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Asada, Dai, Yuma Morishita, Yoko Kawai, Yo Kajiyama, and Kazuyuki Ikeda. "Efficacy of bubble contrast echocardiography in detecting pulmonary arteriovenous fistulas in children with univentricular heart after total cavopulmonary connection." Cardiology in the Young 30, no. 2 (January 9, 2020): 227–30. http://dx.doi.org/10.1017/s104795111900324x.
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AbstractBackground:Development of pulmonary arteriovenous fistulas in patients with cavopulmonary anastomosis may result in a significant morbidity. Although the use of bubble contrast echocardiography with selective injection into both the branch pulmonary arteries in identifying pulmonary arteriovenous fistulas has been increasing, the actual efficacy of this diagnostic modality has not been properly evaluated. Thus, this study aimed to assess the efficacy of bubble contrast echocardiography in detecting pulmonary arteriovenous fistulas in children with total cavopulmonary connection.Methods:A total of 140 patients were included. All patients underwent cardiac catheterisation. Bubble contrast echocardiographic studies were performed by injecting agitated saline solution into the branch pulmonary arteries. Transthoracic echocardiograms that use an apical view were conducted to assess the appearance of bubble contrast in the systemic ventricles. Then, the contrast echocardiogram results and other cardiac parameters were compared.Results:No correlation was found between contrast echocardiogram grade and other cardiac parameters, such as pulmonary capillary wedge saturation and pulmonary artery resistance. Moreover, only 13 patients had negative results on both the right and left contrast echocardiograms, and 127 of the 140 patients had positive results on contrast echocardiograms even though they had normal pulmonary capillary wedge saturation. Results showed that bubble contrast echocardiography was a highly sensitive method and was likely to obtain false-positive results.Conclusions:Bubble contrast echocardiography might be highly false positive in detecting pulmonary arteriovenous fistulas in patients with cavopulmonary anastomosis. We have to consider how we make use of this method. Further standardisation of techniques is required.
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Chang, Nai-Lun, Priyank Shah, Sharad Bajaj, Hartaj Virk, Mahesh Bikkina, and Fayez Shamoon. "Diagnostic Yield of Echocardiography in Syncope Patients with Normal ECG." Cardiology Research and Practice 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/1251637.
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Aim. This study aimed to assess the role of echocardiography as a diagnostic tool in evaluating syncope patients with normal versus abnormal electrocardiogram.Methods. We conducted a retrospective study of 468 patients who were admitted with syncope in 2011 at St. Joseph’s Regional Medical Center, Paterson, NJ. Hospital records and patient charts, including initial emergency room history and physical, were carefully reviewed. Patients were separated into normal versus abnormal electrocardiogram groups and then further divided as normal versus abnormal echocardiogram groups. Causes of syncope were extrapolated after reviewing all test results and records of consultations.Results. Three hundred twelve of the total patients (68.6%) had normal ECG. Two-thirds of those patients had echocardiograms; 11 patients (5.7%) had abnormal echo results. Of the aforementioned patients, three patients had previous documented history of severe aortic stenosis on prior echocardiograms. The remaining eight had abnormal but nondiagnostic echocardiographic findings. Echocardiography was done in 93 of 147 patients with abnormal ECG (63.2%). Echo was abnormal in 27 patients (29%), and the findings were diagnostic in 6.5% patients.Conclusions. This study demonstrates that echocardiogram was not helpful in establishing a diagnosis of syncope in patients with normal ECG and normal physical examination.
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Oyedeji, Adebayo T., Adeseye A. Akintunde, Olukolade O. Owojori, and Johnson O. Peter. "Spectrum of Echocardiography Abnormalities among 168 Consecutive Referrals to an Urban Private Hospital in South-Western Nigeria." Clinical Medicine Insights: Cardiology 8 (January 2014): CMC.S14320. http://dx.doi.org/10.4137/cmc.s14320.
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Trans-thoracic echocardiography (TTE) is an important non-invasive cardiac examination that provides structural and functional information. It is useful in the diagnosis of cardiac diseases and often guides the management and follow-up of patients with cardiovascular diseases (CVD). The study aimed to present an audit of the echocardiograms performed in an urban private hospital over a two-year period in order to define the pattern of cardiac diseases in our center. Echocardiogram reports of 168 consecutive patients performed between May 2011 and April 2013 at an organized private sector hospital in Lagos, south-west Nigeria were reviewed. Studies were performed with a Toshiba Nemio XG ultrasound machine. The data obtained were analyzed for mean age, sex, clinical indications, and echocardiographic diagnosis in the study subjects. A total of 168 echocardiography reports were examined, comprising of 92 males (54.8%) and 76 females (45.2%). The age range of the subjects was 10-76 years (mean 42.5 ± 12.1 years). The commonest indication for echocardiography was systemic hypertension and hypertension related causes (38.1%), followed by abnormal resting electrocardiogram (14.9%). Routine annual medical screening was the next most common indication, representing 13.1% of the indications for echocardiography. The other indications are as presented in Table 1 . The echocardiogram was normal in 64.3% of the subjects. The commonest abnormality detected was hypertensive heart disease (HHD); accounting for 9.6% of the subjects studied. Isolated atrial enlargement (left, right, or bi-atrial) was the next most common abnormality accounting for 6% of the echocardiographic diagnosis. Pulmonary hypertension was the next most common diagnosis accounting for 4.8% of our findings. The other echocardiographic diagnoses are as listed in Table 2 . Hypertension represents the commonest indication for echocardiography. Normal echocardiogram was the commonest echocardiographic finding while HHD was the commonest echocardiographic abnormality. The prevalence of ischemic heart disease by echocardiography was 2.4%. There was no case of rheumatic heart disease (RHD). The prevalence of hypertrophic cardiomyopathy (HCM) was 1.2%. Ease of access to echocardiography may influence the findings in an echocardiographic audit and policy makers should incorporate appropriateness criteria into their guidelines for reimbursement.
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Rozenbaum, Zach, Yan Topilsky, Shafik Khoury, Milwidsky Assi, Asta Balchyunayte, Michal Laufer-Perl, Shlomo Berliner, David Pereg, Michal Entin-Meer, and Ofer Havakuk. "Relationship between climate and hemodynamics according to echocardiography." Journal of Applied Physiology 126, no. 2 (February 1, 2019): 322–29. http://dx.doi.org/10.1152/japplphysiol.00519.2018.
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Studies performed in controlled laboratory conditions have shown that environmental thermal application may induce various circulatory changes. We aimed to demonstrate the effect of local climate on hemodynamics according to echocardiography. Echocardiographic studies conducted in ambulatory patients, 18 yr of age or older, between January 2012 and July 2016, at our medical center, for whom climate data on the day of the echocardiogram study were available, were retrospectively included in case climate data. Discomfort index, apparent temperature, temperature-humidity index, and thermal index were computed. Echocardiograms conducted in hotter months (June–November) were compared with those done in colder months (December–May). The cohort consisted of 11,348 individuals, 46.2% women, and mean age of 57.9 ± 18.1 yr. Climate indexes correlated directly with stroke volume ( r = 0.039) and e′ (lateral r = 0.047; septal r = 0.038), and inversely with systolic pulmonary artery pressure (SPAP; r = −0.038) (all P values < 0.05). After adjustment for age and sex, echocardiograms conducted during June–November had a lower chance to show e′ septal < 7 cm/s (odds ratio 0.88, 95% confidence interval 0.78–0.98, P = 0.017) and SPAP > 40 mmHg (odds ratio 0.81, 95% confidence interval 0.67–0.99, P = 0.04) compared with those conducted in other months. The authors concluded that climate may affect hemodynamics, according to echocardiographic assessment in ambulatory patients. NEW & NOTEWORTHY In the present study, we examined 11,348 individuals who underwent ambulatory echocardiography. Analyses of the echocardiographic studies demonstrated that environmental thermal stress, i.e., climate, may affect hemodynamics. Most notably were the effects on diastolic function. Higher values of mitral e′, stroke volume, as well as ejection fraction, and lower values of systolic pulmonary artery pressure and tricuspid regurgitation were demonstrated on hotter days and seasons.
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Chang, J. C., A. M. Knight, R. Xiao, L. M. Mercer-Rosa, and P. F. Weiss. "Use of echocardiography at diagnosis and detection of acute cardiac disease in youth with systemic lupus erythematosus." Lupus 27, no. 8 (April 24, 2018): 1348–57. http://dx.doi.org/10.1177/0961203318772022.
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Objectives There are no guidelines on the use of echocardiography to detect cardiac manifestations of childhood-onset systemic lupus erythematosus (SLE). We quantify the prevalence of acute cardiac disease in youth with SLE, describe echocardiogram utilization at SLE diagnosis, and compare regional echocardiogram use with incident cardiac diagnoses. Methods Using the Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) de-identified United States administrative database from 2000 to 2013, we identified youth ages 5–24 years with new-onset SLE (≥3 ICD-9 SLE codes 710.0, > 30 days apart) and determined the prevalence of diagnostic codes for pericardial disease, myocarditis, endocarditis, and valvular insufficiency. Multiple logistic regression was used to identify factors associated with echocardiography during the baseline period, up to one year before or six months after SLE diagnosis. We calculated a regional echocardiogram utilization index, which is the ratio of observed use over the mean predicted probability based on all available baseline characteristics. Spearman’s rank correlation coefficient was used to evaluate the association between regional echocardiogram utilization indices and percentage of imaged youth diagnosed with their first cardiac manifestation following echocardiography. Results Among 699 youth with new-onset SLE, 18% had ≥ 1 diagnosis code for acute cardiac disease, of which valvular insufficiency and pericarditis were most common. Twenty-five percent of all youth underwent echocardiogram during the baseline period. Regional echocardiogram use was positively correlated with the percentage of imaged youth found to have cardiac disease (ρ = 0.71, p = 0.05). There was up to a five-fold difference in adjusted odds of baseline echocardiography between low- and high-utilizing regions (OR = 0.19, p = 0.007). Conclusion Nearly one-fifth of youth with new-onset SLE have acute cardiac manifestations; however, use of echocardiograms at SLE diagnosis is highly variable. There may be incremental diagnostic value to early use of echocardiography, but prospective studies are needed to determine whether greater use of echocardiograms modifies outcomes.
