Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Aug 2013
Clinical TrialMyocardial mechanical remodeling after septal myectomy for severe obstructive hypertrophic cardiomyopathy.
Septal myectomy for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) is a well-established procedure for symptomatic relief. Myocardial mechanics are abnormal in patients with HOCM, demonstrating low longitudinal strain, high circumferential strain, and high apical rotation compared with healthy subjects. The aim of this study was to determine whether functional improvement after myectomy is associated with improved myocardial mechanics. ⋯ In patients with HOCM, surgical myectomy alleviated symptoms, relieved obstruction, and decreased left atrial volume index. Longitudinal strain remained unchanged, but circumferential strain and rotation decreased, demonstrating different mechanical adaptations to chronic elevated afterload seen in patients with severe aortic stenosis undergoing valve replacement. Disease extent (age, posterior wall involvement) and the presence of diastolic dysfunction seem to be related to partial symptomatic response to myectomy.
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J Am Soc Echocardiogr · Aug 2013
Left ventricular three-dimensional global systolic strain by real-time three-dimensional speckle-tracking in children: feasibility, reproducibility, maturational changes, and normal ranges.
Three-dimensional (3D) strain analysis may help overcome the limitations of Doppler and two-dimensional strain analysis for the left ventricle and become the method of choice for left ventricular (LV) systolic function. The aims of this study were to evaluate the feasibility and reproducibility of LV global 3D systolic strain by real-time 3D speckle-tracking echocardiography (STE) in children and to establish their maturational growth patterns and normal values. ⋯ LV global 3D systolic strain analysis using the new 3D STE is feasible and reproducible in the pediatric population. There are small maturational changes in GLS and GCS, but not in GRS and GS, that are statistically significant but probably clinically irrelevant. Further investigation is warranted for potential clinical application of this new technology in a pediatric population.
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J Am Soc Echocardiogr · Aug 2013
Admission wall motion score and quantitative ST-segment depression in the assessment of 30-day mortality in patients with first non-ST-segment elevation acute coronary syndromes.
Whether admission myocardial wall motion score (WMS) in non-ST-segment elevation acute coronary syndromes might be a better predictor of 30-day mortality than currently recognized prognostic markers is unknown. ⋯ In comparison with quantitative ST-segment depression, troponin I, and TIMI risk score, WMS on admission is a better early predictor of 30-day mortality in patients with first non-ST-segment elevation acute coronary syndromes.
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J Am Soc Echocardiogr · Aug 2013
Comparative StudyComparison of echocardiographic measurements of left ventricular volumes to full volume magnetic resonance imaging in normal and diseased rats.
Clinical two-dimensional (2D) and clinical three-dimensional echocardiography are validated against cardiac magnetic resonance imaging (CMR), the gold standard for left ventricular (LV) volume measurement. In rodents, there is no widely accepted echocardiographic measure of whole LV volumes, and CMR measurements vary among studies. The aim of this study was to compare LV volumes by 2D echocardiography (using a hemisphere-cylinder [HC] model) with HC and full-volume (FV) CMR in normal and diseased rats to measure the impact of geometric models and imaging modalities. ⋯ Concordant measures of LV volume and function were obtained using (1) a relatively simple HC model of the left ventricle inclusive of two orthogonal 2D echocardiographic planes and (2) FV CMR in normal and diseased rats. The HC model appeared to compensate for the underestimation of LV dimensions by echocardiography.
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J Am Soc Echocardiogr · Jul 2013
Impact of valvuloarterial impedance on 2-year outcome of patients undergoing transcatheter aortic valve implantation.
Elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) often have increased calcification and fibrosis of the aorta. Indices that account for the severity of valvular obstruction and systemic vascular impedance may better assess total left ventricular afterload. The aims of the present study were to evaluate changes in valvuloarterial impedance (Zva), systemic arterial compliance, and systemic vascular resistance after TAVI and to investigate the prognostic value of these parameters. ⋯ In patients undergoing TAVI, there is a significant postprocedural reduction in Zva, but there is no reduction in systemic arterial compliance or vascular resistance. Baseline Zva is an independent predictor of overall mortality at 2-year follow-up.