Zhian Li

Relation between the incidence, location, and extent of thoracic aortic atherosclerosis detected by transesophageal echocardiography and the extent of coronary artery disease by angiography.

Atherosclerotic lesions in the thoracic aorta detected by transesophageal echocardiography (TEE) have been correlated with coronary artery disease (CAD). We determined whether simple or complex aortic plaques seen on transesophageal echocardiogram correlated with extent, location, and severity of CAD. The study population consisted of 188 patients who underwent TEE and coronary angiography. Atherosclerotic plaques seen on transesophageal echocardiogram were defined as (1) complex plaques in the presence of protruding atheroma ≥4-mm thickness, mobile debris, or plaque ulceration or (2) simple plaques in the absence of findings consistent with complex plaques. Extent of CAD was grouped into 4 groups according to number of coronary vessels with ≥70% stenosis. Numbers of patients with CAD with 0-, 1-, 2-, and 3-vessel disease were 99, 31, 28, and 30 respectively. Compared to patients without CAD, patients with CAD (n = 89) had a significantly greater prevalence of aortic atherosclerotic plaques irrespective of degree of plaque complexity or location (p <0.05). Multivariate analysis found that hypertension (odds ratio 3.0, 95% confidence interval 1.3 to 7.0, p = 0.013), diabetes mellitus (odds ratio 2.4, 95% confidence interval 1.1 to 4.9, p = 0.022), and aortic plaque (odds ratio 3.8, 95% confidence interval 1.8 to 8.2, p = 0.001) were significantly associated with CAD. There was a significant relation between simple and complex aortic plaques with increasing severity of CAD (p <0.001). Multivariate logistic regression analysis showed that complex plaque in the descending aorta (odds ratio 5.4, 95% confidence interval 1.8 to 16.4, p = 0.003) was the strongest predictor of CAD. In conclusion, simple and complex thoracic atherosclerotic plaques detected by TEE are associated with increasing severity of CAD. Complex plaque in the descending aorta was the strongest association with presence of CAD.

Body Mass Index and Risk of Left Atrial Thrombus in Patients With Atrial Fibrillation

This study sought to assess the impact of body mass index (BMI) on the risk of left atrial (LA)/left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) before catheter ablation. From January 2007 to March 2008, 433 consecutive patients with nonvalvular AF were enrolled. Patients with valvular heart disease, deep vein thrombosis, or pulmonary embolism were excluded. All patients underwent transesophageal echocardiography. Twenty-six of 433 patients (6.0%) had LA/LAA thrombus and the patients with thrombus had a significantly higher BMI (27.9 +/- 3.1 vs 26.0 +/- 3.3 kg/m(2), p = 0.005). The area under the receiver operating characteristic curve of BMI predicting thrombus was 0.662. With a cut-off point of 27.0 kg/m(2), the sensitivity and specificity of BMI for the diagnosis of thrombus were 69.2% and 83.1%, respectively. The incidence of LA/LAA thrombus was 10.6% in patients with BMI > or =27.0 kg/m(2) versus only 3.0% for patients with BMI <27.0 kg/m(2) (p = 0.001). In multivariable analysis, BMI > or =27.0 kg/m(2) (odds ratio 4.02, 95% confidence interval 1.19 to 13.55, p = 0.025), Cardiac Failure, Hypertension, Age, Diabetes, Stroke Doubled score > or =2, and nonparoxysmal AF were independent risk factors of LA/LAA thrombus. In conclusion, BMI > or =27.0 kg/m(2) is an independent risk factor of LA/LAA thrombus in patients with AF.

Comparison of frequencies of patent foramen ovale and thoracic aortic atherosclerosis in patients with cryptogenic ischemic stroke undergoing transesophageal echocardiography.

Studies have shown an association between the presence of a patent foramen ovale (PFO) and cryptogenic stroke (CS) in patients aged <55 years. In addition, protruding atheromatous plaques in the ascending aorta and aortic arch are an independent risk factor for ischemic stroke in patients aged ≥55 years. The aim of this study was to determine the association of CS in the 2 age groups with PFO and with atheromatous plaques in the ascending aorta and in the aortic arch. Transesophageal echocardiograms in 229 patients evaluated for CS were compared to those in 314 patients evaluated for cardiac disease other than PFO with no histories of stroke (the control group). The prevalence of PFO and the presence of complex atheromatous plaques in the ascending aorta and aortic arch were determined in all patients and compared between the CS and control patients in the 2 age groups. The prevalence of PFO was significantly higher in patients with CS than in control patients among those aged <55 years (31 of 114 [27%] vs 24 of 171 [14%], p = 0.006) and those aged ≥55 years (28 of 115 [24%] vs 21 of 143 [15%], p = 0.049). The incidence of atrial septal aneurysm was similar in the 2 groups irrespective of patient age, as was the prevalence of complex atheromatous plaques. Multivariate analysis showed that PFO was independently associated with CS, irrespective of patient age (<55 years: odds ratio 2.4, 95% confidence interval 1.3 to 4.5, p = 0.01; ≥55 years: odds ratio 1.9, 95% confidence interval 1.1 to 3.5, p = 0.03). In conclusion, PFO was significantly associated with CS in younger (aged <55 years) and older (aged ≥55 years) patients. Atrial septal aneurysm and complex atheromas in the ascending aorta and aortic arch do not appear to be associated with CS.

Myxoma of the Left Ventricular Outflow Tract

Cardiac myxomas are uncommon tumors found in 0.5 per million population per year. 1 Furthermore, a myxoma found in the left ventricular outflow tract is rare. This is a report of such a tumor, with surgical and pathologic confirmation of the echocardiographic diagnosis.

