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Cardiovascular Ultrasound - Latest Articles
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The latest research articles published by Cardiovascular Ultrasound
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Detection of coronary microembolization by Doppler ultrasound in patients with stable angina pectoris during percutaneous coronary interventions under an adjunctive antithrombotic therapy with abciximab: design and rationale of the High Intensity Transient Signals ReoPro (HITS-RP) study
Background:
Embolization of atherosclerotic debris from the rupture of a vulnerable atherosclerotic plaque occurs iatrogenically during percutaneous coronary interventions (PCI) and can induce myocardial necrosis. These microembolizations are detected as high intensity transient signals (HITS) using intracoronary Doppler technology. Presentation of the hypothesis In the presented study we will test if abciximab (ReoPro(R)) infusion reduces high intensity transient signals in patients with stable angina pectoris undergoing PCI in comparison to standard therapy alone.Testing the hypothesisThe High Intensity Transient Signals ReoPro(R) (HITS-RP) study will enroll 60 patients. It is a prospective, single center, randomized, double-blind, controlled trial. The study is designed to compare the efficacy of intravenous abciximab administration for reduction of microembolization during elective PCI. Patients will be randomized in a 1:1 fashion to abciximab or placebo infusion. The primary end poin of the HITS-RP-Study is the number of HITS during PCI measured by intracoronary Doppler wire. Secondary endpoints are bleeding complications, elevation of cardiac biomarkers or ECG changes after percutaneous coronary interventions, changes in coronary flow velocity reserve, hs-CRP elevation, any major adverse cardio-vascular event during one month follow-up. Implications of the hypothesisThe HITS-RP-Study addresses important questions regarding the efficacy of intravenous abciximab administration in reducing microembolization and periprocedural complications in stable angina pectoris patients undergoing PCI.Trial registrationThe trial is registered under www.drks-neu.uniklinik-freiburg.de/drks_web/:DRKS00000603.
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The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography
Age may affect coronary flow reserve (CFR) especially in subjects with atherosclerotic risk factors (ARFs). The aim of this prospective, multicenter, observational study was to determine the effects of aging on CFR in patients with normal epicardial coronary arteries and ARFs. Three-hundred-thirty-five subjects (mean age = 61 years) with at least one ARF but normal coronary angiography underwent high-dose dipyridamole stress-echo with Doppler evaluation of left anterior descending artery. CFR was calculated as the ratio between hyperemic and resting coronary diastolic peak velocities. Patients were divided in age quartiles. CFR was progressively reduced with aging (1st quartile: 3.01 +/- 0.69, 4th quartile: 2.39 +/- 0.49, p<0.001). This was mainly due to a gradual increase of resting velocities (1st quartile = 26.3 +/- 6.1 cm/s, 4th quartile = 30.2 +/- 6.4 cm/s, p<0.001) while the reduction of hyperemic velocities remained unaffected (1st quartile = 77.7 +/- 18.9 cm/s, 4th quartile = 70.9 +/- 18.4 cm/s, NS). When age quartiles and ARFs were entered into a regression model, third and fourth age quartile (p<0.0005 and p<0.0001 respectively), left ventricular mass index (p<0.0001), diastolic blood pressure (p<0.001), total cholesterol (p<0.002), fasting blood glucose (p<0.01) and male gender (p<0.05) were independent determinants of CFR in the whole population. Aging reduces coronary flow reserve in patients with angiographically normal coronary arteries due to a gradual increase of resting coronary flow velocity. CFR is also affected by atherosclerotic risk factors and left ventricular hypertrophy
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Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study
Background:
Present data regarding how the fetal heart works and develops throughout gestation is limited. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Thus, the objective of this study was to evaluate human fetal myocardial characteristics and deformation properties using color-coded tissue velocity imaging (TVI). MethodsTVI recordings from 55 healthy fetuses, at 18 to 42 weeks of gestation, were acquired at a frame rate of 201-273 frames/s for offline analysis using software enabling retrieval of the myocardial velocity curve and 2D anatomical information. The measurements were taken from an apical four chamber view, and the acquired data was correlated using regression analysis.
