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Evaluation of right and left ventricular function using speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy and their first degree relatives
Meriam Aneq, Jan Engvall, Lars Brudin, Eva Nylander
Cardiovascular Ultrasound , 2012, DOI: 10.1186/1476-7120-10-37
Abstract: Seventeen male patients, fulfilling Task force criteria for ARVC, 49 (32–70) years old, nineteen male first degree relatives 29 (19–73) y.o. and twenty-two healthy male volunteers 36 (24–66) y.o participated in the study. Twelve-lead and signal-averaged electrocardiograms were recorded. All subjects underwent echocardiography. LV and RV diameters, peak systolic velocity from tissue Doppler and longitudinal strain based on speckle tracking were measured from the basal and mid segments in both ventricles. RV longitudinal strain measurement was successful in first degree relatives and controls (95 resp. 86%) but less feasible in patients (59%). Results were not systematically different between first degree relatives and controls. Using discriminant analysis, we then developed an index based on echocardiographic parameters. All normal controls had an index?<?l while patients with abnormal ventricles had an index between 1–4. Some of the first degree relatives deviated from the normal pattern.Longitudinal strain of LV and RV segments was significantly lower in patients than in relatives and controls. An index was developed incorporating dimensional and functional echocardiographic parameters. In combination with genetic testing this index might help to detect early phenotype expression in mutation carriers.Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by fibro-fatty substitution of the myocardium in the right (RV) and, not infrequently, in the left ventricle (LV). The loss of normal myocardium and the development of scar is associated with electrical instability manifested as ventricular arrhythmia and potential sudden death [1]. A less common manifestation is right ventricular dysfunction causing heart failure and thromboembolism. ARVC is typically transmitted as an autosomal dominant trait with variable expressivity and penetrance [2]. Current guidelines recommend that all first degree relatives of a patient with ARVC undergo screening as sudd
The limited usefulness of real-time 3-dimensional echocardiography in obtaining normal reference ranges for right ventricular volumes
Erlend Aune, Morten Baekkevar, Olaf Rodevand, Jan Otterstad
Cardiovascular Ultrasound , 2009, DOI: 10.1186/1476-7120-7-35
Abstract: 166 participants; 79 males and 87 females aged between 29–79 years and considered free from clinical and subclinical cardiovascular disease. Normal ranges are defined as 95% reference values and reproducibility as coefficients of variation (CV) for repeated measurements.None of the apical recordings with RT3DE and 2DE included the RV outflow tract. Upper reference values were 62 ml/m2 for RV end-diastolic (ED) VI and 24 ml/m2 for RV end-systolic (ES) VI. Lower normal reference value for RVEF was 41%. The respective reference ranges were 17 cm2/m2 for RVEDAI, 11 cm2/m2 for RVESAI and 27% for RVAF. Males had higher upper normal values for RVEDVI, RVESVI and RVEDAI, and a lower limit than females for RVEF and RVAF. Weak but significant negative correlations between age and RV dimensions were found with RT3DE, but not with 2DE. CVs for repeated measurements ranged between 10% and 14% with RT3DE and from 5% to 14% with 2DE.Although the normal ranges for RVVIs and RVAIs presented in this study reflect RV inflow tract dimensions only, the data presented may still be regarded as a useful tool in clinical practice, especially for RVEF and RVAF.Right ventricular (RV) function is an important prognostic factor in both congenital and acquired heart disease [1]. In clinical practice the assessment of right ventricular dysfunction is important to a variety of conditions [2]. As early as 1982 an attempt was made to determine RV volume from the apical window by 2-dimensional echocardiography (2DE) using the Simpson's biplane method [3]. In that study, however, only "body" volumes were obtained, reflecting inflow tract dimensions which represented 55% of the total RV volume as obtained by RV angiography. In order to compensate for these problems, Levine et al. [4] incorporated a combination of apical four-chamber (for inflow) and subcostal views (for outflow). This approach, however, has not gained widespread acceptance within clinical practice. According to present guidelines, asse
Giant Dilatation of the Right Coronary Aortic Bulb with Compression of the Right Ventricular Outflow Tract Mimicking a Ventricular Septal Defect: Diagnostic workup Using Echocardiography, Heart Catheterization, and Cardiac Computed Tomography
Nina P. Hofmann,Hassan Abdel-Aty,Stefan Siebert,Hugo A. Katus,Grigorios Korosoglou
Case Reports in Medicine , 2012, DOI: 10.1155/2012/524526
Abstract: Annuloaortic ectasia is a relatively rare diagnosis. Herein, we report an unusual case of an annuloaortic ectasia with asymmetric dilatation of the right coronary bulb mimicking a membranous ventricular septal defect (VSD) with Eisenmenger reaction by transthoracic echocardiography. Aortic angiography showed a dilated aortic root and moderate aortic regurgitation. Right cardiac catheterization, on the other hand, exhibited normal pulmonary artery blood pressure and normal pulmonary resistance, whereas normal venous gas values were measured throughout the caval vein and the right atrium, excluding relevant left-right shunting. Further diagnostic workup by cardiac computed tomography angiography (CCTA) unambiguously illustrated the asymmetric geometry of the ectatic aortic cusp and root causing compression of the right heart and of the right ventricular (RV) outflow tract. After review of echocardiographic acquisitions, the blood flow detected between the left and right ventricles (mimicking VSD) was interpreted as turbulent inflow from the left ventricle into the ectatic right coronary cusp. Furthermore, elevated pulmonary artery blood pressure measured by echocardiography was attributed to “functional pulmonary stenosis” due to compression of the RV outflow tract by the aorta, as demonstrated by CCTA.
