmHg/mL, P < 0.001), ventricular–arterial coupling measured by the ratio of Ees on PA elastance (Ea) was decreased (0.68 ± 0.17 vs. 1.18 ± 0.18, P < 0.001). There was a strong direct relationship between Ees/Ea and indices of RV function, while relationship between Ees and indices of RV function was moderate. Changes in indices of RV function with time and after left lung reperfusion were associated with changes in Ees/Ea.
Usual indices of RV function are associated with ventricular–arterial coupling rather than with ventricular contractility in a model of chronic pressure overload.
- Bioabsorbable scaffold optimization in provisional stenting: insight from optical coherence tomography
- Myocardial infarct heterogeneity assessment by late gadolinium enhancement cardiovascular magnetic resonance imaging shows predictive value for ventricular arrhythmia development after acute myocardial infarction
The aim of this study was to assess the association between the proportions of penumbra—visualized by late gadolinium enhanced cardiovascular magnetic resonance imaging (LGE-CMR)—after acute myocardial infarction (AMI) and the prevalence of ventricular tachycardia (VT).
One-hundred and sixty-two AMI patients, successfully, treated by primary percutaneous coronary intervention (PCI) underwent LGE-CMR after a median of 3 days (3–4) and 24-h Holter monitoring after 1 month. With LGE-CMR, the total amount of enhanced myocardium was quantified and divided into an infarct core (>50% of maximal signal intensity) and penumbra (25–50% of maximal signal intensity). With Holter monitoring, the number of VTs (≥4 successive PVCs) per 24 h was measured.
The mean total enhanced myocardium was 31 ± 11% of the left ventricular mass. The % penumbra accounted for 39 ± 11% of the total enhanced area. In 29 (18%) patients, Holter monitoring showed VT, with a median of 1 episode (1–3) in 24 h. A larger proportion of penumbra within the enhanced area increased the risk of VTs [OR: 1.06 (95% CI: 1.02–1.10), P = 0.003]. After multivariate logistic regression analysis, the presence of ventricular fibrillation before primary PCI [OR: 5.60 (95% CI: 1.54–20.29), P = 0.01] and the proportional amount of penumbra within the enhanced myocardium [OR: 1.06 (95% CI: 1.02–1.10), P = 0.04] were independently associated with VT on Holter monitoring.
Larger proportions of penumbra in the subacute phase after AMI are associated with increased risk of developing VTs. Quantification of penumbra size may become a useful future tool for risk stratification and ultimately for the prevention of ventricular arrhythmias.
- Relationship between chronic obstructive pulmonary disease and subclinical coronary artery disease in long-term smokers
Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers.
Methods and results
In this cross-sectional study, long-term smokers without clinically manifested CAD were recruited from the Danish Lung Cancer Screening Trial and classified according to lung function by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Coronary artery calcium deposit as a measure of subclinical CAD and cardiac risk was evaluated with multi detector computed tomography and the Agatston coronary artery calcium score (CACS). Participants were categorized into five CACS risk classification groups according to the CACS. The population (n = 1535) consisted of 41% participants without COPD, 28% with mild, and 31% with moderate-to-severe COPD (n = 46 with severe COPD). In addition to age, male gender, hypertension, hypercholesterolaemia, and continued smoking, COPD according to GOLD classification were independent predictors of a higher CACS risk classification group in multivariable analysis [odds ratio (OR): 1.28 (1.01–1.63) and OR: 1.32 (1.05–1.67), for mild and moderate-to-severe COPD, respectively, compared with no COPD].
COPD in long-term smokers is independently correlated with the CACS, while COPD severity per se does not show a dose–response relationship.
- Evaluation of myocardial mechanics with three-dimensional speckle tracking echocardiography in heart transplant recipients: comparison with two-dimensional speckle tracking and relationship with clinical variables
Two-dimensional speckle-tracking echocardiography (2D-STE) is limited by its inability to track tissue motion in three dimensions. This is particularly relevant in heart transplant recipients, in whom marked translational motion of the transplanted heart is present. We aimed to compare 3-dimensional (3D)- and 2D-STE-derived strain parameters, and to identify clinical features associated with myocardial mechanics in transplant recipients.
Methods and results
In 36 heart transplant recipients, global and regional left-ventricular (LV) longitudinal and circumferential strain (LSt and CSt), and radial displacement (RDisp) were obtained by 3D- and 2D-STE, and their results were compared. 3D-STE deformation from a subset of transplant recipients with preserved ejection fraction was compared with a control group of 25 subjects matched by gender, age, history of hypertension, and ejection fraction. Associations between global LSt and CSt and clinical, echocardiographic, and haemodynamic parameters in transplant recipients were investigated. 3D-STE yielded lower magnitude of global LSt compared with 2D-STE (–13 ± 3 vs. –16 ± 3%, P < 0.001). The inferolateral wall was a source of variation between 3D- and 2D-STE both for LSt and CSt. Inferolateral wall 3D-STE-derived RDisp was greater than that observed in control subjects (7.4 ± 1.2 vs. 6.5 ± 1.7 mm, P = 0.03), while anteroseptal RDisp was lower than controls (4.2 ± 1.0 vs. 7.3 ± 1.6 mm, P < 0.001). Multiple regression analysis demonstrated that 3D-STE-derived LSt was independently associated with NYHA class (P < 0.001), while 2D-STE-derived LSt was not.