Results:
Left ventricular length and width increased uniformly with gestational age. Atrioventricular plane displacement and the E'/A' ratio also increased with gestational age, while a longitudinal shortening was observed.
Conclusions:
Fetal cardiac muscle contractility decreases with gestational age. As numerous fetal- and pregnancy-associated conditions directly influence the pumping function of the fetal heart, we believe that this new insight into the physiology of the human fetal cardiovascular system could contribute to make diagnosis and risk assessment easier and more accurate.
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Correction: Visualization of the intracavitary blood flow in systemic ventricles of Fontan patients by contrast echocardiography using particle image velocimetry
Following publication of our article [Lampropoulos et al., Cardiovascular Ultrasound 2012, 10:5] the authors noted that the legends for Figure 1 and Figure 2 were incorrect.The correct legend for Figure 1 is:Sequence analysis of systemic ventricular flow during systole and diastole in Fontan patients. The vortex from the Fontan group was consistently shorter, wider and rounder. The vortices were located at the centre of the left ventricle throughout diastole and systole and did not redirect flow in a coherent, sequential fashion as in controls. The location, shape and sphericity of the main vortices differ clearly from controls in all cardiac cycle [early diastole(A), late diastole(B), ejection (C)].The correct legend for Figure 2 is:Sequence analysis of systemic ventricular flow during systole and diastole in controls. The vortex from the control group was compact, elliptically shaped, and located apically. The location, shape and sphericity of the main vortices differ clearly from the Fontan group in all cardiac cycle [early diastole(A), late diastole(B), ejection (C)].It was also noted the legends for the Additional file 1 and Addition file 2 were also incorrect:The correct legend for Additional file 1 is:The flow patterns of a 38 year old female without cardiac abnormalitiesThe correct legend for Additional file 2 is:The flow pattern of a 29 year old male with Fontan circulation.The authors would like to apologize for any inconvenience caused by this error.
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Value of segmental myocardial strain by 2-dimensional strain echocardiography for assessment of scar area induced in a rat model of myocardial infarction
ObjectivesTwo-dimensional strain echocardiography (2DSE) technique has enabled accurate quantification of regional myocardial function. This experimental study was aimed to investigate the value of 2DSE in detection of segmental regional myocardial dysfunction induced by fibrosis following myocardial infarction in a small animal (rat) model.
Methods:
A rat model of myocardial infarction was established by ligation of the proximal left anterior descending coronary artery in 17 SD rats. Regional myocardial function was detected by 2DSE at baseline and 4-weeks post-infarction, including end-systolic radial strain and strain rate (SR and SrR) and end-systolic circumferential strain and strain rate (SC and SrC) of each of six segments at papillary level. According to the size of scar found by histologic Masson staining, the optimal cutoff points of parameters for detecting scar area were analyzed and the sensitivity and specificity of every parameter to detect myocardial scar were obtained using ROC.
Results:
(1) Comparing with parameters measured at baseline, there were significant decreases in SR, SrR, SC and SrC of each segment at 4 weeks post-infarction, with the worst in the infarct area (32.90 ± 8.79 vs 11.18 ± 3.89, 6.28 ± 1.35 vs 3.18 ± 0.47, -14.46 ± 2.21 vs -6.30 ± 2.17 and 4.93 ± 0.95 vs 2.59 ± 1.16, respectively) (all P < 0.05). (2)By 4 weeks, the myocardium of infarct area (anteroseptum, anterior and anterolateral) had fibrosis (31.33 ± 9.89, 73.42 ± 13.21 and 13.99 ± 3.24%, respectively) with minimal fibrosis in inferoseptal segment (0.32 ± 0.19%), no fibrosis was found in the inferior and inferolateral segments. (3)Significant negative correlations were found between the size of segmental scar and 2DSE parameters (r-value -0.61 ~ -0.80, all P < 0.01) with the strongest correlation in SR. SR less than 10% has 84% sensitivity and 98% specificity for detecting segments of scar area greater than 30% with AUC = 0.97.
Conclusions:
2DSE is able to assess regional myocardial dysfunction in a rat model of myocardial infarction and has high accuracy in detecting infarct segments with scar area greater than 30%.
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