Birger Wandt

Enhanced left ventricular endocardial border delineation with an intravenous injection of SonoVue, a new echocardiographic contrast agent : A European multicenter study.

The safety and efficacy of SonoVue (also referred to as BR1), a new contrast agent for delineating endocardial border of the left ventricle after intravenous administration, was assessed. Two hundred and eighteen patients with suspected coronary artery disease undergoing fundamental echocardiography for the assessment of left ventricle were enrolled in a prospective multicenter, single blind, cross‐over study with random sequence allocation of four different doses of SonoVue. Endocardial border definition in the apical and parasternal views was scored as O = not visible, 1 = barely visible, and 2 = well visualized before and after contrast enhancement. Analysis was performed by two pairs of off‐site observers. Safety of SonoVue was also assessed. Results of our study indicated that the mean improvements in the endocardial border visualization score were as follows: 3.1 ± 7.8 (95% CI, 2.5 and 3.7) for 0.5 ml, 3.4 ± 8.0 (95% CI, 2.8 and 4.0) for 1 ml, 3.4 ± 7.9 (95% CI, 2.8 and 4.0) for 2 ml, and 3.7 ± 8.0 (95% CI, 3.1 and 4.3) for 4 ml (P < 0.05 for all doses from baseline). Changes from baseline in endocardial visualization scores were also seen in the apical views (P < 0.05) and they were dose‐dependent (P < 0.001). Similar enhancements of endocardial visualization scores were observed in the apical views in patients with suboptimal baseline echocardiographic images. Diagnostic confidence for assigning a score and image quality also were significantly better following contrast enhancement. No significant changes in the laboratory parameters and vital signs were noted following contrast enhancement, and the side effects were minimal. It was concluded that SonoVue is safe and effective in delineating endocardial border, including in patients with suboptimal baseline images.

Non-invasive imaging of coronary arteries in living mice using high-resolution echocardiography.

Objective—In vivo mouse coronary artery circulation is still largely unknown. We demonstrate here in vivo coronary flow velocity profiles in anesthesized mice using a novel high‐resolution ultrasound technique. Methods—Seven 10‐week‐old C57/Bl6 mice were used for ultrasonographic examination under anesthesia. An Acuson Sequoia 512 echocardiograph with a Microson 15L8 transducer was used. Left coronary artery (LCA) anatomy was mapped in situ. Results—The proximal, mid LCA and its anterior (A‐LCA) and lateral (L‐LCA) branches could be visualized and coronary flow velocity was reproducibly recorded in all animals. Peak flow velocity was 31.3 ± 1.5 and 20.7 ± 2.3 cm/s in the mid LCA and L‐LCA branches, respectively. Mean flow velocity was 18.4 ± 0.7 and 13.8 ± 1.5 cm/s in the respective vessels. Both the peak and mean flow velocities were higher in the mid LCA than in the distal part of the L‐LCA (p = 0.006 and 0.01, respectively). Measurements of the velocity time integral show percentage systolic flow was 15.7 ± 1.6% and 10.2 ± 1.4% in the mid LCA and L‐LCA, respectively. Conclusion—Despite the extremely high heart rate in mice, there are striking similarities between murine and human coronary flow velocity profiles. The presented technique and findings confirm the relevance of the mouse as an animal model in cardiovascular research.

Left ventricular diastolic function and right atrial size are important rhythm outcome predictors after intraoperative ablation for atrial fibrillation.

Background: Left ventricular (LV) diastolic function and right atrial (RA) size are not routinely included in preoperative echocardiographic examination in patients undergoing cardiac surgery with concomitant ablation for atrial fibrillation (AF). Objective: To investigate the role of echocardiographic variables including LV diastolic function and RA area in long‐term rhythm outcome prediction, in patients with documented AF undergoing intraoperative ablation concomitant to coronary artery bypass grafting (CABG). Methods: Thirty‐five consecutive patients, scheduled for CABG, and with a history of paroxysmal or permanent AF for 8.5 ± 11.3 years (mean ± SD) (median 5.8 years), were included in this prospective study. Echocardiography was performed prior to and 2.3 ± 0.4 years after the surgical procedure. Results: Both LA and RA areas, LV diastolic function, paroxysmal AF, and sinus rhythm (SR) preoperatively were associated with SR at long‐term follow‐up. In the multivariate analysis, RA area (P = 0.004), and decreased LV diastolic function preoperatively, measured as the maximal LV long‐axis relaxation velocity (P = 0.02), predicted SR at follow‐up. Conclusions: RA size and LV diastolic function may be important variables in prediction of long‐term rhythm outcome after intraoperative ablation for AF. (Echocardiography 2010;27:961‐968)

Comparison between circumflex artery motion and mitral annulus motion.

