Eli Peleg

Speckle Tracking Imaging in Acute Inflammatory Pericardial Diseases

Background: Left ventricular (LV) function in acute perimyocarditis is variable. We evaluated LV function in patients with acute perimyocarditis with speckle tracking. Methods: Thirty‐eight patients with acute perimyocarditis and 20 normal subjects underwent echocardiographic examination. Three‐layers strain and twist angle were assessed with a speckle tracking. Follow‐up echo was available in 21 patients. Results: Strain was higher in normal subjects than in patients with perimyocarditis. Twist angle was reduced in perimyocarditis—10.9°± 5.4 versus 17.6°± 5.8, P < 0.001. Longitudinal strain and twist angle were higher in normal subjects than in patients with perimyocarditis and apparently normal LV function. Follow‐up echo in 21 patients revealed improvement in longitudinal strain. Conclusions: Patients with acute perimyocarditis have lower twist angle, longitudinal and circumferential strain. Patients with perimyocarditis and normal function have lower longitudinal strain and twist angle. Short‐term follow‐up demonstrated improvement in clinical parameters and longitudinal strain despite of residual regional LV dysfunction. (Echocardiography 2011;28:548‐555)

Improved detection of inferobasal ischemia during dobutamine echocardiography with doppler tissue imaging

OBJECTIVES The purpose of this study was quantitative evaluation of the inferobasal segment during dobutamine stress echocardiography using Doppler tissue imaging (DTI). BACKGROUND Overdiagnosis of myocardial ischemia during dobutamine echocardiography is a common problem. DTI may permit more accurate quantitative diagnosis of ischemia. METHODS A total of 50 patients with normal contraction of the inferobasal segment at rest were referred for dobutamine stress echocardiography. All underwent coronary angiography. Systolic and diastolic myocardial velocities were measured from apical 2-chamber view at rest and at the peak of dobutamine infusion. RESULTS Stenosis of the right coronary artery >or= 70% was detected in 11 patients. Conventional stress echocardiography was falsely positive in 10.3% and falsely negative in 27.3%. When DTI was combined with conventional stress echocardiography, sensitivity and specificity was 81.8% and 97.4%, respectively. CONCLUSION DTI may enhance the diagnosis of inferior ischemia during dobutamine echocardiography and can be added to conventional imaging in the treatment of these patients.

Non-invasive measurement of cardiac output by whole-body bio-impedance during dobutamine stress echocardiography: Clinical implications in patients with left ventricular dysfunction and ischaemia

To compare non‐invasive determination of cardiac index (CI) by whole body electrical bioimpedance using the NICaS apparatus and Doppler echocardiography, and the role of cardiac power index (Cpi) and total peripheral resistance index (TPRi) calculation during dobutamine stress echocardiography (DSE).

Clinical significance and prevalence of valvular strands during routine echo examinations

AIMS Lambls excrescences (valvular strands) have been associated with an increased embolic risk. In previous studies, valvular strands have mostly been detected by transoesophageal echo (TEE). The current high-resolution echo systems allow better detection of valvular strands often even by transthoracic echocardiography (TTE). We attempted to determine the incidence of valvular strands during routine echo exams, TTE and/or TEE, and their relation to the cardiovascular risk factor, co-morbidities, and outcome. METHODS AND RESULTS Over 21 000 echo exams were performed at our hospital during 2008-12 and were searched for reporting of valvular strands. One hundred and fifty such studies were identified and the presence of valvular strands was confirmed. These patients were then evaluated for clinical characteristics, co-morbidities, and outcome, and compared with 150 age- and gender-matched patients without valvular strands. Incidence of valvular strands was maximal at age 61-70 (0.94%), and they were found more commonly in men than in women, 92 vs. 58, P < 0.00001. Valvular strands occurred more often on the aortic than on the mitral valve, 125 vs. 36, respectively, P < 0.00001, were more often associated with thickened or calcified aortic or mitral valve, and occupied the ventricular side of the aortic valve and the atrial side of the mitral valve, P < 0.00001. Embolic events occurred in 40 of the 150 patients with strands (27%). Valvular strands were not associated with increased mortality. CONCLUSION Valvular strands (Lambls excrescences) appear not to affect life expectancy, but are often associated with embolic/cerebrovascular events, are more common in older patients, in men than in women, and are more commonly located on the aortic than on the mitral valve.

Left ventricular function in acute inflammatory peri-myocardial diseases - new insights and long-term follow-up.

BackgroundUntil recently acute inflammatory peri-myocardial syndromes have been associated with global rather regional left ventricular (LV) dysfunction. Recent advances in cardiac imaging with echocardiographic techniques and magnetic resonance imaging (MRI) permit comprehensive evaluation of global and regional LV function. Our study was aimed to assess regional LV function in 100 patients with acute perimyocarditis, and correlate these findings with the clinical presentation.MethodsWe report on 100 patients with acute perimyocarditis admitted during 2008–2011, in whom LV function was assessed by semi-quantitative wall motion score analysis on conventional echo. Long-term mortality and recurrent hospitalization were also assessed.ResultsWall motion score in 100 patients with acute perimyocarditis demonstrated a significant predominance of regional wall motion abnormalities in the infero-postero-lateral LV wall. These data correspond well with speckle tracking results of a subgroup of these patients published earlier. Recent MRI data show frequent late enhancement of contrast in the infero-lateral region of the LV in patients with perimyocarditis. These observations were useful in re-classification of our patients into one of the following groups: pure or predominant pericarditis, and pure or predominant myocarditis. Over a mean period of 37 months, there was no mortality. Though recurrent hospitalizations were rather frequent, no significant differences were observed among groups.ConclusionsRegional wall motion abnormalities in the infero-postero-lateral segments of the LV are frequent in patients with acute perimyocarditis. Detailed echocardiographic examination early in the course of the disease should become a major factor in the clinical differentiation among the various clinical presentations of acute inflammatory peri-myocardial syndromes. The long-term outcome of these patients appears to be benign, though recurrent hospitalizations are not infrequent.

