Sanjay Doddamani

Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: Implications for the determination of aortic valve area

Background: Determination of the left ventricular outflow tract cross‐sectional area (ALVOT) is necessary for calculating aortic valve area (AVA) by echocardiography using the continuity equation (CE). In the commonly applied form of CE, πr2 is used to estimate ALVOT utilizing the assumptions that LVOT is round and the parasternal long axis (PLAX) plane bisects LVOT. Imaging LVOT using real time 3D echocardiography (RT3DE) eliminates the need for these assumptions. We tested the hypothesis that LVOT is round based on a formula for eccentricity. Methods and Results: In 53 patients, 2D echocardiography (2DE) and RT3DE were acquired. ALVOT was calculated by 2DE using πr2 (ALVOT‐2D). Using RT3DE, ALVOT planimetry was performed immediately beneath the aortic valve (ALVOT‐3Dplan). Eccentricity Index (EI) was calculated using the shortest and longest LVOT diameters. The long axis was measured to be larger by 0.53 cm ± 0.36 (P < 0.005). The median EI was 0.20 (0.00–0.54), indicating that half the subjects had at least a 20% difference between the major and minor diameters. ALVOT‐3Dplan was larger than ALVOT‐2D (3.73 ± 0.95 cm2 vs. 3.18 ± 0.73 cm2; P < 0.001) by paired analysis. Using the equation of an ellipse (πab), ALVOT‐3Dellip was 3.57 ± 0.95 resulting in improved agreement with ALVOT‐3Dplan. Conclusions: In our small patient sample with normal aortic valves, we showed the LVOT shape is usually not round and frequently, elliptical. Incorrectly assuming a round LVOT underestimated the ALVOT‐3Dplan and consequently the AVA by 15%. Investigating the LVOT in aortic stenosis is warranted to evaluate whether RT3DE may improve measurement of AVA.

A case of Takotsubo cardiomyopathy mimicking an acute coronary syndrome

Background A 71-year-old woman presented with severe chest pain after an episode of acute emotional distress. Her serum levels of cardiac enzymes were slightly elevated and electrocardiography revealed anterior ST-segment elevations. Significant coronary stenoses were excluded. A left ventriculogram revealed apical ballooning and a hypercontractile basal segment.Investigations Serum cardiac enzyme measurements, echocardiography, coronary angiography and left ventriculography.Diagnosis Takotsubo cardiomyopathyManagement Treatment with β-blockers, aspirin, angiotensin-converting-enzyme inhibitors, and intravenous diuretics.

Three-dimensional echocardiography of post-myocardial infarction cardiac rupture.

Ventricular septal defects and pseudoaneurysms are two serious complications of acute myocardial infarction and are associated with a high mortality if not surgically treated. Two‐dimensional echocardiography provides excellent diagnostic information in such cases, but three‐dimensional echocardiography may provide superior anatomic data of these potentially fatal complications. We describe two cases in which three‐dimensional echocardiography provided incremental morphological information. (ECHOCARDIOGRAPHY, Volume 21, April 2004)

The Association of Blood Urea Nitrogen Levels and Coronary Artery Disease

Renal dysfunction has been associated with adverse cardiovascular outcomes. Estimates of renal function routinely utilize creatinine-based measures. Serum blood urea nitrogen (BUN) levels, however, may provide supplemental information in regard to renal function as renal proximal tubule cells may increase BUN reabsorption in the setting of increased neurohormonal activation. We performed a retrospective chart review on 156 consecutive adult patients presenting to the Montefiore Medical Center Emergency Department with symptoms of unstable angina and no known prior history of coronary artery disease (CAD) who underwent cardiac catheterization as part of their index hospitalization. On multivariate analysis, admission serum BUN was associated with an increased burden of CAD on cardiac catheterization and was not associated with ruling in for myocardial infarction (MI).

Erratum: Isolated subacute effusive and nonconstrictive epicarditis masquerading as a right atrial mass (Echocardiography (2009) 26 (732-735) DOI: 10.1111/j.1540-8175.2008.00846.x)

22nd Annual Conference on 2D, Conventional and Color Doppler Echocardiography and Allied Techniques. September 17–20, 2009, Callaway Gardens Resort, Pine Mountain, Georgia. Conference Director: Dr. Navin C. Nanda. Contact: Lindy Chapman, University of Alabama at Birmingham. Tel: 205-934-8256; Email: lindyc@uab.edu. Jointly sponsored by the University of Alabama at School of Medicine, UAB Division of Continuing Medical Education, University of Alabama at Birmingham Echocardiography Laboratory, the Georgia Heart Clinic, LaGrange, Georgia and the International Society of Cardiovascular Ultrasound.