Application of spatio-temporal image correlation technology in the diagnosis of fetal cardiac abnormalities

Congenital heart disease is the birth defect with the highest incidence in China. Its timely and accurate prenatal diagnosis is critical for appropriate perinatal and postnatal management and salvage treatment. With improvements in the diagnostic capabilities of ultrasound and clinical manipulation techniques, prenatal diagnosis is conducted increasingly early and with greater accuracy. However, the representations of tiny blood vessels and the determination of abnormal spatial structures in the fetal period continue to cause difficulties in prenatal diagnosis. In theory, spatio-temporal image correlation (STIC) technology is able to compensate for the defects of previous traditional two-dimensional (2D) ultrasound and improve the diagnostic accuracy. The aim of the present study was to investigate the clinical application value of STIC technology combined with traditional 2D ultrasound in the diagnosis of fetal cardiac abnormalities. A total of 1,286 fetuses were subjected to sequential echocardiographic examination, during which STIC technology was used to collect heart volume data and carry out image post-processing and off-line analysis. In addition, the prenatal and postnatal echocardiography results were compared with the pathology results following the induced labor of fetuses with cardiac abnormalities. The sensitivity, specificity, misdiagnosis rate and rate of missed diagnosis for the STIC technology in the diagnosis of prenatal fetal cardiac abnormalities were 97.4, 99.6, 0.4 and 2.6%, respectively. The total coincidence rate was 99.2% and the positive and negative predictive values were 97.9 and 99.4%, respectively; the statistics for the consistency check of the STIC technology in the diagnosis of fetal cardiac abnormalities are κ=0.991, P=0.000. STIC technology combined with fetal echocardiography may be used for the definite diagnosis of fetal heart malformations, with high sensitivity and specificity.

Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa in a Patient After Radio Frequency Catheter Ablation of Atrial Fibrillation

Received September 8, 2008, from the Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (J.H., Y.H., Z.L., J.C., X.G., J.P., J.X.); and Pauley Heart Center, VCU Health System, Virginia Commonwealth University, Richmond, Virginia USA (J.V.N., M.C.K.). Revision requested September 25, 2008. Revised manuscript accepted for publication October 28, 2008. Address correspondence to Zhian Li, MD, Beijing Anzhen Hospital, 2 Anzhenli, Chaoyang District, 100029 Beijing, China. E-mail: lizhian_anzhen@yahoo.com.cn Abbreviations MAIVF, mitral-aortic intervalvular fibrosa; 3D, 3-dimensional; TTE, transthoracic echocardiography Case Report

EVALUATION OF CORONARY FLOW VELOCITY RESERVE IN HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA BY TRANSTHORACIC DOPPLER ECHOCARDIOGRAPHY AND DUAL-SOURCE COMPUTED TOMOGRAPHY

Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis and usually occurs at the ostia of coronary arteries. In this study, we used transthoracic Doppler echocardiography (TTDE) to evaluate the dynamic changes of coronary flow in HoFH patients and to detect aortic and coronary atherosclerosis by dual-source computed tomography (DSCT). We studied 20 HoFH patients (12 females, 8 males, mean age 13.1 ± 5.3 years, with a mean low density lipoprotein (LDL) cholesterol of 583 ± 113 mg/dL) and 15 control patients (8 females, 7 males, mean age 15.2 ± 6.9 years, with a mean LDL cholesterol 128 ± 71 mg/dL) using TTDE and DSCT. None of the patients showed evidence of ischemia with standard exercise testing. Though the baseline coronary flow was similar between HoFH patients and normal controls, the hyperemic flow velocities and, thus, the coronary flow velocity reserve (CFVR) were significantly lower in those with HoFH. All HoFH patients had aortic plaques, nine of them with the coronary artery ostia simultaneously, who had significantly higher LDL-cholesterol and lower CFVR than those without ostia plaques. Our data demonstrated that TTDE together with DSCT could be a useful noninvasive method for detection of coronary flow dynamics and atherosclerosis specifically in HoFH subjects with coronary ostia.

Malposition of a Central Venous Catheter in the Right Main Pulmonary Artery Detected by Transesophageal Echocardiography

The authors report a case of a malpositioned central venous catheter, the malposition of which was not recognized on chest x-ray or chest computed tomography but was correctly diagnosed on transesophageal echocardiography.

Noninvasive Assessment of Atherosclerosis in Apolipoprotein-E Knockout Mice by Ultrasound Biomicroscopy

Intima media thickness is a marker for human atherosclerosis. This study aimed to validate the hypothesis that atherosclerosis progression in vivo in mice can be visualized noninvasively using high-resolution ultrasound biomicroscopy (UBM), and to study the association between UBM characteristics and plasma lipids in the apolipoprotein-E knockout (ApoE-/-) mouse model. Four age groups of male ApoE-/- mice were used as atherosclerotic models, with age-matched male C57BL/6 mice used as controls. Plaque thickness and area measured by UBM correlated with histologic measurements (r = 0.81, r = 0.70, respectively; p < 0.001). Serum total cholesterol, low density lipoprotein cholesterol and triglycerides were higher in the ApoE-/- groups compared with controls (p < 0.01). Plaque thickness was correlated with total cholesterol (r = 0.505, p < 0.001). High-resolution UBM provides a noninvasive, accurate means of detecting atherosclerosis progression in vivo in mice and can detect changes in the early stage of atherosclerosis.

Transthoracic Echocardiographic Findings of Pulmonary Artery Dissection

Pulmonary artery dissection is a rare and fatal disease. To our knowledge, there have been no more than 70 cases reported in the literature. The diagnosis is made mainly at autopsy because many of these patients have sudden death when the main pulmonary artery dissects into the pericardium, causing acute cardiac tamponade. We report a case of pulmonary artery dissection diagnosed by transthoracic echocardiography in a patient with dilatation of the pulmonary artery.