Quantification of Right and Left Ventricular Function in Cardiac MR Imaging: Comparison of Semiautomatic and Manual Segmentation Algorithms  [PDF]
Miguel Souto,Lambert Raul Masip,Miguel Couto,Jorge Juan Suárez-Cuenca,Amparo Martínez,Pablo G. Tahoces,Jose Martin Carreira,Pierre Croisille
Diagnostics , 2013, DOI: 10.3390/diagnostics3020271
Abstract: The purpose of this study was to evaluate the performance of a semiautomatic segmentation method for the anatomical and functional assessment of both ventricles from cardiac cine magnetic resonance (MR) examinations, reducing user interaction to a “mouse-click”. Fifty-two patients with cardiovascular diseases were examined using a 1.5-T MR imaging unit. Several parameters of both ventricles, such as end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF), were quantified by an experienced operator using the conventional method based on manually-defined contours, as the standard of reference; and a novel semiautomatic segmentation method based on edge detection, iterative thresholding and region growing techniques, for evaluation purposes. No statistically significant differences were found between the two measurement values obtained for each parameter (p > 0.05). Correlation to estimate right ventricular function was good (r > 0.8) and turned out to be excellent (r > 0.9) for the left ventricle (LV). Bland-Altman plots revealed acceptable limits of agreement between the two methods (95%). Our study findings indicate that the proposed technique allows a fast and accurate assessment of both ventricles. However, further improvements are needed to equal results achieved for the right ventricle (RV) using the conventional methodology.
Diagnosis value of arrhythmogenic right ventricular dysplasia by echocardiography

LIU Mei,LIANG Xiao-lu,DING Gui-chun,JIAN Wen-hao,WANG Jianhua,

中华医学超声杂志(电子版) , 2010,
Abstract: Objective To investigate the diagnositic value of arrhythmogenic right ventricular dysplasia by echocardiography.Methods The retrospective view for echocardiography in 5 patient was applied,which were diagnosed as arrhythmogenic right ventricular dysplasia.The literatures referring to arrhythmogenic right ventricular dysplasia were reviewed.Results Abnormal echocardiography was found in all 5 patients,right atrium and ventricle were enlarged in the dimention of right ventricule of 4 patients except only 1 p...
Single beat 3D echocardiography for the assessment of right ventricular dimension and function after endurance exercise: Intraindividual comparison with magnetic resonance imaging
Sebastian Schattke, Moritz Wagner, Robert H?ttasch, Sabrina Schroeckh, Tahir Durmus, Ingolf Schimke, Wasiem Sanad, Sebastian Spethmann, Jürgen Scharhag, Alexander Huppertz, Gert Baumann, Adrian C Borges, Fabian Knebel
Cardiovascular Ultrasound , 2012, DOI: 10.1186/1476-7120-10-6
Abstract: 21 non-elite male marathon runners were examined by sb3DE (Siemens ACUSON SC2000, matrix transducer 4Z1c, volume rates 10-29/s), CMR (Siemens Magnetom Avanto, 1,5 Tesla) and blood tests before and immediately after each athlete ran 30 km. The runners were not allowed to rehydrate after the race. The order of sb3DE and CMR examination was randomized.Sb3DE for the acquisition of RV dimension and function was feasible in all subjects. The decrease in mean body weight and the significant increase in hematocrit indicated dehydration. RV dimensions measured by CMR were consistently larger than measured by sb3DE.Neither sb3DE nor CMR showed a significant difference in the RV ejection fraction before and after exercise. CMR demonstrated a significant decrease in RV dimensions. Measured by sb3DE, this decrease of RV volumes was not significant.First, both methods agree well in the acquisition of systolic RV function. The dimensions of the RV measured by CMR are larger than measured by sb3DE. After exercise, the RV volumes decrease significantly when measured by CMR compared to baseline.Second, endurance exercise seems not to induce acute RV dysfunction in athletes without rehydration.Extreme exercise might lead to right ventricular (RV) dysfunction and an elevated risk of arrhythmias in some athletes [1-7]. To acquire RV data cardiovascular magnetic resonance imaging (CMR) and echocardiography have been proven valuable tools.Acquisition of RV echocardiographic data has been conventionally proven difficult due to its anterior position in the chest, a complex geometry and morphology with prominent trabeculations. Over the years several parameters have been developed to determine RV function by 2D echocardiography, e.g. Tricuspid Annular Plane Systolic Excursion (TAPSE), Tei-Index, systolic pulmonary arterial pressure (sPAP), strain and speckle tracking or even simple "eyeballing". It is, however, highly dependent on a standardized acquisition since a slight drift in angle of v
Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study
Sebastian Schattke, Fabian Knebel, Andrea Grohmann, Henryk Dreger, Friederike Kmezik, Gabriela Riemekasten, Gert Baumann, Adrian C Borges
Cardiovascular Ultrasound , 2010, DOI: 10.1186/1476-7120-8-3
Abstract: 22 patients and 22 gender- and age-matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI) and speckle tracking strain to assess RV function.Tricuspid annular plane systolic excursion (TAPSE) (23.2 ± 4.1 mm vs. 26.5 ± 2.9 mm, p < 0.006), peak myocardial systolic velocity (Sm) (11.6 ± 2.3 cm/s vs. 13.9 ± 2.7 cm/s, p = 0.005), isovolumetric contraction velocity (IVV) (10.3 ± 3 cm/s vs. 14.8 ± 3 cm/s, p < 0.001) and IVA (2.3 ± 0.4 m/s2 vs. 4.1 ± 0.8 m/s2, p < 0.001) were significant lower in the patient group. IVA was the best parameter to predict early systolic dysfunction with an area under the curve of 0.988.IVA is a useful tool with high-predictive power to detect early right ventricular systolic impairment in patients with SSc and without pulmonary hypertension.Systemic sclerosis is a connective tissue disease characterized by vascular inflammation and fibrosis. Visceral involvement, e.g. pulmonary fibrosis, pulmonary hypertension, myocardial and renal affliction, is associated with poor prognosis [1-4]. Cardiac manifestations include myocardial fibrosis, hypertrophy, coronary and conduction systems disorders that can lead to severe clinical complications such as congestive heart failure, arrhythmias and sudden cardiac death [5].Primary myocardial involvement and pulmonary hypertension are common in SSc. According to histological and clinical studies, cardiac involvement occurs in up to 80% of SSc patients [3,6-8]. It often begins in early stages of the disease and initially remains clinically asymptomatic. Therefore, early detection of cardiac involvement in patients with SSc is of clinical importance to identify patients with higher risk which would benefit from early medical intervention. Impaired hemodynamic parameters of right ventricular (RV) function are predictors of poor outcome in patients with SSc. A good correlation of RV myocardial diastolic dysfunction and increased pulmonary artery systolic pressure has been de
Evaluation of right ventricular function using tricuspid annular systolic motion in patients with dilated cardiomyopathy: tissue Doppler echocardiography or M-Mode measurements?
Micha? Kidawa,Richard Isnard,Philippe Charron,Francoise Pousset
Polish Journal of Cardiology , 2005,
Abstract: Introduction: Recent studies have emphasized the prognostic value of right ventricular (RV) function in chroni heartfailure. However, routine noninvasive measurement of RVfunction remains difficult. Recently, both tricuspid annular plane systolic excursion (TAPSE) measured in M-Mode and tricuspid annular systolic ve-locity (TASV) measured using tissue Doppler echocardiography (TDE) have been shown to be simple mar-kers of RV function. Methods and results: we compared TAPSE and TASV in 85 consecutive patients with dilated cardiomyopathy (age 53+13 years, 56 in NYHA 2, 29 in NYHA 3; LVEF 33+8%) with and without evidence of RV dilatation or dysfunction, and in 34 controls (age 50+11 years). TDE systolic and diastolic (early E' and late A) velo-cities of the free wali portion of tricuspid annulus were recorded from the apical window. TAPSE was measured at the same location from the same window. There was a good correlation between TAPSE and TASV in the controls (r=0.71; p<0.01) and the subgro-upsof patients (NYHA 2: r=O,71; p<0.01; NYHA 3: r=0.73; p<0.01). Patients had Iower TAPSE (1.8+0.5 cm/s vs 2.4+0.4 cm/s; p<0.01) and TASV(9.8+2.7 cm/s vs 12.6+2.4 cm/s; p
Left Ventricular Endocardium Tracking by Fusion of Biomechanical and Deformable Models  [PDF]
Hussin Ketout,Jason Gu
Computational and Mathematical Methods in Medicine , 2014, DOI: 10.1155/2014/302458
Abstract: This paper presents a framework for tracking left ventricular (LV) endocardium through 2D echocardiography image sequence. The framework is based on fusion of biomechanical (BM) model of the heart with the parametric deformable model. The BM model constitutive equation consists of passive and active strain energy functions. The deformations of the LV are obtained by solving the constitutive equations using ABAQUS FEM in each frame in the cardiac cycle. The strain energy functions are defined in two user subroutines for active and passive phases. Average fusion technique is used to fuse the BM and deformable model contours. Experimental results are conducted to verify the detected contours and the results are evaluated by comparing themto a created gold standard. The results and the evaluation proved that the framework has the tremendous potential to track and segment the LV through the whole cardiac cycle. 1. Introduction Echocardiography is an important imaging modality that enables the cardiologist to evaluate the structure and functions of the heart. Because of noninvasive characteristics, low cost, and being nonionizing radiation, echocardiography has been largely applied in the evaluation of cardiac function. One of the most important applications of echocardiography is in determining systolic and diastolic ventricular volumes of the patient, both of which are used to calculate the left ventricular ejection fraction, muscle contraction ratio of cardiac cavities, local ejection fraction, myocardial thickness, and the ventricle mass [1]. To calculate the above-mentioned parameters, the cardiac muscle contour on the echocardiography image needs to be identified. The border detection process simplifies image analysis and greatly reduces the amount of data which needs to be processed, while preserving the structural information about the contours of the object under study [2]. However, in clinical practice, this task still relies on manual outlining. Manual outlining of these borders is slow, time consuming, and tedious task. Moreover, the resulting outlines vary between different observers and suffer from a subjective bias [3]. Automatic LV border detection and tracking over the cardiac cycle in echocardiographic image sequences remain open and a challenging problem due to many difficulties related to the heart and its dynamics and other difficulties related to the echocardiography ultrasound machine. Echocardiography has a poor image quality and resolution with various image artifacts like speckle, shadowing, and side lobes [3]. The images of
Assessment of left ventricular function by three-dimensional echocardiography
Boudewijn J Krenning, Marco M Voormolen, Jos RTC Roelandt
Cardiovascular Ultrasound , 2003, DOI: 10.1186/1476-7120-1-12
Abstract: Accurate quantification of left ventricular (LV) volume and function is important in clinical decision-making and follow-up assessment. Although various other techniques including invasive angiography, radionuclide angiography and magnetic resonance imaging are used, echocardiography is currently the most commonly applied modality in the practice of cardiology.M-mode echocardiography, a one dimensional ultrasound scanning of the cardiac structures, was developed in the early 1970s and immediately applied in practice for left ventricular function assessment because of its simple algorithm and non-invasiveness. Ejection fraction was estimated as a percentage derived from the mid left ventricular diameters in end-systole and end-diastole and expressed as fractional shortening. However, serious problems were raised especially in patients with myocardial infarction and asymmetric ventricles.Two-dimensional sectional echocardiography, with the ability of imaging of the heart in tomographic views, considerably improved the accuracy of left ventricular volume measurement. Of the different mathematical models, modified biplane Simpson's rule provided more accurate data in both symmetric and asymmetric left ventricles. Software-based algorithms for automatic endocardial border detection and on-line calculation of left ventricular volume and ejection fraction have been developed. As a result, two-dimensional echocardiography has become a routine examination for left ventricular volume and function assessment but the assumptions about LV geometry remain a limitation.In the past decade, three-dimensional echocardiography has emerged as a more accurate and reproducible approach to LV quantitation mainly by avoiding the use of geometric assumptions of the LV shape. Three methods have been proposed for the acquisition of temporal and positional image data: the use of positional locators (free-hand scanning), rotational systems and real-time volumetric scanning. Reconstruction metho
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