Echocardiographic assessment of right ventricular volumes: a comparison of different techniques in children after surgical repair of tetralogy of Fallot.
Eur J Echocardiogr. 2011 Dec 22;
Authors: Dragulescu A, Grosse-Wortmann L, Fackoury C, Mertens L
Abstract
AIMS: Different echocardiographic techniques are available for assessing right ventricular (RV) volumes but their clinical validity has not been well established. We compared the feasibility, reproducibility and accuracy of three different echocardiographic techniques for measuring RV volumes and ejection fraction (EF) in children after tetralogy of Fallot (TOF) repair. METHODS AND RESULTS: Seventy patients (age 14.2 ± 7.3years) were studied using three-dimensional (3D) volume acquisition analysis (Tomtec, Germany), 2D echo with knowledge-based 3D reconstruction (3DR) (Ventripoint, USA) and the four-chamber area (4C area) methods. Parameters analysed were RV end-diastolic volume (EDV), end-systolic volume and EF. Magnetic resonance imaging (MRI) data were available in 41 patients. Intra- and inter-observer as well as inter-technique variability was assessed using Pearson’s correlation analysis (R), coefficient of variance, and Bland-Altman analysis. Feasibility was good for all echo techniques (91% for the 3D, 98% for the 3DR, and 100% for the 4C area method). Intra- and inter-observer variability was low for both 3DR and the 3D echo, while more variability was observed for the 4C method. Compared with MRI volumes, 3DR and 3D underestimated EDV by 6.6 ± 10 and 18.2 ± 17.8 mL, respectively, (P < 0.001), while the 4C area method overestimated the EDV by 9.6 ± 33 mL, not significant due to a wide range. CONCLUSION: Current echocardiographic techniques to assess RV volumes are highly feasible and reproducible in paediatric post-operative TOF patients. When compared with MRI measurements, 3DR was the most accurate technique but requires extra equipment that is not readily available.
PMID: 22194094 [PubMed - as supplied by publisher]
Importance and inter-relationship of tissue Doppler variables for predicting adverse outcomes in high-risk patients: an analysis of 388 diabetic patients referred for coronary angiography.
AIMS: To investigate the relative importance of individual tissue Doppler imaging variables to predict adverse events in a high-risk population with diabetes, ischaemic heart disease, and/or systolic dysfunction. METHODS AND RESULTS: Transthoracic echocardiograms were analysed in 388 diabetic patients without significant valve disease, bundle branch block, and atrial fibrillation who underwent coronary angiography. Multivariable Cox’s regression analyses were used to establish the association between peak systolic (s’), early diastolic (e’), and late diastolic (a’) tissue velocities and outcomes (hospitalization for heart failure or death). The mean age and left ventricular ejection fraction (LVEF) was 66 ± 10 years and 45 ± 12%, respectively. During 2.3 (±1.0) years of follow-up, 91 patients (24%) met the combined endpoint. After adjustment for LVEF, coronary artery pathology, heart failure at baseline, age, and gender, each 1 cm/s decrease in s’, e’, and a’ was associated with a hazard ratio (HR) of 1.18 (0.89-1.57), 1.03 (0.86-1.22), and 1.20 (1.05-1.37), respectively. A significant interaction was found between s’ and a’, P < 0.01. In patients with lower than mean s’, 1 cm/s decrease in a’ was associated with HR 1.31 (1.10-1.55, P < 0.01), whereas a’ was without prognostic importance in patients with higher than mean s’ [HR 0.99 (0.78-1.25, P = 0.6)]. Patients having lower than mean values of both s’ and a’ had a poorer prognosis than patients having at least one of s’ and a’ high. CONCLUSION: Peak systolic and late diastolic tissue velocities add prognostic information beyond LVEF in high-risk patients. Variables should be considered together as they interact on prognosis.
PMID: 22207342 [PubMed - as supplied by publisher]
Influence of pre-infarction angina, collateral flow, and pre-procedural TIMI flow on myocardial salvage index by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction.
Eur J Echocardiogr. 2011 Dec 29;
Authors: Lønborg J, Kelbæk H, Vejlstrup N, Bøtker HE, Kim WY, Holmvang L, Jørgensen E, Helqvist S, Saunamäki K, Thuesen L, Krusell LR, Clemmensen P, Engstrøm T
Abstract
BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial salvage index (MSI) and infarct size adjusting for area at risk in patients with STEMI treated with primary percutaneous coronary intervention. METHODS AND RESULTS: Cardiac magnetic resonance (CMR) was used to measure myocardial area at risk within 1-7 days and final infarct size 90±21 days after the STEMI in 200 patients. MSI was calculated as (area-at-risk infarct size) / area-at-risk. Patients with pre-infarction angina had a median MSI of 0.80 (IQR 0.67 to 0.86) versus 0.72 (0.61 to 0.80) in those without pre-infarction angina, P = 0.004). In a regression analysis of the infarct size plotted against the area-at-risk there was a strong trend that the line for the pre-infarction angina group was below the one for the non-angina group (P = 0.05). Patients with pre-procedural TIMI flow 0/1, 2 and 3 had a median MSI of (0.69 (IQR 0.59 to 0.76), 0.78 (0.68 to 0.86) and 0.85 (0.77 to 0.91), respectively (P<0.001). Collateral flow did not change MSI (P = 0.45) nor area-at-risk (P = 0.40) and no significant difference in infarct size adjusted for area at risk (P = 0.25) was observed. CONCLUSIONS: Pre-infarction angina increases MSI in patients with STEMI supporting the theory that pre-infarction angina leads to ischemic preconditioning. As opposed to the presence of angiographically visible collateral flow to the infarct area pre-procedural TIMI flow is strongly associated with MSI.
PMID: 22207343 [PubMed - as supplied by publisher]