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Cartoski, Mark J., Meghan Kiley, and Philip J. Spevak. "Appropriate Use Criteria for paediatric echocardiography in an outpatient practice: a validation study." Cardiology in the Young 28, no. 6 (April 25, 2018): 862–67. http://dx.doi.org/10.1017/s1047951118000513.
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AbstractBackgroundAlthough transthoracic echocardiography is the dominant imaging modality in CHD, optimal utilisation is unclear. We assessed whether adherence to the paediatric Appropriate Use Criteria for outpatient transthoracic echocardiography could reduce inappropriate use without missing significant cardiac disease.MethodsUsing the Appropriate Use Criteria, we determined the indication and appropriateness rating for each initial echocardiogram performed at our institution during calendar year 2014 (N=1383). Chart review documented ordering provider training, patient demographics, and study result, classified as normal, abnormal, or abnormal motivating treatment within a 2-year follow-up period. We tested whether provider training level or patient age correlated with echocardiographic findings or appropriateness rating.ResultsWe found that 83.9% of echocardiograms were normal and that 66.7% had an appropriate indication. Nearly all abnormal results and all results motivating treatment were in appropriate studies, giving an odds ratio of 2.73 for an abnormal result if an appropriate indication was present (95% confidence interval 1.92–3.89, p<0.001). None of the remaining initial abnormal results with less than appropriate indications became significant, resulting in treatment over 2 years. Results suggest a potential reduction in imaging volume of as much as 33% with application of the criteria. Cardiologists ordered nearly all studies resulting in treatment but also more echocardiograms with less appropriate indications. Most examinations were in older patients; however, most abnormal results were in patients younger than 1 year.ConclusionsThe Appropriate Use Criteria can be used to safely reduce echocardiography volume while still detecting significant heart disease.
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Yadlapati, Ajay, Timothy R. Maher, James D. Thomas, Mark Gajjar, Kofo O. Ogunyankin, and Jyothy J. Puthumana. "Global longitudinal strain from resting echocardiogram is associated with long-term adverse cardiac outcomes in patients with suspected coronary artery disease." Perfusion 32, no. 7 (March 23, 2017): 529–37. http://dx.doi.org/10.1177/0267659117701563.
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Purpose: Measuring myocardial strain using two-dimensional speckle tracking echocardiography has emerged as a new tool to identify subclinical ventricular dysfunction. Abnormal strain has been shown to have superior sensitivity compared with dobutamine stress echocardiography for viability assessment; however, there is a paucity of data regarding the prediction of long-term major adverse cardiac events. We compared the prognostic ability of both global longitudinal strain (GLS) from resting echocardiograms to regional wall motion score index (WMSI) from stress echocardiograms in their ability to predict long-term major adverse cardiac events. Methods: Patients referred for stress echocardiography, who also underwent coronary angiography within 3 months of stress echo (n=122), were enrolled. Patients with reduced ejection fractions (<40%) were excluded. Patients were followed for a median of 3.4 years for major adverse cardiac events, readmissions and repeat cardiac testing. Results: Patients with abnormal GLS (GLS <16.8%) from the resting echocardiogram obtained as part of the exercise echocardiogram experienced a significantly shorter time to major adverse cardiac events (p=0.026), first cardiovascular hospitalization and repeat cardiac testing (p=0.0011) compared to those with normal GLS. Abnormal GLS appears to be a better predictor than abnormal WMSI in predicting major adverse cardiac events (p=0.174) and time to first cardiovascular hospitalization or repeat cardiac testing (p=0.0093). Conclusion: GLS may be a better predictor of long-term major adverse cardiac events, readmissions and repeat cardiac testing than WMSI in patients undergoing stress echocardiography.
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Friedman, Mark A. "Contrast Echocardiography." Einstein Journal of Biology and Medicine 21, no. 1 (March 2, 2016): 2. http://dx.doi.org/10.23861/ejbm200421443.
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Ultrasound contrast agents are widely used in clinical practice for left ventricle opacification in sub-optimal echocardiograms. Recently, significant research has focused on the use of contrast echocardiography as a non invasive means to evaluate myocardial perfusion. Advances in contrast agents as well as ultrasound technology have enabled investigations into myocardial contrast echocardiography as a possible alternative to nuclear imaging studies. This review will focus on the development and current uses of contrast echocardiography, as well as future indications, including myocardial perfusion and risk stratification following myocardial infarction.
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Klein, Jennifer H., Andrea Beaton, Alison Tompsett, Justin Wiggs, and Craig Sable. "Effect of anaemia on the diagnosis of rheumatic heart disease using World Heart Federation criteria." Cardiology in the Young 29, no. 7 (June 20, 2019): 862–68. http://dx.doi.org/10.1017/s1047951119000404.
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AbstractBackground:There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries.Objective:To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening.Method/Design:A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared.Results:Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6–3.3%) and non-anaemic children (1.3%, 95% CI 0.3–2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012).Conclusion:Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.
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Usry, Courtney R., Satoshi R. Shin, James K. Aden, and Rosco Gore. "Optimizing contrast-enhanced echocardiography by employing a sonographer driven protocol." Journal of Echocardiography 19, no. 3 (April 2, 2021): 173–78. http://dx.doi.org/10.1007/s12574-021-00523-y.
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Abstract Background The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional policies. Methods We aimed to retrospectively evaluate if allowing sonographers to place a peripheral intravenous catheter and administer enhancing agent led to a decrease in time to complete outpatient transthoracic echocardiograms in comparison to using nursing personnel. Three separate protocols were employed. The ‘nurse driven protocol’ utilized nurses to place a peripheral intravenous catheter and inject enhancing agent. In a ‘mixed protocol,’ a nurse placed a peripheral intravenous catheter and the sonographer gave the enhancing agent. The ‘sonographer driven protocol’ involved the sonographer placing the peripheral intravenous catheter and delivering enhancing agent. Results A total of 232 echocardiograms were included for analysis. Patient characteristics across the three protocols were not statistically significant. The ‘mixed protocol’ had an average study time that was significantly less than the ‘nurse driven protocol’ (49.4 min ± 11.4 vs 54.6 min ± 12.9; p = 0.024). The ‘sonographer driven protocol’ also showed a significant reduction in study time (50.3 min ± 12.6) when compared to the ‘nurse driven protocol’ (p = 0.017). The additional task for the sonographer to place the peripheral intravenous catheter did not significantly increase the time to complete the study. Conclusion Allowing sonographers to administer enhancing agent reduced individual echocardiogram study times by approximately 5 min, supporting that a ‘sonographer driven protocol’ is more efficient with potential downstream economic benefits.
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Kerwin, Chris, Laura Tommaso, and Erik Kulstad. "A Brief Training Module Improves Recognition of Echocardiographic Wall-Motion Abnormalities by Emergency Medicine Physicians." Emergency Medicine International 2011 (2011): 1–5. http://dx.doi.org/10.1155/2011/483242.
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Objective. Wall-motion abnormality on echocardiogram is more sensitive in detecting cardiac ischemia than the electrocardiogram, but the use of bedside echocardiography by emergency physicians (EPs) for this purpose does not appear to be widespread, apparently due to limited data on proficiency of EPs for this task. We sought to determine the effect of a brief training module on the ability of EPs to recognize wall motion abnormalities on echocardiograms.Methods. We developed a brief training and testing module and presented it to EPs. After baseline testing of 15 echocardiograms, we presented the 30-minute training module, and administered a new test of 15 different echocardiograms. Physicians were asked to interpret the wall motion as normal or abnormal.Results. 35 EPs over two separate sessions showed significant improvement recognition of wall-motion abnormalities after the brief training module. Median score on the baseline test was 67%, interquartile range (IQR) 53% to 80%, while the median score on the posttraining test was 87%, IQR 80% to 87%, , independent of time in practice or prior training.Conclusion. With only brief training on how to recognize wall motion abnormalities on echocardiograms, EPs showed significant improvement in ability to identify wall motion abnormalities.
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Allen, Marvin, John Allen, Take Naseri, Rebecca Gardner, Dennis Tolley, and Lori Allen. "A rapid echocardiographic screening protocol for rheumatic heart disease in Samoa: a high prevalence of advanced disease." Cardiology in the Young 27, no. 8 (June 15, 2017): 1599–605. http://dx.doi.org/10.1017/s1047951117000907.
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AbstractBackgroundEchocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease.MethodsWe performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students. Children with predefined criteria suspicious for rheumatic hear diseases were referred for a more comprehensive echocardiogram. Complete echocardiograms were classified according to the World Heart Federation guidelines and severity of valve disease.ResultsEchocardiographic screening was performed on 11,434 children, with a mean age of 10.2 years; 51% of them were females. A total of 558 (4.8%) children underwent comprehensive echocardiography, including 49 students who were randomly selected as controls. Definite rheumatic heart disease was observed in 115 students (10.0 per 1000): 92 students were classified as borderline (8.0 per 1000) and 23 with CHD. Advanced disease was identified in 50 students (4.4 per 1000): 15 with severe mitral regurgitation, five with severe aortic regurgitation, 11 with mitral stenoses, and 19 with mitral and aortic valve disease.ConclusionsWe successfully applied a rapid echocardiographic screening protocol to a large number of students over a short time period – 28 days of screening over a 3-year time period – to identify a high prevalence of rheumatic heart disease. We also reported a significantly higher rate of advanced disease compared with previously published echocardiographic screening programmes.
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Fonseca, Ricardo, Faraz Pathan, and Thomas Marwick. "IDENTIFICATION OF RARELY APPROPRIATE ECHOCARDIOGRAMS IN THE ECHOCARDIOGRAPHY LABORATORY." Journal of the American College of Cardiology 67, no. 13 (April 2016): 1603. http://dx.doi.org/10.1016/s0735-1097(16)31604-7.
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Allen, Jane, David F. Dickinson, Arun Ramachandran, and John D. R. Thomson. "Development of a cardiac technician led paediatric echocardiographic service – experience from a district general hospital in the United Kingdom." Cardiology in the Young 15, no. 3 (May 3, 2005): 299–301. http://dx.doi.org/10.1017/s1047951105000600.
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Objectives:To report our experience in providing cardiac technician led paediatric echocardiography services in a district general hospital in the United Kingdom.Methods:We have collected prospectively the numbers of referrals, and the proportion of abnormal echocardiograms, since inception of the service in 2000. In additional, for a period of 12 months, we have audited in detail the patterns of referral to the service, and outcomes, assessing the effect of the service on the outreach clinic run by a visiting paediatric cardiologist.Results:Use of the system resulted in detection of a wide range of abnormalities, with our audit showing that the patients received appropriate management. The total referrals to the service increased 10 fold over the 4 year period of the study. The proportion of abnormal hearts detected by echocardiography, however, dropped from 90 per cent to 16 per cent over the same period. The numbers of patients seen in the outreach cardiology clinic remained unaltered.Conclusions:Having been proved to be an effective model for the triage of children with suspected congenital cardiac disease, adoption of a cardiac technician led echocardiographic service has seen a dramatic increase in the numbers of echocardiograms requested, without decreasing the workload of the visiting paediatric cardiologist.
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Sicari, Rosa, and Lauro Cortigiani. "Appropriateness in Echocardiography." European Cardiology Review 8, no. 1 (2012): 23. http://dx.doi.org/10.15420/ecr.2012.8.1.23.
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Appropriateness is the new imperative of contemporary medicine. In the words of the American College of Cardiology Foundation (ACCF), ‘Appropriate echocardiograms are those that are likely to contribute to improving patients’ clinical outcomes, and importantly, inappropriate use of echocardiography may be potentially harmful to patients and generate unwarranted costs to the healthcare system’. The appropriateness criteria issued by the ACCF stem from a real practical need to reduce costs and avoid the abuse and misuse of non-invasive imaging technologies. Even though very often cited and referred to, these criteria have not yet had a real impact on routine clinical practice. The present article assesses the impact of the ACCF criteria on the basis of the available evidence.
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Madriago, Erin J., Rajesh Punn, Natalie Geeter, and Norman H. Silverman. "Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD." Cardiology in the Young 26, no. 2 (March 2, 2015): 263–68. http://dx.doi.org/10.1017/s1047951115000098.
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AbstractObjectivesTrans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown.MethodsWe retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings.ResultsThe diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging.ConclusionsThis study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.
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Rouse, Christopher A., Brandon T. Woods, and C. Becket Mahnke. "A retrospective analysis of a pediatric tele-echocardiography service to treat, triage, and reduce trans-Pacific transport." Journal of Telemedicine and Telecare 24, no. 3 (January 17, 2017): 224–29. http://dx.doi.org/10.1177/1357633x16689500.
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Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii. Results During the study period 100 infants received 192 tele-echocardiograms: 46% of infants had tele-echocardiograms completed for suspected patent ductus arteriosus, 28% for suspected congenital heart disease, 12% for possible congenital heart disease in the setting of likely pulmonary hypertension, and 10% for possible congenital heart disease in the setting of other congenital anomalies. Of these, 17 patients were aeromedically evacuated for cardiac reasons; 12 patients were transported to Hawaii, while five patients with complex heart disease were transported directly to the United States mainland for interventional cardiac capabilities not available in Hawaii. Discussion This study demonstrates the use of tele-echocardiography to guide treatment, reduce long and potentially risky trans-Pacific transports, and triage transports to destination centers with the most appropriate cardiac capabilities.
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Talle, Mohammed Abdullahi, Faruk Buba, and Charles Oladele Anjorin. "Prevalence and Aetiology of Left Ventricular Thrombus in Patients Undergoing Transthoracic Echocardiography at the University of Maiduguri Teaching Hospital." Advances in Medicine 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/731936.
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Objectives. We sought to determine the prevalence and aetiology of LVT among patients undergoing echocardiography.Methods. We reviewed case notes and echocardiographic data of patient diagnosed with LVT using noncontrast transthoracic echocardiography. Definition of various conditions was made using standard guidelines. Mean ± SD were derived for continuous variables and comparison was made using Student’st-test.Results. Total of 1302 transthoracic echocardiograms were performed out of which 949 adult echocardiograms were considered eligible. Mean age of all subjects with abnormal echocardiograms was 44.73 (16.73) years. Abnormalities associated with LVT were observed in 782/949 (82.40%) subjects among whom 84/782 (8.85%) had LVT. The highest prevalence of 39.29% (33/84) was observed in patients with dilated cardiomyopathy, followed by myocardial infarction with a prevalence of 29.76% (25/84). Peripartum cardiomyopathy accounted for 18/84 (21.43%) cases with some having multiple thrombi, whereas hypertensive heart disease was responsible for 6/84 (7.14%) cases. The lowest prevalence of 2.38% (2/84) was observed in those with rheumatic heart disease. Left ventricular EF of <35% was recorded in 55/84 (65.48%).Conclusions. Left ventricular thrombus is common among patients undergoing echo, with dilated cardiomyopathy being the most common underlying aetiology followed by myocardial infarction. Multiple LVTs were documented in peripartum cardiomyopathy.
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Rasiah, S. V., A. K. Ewer, P. Miller, J. G. Wright, and M. D. Kilby. "Abstracts for the British Congenital Cardiac Association Annual Meeting: The Barbican, London, 24–25 November 2005: Poster Presentations: 8 Years of fetal echocardiography in high-risk mothers: The Birmingham Women’s Hospital experience." Cardiology in the Young 16, no. 3 (June 2006): 322–23. http://dx.doi.org/10.1017/s1047951106340231.
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Introduction: Congenital heart disease (CHD) affects 8 per 1000 live births and it is also responsible for 20% of neonatal deaths. Antenatal diagnosis of major CHD allows appropriate counselling and planning for delivery at a neonatal unit with appropriate intensive care and transport facilities. Birmingham Women’s Hospital provides a supra-regional specialist fetal echocardiography in high-risk mothers. Aim: To evaluate fetal echocardiography findings in high-risk mothers over an 8 year period. Method: We undertook a retrospective review of all pregnant women at high-risk of having a baby with congenital heart disease who underwent fetal echocardiography between 01/01/1997 and 31/12/2004 at Birmingham Women’s Hospital. Results: 3,963 mothers were referred for fetal echocardiography and a total of 5,568 fetal echocardiography examinations were carried out during this period. The main reasons for referral were: (i) previously affected child – 27% (ii) abnormal initial screening scan – 20.7% (iii) maternal cardiac condition – 9.5% (iv) infant of diabetic mothers – 8% and (v) increased fetal nuchal translucency – 3%. Seven hundred and twleve (17.9%) echocardiograms were reported as abnormal. The majority of the abnormalities were identified in mothers who had abnormal initial screening scan (62%). In addition, the echocardiogram was also abnormal in 9% of cases with increased fetal nuchal translucency and in 5.7% of infants of diabetic mothers. In those with previously affected child and maternal cardiac condition, the echocardiogram was abnormal in 2.5% and 2.6% respectively. Conclusion: Abnormal initial screening scans and increased nuchal translucency had the highest yield in identifying CHD in high-risk mothers. Infant of diabetic mothers also have an increased risk warranting fetal cardiac screening for CHD. Normal fetal echocardiogram provides reassurance for the remainder of parents.
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Mohd Adib, Mohd Azrul Hisham, Mohd Fadhlan Yusof, Ahmad Zulkifli, and Mohd Hasni Nur Hazreen. "Detection of Cardiac Geometry via Difference Intensity of Echocardiogram Images." Journal of Integrative Bioinformatics 9, no. 2 (June 1, 2012): 40–45. http://dx.doi.org/10.1515/jib-2012-195.
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Summary Echocardiogram is an ultrasound image of the heart that demonstrates the size, motion and composition of cardiac structures and is also used to diagnose various abnormalities of the heart including abnormal chamber size, shape and congenital heart disease. Echocardiography provides important morphological and functional details of the heart. Most of the presented automatic cardiac disease recognition systems that use echocardiograms based on defective anatomical region detection. In this paper we present a simple technique for cardiac geometry detection via echocardiogram images which conquer these borders and exploits cues from cardiac structure. To demonstrate the effectiveness of this technique, we present results for cardiac geometry detection through difference intensity of echocardiogram images. We have developed a simple program code for the prediction of cardiac geometry using difference intensity of echocardiogram images. With this code, users can generate node or point for detection of cardiac geometry as ventricle and atrium in size, shape and location.
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Compton, Gregory, Lynne Nield, Andreea Dragulescu, Lee Benson, and Lars Grosse-Wortmann. "Echocardiography as a Screening Test for Myocardial Scarring in Children with Hypertrophic Cardiomyopathy." International Journal of Pediatrics 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/1980636.
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Introduction. Hypertrophic cardiomyopathy (HCM) is burdened with morbidity and mortality including tachyarrhythmias and sudden cardiac death. These complications are attributed in part to the formation of proarrhythmic scars in the myocardium. The presence of extensive LGE is a risk factor for adverse outcomes in HCM. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (cMRI) is the standard for the noninvasive evaluation of myocardial scars. However, echocardiography represents an attractive screening tool for myocardial scarring. The aim of this study was to compare the suitability of echocardiography to detect myocardial scars to the standard of cMRI-LGE.Methods. The cMRI studies and echocardiograms from 56 consecutive children with HCM were independently evaluated for the presence of cMRI-LGE and echocardiographic evidence of scarring by expert readers.Results. Echocardiography had a high sensitivity (93%) and negative predictive value (94%) in comparison to LGE. The false positive rate was high, leading to a low specificity (37%) and a low positive predictive value (35%).Conclusions. Given the poor specificity and positive predictive value, echocardiography is not a suitable screening test for the presence of myocardial scarring in children with HCM. However, children without echocardiographic evidence of myocardial scarring may not need to undergo cardiac magnetic resonance imaging to “rule in” LGE.
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Chen, Tainsong, Tzu-Pei Chen, and Liang Miin Tsai. "Computerized Quantification Analysis of Left Ventricular Wall Motion from Echocardiograms." Ultrasonic Imaging 19, no. 2 (April 1997): 138–44. http://dx.doi.org/10.1177/016173469701900204.
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Two-dimensional echocardiography (2-D echo) imaging is a more attractive clinical tool than other modalities that either involve radiation exposure or are too slow to image heart motion in real-time. Computer-aided analysis of left ventricular (LV) wall motion provides quantitative parameters for diagnosis. This study presents a computerized model for quantitative analysis of left ventricular wall motion from two-dimensional echocardiography by the application of image processing algorithms, including automatic threshold estimation, contrast stretching, boundary detection and border smoothing. The wall motion measurements rely primarily on sequential changes from end-diastolic to end-systolic frames in the left ventricular contours of apical four-chamber view echocardiograms. Left ventricular wall motion was analyzed on the 30 segments of 5 patients with acute myocardial infarction. The results from the computerized model were compared to those obtained from qualitative analysis of echocardiograms by an experienced clinical cardiologist who was unaware of the results of quantitative data.
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Kammeraad, Janneke A. E., Narayanswami Sreeram, Vincent van Driel, Ron Oliver, and Seshadri Balaji. "Is routine echocardiography valuable after uncomplicated catheter ablation in children?" Cardiology in the Young 14, no. 4 (August 2004): 386–88. http://dx.doi.org/10.1017/s1047951104004068.
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We determined the clinical value of routine transthoracic echocardiography performed after catheter ablation of supraventricular tachyarrhythmias in children. Between April 1996 and December 2003, 253 children, of whom 135 male, with the overall group having a median age of 9, ranging from 0.1 to 19 years, underwent 280 uncomplicated radiofrequency catheter ablation procedures for supraventricular tachyarrhythmias at three institutions. In every child, transthoracic Doppler echocardiography was performed before and after the procedure. The pre-ablation transthoracic echocardiograms were normal in all, and this was one of the criterions for inclusion. The post-ablation echocardiogram showed a disorder in four asymptomatic patients. In one patient, with focal atrial tachycardia, ablated via a retrograde aortic approach, there was mild aortic valvar insufficiency. This had resolved 6 months later. Pericardial effusions developed in 3 other children. In 2 the effusions resolved spontaneously but 1 patient required pericardial drainage. This same patient also developed clinically asymptomatic mild aortic insufficiency, which resolved spontaneously within 6 months. Routine echocardiography after uncomplicated catheter ablation procedures is of clinical value, and is especially indicated when a retrograde aortic approach has been used.
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Drake, William M., Craig E. Stiles, John S. Bevan, Niki Karavitaki, Peter J. Trainer, D. Aled Rees, Tristan I. Richardson, et al. "A Follow-Up Study of the Prevalence of Valvular Heart Abnormalities in Hyperprolactinemic Patients Treated With Cabergoline." Journal of Clinical Endocrinology & Metabolism 101, no. 11 (August 29, 2016): 4189–94. http://dx.doi.org/10.1210/jc.2016-2224.
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Context: Uncertainty exists whether the long-term use of ergot-derived dopamine agonist (DA) drugs for the treatment of hyperprolactinemia may be associated with clinically significant valvular heart disease and whether current regulatory authority guidelines for echocardiographic screening are clinically appropriate. Objective: Our objective was to provide follow-up echocardiographic data on a previously described cohort of patients treated with DA for lactotrope pituitary tumors and to explore possible associations between structural and functional valve abnormalities with the cumulative dose of drug used. Design: Follow-up echocardiographic data were collected from a proportion of our previously reported cohort of patients; all had received continuous DA therapy for at least 2 years in the intervening period. Studies were performed according to British Society of Echocardiography minimum standards for adult transthoracic echocardiography. Generalized estimating equations with backward selection were used to determine odds ratios of valvular heart abnormalities according to tertiles of cumulative cabergoline dose, using the lowest tertile as the reference group. Setting: Thirteen centers of secondary/tertiary endocrine care across the United Kingdom were included. Results: There were 192 patients (81 males; median age, 51 years; interquartile range [IQR], 42–62). Median (IQR) cumulative cabergoline doses at the first and second echocardiograms were 97 mg (20–377) and 232 mg (91–551), respectively. Median (IQR) duration of uninterrupted cabergoline therapy between echocardiograms was 34 months (24–42). No associations were observed between cumulative doses of dopamine agonist used and the age-corrected prevalence of any valvular abnormality. Conclusion: This large UK follow-up study does not support a clinically significant association between the use of DA for the treatment of hyperprolactinemia and cardiac valvulopathy.
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Sheehan, Megan M., Yoshihito Saijo, Zoran B. Popovic, and Michael D. Faulx. "Echocardiography in suspected coronavirus infection: indications, limitations and impact on clinical management." Open Heart 8, no. 2 (August 2021): e001702. http://dx.doi.org/10.1136/openhrt-2021-001702.
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ObjectivesTo describe the use of echocardiography in patients hospitalised with suspected coronavirus infection and to assess its impact on clinical management.MethodsWe studied 79 adults from a prospective registry of inpatients with suspected coronavirus infection at a single academic centre. Echocardiographic indications included abnormal biomarkers, shock, cardiac symptoms, arrhythmia, worsening hypoxaemia or clinical deterioration. Study type (limited or complete) was assessed for each patient. The primary outcome measure was echocardiography-related change in clinical management, defined as intensive care transfer, medication changes, altered ventilation parameters or subsequent cardiac procedures within 24 hours of echocardiography. Coronavirus-positive versus coronavirus-negative patient groups were compared. The relationship between echocardiographic findings and coronavirus mortality was assessed.Results56 patients were coronavirus-positive and 23 patients were coronavirus-negative with symptoms attributed to other diagnoses. Coronavirus-positive patients more often received limited echocardiograms (70% vs 26%, p=0.001). The echocardiographic indication for coronavirus-infected patients was frequently worsening hypoxaemia (43% vs 4%) versus chest pain, syncope or clinical heart failure (23% vs 44%). Echocardiography changed management less frequently in coronavirus-positive patients (18% vs 48%, p=0.01). Among coronavirus-positive patients, 14 of 56 (25.0%) died during hospitalisation. Those who died more often had echocardiography to evaluate clinical deterioration (71% vs 24%) and had elevated right ventricular systolic pressures (37 mm Hg vs 25 mm Hg), but other parameters were similar to survivors.ConclusionsEchocardiograms performed on hospitalised patients with coronavirus infection were often technically limited, and their findings altered patient management in a minority of patients.
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Walker, Humphrey, and Nadia Short. "Point-of-Care Screening Echocardiograms and their Potential Utility in the Acute Inpatient Medical Setting." Acute Medicine Journal 19, no. 4 (January 10, 2020): 201–8. http://dx.doi.org/10.52964/amja.0828.
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Demands on echocardiography services are increasing annually. This Quality Improvement Project aimed to see whether a point of care screening echocardiography (SE) service in the acute inpatient medical setting might help reduce demand on full trans-thoracic echocardiography services (FE). The indication and results of all FE requests on the admission ward were analysed over a three-month period. Following this, it was considered whether a theoretical SE occurring prior, would have changed the on-going utilisation of FE resources. Of the 67 requests analysed, 57 underwent FE. 25% revealed no abnormality. In 47%, a SE prior may have changed the future use of FE resources. This small retrospective review highlights the potential benefits of a SE service and further work is required.
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Sahasrabudhe, Nicole, Nickolas Teigen, Diana S. Wolfe, and Cynthia Taub. "Pregnancy after Prosthetic Aortic Valve Replacement: How Do We Monitor Prosthetic Valvular Function during Pregnancy?" Case Reports in Obstetrics and Gynecology 2018 (2018): 1–4. http://dx.doi.org/10.1155/2018/4935957.
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Background. With modern medicine, many women after structural heart repair are deciding to experience pregnancy. There is a need for further study to identify normal echocardiographic parameters to better assess prosthetic valvular function in pregnancy. In addition, a multidisciplinary approach is essential in managing pregnant patients with complex cardiac conditions.Case. A 22-year-old nulliparous woman with an aortic valve replacement 18 months prior to her pregnancy presented to prenatal care at 20-week gestation. During her prenatal care, serial echocardiography showed a significant increase in the mean gradient across the prosthetic aortic valve. Multidisciplinary management and a serial echocardiography played an integral role in her care that resulted in a successful spontaneous vaginal delivery without complications.Conclusion. Further characterization of the normal echocardiographic parameters in pregnant patients with prosthetic valves is critical to optimize prenatal care for this patient population. This case report is novel in that serial echocardiograms were obtained throughout prenatal care, which showed significant changes across the prosthetic aortic valve.Teaching Points.(1)Further study is needed to identify normal echocardiographic parameters to best assess prosthetic valvular function in pregnancy.(2)Multidisciplinary management is encouraged to optimize prenatal care for women with prosthetic aortic valve replacements.
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Okabe, Toshimasa, Howard M. Julien, Antony G. Kaliyadan, Henry Siu, and Gregary D. Marhefka. "Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography." Texas Heart Institute Journal 42, no. 5 (October 1, 2015): 474–78. http://dx.doi.org/10.14503/thij-14-4447.
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In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.
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Das, Bibhuti B. "SARS-CoV-2 Myocarditis in a High School Athlete after COVID-19 and Its Implications for Clearance for Sports." Children 8, no. 6 (May 21, 2021): 427. http://dx.doi.org/10.3390/children8060427.
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This case report describes a high school athlete with palpitation, myalgia, fatigue, and dyspnea on exertion after SARS-CoV-2 infection with evidence of myocarditis by cardiac magnetic resonance (CMR), but echocardiography and troponin were normal. This case is unusual as the standard cardiac tests recommended by the American Heart Association for sports clearance, including ECG, echocardiography, and cardiac biomarkers, were normal. Still, she continued to be symptomatic after mild COVID-19. The CMR was performed to evaluate her unexplained palpitation and showed patchy myocardial edema two months after her initial SARS-CoV-2 infection. In this case, the diagnosis of myocardial involvement would be missed by normal echocardiograms and cardiac bio-markers without CMR. Because acute myocarditis is a risk factor for sudden death in competitive athletes, pediatric cardiologists should consider performing additional tests such as cardiac MRI in symptomatic COVID-19 patients, even if cardiac biomarkers and echocardiograms are normal.
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Parasuraman, Sathish Kumar, Janaki Srinivasan, and Paul Broadhurst. "Is follow-up echocardiogram mandatory after a STEMI?" Echo Research and Practice 7, no. 3 (September 2020): K27—K30. http://dx.doi.org/10.1530/erp-20-0022.
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Summary Current guidelines do not advise follow-up echocardiograms after ST-segment elevation myocardial infarction (STEMI), unless the left ventricular ejection fraction is ≤40%. We present an interesting case of left ventricular pseudo-aneurysm – diagnosed 6 months after index STEMI presentation. Follow-up echocardiogram was performed in her case, due to jaw pain during routine haemodialysis. The patient was successfully treated with percutaneous closure device. This case raises the question of whether echo follow-up should be routinely advised after STEMI – even in those with minimal cardiac symptoms. Learning points: Patients with left ventricular pseudo-aneurysm can be haemodynamically stable and may not always be in extremis. Left ventricular pseudo-aneurysm can develop months after ST elevation myocardial infarction. In patients re-presenting with cardiac symptoms after ST elevation myocardial infarction, a repeat echocardiogram should be considered. In patients suffering ST elevation myocardial infarction, it is reasonable to consider repeat echocardiography even with mild LV dysfunction, especially with late presentation or disproportionately high biomarkers.
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Fletcher, Scott E., Derek A. Fyfe, Henry B. Wiles, and Lisa F. McKellar. "Magnetic resonance imaging and transesophageal echocardiography—a comparative study in patients with congenital heart disease." Cardiology in the Young 4, no. 2 (April 1994): 156–59. http://dx.doi.org/10.1017/s1047951100002109.
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AbstractTransesophageal echocardiography and magnetic resonance imaging have proved useful as noninvasive imaging modalities in postoperative patients with congenital heart disease, or patients with suboptimal transthoracic echocardiograms. Each modality has specific advantages. When both are of equal efficacy, magnetic resonance imaging is recommended because it is less invasive and more comfortable for the patient.
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Öztunç, Funda, Irfan Levent Saltık, and Halil Türkoğlu. "Mitral perforation: a rare cause of congenital mitral regurgitation." Cardiology in the Young 13, no. 5 (October 2003): 472–74. http://dx.doi.org/10.1017/s1047951103000982.
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In a 4-year-old boy with severe mitral regurgitation, cross sectional echocardiography combined with Doppler interrogation confirmed the presence of isolated perforation of the aortic leaflet of the mitral valve. The perforation was closed with a patch of fresh autologous pericardium. Serial echocardiograms taken postoperatively showed no regurgitation across the mitral valve.
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Chang, Justin S., Bheeshma Ravi, Richard J. Jenkinson, J. Michael Paterson, Anjie Huang, and Daniel Pincus. "Impact of preoperative echocardiography on surgical delays and outcomes among adults with hip fracture." Bone & Joint Journal 103-B, no. 2 (February 1, 2021): 271–78. http://dx.doi.org/10.1302/0301-620x.103b2.bjj-2020-1011.r1.
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Aims Echocardiography is commonly used in hip fracture patients to evaluate perioperative cardiac risk. However, echocardiography that delays surgical repair may be harmful. The objective of this study was to compare surgical wait times, mortality, length of stay (LOS), and healthcare costs for similar hip fracture patients evaluated with and without preoperative echocardiograms. Methods A population-based, matched cohort study of all hip fracture patients (aged over 45 years) in Ontario, Canada between 2009 and 2014 was conducted. The primary exposure was preoperative echocardiography (occurring between hospital admission and surgery). Mortality rates, surgical wait times, postoperative LOS, and medical costs (expressed as 2013$ CAN) up to one year postoperatively were assessed after propensity-score matching. Results A total of 2,354 of 42,230 (5.6%) eligible hip fracture patients received a preoperative echocardiogram during the study period. Echocardiography ordering practices varied among hospitals, ranging from 0% to 23.0% of hip fracture patients at different hospital sites. After successfully matching 2,298 (97.6%) patients, echocardiography was associated with significantly increased risks of mortality at 90 days (20.1% vs 16.8%; p = 0.004) and one year (32.9% vs 27.8%; p < 0.001), but not at 30 days (11.4% vs 9.8%; p = 0.084). Patients with echocardiography also had a mean increased delay from presentation to surgery (68.80 hours (SD 44.23) vs 39.69 hours (SD 27.09); p < 0.001), total LOS (19.49 days (SD 25.39) vs 15.94 days (SD 22.48); p < 0.001), and total healthcare costs at one year ($51,714.69 (SD 54,675.28) vs $41,861.47 (SD 50,854.12); p < 0.001). Conclusion Preoperative echocardiography for hip fracture patients is associated with increased postoperative mortality at 90 days and one year but not at 30 days. Preoperative echocardiography is also associated with increased surgical delay, postoperative LOS, and total healthcare costs at one year. Echocardiography should be considered an urgent test when ordered to prevent additional surgical delay. Cite this article: Bone Joint J 2021;103-B(2):271–278.
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Katamreddy, Adarsh, Aaron J. Wengrofsky, Weijia Li, and Cynthia C. Taub. "DNR Code Status Is Not Associated with Under-Utilization of Inpatient Transthoracic Echocardiograms." Journal of Cardiovascular Development and Disease 8, no. 9 (September 15, 2021): 112. http://dx.doi.org/10.3390/jcdd8090112.
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In the strictest sense, do-not-resuscitate (DNR) status means that cardiopulmonary resuscitation should not be performed after death has occurred; all other medical interventions in line with a patient’s goals of care should be implemented. The use of transthoracic echocardiography (TTE) in patients with DNR status is unknown. Therefore, we aim to evaluate the utilization of TTE among patients with DNR status using this retrospective data analysis. A total of 16,546 patient admissions were included in the final study. A total of 4370 (26.4%) of the patients had a TTE during hospitalization; among full code patients, 3976 (25.7%) underwent TTE, whereas TTEs were performed in 394 (37.4%) of DNR patients. On univariate logistic regression analysis, full code status had OR (95% confidence interval, CI) 0.57 (0.51–0.66), p < 0.01 compared with DNR status for the performance of inpatient TTE. In the final multivariate model adjusted for age, sex, race, and clinical comorbidities, the full code patients had OR (95% CI) 0.91 (0.79–1.05), p = 0.22 compared with DNR patients for the performance of inpatient TTE. DNR status is not associated with a decrease in inpatient transthoracic echocardiography performance.
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Cooper, Amy, Kacy Sisco, Carl H. Backes, Marc Dutro, Ruth Seabrook, Stephanie L. Santoro, and Clifford L. Cua. "Usefulness of Postnatal Echocardiography in Patients with Down Syndrome with Normal Fetal Echocardiograms." Pediatric Cardiology 40, no. 8 (September 20, 2019): 1716–21. http://dx.doi.org/10.1007/s00246-019-02209-w.
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Alotaibi, Ghazi S., Irwindeep Sandhu, Joseph M. Brandwein, and Lalit Saini. "The Yield of Echocardiography in the Diagnosis of Infective Endocarditis in Patients Undergoing Chemotherapy for Acute Myeloid Leukemia." Blood 132, Supplement 1 (November 29, 2018): 5177. http://dx.doi.org/10.1182/blood-2018-99-120018.
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Abstract INTRODUCTION: The pathogenesis of infective endocarditis (IE) , a typical biofilm-associated infectious disease frequently caused by commensal or pathogenic bacteria, is mainly attributed to the formation of septic vegetations, which are fibrin-platelet complexes embedded with bacteria on heart valves detected by echocardiography. Patients with acute myeloid leukemia (AML) are prone to neutropenia, immunosuppression and central venous catheters leading to high rates of bacteremia. It has been postulated that despite high rates of bacteremia, patients with AML undergoing intensive chemotherapy are only rarely able to form vegetations due the frequent thrombocytopenia associated with such treatment (McCormick 2002). Here, we sought to determine the rate of echocardiographic detection of IE in patients with AML and chemotherapy induced thrombocytopenia . METHODS: To assess the yield of echocardiography, we conducted a retrospective, single center, analysis of patients with AML who underwent treatment using anthracycline or fludarabine induction and intermediate/high dose cytarabine based consolidation. At all time points, patients with febrile neutropenia were empirically treated with piperacillin/tazobactam ± aminoglycosides and underwent appropriate investigations including blood cultures. Cultures were drawn every 24 to 48 hours with fevers and daily, if positive, till culture clearance. Patients with positive blood cultures for organisms associated with IE underwent an echocardiogram as standard of care. RESULTS: From January 2010 to January 2018, 296 patients underwent curative intent chemotherapy for treatment of acute myeloid leukemia (AML) at the University of Alberta Hospital, Edmonton, Canada. The median age of all patients was 56.7 years (IQR: 44-64) and 40.2% were females. During the induction or consolidation chemotherapy , 53 echocardiogram were done to investigate 53 episodes of bacteremia in 50 patients (16.9%) who had organisms associated with IE (Table 1). Two echocardiograms were done to investigate possible culture negative IE based upon clinical suspicion. Transesophageal echocardiogram were utilized in 19 patients (36%) while transthoracic echocardiogram were done in 34 patients (64%). The median platelets count on the day of the echocardiogram was 23 x109/L (IQR: 14-38). Viridans Group Streptococci and Staphylococcus aureus were the most frequent isolates cultured in the blood in 36% and 16% of cases, respectively. The median duration of bacteremia was 1 day (IQR 1-2). Three (5.6%) patients had echocardiographic findings suggestive of IE based on a positive transesophageal study (n=2) or transthoracic study (n=1). Among these, two were secondary to Enterococcus bacteria and involved the mitral valve and the third was secondary to a non-HACEK gram-negative bacteria leading to tricuspid valve involvement . CONCLUSION: This study is the first to suggest that despite the high prevalence of Viridans Group Streptococci and Staphylococcusaureus in patients with AML undergoing chemotherapy, echocardiographic findings of IE in these patients are rare, with the notable exception of Enterococcal and Non-HACEK gram negative organisms. In contrast, in the general population, Viridans Group Streptococci and Staphylococcus aureus and bacteremia are associated with IE in 20% and 63% %, respectively (Westling 2009, Rasmussen 2011). The low incidence in our cohort may be attributed to impaired fibrin-platelet deposition in these patients with inability to mount a vegetation response, or the early initiation of broad spectrum antibiotics. Given these findings, the value of routine echocardiography should be questioned in patients with AML without other clinical features of IE. Disclosures Sandhu: Bioverativ: Honoraria; Celgene: Honoraria; Novartis: Honoraria; Janssen: Honoraria; Amgen: Honoraria. Brandwein:Pfizer: Consultancy; Celgene: Consultancy; Boehringer Ingelheim: Consultancy, Research Funding; Novartis: Consultancy; Lundbeck: Consultancy.
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Thomas-Dewing, Rowena R., John Chambers, Nicholas Hart, and Jo Howard. "A Comparison of Echocardiogram Screening for Pulmonary Hypertension in Asymptomatic and Symptomatic Patients with Sickle Cell Disease." Blood 112, no. 11 (November 16, 2008): 4801. http://dx.doi.org/10.1182/blood.v112.11.4801.4801.
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Abstract Background: Pulmonary hypertension (PHT) is an increasingly recognised complication of sickle cell disease (SCD), even in asymptomatic patients. Studies from the US have shown a prevalence of PHT of between 20–30% and this has been associated with an increased mortality. The prevalence of PHT in the UK sickle cell disease population is unknown. Method: We identified adult patients with a diagnosis of SCD (HbSS, HbSC, HbSB0thalassaemia and HbSB+ thalassaemia) who had screening for PHT using transthoracic echocardiography over a one year period. We compared the echocardiographic findings of symptomatic and asymptomatic patients. Direct measurements of tricuspid regurgitant jet velocity (TRVmax) were recorded, as has been done in previous similar studies with a peak TRV of ≥ 2.5m/s indicating risk of PHT. In order to increase specificity and sensitivity of the echocardiogram recording and as TRVmax is not always measurable other indirect indicators of PHT were also recorded, including ‘time from start of flow to peak velocity’ which is measured by placing the pulsed sample in the centre of the main PA or pulmonary valve annulus; a time of >105ms excluded PHT while a time <80ms made PHT highly likely. Systolic function of the right ventricle was quantified using long-axis measurements: TAPSE (tricuspid annular plane systolic excursion) using a TAPSE <18mmHg as an abnormal threshold and ‘Doppler tissue S velocity’ was measured by placing the Doppler tissue sample in the RV free wall at the tricuspid annulus and recording the peak systolic velocity. A velocity of <10m/s was consistent with a reduced RV ejection fraction or PHT. Results: 32 asymptomatic patients and 40 symptomatic patients had echocardiogram screening for PHT. The asymptomatic group had a mean age (± SD) 36.5 years(± 10.2), 17 patients were men, 20 patients had HbSS, 10 patients had HbSC, 1 patient had HbSB0thalassaemia and 1 patient had HbSB+ thalassaemia. 3/32 (9.4%) of patients had abnormal echocardiograms with a TRV of 2.5, 2.5 and 2.6 m/s respectively. One patient with a TRV = 2.5m/s had a history of chest crisis and was on hydroxyurea. The symptomatic group had a mean age (± SD) 35.8 years (± 11.2), 13 patients were men, 31 patients had HbSS, 8 patients had HbSC, 1 patient had HbSB0thalassaemia. 2 patients who had TRV ≥ 2.5m/s were excluded from analysis as had pulmonary stenosis. 7/38 (18.4%) patients had TRV ≥ 2.5m/s (range 2.5 to 2.7m/s). Of these 7 patients, 6 had HbSS, 1 had HbSC, only one was on hydroxyurea, and only one had a history of chest crisis. In 2 further patients in whom TRV was not measurable, other echocardiographic features were used to identify PHT; 1 patient had a ‘time to peak velocity’ of 58ms and 1 patient had a TAPSE of 17mmHg and a ‘time to peak velocity’ of 80ms. Both patients had HbSS, 1 had a history of chest crisis and none were on hydroxyurea. Conclusion: In the asymptomatic group, 9.4% of patients had abnormal echocardiograms, which were suggestive of PHT. In the symptomatic group, 24% patients had echocardiograms suggestive of PHT with 7 patients having a peak TRV ≥ 2.5m/s and a further 2 patients being identified using other echocardiogram criteria. We conclude that the prevalence of PHT in the asymptomatic group was low but in the symptomatic group, the prevalence of PHT was comparable to figures in the US. In addition, transthoracic doppler echocardiographic screening for PHT should include other criteria apart from TRV.
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Bibevski, Steve, Mark Ruzmetov, Laura Mendoza, Jonathan Decker, Breanna Vandale, Kaimal A. Jayakumar, Kak Chen Chan, Edward Bove, and Frank G. Scholl. "The Destiny of Postoperative Residual Ventricular Septal Defects After Surgical Repair in Infants and Children." World Journal for Pediatric and Congenital Heart Surgery 11, no. 4 (July 2020): 438–43. http://dx.doi.org/10.1177/2150135120918537.
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Purpose: Residual ventricular septal defects (rVSDs) of small size are commonly seen on transesophageal echocardiography after surgical repair. This study aimed to determine the destiny of rVSD found on intraoperative echocardiogram. Methods: Patients undergoing surgical repair of VSD as the primary procedure with available intraoperative and discharge echocardiograms between 2007 and 2017 were reviewed. Presence of an rVSD on intraoperative echo triggered review of discharge echo and of subsequent follow-up echocardiograms. Results: One hundred four patients were analyzed. The mean age and weight for the entire cohort were 1.4 ± 2.9 years (median, 5.4 months; range, 29 days to 14 years) and 8.8 ± 9.9 kg (median, 5.1 kg; range, 2.7-58 kg), respectively. Sixty (57%) patients had rVSD at discharge, with mean size of residual VSD of 1.38 ± 0.92 mm (mode, 0.6; median, 2.2 mm; range, 0.5-3.9 mm). The mean follow-up time was 3.7 ± 3.1 years (range, 1 month to 9.3 years). Among those with rVSD at discharge, a residual shunt persisted in 73% at one-month follow-up. On follow-up at three years postdischarge, of the 60 patients with early rVSD, 6 had a persistent rVSD (10%) with a mean diameter of 3.0 ± 0.8 mm (range, 2.4-3.9 mm). Conclusions: Residual VSD after surgical repair is detected frequently on postoperative echocardiogram. The presence of rVSD was not associated with any preoperative, intraoperative, or postoperative factors. By three years of follow-up, only six patients continued to demonstrate rVSD with a mean diameter of 3 mm, suggesting that defects 3 mm or greater may be less likely to close spontaneously after three years.
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Guliani, Sundeep, Jaideep Das Gupta, Robin Osofsky, John Marek, Muhammad Ali Rana, and Jon Marinaro. "Protocolized use of catheter-directed thrombolysis and echocardiography is highly effective in reversing acute right heart dysfunction in severe submassive pulmonary embolism patients." Perfusion 35, no. 7 (January 17, 2020): 641–48. http://dx.doi.org/10.1177/0267659119896891.
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Objective: The objective of this study was to evaluate the efficacy of protocolized use of catheter-directed thrombolysis and echocardiography in submassive pulmonary embolism patients. Methods: A retrospective study at a single institution of 28 patients that presented with submassive pulmonary embolism from July 2016 to September 2019 was performed. All patients were diagnosed using chest computed tomography demonstrating a pulmonary embolism and abnormal right ventricular to left ventricular ratio. Patients with severe right heart dysfunction (right ventricular to left ventricular ratio ⩾1.4) were protocolized to receive catheter-directed thrombolysis via EkoSonic catheters (EKOS Corporation, Bothell, WA, United States). Transthoracic echocardiogram was performed after 24 hours to assess right ventricular function and determine the need to continue thrombolysis. Patients after discharge then received follow-up echocardiograms at 6 weeks to determine new post-treatment baseline. Results: The mean patient age was 54.6 years, mean body mass index was 35.0, and mean right ventricular to left ventricular ratio on admission computed tomography imaging was 1.70. Interval mean right ventricular to left ventricular ratio on echocardiography during thrombolysis therapy was 1.01 (p < 0.00001). Patients were tachycardic on admission (mean heart rate 102.2 beats per minute) with improvement by completion of thrombolysis (mean heart rate 72.9 beats per minute) (p < 0.00001). There was a 0% incidence of periprocedural complications. Overall 30-day complication rate was 7.1% (n = 1 arrhythmia, n = 1 delayed intracranial hemorrhage). At 6-week follow-up, 91% of the patients who received echocardiography had normal right ventricular function. Conclusion: This retrospective study demonstrates the effectiveness of protocolized use of catheter-directed thrombolysis and echocardiography in reversing severe right heart dysfunction in submassive pulmonary embolism patients.
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Hepner, Absalom D., Holly Morrell, Seaneen Greaves, Jeff Greaves, and Mohammad Reza Movahed. "Prevalence of mitral valvar prolapse in young athletes." Cardiology in the Young 18, no. 4 (August 2008): 402–4. http://dx.doi.org/10.1017/s104795110800245x.
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AbstractBackgroundThe prevalence of mitral valvar prolapse has been reported to be between 0.6 and 21%. The goal of our study was to evaluate its prevalence in young athletes who underwent hand-held echocardiography as a screening mostly in southern California.MethodsWe retrospectively analyzed 1742 echocardiograms that were performed as a part of a cardiac screening of teenage athletes. The total prevalence of mitral valvar prolapse was calculated and stratified based on gender.ResultsWe screened a total of 1172 male and 570 female high school athletes. The echocardiographic prevalence of mitral valvar prolapse was 0.9%. The prevalence was similar in both genders, at 1.2% in male and 0.7% in female athletes.ConclusionThe prevalence of mitral valvar prolapse in young athletes mostly in southern California was found to be less than 1%, and was similar in both genders.
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Sahadan, Dayang Zuraini, Ee Wei Ng, and Yinn Khurn Ooi. "Delayed Diagnosis of Rare Cyanotic Cardiac Lesion in A Hypoxemic but otherwise Asymptomatic Infant." Malaysian Journal of Paediatrics and Child Health 26, no. 2 (October 28, 2020): 68–75. http://dx.doi.org/10.51407/mjpch.v26i2.125.
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The causes of neonatal hypoxemia are usually either pulmonary or cardiac pathologies. We report a case of a 2-month-old boy with oxygen dependency since birth. He would desaturate down to 88-90% whenever supplemental oxygen was weaned off. Initial screening echocardiograms described only a small atrial septal defect, thus lung disease was thought to be the aetiology. Eventually, a detailed echocardiogram and CT angiography revealed anomalous right superior vena cava (RSVC) draining into the left atrium (LA). Echocardiography with bubble study injected via the upper extremities showed brisk filling of “bubbles” in the left heart, confirming fixed right-to-left shunting. Anomalous RSVC drainage into the LA is an extremely rare form of anomalous systemic venous drainage whereby unexplained hypoxemia is present and is sometimes the only clinical manifestation. Surgical correction of this anomaly is indicated to prevent complications of cyanosis and risk of systemic embolization. The surgery generally carries low risk and is associated with good long-term prognosis.
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SUDARSHAN, VIDYA K., E. Y. K. NG, U. RAJENDRA ACHARYA, RU SAN TAN, SIAW MENG CHOU, and DHANJOO N. GHISTA. "INFARCTED LEFT VENTRICLE CLASSIFICATION FROM CROSS-SECTIONAL ECHOCARDIOGRAMS USING RELATIVE WAVELET ENERGY AND ENTROPY FEATURES." Journal of Mechanics in Medicine and Biology 16, no. 01 (February 2016): 1640009. http://dx.doi.org/10.1142/s0219519416400091.
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Parasternal and apical echocardiography images captured from different cross-sectional planes (short-axis and four chambers) convey significant information about the structure and function of infarcted Left Ventricular (LV) myocardium. Thus, features from these cross-sectional views of echocardiograms extracted using computer-aided techniques may aid in characterizing Myocardial Infarction (MI). Therefore, this paper proposes a new algorithm for automated MI characterization using features extracted from parasternal short axis and apical four chambers cross-sectional views of 160 subjects (80 with MI and 80 normal) echocardiograms. The Stationary Wavelet Transform (SWT) method is used to extract the Relative Wavelet Energy and Entropy (RWE and RWEnt) features from the two cross-sectional views of echocardiography images separately. These features are ranked and subjected to classification in two different steps: (i) the features from each view are separately ranked using entropy, t-test and Wilcoxon ranking tests and fed to the classifier, and (ii) later, the features from both the views are combined and ranked. Finally, these ranked features are subjected to the Support Vector Machine (SVM) classifier for characterization of normal and MI using a minimum number of features. The proposed method is able to identify MI with 95.0% of accuracy, 93.7% of sensitivity and 96.2% of specificity using 32 features extracted from parasternal short-axis view; an accuracy of 96.2%, sensitivity of 97.5% and specificity of 95.0% with 18 apical four chamber view features. The results show that by combining the features from both views enables the confirmation of MI LVs with an accuracy of 96.8%, sensitivity of 93.7% and specificity of 100% using 16 features extracted from only two frames. Software development is in progress which can be incorporated into the echocardiography ultrasound machine for automated detection of MI patients.
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Oliver, Ana Carolina, Roberto Superchi, Superchi Federico, Canabal Matilde, Jubin Silvana, Carolina Errecarte, Caneiro Ada, et al. "Role of Echocardiography and Cardiac Biomarkers in Early Detection of Hematopoietic Stem Cell Transplantation Associated Cardiotoxicity." Blood 134, Supplement_1 (November 13, 2019): 5688. http://dx.doi.org/10.1182/blood-2019-127680.
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Introduction: Cardiovascular disease is the first cause of death worldwide; in Uruguay it corresponds to 30%. Classical risk factors are: age, smoking, male gender, diabetes, hypertension, hyperuricemia and dyslipidemia. In the last decades, the increasing use of chemotherapy and radiotherapy in oncology have augmented cardiovascular side effects. The improvement in response and overall survival of hematologic patients allow a longer time to develop cardiovascular complications. Cardiotoxicity has been studied extensively in the setting of breast cancer and anthracyclines use.However, within Hematopoietic Stem Cell Transplantation (HSCT) this is still being in research. The estimated incidence is 5-10 % but the data is little and unsystematic. The primary objective of this trial is to assess subclinical myocardial damage using biomarkers and echocardiography and identify patients at high risk of developing cardiotoxicity after HSCT. Methods: This is a prospective, single center trial that started on April 2017. Population: adult patients admitted in the British Hospital Transplant Unit, Montevideo Uruguay to receive either an autologous or allogeneic HSCT. Inclusion criteria: 18 years old or older, Eastern Cooperative Oncology Group performance status 0-1. Patients who signed informed consent. Exclusion criteria: baseline left ventricular ejection fraction (LVEF) <50%, systemic amyloidosis. We have performed serial measurements of cardiac biomarkers (pro-BNP, Troponin T, Troponin I and CPK) at the admission, day 1, day 14 and day 30 after HSCT. Echocardiograms at admission and at day 30 were performed by the same physicians. Biomarkers and echocardiogram were repeated at day 100 if there were alterations in normal values of biomarkers or myocardial dysfunction measured by the echocardiography in day 30. Results: Between May 2017 and April 2019 we have perform 96 HSCT, of those, all 96 consented to enter into the study. Male gender 57 (60%). Median age 56 years old (18-74). Diseases: Multiple myeloma: 42, Non Hodgkin Lymphoma 27, Hodgkin Lymphoma 12, Acute Myeloid Leukemia 11, Solid tumors 2, Aplasia 1, Renal Amyloidosis 1. Type of transplant: Autologous were 85 and Related Allogenic 11 patients. 82 patients (85,5%) have been studied with the 4 biomarkers determinations and the 2 echocardiograms proposed by the study. Causes for which patients were not studied: 3 because they died before the time points, and 11 because violation of protocol. Forty nine (51%) patients had one biomarker elevated at Day 30, so they would have to be studied at Day 100. Of them 49% performed the echocardiogram studies at D100 and 45% the biomarkers. Biomarkers: The evolution of the biomarkers during transplant is shown in figure 1. Pro-BNP is the biomarker that has more significant changes: 71% of transplanted patients has pro-BNP elevated at day 14; at day 30 53% persists with this biomarker elevated. At day 100, Troponin T and I 0% elevated, CPK 4% and pro-BNP 75% elevated. Echocardiogram: no one patient reached the definition of cardiotoxicity in terms of a decrease in LVEF of more than 10% to a value of less than 53%. However, 12 patients (12,5%) had a reduction of the Global Longitudinal Strain (GLS) of more than 15%. Currently, the deformation index strain is an echocardiographic way to detect early cardiac involvement. The decline in rates of deformation precedes the decline in LVEF and persists during subsequent cancer treatment. A relative reduction of 15% or more of GLS has the greatest specificity in predicting subclinical left ventricular dysfunction. In 74 patients we were able to measure the strain at the admission and 81 at day 30. At day 100 there were no significant reduction of LVEF and 3 patients had a relative reduction of GLS more than 15%. Conclusions: This is a prospective and systematic analysis of biomarker and echocardiographic changes during HSCT. We found changes in biomarkers and echocardiographic measures during HSCT: pro-BNP is the biomarker that raises during transplant, and it is persistently elevated at day 30 in 53%. GLS has a significant reduction in 12,5% of patients. We hypothesized that this changes can be predictive of clinical cardiotoxicity in the future, therefore, we are planning to enroll 100 more patients to confirm this results and after that, correlate this changes with comorbidities, conditioning regimens and study the development of clinical cardiotoxicity after 1-year post HSCT. Disclosures Galeano: Szabo SA: Other: (Equity interest).