Examination of LV mechanics by 3D- and 2D-STE deformation parameters in heart transplant recipients yields significantly discordant results. 3D-STE-derived LSt is independently associated with NYHA class, suggesting a clinically important relationship between functional status and myocardial mechanics.
- Magnetic resonance myocardial perfusion imaging at 3.0 Tesla for the identification of myocardial ischaemia: comparison with coronary catheter angiography and fractional flow reserve measurements
To assess image quality and diagnostic performance of 3.0 Tesla (3T) cardiac magnetic resonance (CMR) myocardial perfusion imaging with a dual radiofrequency source to detect functional relevant coronary artery disease (CAD), using coronary angiography and invasive pressure-derived fractional flow reserve (FFR) as reference standard.
Methods and results
We included 116 patients with suspected or known CAD, who underwent 3T adenosine myocardial perfusion CMR (resolution 2.97 x 2.97 mm) and coronary angiography plus FFR measurements in intermediate lesions. Image quality of myocardial perfusion CMR was graded on a 4-point scale (1 = poor to 4 = excellent). Diagnostic accuracy was assessed by ROC analyses using a 16-myocardial segment-based summed perfusion score (0 = normal to 3 = transmural perfusion defect) and by determining sensitivity, specificity, positive and negative predictive value on the coronary vessel territory and the patient level. Diagnostic image quality was achieved for all stress myocardial perfusion CMR studies with an average quality score of 2.5, 3.1, and 3.0 for LAD, LCX, and RCA territories. The ability of the myocardial perfusion CMR perfusion score to detect significant coronary artery stenosis yielded an area under the curve of 0.93 on ROC analysis. Values for sensitivity, specificity, positive and negative predictive value on a vessel territory level and the patient level were 89, 95, 87, 96% and 85, 87, 77, 92%, respectively.
In patients with suspected or known significant CAD, 3T myocardial perfusion CMR with standard perfusion protocols provides consistently high image quality and an excellent diagnostic performance.
- Relationship between aspirin/clopidogrel resistance and intra-stent thrombi assessed by follow-up optical coherence tomography after drug-eluting stent implantation
No data exist regarding the relationship between aspirin/clopidogrel resistance and intra-stent thrombi on follow-up optical coherence tomography (OCT) after drug-eluting stent (DES) implantation. The purpose of this study was to evaluate the relationship between aspirin/clopidogrel resistance and intra-stent thrombi on the follow-up OCT in DES-treated patients.
Methods and results
A total of 308 DES-treated patients who underwent follow-up OCT and simultaneous measurement of aspirin reaction unit (ARU) and P2Y12 reaction unit (PRU) using the VerifyNow assay system were selected for the study. Aspirin and clopidogrel resistance were defined as ARU ≥550 and PRU ≥275, respectively. Intra-stent thrombi were detected in 29 patients (9.4%). The mean time interval from DES implantation to OCT was 195 ± 133 days (202.9 ± 103.0 days for patients with intra-stent thrombi vs. 194.7 ± 136.0 days for patients without intra-stent thrombi; P = 0.750). There were no significant differences between patients with and without intra-stent thrombi with regard to the incidence of aspirin resistance (13.8 vs. 11.1%, respectively; P = 0.630) or clopidogrel resistance (72.4 vs. 50.5%, respectively; P = 0.056). The percentage of uncovered struts was 17.9 ± 15.8% in patients with intra-stent thrombi and 12.7 ± 17.3% in patients without intra-stent thrombi (P = 0.098). Stent length was significantly longer in patients with intra-stent thrombi (22.9 ± 6.0 vs. 19.4 ± 5.0 mm, P = 0.006). Multivariate logistic regression analysis showed that stent length (odds ratio = 1.152, 95% confidential interval 1.025–1.295; P = 0.017) was the only independent risk factor for the presence of intra-stent thrombi on OCT.
This OCT study suggested that the presence of intra-stent thrombi may not be associated with aspirin/clopidogrel resistance in DES-treated patients.
- Perforation of the tricuspid valve caused by an implanted device lead
- Quantitative myocardial contrast echocardiography: a new method for the non-invasive detection of chronic heart transplant rejection
Chronic heart transplant rejection, i.e. cardiac allograft vasculopathy (CAV) is a major adverse prognostic factor after heart transplantation (HTx). This study tested the hypothesis that the relative myocardial blood volume (rBV) as quantified by myocardial contrast echocardiography accurately detects severe CAV as defined by coronary intravascular ultrasound (IVUS).
Methods and results
Forty-five HTx patients underwent a total of 50 quantitative IVUS measurements for intima thickness assessment (>1 mm = severe CAV; the reference method). Simultaneously, the two factors constituting myocardial perfusion (mL/min/g) were obtained by transthoracic contrast echocardiography at rest: rBV (the test method), a measure of microvascular density (mL/mL), and its exchange rate β (1/s; a measure of coronary conductance) after mechanical contrast bubble disruption.Sixty-nine per cent (31 of 45) of the HTx patients showed severe CAV. rBV at rest was equal to 0.17 ± 0.05 in the group without severe CAV, and it was equal to 0.12 ± 0.07 in the group with severe CAV (P = 0.0157). Conversely, β amounted to 6.4 ± 4.5 in the former and to 10.3 ± 6.2 in the latter group (P = 0.0410), thus, maintaining normal resting myocardial perfusion at 1 mL/min/g. IVUS determined intima thickness correlated significantly and inversely with rBV at rest. An rBV value at rest <0.14 accurately detected severe CAV (intima thickness >1 mm): area under the receiver operating characteristics curve = 0.844, P = 0.004, sensitivity = 0.90, specificity = 0.75.
Severe CAV can be detected using the non-invasive method of quantitative myocardial contrast echocardiography. rBV at rest amounting to <14% of the surrounding tissue accurately detects coronary intima thickness >1 mm as determined invasively by IVUS.
Clinical trial number: NCT00414895.
- Feasibility and reliability of point-of-care pocket-size echocardiography performed by medical residents
To study the feasibility and reliability of pocket-size hand-held echocardiography (PHHE) by medical residents with limited experience in ultrasound.
Methods and results
A total of 199 patients admitted to a non-university medical department were examined with PHHE. Six out of 14 medical residents were randomized to use a focused protocol and examine the heart, pericardium, pleural space, and abdominal large vessels. Diagnostic corrections were made and findings were confirmed by standard diagnostics. The median time consumption for the examination was 5.7 min. Each resident performed a median of 27 examinations. The left ventricle was assessed to satisfaction in 97% and the pericardium in all patients. The aortic and atrioventricular valves were assessed in at least 76% and the abdominal aorta in 50%, respectively. Global left-ventricular function, pleural, and pericardial effusion showed very strong correlation with reference method (Spearman's r ≥ 0.8). Quantification of aortic stenosis and regurgitation showed strong correlation with r = 0.7. Regurgitations in the atrioventricular valves showed moderate correlations, r = 0.5 and r = 0.6 for mitral and tricuspid regurgitation, respectively, similar to dilatation of the left atrium (r = 0.6) and detection of regional dysfunction (r = 0.6). Quantification of the abdominal aorta (aneurysmatic or not) showed strong correlation, r = 0.7, while the inferior vena cava diameter correlated moderately, r = 0.5.
By adding a PHHE examination to standard care, medical residents were able to obtain reliable information of important cardiovascular structures in patients admitted to a medical department. Thus, focused examinations with PHHE performed by residents after a training period have the potential to improve in-hospital diagnostic procedures.
- I can hear it, but where is it coming from? A case of iatrogenic arteriovenous fistula after pacemaker lead extraction
- Added prognostic value of myocardial blood flow quantitation in rubidium-82 positron emission tomography imaging
We studied the respective added value of the quantitative myocardial blood flow (MBF) and the myocardial flow reserve (MFR) as assessed with 82Rb positron emission tomography (PET)/CT in predicting major adverse cardiovascular events (MACEs) in patients with suspected myocardial ischaemia.
Methods and results
Myocardial perfusion images were analysed semi-quantitatively (SDS, summed difference score) and quantitatively (MBF, MFR) in 351 patients. Follow-up was completed in 335 patients and annualized MACE (cardiac death, myocardial infarction, revascularization, or hospitalization for congestive heart failure or de novo stable angor) rates were analysed with the Kaplan–Meier method in 318 patients after excluding 17 patients with early revascularizations (<60 days). Independent predictors of MACEs were identified by multivariate analysis. During a median follow-up of 624 days (inter-quartile range 540–697), 35 MACEs occurred. An annualized MACE rate was higher in patients with ischaemia (SDS >2) (n = 105) than those without [14% (95% CI = 9.1–22%) vs. 4.5% (2.7–7.4%), P < 0.0001]. The lowest MFR tertile group (MFR <1.8) had the highest MACE rate [16% (11–25%) vs. 2.9% (1.2–7.0%) and 4.3% (2.1–9.0%), P < 0.0001]. Similarly, the lowest stress MBF tertile group (MBF <1.8 mL/min/g) had the highest MACE rate [14% (9.2–22%) vs. 7.3% (4.2–13%) and 1.8% (0.6–5.5%), P = 0.0005]. Quantitation with stress MBF or MFR had a significant independent prognostic power in addition to semi-quantitative findings. The largest added value was conferred by combining stress MBF to SDS. This holds true even for patients without ischaemia.
Perfusion findings in 82Rb PET/CT are strong MACE outcome predictors. MBF quantification has an added value allowing further risk stratification in patients with normal and abnormal perfusion images.
- Fractional flow reserve as the reference standard for myocardial perfusion studies: fool's gold?
- STEMI revealing an exceptional variant of single right coronary artery
- Incidental post-surgical pseudoaneurysm of the left ventricle: an unexpected finding
- Hamartoma of mature cardiac myocytes: a cardiac tumour with preserved contractility
- Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography