RESUMEN
Acute rheumatic fever and its chronic sequela, rheumatic heart disease (RHD), pose major health problems globally, and remain the most common cardiovascular disease in children and young people worldwide. Echocardiography is the most important diagnostic tool in recognizing this preventable and treatable disease and plays an invaluable role in detecting the presence of subclinical disease needing prompt therapy or follow-up assessment. This document provides recommendations for the comprehensive use of echocardiography in the diagnosis and therapeutic intervention of RHD. Echocardiographic diagnosis of RHD is made when typical findings of valvular and subvalvular abnormalities are seen, including commissural fusion, leaflet thickening, and restricted leaflet mobility, with varying degrees of calcification. The mitral valve is predominantly affected, most often leading to mitral stenosis. Mixed valve disease and associated cardiopulmonary pathology are common. The severity of valvular lesions and hemodynamic effects on the cardiac chambers and pulmonary artery pressures should be rigorously examined. It is essential to take advantage of all available modalities of echocardiography to obtain accurate anatomic and hemodynamic details of the affected valve lesion(s) for diagnostic and strategic pre-treatment planning. Intraprocedural echocardiographic guidance is critical during catheter-based or surgical treatment of RHD, as is echocardiographic surveillance for post-intervention complications or disease progression. The role of echocardiography is indispensable in the entire spectrum of RHD management.
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Estenosis de la Válvula Mitral , Fiebre Reumática , Cardiopatía Reumática , Niño , Humanos , Adolescente , Cardiopatía Reumática/diagnóstico por imagen , Ecocardiografía , Fiebre Reumática/complicaciones , Estenosis de la Válvula Mitral/diagnóstico por imagen , Válvula Mitral , Progresión de la EnfermedadRESUMEN
BACKGROUND: Adverse cardiac events are common following transcatheter aortic valve replacement (TAVR). Our aim was to investigate the low left ventricular stroke volume index (LVSVI) 30 days after TAVR as an early echocardiographic marker of survival. HYPOTHESIS: Steady-state (30-day) LVSVI after TAVR is associated with 1-year mortality. METHODS: A single-center retrospective analysis of all patients undergoing TAVR from 2017 to 2019. Baseline and 30-day post-TAVR echocardiographic LVSVI were calculated. Patients were stratified by pre-TAVR transaortic gradient, surgical risk, and change in transvalvular flow following TAVR. RESULTS: This analysis focuses on 238 patients treated with TAVR. The 1-year mortality rate was 9% and 124 (52%) patients had normal flow post-TAVR. Of those with pre-TAVR low flow, 67% of patients did not normalize LVSVI at 30 days. The 30-day normal flow was associated with lower 1-year mortality when compared to low flow (4% vs. 14%, p = .007). This association remained significant after adjusting for known predictors of risk (adjusted odds ratio [OR] of 3.45, 95% confidence interval: 1.02-11.63 [per 1 ml/m2 decrease], p = .046). Normalized transvalvular flow following TAVR was associated with reduced mortality (8%) when compared to those with persistent (15%) or new-onset low flow (12%) (p = .01). CONCLUSIONS: LVSVI at 30 days following TAVR is an early echocardiographic predictor of 1-year mortality and identifies patients with worse intermediate outcomes. More work is needed to understand if this short-term imaging marker might represent a novel therapeutic target.
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Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Volumen Sistólico , Estudios Retrospectivos , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Resultado del Tratamiento , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Índice de Severidad de la Enfermedad , Función Ventricular Izquierda , Factores de RiesgoRESUMEN
The quantitative assessment of mitral regurgitation (MR) by echocardiography has limitations. Cardiac magnetic resonance (CMR) imaging has an emerging role in the quantitation of MR, and preliminary studies indicate that CMR assessment may more accurately quantify MR and better correlate with postsurgical left ventricular reverse remodeling. The authors here report a case of MR in which multimodality imaging with CMR and transesophageal echocardiography was crucial in accurately diagnosing the severity of MR when transthoracic and provocative supine bike echocardiography underestimated the degree of MR in a unique variant known as "garden-hose" MR.
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Insuficiencia de la Válvula Mitral , Ecocardiografía , Jardines , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Remodelación VentricularRESUMEN
Mitral regurgitation (MR) is a common form of valvular heart disease that is associated with significant morbidity and mortality. MR can be broadly classified into 2 different categories: primary and secondary MR. Primary MR usually is caused by leaflet abnormalities, whereas secondary MR is a chronic disease secondary to geometric distortion of both the annulus and subvalvular apparatus because of left ventricular remodeling. Without acute changes in loading conditions, myocardial blood flow, or rhythm disturbances, functional MR typically is not transient. In this E-Challenge, the authors show a transient and completely reversible acute and severe form of functional MR with the use of multimodal echocardiography.
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Insuficiencia de la Válvula Mitral , Ecocardiografía , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Remodelación Ventricular/fisiologíaRESUMEN
Anatomic variants in the right atrium are under-recognized and under-reported phenomena in cardiac imaging. In the fetus, right atrium serves as a conduit for oxygenated blood to be delivered to the left heart bypassing the right ventricle and the nonfunctional lungs. The anatomy in the fetal right atrium is designed for such purposeful circulation. The right and left venous valves are prominent structures in the fetal heart that direct inferior vena caval flow towards the foramen ovale. These anatomic structures typically regress and the foramen ovale closes after birth. However, the venous valves can persist leading to a range of anatomic, physiological, and pathological consequences in the adult. We describe various presentations of persistent venous valves, focusing on the right venous valve in this illustrated multimodality imaging article.
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Corazón Fetal/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Diagnóstico Prenatal/métodos , Vena Cava Inferior/diagnóstico por imagen , Válvulas Venosas/diagnóstico por imagen , Ecocardiografía/métodos , Femenino , Atrios Cardíacos/anomalías , Humanos , Embarazo , Vena Cava Inferior/anomalías , Válvulas Venosas/anomalíasRESUMEN
OBJECTIVE: Although American and European consensus statements advocate using the ratio of the transmitral E velocity and tissue Doppler early diastolic mitral annular velocity (E/e') in the assessment of left-sided heart filling pressures, recent reports have questioned the reliability of this ratio to predict left atrial pressures in a variety of disease states. The authors hypothesized that there is a clinically significant correlation between E/e' and pulmonary capillary wedge pressure (PCWP) in patients with severe aortic stenosis. DESIGN: Retrospective cohort study. PARTICIPANTS: The study comprised 733 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve replacement for severe aortic stenosis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: PCWP and E/e'ave (average of the lateral and medial annulus tissue Doppler velocities) were measured with a pulmonary artery catheter and transthoracic echocardiography during preprocedural evaluation. Patients were grouped by left ventricular ejection fraction (LVEF) ≥50% and LVEF <50%. Spearman rank correlation, analysis of variance, and t and chi-square tests were used to analyze the data. Seventy-nine patients met the inclusion criteria. There was no significant correlation between E/e'ave and PCWP (nâ¯=â¯79, Spearman râ¯=â¯0.096; pâ¯=â¯0.3994). This correlation did not improve when ventricular function was considered (LVEF <50%: nâ¯=â¯11, Spearman râ¯=â¯-0.097; pâ¯=â¯0.776 and LVEF ≥50%: nâ¯=â¯68, Spearman râ¯=â¯0.116; pâ¯=â¯0.345). There was no statistically significant difference in mean PCWP between each range of E/e'ave. CONCLUSION: A clinically relevant relationship between E/e' and PCWP was not observed in patients with severe aortic stenosis.
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Estenosis de la Válvula Aórtica , Función Ventricular Izquierda , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Ecocardiografía Doppler , Humanos , Presión Esfenoidal Pulmonar , Reproducibilidad de los Resultados , Estudios Retrospectivos , Volumen SistólicoRESUMEN
BACKGROUND: Echocardiography- and cardiovascular magnetic resonance (CMR)-based studies have revealed a wide range of phenotypic manifestations in hypertrophic cardiomyopathy (HCM) apart from hypertrophy. This study sought to comprehensively describe a number of structural abnormalities in HCM beyond hypertrophy, by multimodality imaging. METHODS: A total of 100 HCM patients were prospectively enrolled, undergoing standard and contrast echocardiography, and CMR. Morphological characteristics involving mitral valve leaflets (MVL), subvalvular apparatus, and left ventricular cavity and wall were investigated. Seventy healthy volunteers served as control population. RESULTS: As assessed by echo, MVLs were longer in HCM patients than in controls (anterior method 1: 24[22,28] vs 19[18,20] mm, P < 0.01; anterior method 2: 27[24, 29] vs 21[19, 23] mm, P < 0.01; posterior: 15[12,19] vs 14[13,15] mm, P < 0.01). Abnormal chordal attachment to anterior MVL, anterior papillary muscle displacement, and accessory apical-basal muscle bundle were present in 42 (42%), 61 (61%), and 35 (35%) patients, respectively (P values vs controls <0.01); direct papillary muscle insertion into MVL and hypertrabeculation were found in two and five patients, respectively. Contrast echocardiography (n = 94) detected myocardial crypts in 15 patients (16%). Overall, 83% of HCM subjects had at least one of these phenotypic manifestations. Echocardiography and CMR agreement for MVL length was poor, while for structural characteristics was moderate to substantial (Cohen's Kappa: 0.53-1.00). Except for posterior MVL length and hypertrabeculation, the phenotypic characteristics studied had acceptable reproducibility by echocardiography and CMR. CONCLUSIONS: Structural abnormalities in HCM beyond hypertrophy are significantly common. Multimodality imaging approach to these HCM facets by echocardiography and CMR is feasible and desirable.
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Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/patología , Imagen Multimodal , Estudios de Casos y Controles , Medios de Contraste , Ecocardiografía , Femenino , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Músculos Papilares/diagnóstico por imagen , Fenotipo , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Prosthesis-patient mismatch (PPM) is relatively common after aortic valve replacement (AVR) and generally is associated with reduced regression of left ventricular (LV) mass. PPM after valve-in-valve transcatheter aortic valve replacement (TAVR) was reported to be 38%. PPM generally is manifested clinically by dyspnea and echocardiographically by high transvalvular gradients. In this E-Challenge, the authors will review a case of a late clinical presentation of PPM 1-year following a valve-in-valve TAVR.
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Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Bioprótesis/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico , Cateterismo Cardíaco , Ecocardiografía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Factores de Riesgo , Factores de TiempoRESUMEN
Our principal aim was to describe functional changes in dilated left atrium (LA) of children by using new applications of LA strain. We studied 66 patients (age range 0.2-22 years) consisting of 33 with LA enlargement. We utilized speckle-tracking imaging for assessment LA longitudinal strain (S) and longitudinal displacement (D). S-D loops were generated by plotting S and D data along Y and X axes, respectively. We also measured noninvasive LA stiffness index, [Formula: see text] (%-1). Peak S in controls was 51.16 ± 19.45% versus 23.16 ± 13.66% in dilated LA (p < 0.0001). S-D loops in dilated LA group were significantly smaller compared to controls (2.62 ± 2.88 units vs. 5.24 ± 4.00 units, p < 0.01). Noninvasive LA stiffness index was higher in dilated LA group (0.77 ± 0.63%-1 vs. 0.17 ± 0.07%-1, p < 0.0001). A cut-off LA stiffness value of 0.25%-1 was found to maximize sensitivity and specificity (84.0% and 84.85%, respectively). Children with enlarged LA demonstrate decreased peak S, abnormal S-D loops and increased LA stiffness, providing a newer insight into LA function. Evaluation of LA mechanics may be applied in future as a surrogate for left ventricular filling parameters.
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Función del Atrio Izquierdo , Ecocardiografía Doppler , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Adolescente , Factores de Edad , Fenómenos Biomecánicos , Niño , Preescolar , Femenino , Atrios Cardíacos/fisiopatología , Cardiopatías/fisiopatología , Humanos , Interpretación de Imagen Asistida por Computador , Lactante , Masculino , Variaciones Dependientes del Observador , Proyectos Piloto , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Función Ventricular Izquierda , Presión Ventricular , Adulto JovenAsunto(s)
Atletas , Prolapso de la Válvula Mitral/epidemiología , Válvula Mitral/fisiopatología , Adolescente , Adulto , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Italia/epidemiología , Masculino , Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/diagnóstico , Prolapso de la Válvula Mitral/fisiopatología , Prevalencia , Pronóstico , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Adulto JovenAsunto(s)
Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Arteritis de Takayasu/diagnóstico por imagen , Enfermedad Aguda , Anciano , Disección Aórtica/etiología , Disección Aórtica/terapia , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/terapia , Ecocardiografía Transesofágica/tendencias , Humanos , Masculino , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/terapiaRESUMEN
Subaortic obstruction due to systolic anterior motion (SAM) of the mitral valve with ventricular septal contact is a major cause of progressive heart failure symptoms in patients with hypertrophic cardiomyopathy (HCM). However, we have recently observed a unique, but not uncommon subgroup of HCM patients with outflow tract obstruction due only to discrete subaortic membrane or who have a membrane in addition to SAM-septal contact. HCM patients with subaortic membranes may be at increased risk for developing progressive heart failure symptoms. Identification requires a high index of suspicion and raises important management considerations, including need for surgical myectomy for definitive relief of obstruction with associated excellent outcomes, as the alternative invasive treatment option with percutaneous alcohol septal ablation would be ineffective.
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Válvula Aórtica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/complicaciones , Obstrucción del Flujo Ventricular Externo/etiología , Tabique Interventricular/diagnóstico por imagen , Procedimientos Quirúrgicos Cardíacos/métodos , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/fisiopatología , Ecocardiografía Doppler , Ecocardiografía Transesofágica , Humanos , Masculino , Persona de Mediana Edad , Sístole , Obstrucción del Flujo Ventricular Externo/diagnóstico , Obstrucción del Flujo Ventricular Externo/cirugía , Tabique Interventricular/cirugíaRESUMEN
BACKGROUND: Sinus venosus defects (SVD) of the inferior vena cava (IVC) type, or inferior SVDs, are an uncommon form of atrial communication located outside the confines of the fossa ovalis and involve override of the IVC. Despite numerous studies describing the anatomical and echocardiographic features of the inferior SVD, distinguishing this defect from a large secundum atrial septal defect (ASD) by echocardiography is often challenging. Accurate diagnosis of an inferior SVD and correct differentiation from a secundum ASD is essential for appropriate presurgical planning. Absence of the posterior rim in the parasternal short-axis views may serve as a useful clue in diagnosing inferior SVDs. We sought to determine the utility of using the presence or absence of a posterior atrial rim in the parasternal short-axis view to help distinguish an inferior SVD from a secundum ASD. This sign may help clinch the diagnosis when subcostal imaging is suboptimal. METHODS: We retrospectively reviewed transthoracic echocardiograms from 15 patients with a known surgical diagnosis of an inferior SVD between 2004 and 2015. The presence or absence of a posterior rim in the parasternal short-axis view was determined by two primary investigators. The posterior rim was also evaluated in 14 patients with a secundum ASD repair as controls. Echocardiograms were then reviewed blindly by attending-level echocardiographers and cardiology fellows in training. Diagnostic accuracy was assessed both with and without the use of the posterior rim criterion. Statistical analysis was used to determine the effect of using the rim criterion on inferior SVD diagnosis. We also reviewed all surgically diagnosed secundum ASDs that were incorrectly diagnosed as inferior SVD by preoperative imaging and determined whether use of the posterior rim criterion would have resulted in the correct diagnosis. RESULTS: The posterior rim was absent in all 15 patients with a surgical diagnosis of inferior SVD and present in all 14 patients with a secundum ASD. For all observers, there was a statistically significant increase in diagnostic accuracy of inferior SVDs with the use of the rim criterion (P < .0001). We noted that secundum ASDs with inferior extension also have persistent posterior rims. The rim criterion correctly classified all large secundum ASDs with inferior extension that were previously misdiagnosed by echocardiogram preoperatively. CONCLUSIONS: Absence of the posterior rim ("bald" posterior wall) is a consistent finding in patients with an inferior SVD and distinguishes an inferior SVD from a large secundum ASD with inferior extension. Parasternal short-axis evaluation of the posterior atrial rim is a helpful tool for all levels of physician training in improving diagnostic accuracy for detecting inferior SVDs and in distinguishing them from secundum ASDs.
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Ecocardiografía/métodos , Defectos del Tabique Interatrial/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Posicionamiento del Paciente/métodos , Esternón/diagnóstico por imagen , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Adolescente , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Masculino , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
We report a case of simultaneous right and left atrial appendage thrombi in a 76-year-old-man with atrial fibrillation. Although transesophageal echocardiography is considered a routine diagnostic procedure, complete and comprehensive visualization of both atrial appendages is of paramount importance, particularly with the introduction of new therapeutic options like left atrial appendage exclusion devices. We expect to raise awareness among clinicians of the prevalence and implications of bilateral atrial appendage thrombi in common clinical practice.
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Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/etiología , Anciano , Anticoagulantes/uso terapéutico , Fibrilación Atrial/terapia , Humanos , Masculino , