Andreea Calin

Respiratory maneuvers in echocardiography: a review of clinical applications

During echocardiographic examination, respiration induces cyclic physiological changes of intracardiac haemodynamics, causing normal variations of the right and left ventricle Doppler inflows and outflows and physiological variation of extracardiac flows. The respiration related hemodynamic variation in intra and extracardiac flows may be utilized in the echocardiography laboratory to aid diagnosis in different pathological states. Nevertheless, physiologic respiratory phases can cause excessive translational motion of cardiac structures, lowering 2D image quality and interfering with optimal Doppler interrogation of flows or tissue motion.This review focuses on the impact of normal respiratory cycle and provocative respiratory maneuvers in echocardiographic examination, both in physiological and pathological states, emphasizing their applications in specific clinical situations.

Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study

Aims To obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender. Methods and results A total of 371 (median age 45 years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS. Conclusion The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.

Correlation between Global Longitudinal Strain and QRS Voltage on Electrocardiogram in Patients with Left Ventricular Hypertrophy

Left ventricular hypertrophy (LVH) is as an independent risk factor. Discrepancies were reported between LV mass (LVM) estimated by echocardiography and electrocardiography (ECG) findings. We hypothesized that QRS voltage criteria may reflect not only anatomical changes (LVM) but also changes in LV function and we tested the relationship between QRS voltage and echocardiographic parameters of LV function in patients (pts) with different types of LVH.

102: Presence of hypertension impacts left ventricular remodeling and function in patients with aortic regurgitation. A speckle-tracking echocardiography study

Chronic aortic regurgitation is associated with a unique pattern of left ventricular (LV) volume and pressure overloading, leading to LV remodeling. Systolic hypertension is a characteristic of severe aortic regurgitation. Apical rotation is considered an effective noninvasive index of global LV function. Aim To study the impact of hypertension on LV shape and mass and systolic and diastolic LV apical rotation assessed by speckle-tracking echocardiography (STE) in pts with chronic AR. Methods We enrolled 27 patients (pts) with moderate-severe and severe chronic AR and 27 age- and gender-matched normal subjects. A comprehensive echocardiogram was performed in all pts. Systolic apical rotation and rotation rate and diastolic apical rotation rate were measured from two-dimensional greyscale LV parasternal apical short-axis images by STE. Global LV geometry was assessed using a sphericity index defined as LV end-diastolic volume divided by the volume of a sphere with the same diameter as the LV end-diastolic longitudinal length. Results Left ventricular EF was similar in both groups. Pts in AR group had higher LV diameters, volumes and mass (p rotation was lower in the AR group (10.5±5.0 vs 18.0±6.2°, p 2 , p=0.05) and a higher SI (0.46±0.1 vs 0.37±0.07, p=0.039). Peak systolic apical rotation (7.9±4.7 vs 12.5±4.5°, p=0.015) and peak diastolic apical rotation rate (-55.4±33.0 vs -102.9± 40.3°/s, p=0.003) were lower in AR pts with hypertension. Conclusions Hypertension impacts not only LV mass but especially shape and systolic and diastolic LV function in pts with significant chronic AR.