Alaa Mabrouk Salem Omar

Utility of Comprehensive Assessment of Strain Dyssynchrony Index by Speckle Tracking Imaging for Predicting Response to Cardiac Resynchronization Therapy

The strain delay index is reportedly a marker of dyssynchrony and residual myocardial contractility. The aim of this study was to test the hypothesis that a relatively simple version of the strain dyssynchrony index (SDI) can predict response to cardiac resynchronization therapy (CRT) and that combining assessment of radial, circumferential, and longitudinal SDI can further improve the prediction of responders. A total of 52 patients who underwent CRT were studied. The SDI was calculated as the average difference between peak and end-systolic strain from 6 segments for radial and circumferential SDI and 18 segments for longitudinal SDI. Conventional dyssynchrony measures were assessed by interventricular mechanical delay, the Yu index, and radial dyssynchrony by speckle tracking strain. Response was defined as a ≥15% decrease in end-systolic volume after 3 months. Of the individual parameters, radial SDI ≥6.5% was the best predictor of response to CRT, with sensitivity of 81%, specificity of 81%, and an area under the curve of 0.87 (p <0.001). Circumferential SDI ≥3.2% and longitudinal SDI ≥3.6% were also found to be predictive of response to CRT, with areas under the curve of 0.81 and 0.80, respectively (p <0.001). Moreover, radial, circumferential, and longitudinal SDI at baseline were correlated with reduction of end-systolic volume with CRT. In addition, the response rate in patients with 3 positive SDIs was 100%. In contrast, rates in patients with either 1 or no positive SDIs were 42% and 22%, respectively (p <0.005 and p <0.001 vs 3 positive SDIs). In conclusion, the SDI can successfully predict response to CRT, and the combined approach leads to more accurate prediction than using individual parameters.

Comparison of mitral valve area by pressure half-time and proximal isovelocity surface area method in patients with mitral stenosis: effect of net atrioventricular compliance

AIMS The aim of this study was to test the hypothesis that, unlike calculation of the mitral valve area (MVA) with the pressure half-time method (PHT), the proximal isovelocity surface area method (PISA) is not affected by changes in net atrioventricular compliance (C(n)). METHODS AND RESULTS We studied 51 patients with mitral stenosis (MS) from two centres. MVA was assessed with the PISA (MVA(PISA)), PHT (MVA(PHT)), and planimetry (MVA(PLN), serving as the gold standard) method. C(n) was calculated with a previously validated equation using 2D echocardiography. MVA(PISA) closely correlated with MVA(PLN) (r = 0.96, P < 0.0001), while MVA(PHT) and MVA(PLN) showed a weaker but still good correlation (r = 0.69, P < 0.0001). The correlation between MVA(PHT) and MVA(PLN) for patients with C(n) between 4 and 6 mL/mmHg (considered to be normal) was excellent (r = 0.93, P < 0.0001), but that for patients with C(n) of less than 4 or more than 6 mL/mmHg was not as good (r = 0.64, P < 0.0001). Importantly, a significant inverse correlation was detected between the percentage difference among MVA(PHT), MVA(PLN), and C(n) (r = -0.77, P < 0.0001), but the line of fit was nearly flat for the percentage difference among MVA(PISA), MVA(PLN), and C(n) (r = 0.1, P = 0.388). CONCLUSION MVA calculated with both the PISA and PHT methods correlated well with MVA calculated with the planimetry method. However, the PISA rather than PHT is recommended for patients with MS and extreme C(n) values because PISA, unlike PHT, is not affected by changes in C(n).

Reply : Deep Learning With Unsupervised Feature in Echocardiographic Imaging

We would like to thank Dr. Krittanawong and colleagues for the encouraging comment about our work on introducing machine learning for artificial intelligence (AI)–aided interpretation of cardiac imaging. The authors make an interesting proposition through introducing the emerging concept of deep

Artificial Intelligence-Based Assessment of Left Ventricular Filling Pressures From 2-Dimensional Cardiac Ultrasound Images

The estimation of left ventricular (LV) filling pressure from the ratio of transmitral and annular velocities (E/e′) is used commonly for identifying diastolic dysfunction in patients who complain of exertional dyspnea [(1)][1]. We have recently illustrated that LV and left atrial speckle tracking

Dynamic Changes in LV Radius as a Marker of Septal Configuration for Predicting RV Failure Following LVAD Implantation

Unanticipated right ventricular failure (RVF) is a commonly encountered complication after implantation of a left ventricular assist device (LVAD). An important observation from recent human and animal experimentation is the significance of normal interventricular septal geometry in maintenance of

Radius of proximal isovelocity surface area in the assessment of rheumatic mitral stenosis: Connecting flow to anatomy and hemodynamics

Background Echocardiographic assessment of left atrial pressure (LAP) in mitral stenosis (MS) is controversial. We sought to examine the role of the radius of the proximal isovelocity surface area (PISA-r) in the assessment of the hemodynamic status of MS after fixing the aliasing velocity (Val). Methods and results We studied 42 candidates of balloon mitral valvuloplasty (BMV), for whom pre-BMV echocardiography was done and LAP invasively measured before dilatation. PISA-r was calculated after fixing aliasing velocity to 33 cm/s. In addition, the ratio IVRT/Te’–E was also measured, where IVRT was isovolumic relaxation time, and Te’–E was the time difference between the onset of mitral flow E-wave and mitral annular early diastolic velocity. IVRT/Te’–E and PISA-r showed a strong correlation with LAP (r = −0.715 and −0.637, all p < 0.001) and with right-sided pressures. In addition, PISA-r correlated with mitral valve area by planimetry method (MVA) and with left ventricular outflow tract stroke volume (r = 0.66 and 0.71, all p < 0.001). Receiver operator characteristic curve (ROC-curve) showed that PISA-r was not inferior to IVRT/Te’–E in differentiating LAP ⩾25 from <25 mmHg. Conclusion Provided that Val is set to a constant of 33 cm/s, PISA-r can assess the hemodynamic status of MS, and seems a simple alternative to the tedious IVRT/Te’–E for estimation of LAP.

THE ABILITY OF THE RADIUS OF PROXIMAL ISOVELOCITY SURFACE AREA TO ASSESS THE ANATOMIC AND HEMODYNAMIC SEVERITY OF MITRAL STENOSIS AFTER FIXING ALIASING VELOCITY

Proximal isovelocity surface area (PISA) has emerged as an accurate method for assessment of mitral valve area (MVA) in patients with mitral stenosis (MS). Test the hypothesis that PISA radius (PISA-r) can be used to assess MS if aliasing velocity (Val) is set to a constant. 70 consecutive