Objective - To compare mitral annulus motion (MAM) with circumflex artery motion (CXM) and the motion amplitude at an endocardial site (representing MAM) with an epicardial site (representing CXM) at the most basal lateral part of the atrioventricular plane (AVP). Design - MAM and CXM were obtained in 28 patients examined by echocardiography and coronary angiography. The motion amplitude epicardially and endocardially was recorded by echocardiography in 13 patients with normal ejection fraction (EF) ( S 0.50) and in 13 patients with decreased EF (< 0.50). Results - CXM was higher than MAM in most patients with normal EF but lower than MAM in most patients with decreased EF. The motion amplitude epicardially was significantly higher ( p < 0.001) than endocardially in patients with normal EF, while there was no significant difference in patients with decreased EF. Conclusion - CXM represents the motion of the epicardial part of the AVP and differs from MAM, which represents the endocardial part of the wall. This must be considered when CXM is used for assessment of left ventricular systolic function.OBJECTIVE To compare mitral annulus motion (MAM) with circumflex artery motion (CXM) and the motion amplitude at an endocardial site (representing MAM) with an epicardial site (representing CXM) at the most basal lateral part of the atrioventricular plane (AVP). DESIGN MAM and CXM were obtained in 28 patients examined by echocardiography and coronary angiography. The motion amplitude epicardially and endocardially was recorded by echocardiography in 13 patients with normal ejection fraction (EF) (> or = 0.50) and in 13 patients with decreased EF (<0.50). RESULTS CXM was higher than MAM in most patients with normal EF but lower than MAM in most patients with decreased EF. The motion amplitude epicardially was significantly higher (p < 0.001) than endocardially in patients with normal EF. while there was no significant difference in patients with decreased EF. CONCLUSION CXM represents the motion of the epicardial part of the AVP and differs from MAM, which represents the endocardial part of the wall. This must be considered when CXM is used for assessment of left ventricular systolic function.

How Should We Assess Diastolic Function in Hypertension

Objective: the aim of our study was to assess the relative merits of three indices of diastolic LV function in a group of patients with hypertension and normal systolic function and a group of healthy controls. Design: In this echocardiographic study, diastolic LV function was assessed by E/A ratio using pulsed Doppler recording and by atrial to total mitral annulus motion (AC) and maximal longitudinal LV relaxation velocity (RVm) by M-mode recordings from apical views. The study took place in the Department of Clinical Physiology in a secondary referral centre. Nineteen consecutive patients with uncomplicated hypertension referred to echocardiographic examination and 20 age- and sex-matched controls were included in the study. Results: All three measures of diastolic function, E/A ratio, AC and RVm indicated impaired diastolic function in the hypertensive group, compared to the healthy controls. However, E/A ratio and AC showed a considerable overlap between the groups, whereas there was a highly significant difference in RVm between the hypertensive group and the controls, with much less of an overlap. Conclusion: The results indicate that of these three indices of diastolic function, RVm may be the most appropriate in patients with hypertension and normal systolic LV function.OBJECTIVE the aim of our study was to assess the relative merits of three indices of diastolic LV function in a group of patients with hypertension and normal systolic function and a group of healthy controls. DESIGN In this echocardiographic study, diastolic LV function was assessed by E/A ratio using pulsed Doppler recording and by atrial to total mitral annulus motion (AC) and maximal longitudinal LV relaxation velocity (RVm) by M-mode recordings from apical views. The study took place in the Department of Clinical Physiology in a secondary referral centre. Nineteen consecutive patients with uncomplicated hypertension referred to echocardiographic examination and 20 age- and sex-matched controls were included in the study. RESULTS All three measures of diastolic function, E/A ratio, AC and RVm indicated impaired diastolic function in the hypertensive group, compared to the healthy controls. However, E/A ratio and AC showed a considerable overlap between the groups, whereas there was a highly significant difference in RVm between the hypertensive group and the controls, with much less of an overlap. CONCLUSION The results indicate that of these three indices of diastolic function, RVm may be the most appropriate in patients with hypertension and normal systolic LV function.

Primary Chondroblastic Osteogenic Sarcoma of the Left Atrium: Case Report

A case of chondroblastic osteogenic sarcoma of the left atrium is presented. The malignant nature of the tumour was not revealed until surgery. It was considered to be nonresectable. At autopsy the tumour was found to be confined to the atrial septum. The possibility of preoperatively establishing the diagnosis and determining the extent of the tumour is discussed.