Speckle Tracking Imaging in Normal Stress Echocardiography.

Exercise stress echocardiography is a widely used modality for the diagnosis and follow‐up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle‐tracking imaging parameters during nonischemic exercise stress echocardiography.

Cardiac Rupture: New Features of the Old Disease

Objectives: Myocardial rupture is a rare but a fatal complication of acute myocardial infarction. During recent years, treatment strategies of acute myocardial infarction have changed. Primary percutaneous coronary interventions have replaced fibrinolytic therapy, thus reducing one of the major risk factors for myocardial rupture. In this work, we describe a group of patients who suffered myocardial rupture, none of whom were treated with thrombolytic therapy. Methods: The digital database of our hospital was searched for all patients who experienced myocardial rupture between 2008 and 2015. The demographic, clinical, angiographic and echocardiographic data of these patients were analyzed. Results: Out of 2,380 patients admitted with acute myocardial infarction, 12 (0.5%) developed myocardial rupture. The mean age was 78 years, and there were 7 males and 5 females. Ten patients already had pericardial effusion on admission. Seven patients underwent coronary angiography, whilst primary percutaneous intervention was performed in 4 patients. Six patients entered the operating room and all survived the procedure. All patients who were treated conservatively died due to rupture. Factors related to the treatment strategy were advanced age (≥90 years) and cognitive impairment. Conclusions: The risk of myocardial rupture may be diminished by primary coronary intervention during myocardial infarction, but mortality remains high. An early, comprehensive echocardiographic examination and rapid surgery may contribute to improved survival.

Improved Detection of Spontaneous Echo Contrast in the Aorta with Tissue Doppler Imaging

Aims: Spontaneous echo contrast (SEC) within the cardiac chambers has been associated with increased risk of thromboembolism. We investigated the presence and severity of SEC in the aorta with tissue Doppler imaging (TDI) and compared these to the aortic flow velocity and to the clinical profile of the patients. Methods and Results: Seventy patients (35 males, 35 females, mean age 64, 22–86 years) underwent TEE for standard indications. Spontaneous echo contrast was studied with conventional and TDI imaging. Aortic flow velocity was measured in the center and lateral part of the descending aorta. SEC of any grade was detected in 24 patients with conventional imaging and in 53 using TDI (P < 0.0001). The presence of swirling was associated with aortic atherosclerosis, older age, history of hypertension and coronary artery disease, atrial fibrillation, and previous embolic events. There was correlation between intraaortic swirling, larger descending aortic diameter (23.6 vs 17 mm, P < 0.00001) and lower peak aortic flow velocity (55 vs 68 cm/s, P = 0.038). Conclusion: Spontaneous echo contrast in the aorta is common in high‐risk patients and is associated with increased clinical profile, larger aortic diameter, and lower peak aortic flow velocity. Tissue Doppler imaging is more sensitive in the detection of SEC than conventional imaging.

Unusual Right-Sided Cardiac Masses

(Echocardiography 2010;27:1151‐1155)

Contents Vol. 133, 2016

D.H. Adams, New York, N.Y. C.W. Akins, Boston, Mass. J.S. Alpert, Tucson, Ariz. E.A. Amsterdam, Davis, Calif. W.S. Aronow, Valhalla, N.Y. J.J. Badimon, New York, N.Y. J. Bax, Leiden R.C. Becker, Durham, N.C. G.A. Beller, Charlottesville, Va. P.C. Block, Atlanta, Ga. A.S. Budzikowski, Brooklyn, N.Y. A.J. Camm, London B.A. Carabello, Houston, Tex. P.F. Cohn, Stony Brook, N.Y. J. Coromilas, New Brunswick, N.J. M.H. Crawford, San Francisco, Calif. J.E. Dalen, Tucson, Ariz. S. Dalla Volta, Padova A. Davidson, Philadelphia, Pa. P.C. Deedwania, Fresno, Calif. A.N. De Maria, San Diego, Calif. J.A. Eleft eriades, New Haven, Conn. U. Elkayam, Los Angeles, Calif. C. Erol, Ankara M.D. Ezekowitz, Wynnewood, Pa. R. Ferrari, Ferrara G. Filippatos, Athens G.I. Fishman, New York, N.Y. K. Fox, London G.S. Francis, Minneapolis, Minn. V. Fuster, New York, N.Y. B.J. Gersh, Rochester, Minn. W. Gersony, New York, N.Y. J.P. Gold, Toledo, Ohio R.J. Goldberg, Worcester, Mass. M.E. Goldman, New York, N.Y. P.J. Goldschmidt, Miami, Fla. J. Gore, Worcester, Mass. J.L. Halperin, New York, N.Y. Z.-X. He, Beijing D. Heistad, Iowa City, Iowa C.H. Hennekens, Boca Raton, Fla. I.M. Herling, Wynnewood, Pa. E.M. Herrold, Brooklyn, N.Y. G. Heusch, Essen C.A. Hochreiter, New York, N.Y. M. Hori, Osaka S.K.S. Huang, Temple, Tex. B.K. Kantharia, Houston, Tex. J.S. Karliner, San Francisco, Calif. International Journal of Cardiovascular Medicine, Surgery, Pathology and Pharmacology