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Definitions and Clinical Diagnosis of Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Katerina K. Naka, Aris Bechlioulis
For LVEF, the modified biplane Simpson's method is recommended, although reporting regional wall motion abnormalities might be particularly relevant for patients with suspected coronary artery disease (CAD) or myocarditis. Three-dimensional echocardiography of adequate quality improves the quantification of LV volumes and LVEF and provides values closest to those obtained with cardiac magnetic resonance (CMR). Although LVEF is still the cornerstone of diagnosis, choice of treatment, and prognosis in HF, the calculation of LVEF has important pitfalls, due to its high load dependence. Thus, true myocardial function often remains underestimated or overestimated under different conditions.21 Other components of LV geometry and function as well as loading conditions should be considered when assessing cardiac function. The stroke volume index, with a cut-off of ≤22 mL/m2.04 derived from aortic stenosis studies, corresponding to the previously reported cut-off of 35 mL/m2 when normalized for body surface area,22 has been reported to be important, particularly in HFpEF.23 Recently, tissue Doppler parameters (S′ wave) and myocardial deformation imaging (to assess strain and strain rate) have been shown to be reproducible and feasible for clinical use, especially in detecting subclinical abnormalities in systolic function.2,5 However, measurements may vary among vendors and software versions.
Speckle Tracking
Published in Takahiro Shiota, 3D Echocardiography, 2020
Nicolas Duchateau, Filip Loncaric, Marta Sitges, Bart Bijnens
Tissue Doppler differs from the previous methods. It does not aim at matching image contents but analyzes phase shifts of the returning echoes from which local motion and deformation can be calculated along the beam direction. It therefore has a much higher temporal resolution compared to speckle tracking (around 200 frames/s). However, it requires aligning the beam parallel/orthogonal to the wall, for the recovery of longitudinal (apical view) or radial (parasternal view) velocities. Manual tracking of the observation points is offered in some software to prevent inadequate measurements from the originally fixed observation point.
Anesthetic Management for Surgical Myectomy in Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Heather K. Hayanga, Jeremiah W. Hayanga, Joseph McGuire, Vinay Badhwar
Diastolic dysfunction occurs in almost all patients with HCM [14, 15]. Reduced systolic and diastolic velocities may be assessed using tissue Doppler imaging (TDI) [7]. Reduction in systolic velocity in the presence of a normal or elevated ejection fraction is highly suggestive of HCM. Mitral annular systolic velocity < 4 m/s serves as an independent predictor of heart failure and mortality [7, 21, 22, 24–26]. Notably, in aortic stenosis, acceleration decreases as velocity increases. In obstructive HCM, however, as velocity increases so too does acceleration [10].
Echocardiographic diagnosis of heart failure with preserved ejection fraction in elderly patients with hypertension
Published in Scandinavian Cardiovascular Journal, 2022
Magnus C. Johansson, Annika Rosengren, Michael Fu
The RV area was measured in end-diastole and end-systole in the RV focused apical four-chamber view, indexed for BSA (RVADI and RVASI, respectively), and the fractional area shortening (FAC) was calculated. In the focused RV apical view, RV free wall longitudinal strain (RVFWS) was measured using a mean of two consecutive beats. Using tissue Doppler, RV systolic velocity (RV-s′) was measured. The right ventricular isovolumetric relaxation time (RVIVRT) was measured to test it as a diagnostic parameter because it may be a semiquantitative estimate of tricuspid regurgitation (TR) velocity (Figure 2(A,B)) [25]. The TR velocity was measured in modified apical four-chamber views. The right atrial pressure (RAP) was estimated by the variation in inferior vena cava (IVC) diameter during a brief sniff, and RV systolic pressure (RVSP) was calculated. The RAP was estimated as normal (3 mmHg) if the IVC diameter was <21 mm with >50% collapse; the RAP was considered to be increased to 15 mmHg if the IVC diameter was >21 mm with <50% collapse. When this paradigm did not fit, the RAP was considered to be 8 mmHg [20]. The tricuspid annular plane systolic excursion (TAPSE) was measured in the apical view using anatomic M-mode. The ratio TAPSE/RVSP was calculated as a measure of RV-pulmonary artery coupling [26]. RV dysfunction was defined as at least two of the following: increased RVADI (men >12.6 cm2/m2, women >11.5 cm2/m2), FAC <35%, TAPSE <17 mm, RV-s′ <9.5 cm/s, RVFWS <20% and increased estimated RAP [20].
Subclinical cardiovascular dysfunction in children and adolescents with asthma
Published in Journal of Asthma, 2022
Zeynep Karakaya, Özlem Cavkaytar, Öykü Tosun, Mustafa Arga
The current study revealed the presence of subclinical atherosclerosis and subclinical cardiac dysfunction in patients with, steroid-naive, mild-persistent asthma, independent of their atopy status. Therefore, screening of asthmatic patients even without the risk of cardiovascular disease is important. Tissue Doppler imaging is more sensitive in evaluating cardiac functions than conventional echocardiography. The duration of the disease is important in the development of both subclinical atherosclerosis and subclinical cardiac dysfunction. It is important to note that children with asthma might have subclinical changes even at the time of diagnosis. Prospective long-term studies are needed on subclinical atherosclerosis and cardiac dysfunction and on the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.
Evaluation of right side foetal myocardial performance index in pregestational and gestational diabetes mellitus
Published in Journal of Obstetrics and Gynaecology, 2022
Gökalp Şenol, Berna Aslan Çetin, Didem Esin, Nura Fitnat Tobaş Selçuki, Ahmet Tayyar, Uğur Turhan, Zafer Bütün, Mehmet Aytaç Yüksel
The effects of maternal diabetes on the foetus are explained by the Pederson hypothesis, which suggests that maternal hyperglycaemia stimulates foetal pancreatic cells, resulting in increased insulin secretion and foetal hypoxia (Pedersen 1952). The foetal heart is the most affected organ by this hyperinsulinemia and hypoxia, and myocardial hypertrophy has been frequently reported in infants of diabetic mothers (Arslan et al. 2013; Garg et al. 2014). In recent years, it has been argued that early cardiac dysfunction can be demonstrated with myocardial tissue doppler. Myocardial tissue Doppler is a sensitive method that demonstrates changes in myocardial flow velocity caused by cardiac dysfunction in the preclinical stage, evaluates myocardial movements against time, and is easily applicable in foetuses (Tsutsumi et al. 1999). This is the superiority of tissue doppler to classical doppler.