Predictors of hospitalization for heart failure and of all-cause mortality after atrioventricular nodal ablation and right ventricular pacing for atrial fibrillation

AIMS Atrioventricular junction ablation (AVJA) is a highly effective treatment in patients with therapy refractory atrial fibrillation (AF) but renders the patient pacemaker dependent. We aimed to analyse the long-term incidence of hospitalization for heart failure (HF) and all-cause mortality in patients who underwent AVJA because of AF and to determine predictors for HF and mortality. METHODS AND RESULTS We retrospectively enrolled 162 consecutive patients, mean age 67 ± 9 years, 48% women, who underwent AVJA because of symptomatic AF refractory to pharmacological treatment (n = 117) or unsuccessful repeated pulmonary vein isolation (n = 45). Hospitalization for HF occurred in 32 (20%) patients and 35 (22%) patients died, representing a cumulative incidence for hospitalization for HF and mortality over the first 2 years after AVJA of 9.1 and 5.2%, respectively. Hospitalization for HF occurred to the same extent in patients who failed pharmacological treatment as in patients with repeated pulmonary vein isolation (PVI), although the mortality was slightly higher in the former group. QRS prolongation ≥120 ms and left atrial diameter were independent predictors of hospitalization for HF, while hypertension and previous HF were independent predictors of death. CONCLUSION The long-term hospitalization rate for HF and all-cause mortality was low, which implies that long-term ventricular pacing was not harmful in this patient population, including patients with unsuccessful repeated PVI.

Cardiac function in relation to rhythm outcome after intraoperative epicardial left atrial cryoablation

Abstract Objectives. To assess the effects of intraoperative left atrial epicardial cryoablation on rhythm and atrial and ventricular function. Design. Thirty five patients with coronary artery disease and documented atrial fibrillation underwent coronary artery bypass surgery and concomitant cryoablation. An age and gender matched control group of 35 patients with atrial fibrillation underwent bypass surgery alone. Echocardiography was performed 9 ± 32 days before and 22 ± 6 months after surgery. Results. The proportion of patients in sinus rhythm at follow-up was 63% and 34% (p = 0.04) in the cryoablation and control groups, respectively. In patients with sinus rhythm both before surgery and at follow-up, the left atrial area increased (p = 0.002) and the mitral annular excursion during atrial contraction decreased (p = 0.01) after cryoablation. The mitral flow velocity during atrial systole decreased after cryoablation (p = 0.002). The LV diameter increased (p = 0.03) and the left ventricular ejection fraction (LVEF) decreased (p = 0.03) in cryoablated but not in control patients. Continued deterioration was seen in patients with atrial fibrillation both pre- and postoperatively. Conclusions. At long-term follow-up, a significantly higher proportion of patients was in sinus rhythm in the cryoablation than in the control group. The atrial and ventricular function had decreased at follow-up two years after surgery. This decrease was small and occurred within or close to the reference values in patients with sinus rhythm at follow-up, while patients remaining in atrial fibrillation showed a significant continued deterioration. Some subgroups were small, and the findings, although statistically significant, should be interpreted with caution.

Assessment of left ventricular function from M‐mode measurement of circumflex artery motion recorded by coronary angiography

Objective—To evaluate the usefulness of M‐mode measurement of circumflex artery motion (CAM) for assessment of left ventricular (LV) function. Design—Seventy‐two patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and systolic and diastolic parameters of CAM were measured by M‐mode from coronary angiography. Twenty‐three patients, examined by echocardiography of mitral annulus motion (MAM) within 24 h before the angiographic examination, formed a subgroup for comparison between angiographic M‐mode of CAM and echocardiographic M‐mode of MAM. Results—In addition to previous reported CAM amplitude and longitudinal fractional shortening (FS L ) the maximal systolic velocity of CAM can be reliably recorded by M‐mode. The diastolic indices, atrial contribution to the total amplitude and maximal early and late diastolic velocities, are also well monitored by M‐mode of CAM in comparison with echocardiographic MAM. Conclusion—LV systolic and diastolic function can be assessed by M‐mode of CAM.

Circumflex artery motion : a new angiographic method for assessment of left ventricular function

OBJECTIVE To evaluate the usefulness of circumflex artery motion (CAM) for assessment of left ventricular (LV) function. DESIGN Seventy-three consecutive patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and CAM was measured from coronary angiography. RESULTS The ratio between CAM and the end-diastolic length of the ventricle, which can be denominated long-axis fractional shortening (FS(L)), was found to be a better index of LV function than CAM per se. There was a significant linear correlation between EF and FS(L) (r = 0.81, SEE = 8.2, p < 0.001). When values of FS(L) > or =10% were selected to define a normal EF (> or =50%) there was a sensitivity of 95% and a specificity of 93%. Visual estimation of EF from CAM was not as good as the use of calculated FS(L) but may me useful as a fast screening method. CONCLUSION LV systolic function can be assessed by studying CAM recorded by coronary angiography.