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Kerwin, Todd C., Harmony Leighton, Kunal Buch, Azriel Avezbadalov, and Hormoz Kianfar. "The Effect of Adoption of an Electronic Health Record on Duplicate Testing." Cardiology Research and Practice 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/1950191.
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Background. The electronic health record (EHR) has been promoted as a tool to improve quality of patient care, reduce costs, and improve efficiency. There is little data to confirm that the use of EHR has reduced duplicate testing. We sought to evaluate the rate of performance of repeat transthoracic echocardiograms before and after the adoption of EHR.Methods. We retrospectively examined the rates of repeat echocardiograms performed before and after the implementation of an EHR system.Results. The baseline rate of repeat testing before EHR was 4.6% at six months and 7.6% at twelve months. In the first year following implementation of EHR, 6.6% of patients underwent a repeat study within 6 months, and 12.9% within twelve months. In the most recent year of EHR usage, 5.7% of patients underwent repeat echocardiography at six months and 11.9% within twelve months. All rates of duplicate testing were significantly higher than their respective pre-EHR rates (p<0.01for all).Conclusion. Our study failed to demonstrate a reduction in the rate of duplicate echocardiography testing after the implementation of an EHR system. We feel that this data, combined with other recent analyses, should promote a more rigorous assessment of the initial claims of the benefits associated with EHR implementation.
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Bhandari, Purushotam, and Ruwan Morawakkorala. "Pediatric tele-echocardiography in the diagnosis of congenital heart diseases in a regional referral hospital in eastern Bhutan." Bhutan Health Journal 1, no. 1 (November 16, 2015): 70–73. http://dx.doi.org/10.47811/bhj.11.
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Introduction: Congenital Heart Diseases are the commonest birth defects and the most common reason for out-country referral of pediatric patients in Bhutan.Without any qualified pediatric cardiologists in the country, early diagnosis and appropriate care of pediatric cardiac patients is often delayed or inappropriate. Collaboration through telemedicine between general pediatrician and pediatric cardiologist can improve the diagnosis of congenital heart diseases in Bhutan.
Methods: Pediatric patients clinically suspected to have congenital heart diseases underwent Echocardiography at Mongar regional referral hospital. The Echocardiograms, performed by general pediatrician, were e-mailed to Pediatric Cardiologist working in UK, who gave the diagnosis after viewing the Echo-loops. This was compared with the final diagnosis made at tertiary cardiac centre in India.
Results: 30 echocardiograms performed by general pediatrician at Mongar Hospital in eastern Bhutan were mailed to Pediatric Cardiologist working in UK. Of the thirty cases, 20 required no immediate referral and were put on medications and follow up plans. 10 of the 30 cases requiredearly referral to tertiary care hospital in India. There was excellent concordance between the diagnosis made through tele-echocardiology and the final diagnosis made at tertiary cardiac centre.
Conclusions: Tele-echocardiography between a general Pediatrician and a Pediatric Cardiologist can greatly enhance the diagnosis of congenital heart diseases in children.
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Lopez, Leo, Roque Ventura, Elizabeth M. Welch, David G. Nykanen, and Evan M. Zahn. "Echocardiographic considerations during deployment of the Helex Septal Occluder for closure of atrial septal defects." Cardiology in the Young 13, no. 3 (June 2003): 290–98. http://dx.doi.org/10.1017/s1047951103000556.
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The Helex Septal Occluder is a new device used to close atrial septal defects via interventional catheterization. In order to study the role of echocardiography during its use, and to describe the morphologic variants of defects suitable for closure with this occluder, we evaluated all patients undergoing intended closure of an atrial septal defect with the Helex occluder. A combination of transthoracic, transesophageal, three-dimensional, and intracardiac echocardiography were used before, during, and after the procedure to characterize anatomy, assess candidacy for closure, guide the device during its deployment, and evaluate results. Among the 60 candidates included in the study, 11 were excluded because of transesophageal echocardiographic and/or catheterization data obtained in the laboratory. Attempts at closure were successful in 46 patients, and unsuccessful in 3. We successfully treated four types of defects. These were defects positioned centrally within the oval fossa with appreciable rims along the entire circumference of the defect, defects with deficient or absent segments of the rim, defects with aneurysm of the primary atrial septum, and defects with multiple fenestrations. Follow-up transthoracic echocardiograms taken at a median of 7 months demonstrated no residual defects in 21, trivial residual defects in 17, and small residual defects in 8 patients. In 20 patients, three-dimensional reconstructions were used to characterize the morphology of the defect and the position of the device. Because transesophageal echocardiography was often limited by acoustic interference from the device, intracardiac echocardiography was utilized in 3 cases to overcome this limitation.
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Sandhu, Alexander T., Justin Parizo, Narges Moradi-Ragheb, and Paul A. Heidenreich. "Association Between Offering Limited Left Ventricular Ejection Fraction Echocardiograms and Overall Use of Echocardiography." JAMA Internal Medicine 178, no. 9 (September 1, 2018): 1270. http://dx.doi.org/10.1001/jamainternmed.2018.3317.
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Aguilar, Frank G., Senthil Selvaraj, Eva E. Martinez, Daniel H. Katz, Lauren Beussink, Kwang-Youn A. Kim, Jie Ping, et al. "Archeological Echocardiography: Digitization and Speckle Tracking Analysis of Archival Echocardiograms in the HyperGEN Study." Echocardiography 33, no. 3 (November 3, 2015): 386–97. http://dx.doi.org/10.1111/echo.13095.
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Martinez, Hugo, Ralph Salloum, Erin Wright, Philip Khoury, Justin Tretter, and Thomas Ryan. "RONC-31. ADVANCED ECHOCARDIOGRAPHY WITH MYOCARDIAL-STRAIN-ANALYSIS DESCRIBES SUBCLINICAL CARDIAC DYSFUNCTION AFTER CRANIOSPINAL IRRADIATION (CSI) IN PEDIATRIC AND YOUNG ADULT PATIENTS WITH CENTRAL NERVOUS SYSTEM (CNS) TUMORS." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii460—iii461. http://dx.doi.org/10.1093/neuonc/noaa222.797.
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Abstract CSI is part of the treatment of CNS tumors and is associated with cardiovascular disease; data in pediatric/young-adult patients are limited. Myocardial-strain-analysis can reveal subclinical dysfunction. Retrospective, single-center study in CNS tumor patients managed with CSI from 1986–2018. Clinical details, and echocardiography including myocardial-strain-analysis were collected at T1=first echocardiogram after CSI, and T2=most recent echocardiogram. Data are mean±standard deviation. Echocardiograms were available in 44 patients (36%female, 14±8.0years) at T1 and 39 patients (38%female, 21.0±11.3years) at T2. Standard echocardiography was normal for all subjects. At T1, global longitudinal peak systolic strain (GLS) was -16.3%±3.7% in CSI vs. -21.6%±3.5% in controls (p<0.0001); global radial peak systolic strain (GRS) was 21.5%±10.1% in CSI vs. 26.5%±7.4% in controls, and global circumferential peak systolic strain (GCS) was -19.5%±6.0% in CSI vs. -21.4%±3.4% in controls (p<0.05, both comparisons). At T2, GLS was -15.8%±5.2% in CSI vs. -21.9±3.5% in controls (p<0.0001); GRS was 22.6%±10.4% in CSI vs. 27.1±8.2% in controls (p<0.05); GCS was -20.5%±6.9% in CSI vs. -21.8±3.5% in controls (p=0.10). For 17 patients with myocardial-strain-analysis available for both time points: difference in GLS was 0.06±7.2% (p>0.95); GRS was 5.5±9.5% (p<0.05); GCS was -3.4±4.9% (p<0.05). Subclinical dysfunction is present at first echocardiogram after CSI. Myocardial impairment may recover with time, however further analysis is needed to identify risk factors and trends. These results argue for inclusion of baseline cardiovascular assessment and longitudinal follow-up in CNS tumor patients post CSI.
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Hu, Guobing, Xiangming Zhu, Fang Song, and Ya Yang. "Relationship Between Interatrial Septal Thickness and Left Atrial Geometry Assessed by Echocardiography in Patients with Rheumatic Mitral Stenosis." Journal of Medical Imaging and Health Informatics 10, no. 5 (May 1, 2020): 994–97. http://dx.doi.org/10.1166/jmihi.2020.3006.
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Objective: To evaluate the relationship between interatrial septal thickness (IAST) and left atrial geometry in patients with rheumatic mitral stenosis (RMD), as measured by transesophageal and transthoracic echocardiography. Methods: Transesophageal and transthoracic echocardiograms were used to detect IAST and left atrial geometry respectively in 100 patients. Results: IAST and interatrial septal thickening fraction (IASTF) were significantly different in patients with different degrees of mitral stenosis. The left atrial volume change fraction (LAVCF) and IASTF were positively correlated (r = 0.766, P < 0.001). Conclusion: There is important clinical significance for transesophageal and transthoracic echocardiography in evaluating the relationship between IAST and left atrial geometry, IAST and IASTF can reflect the changes in left atrial geometry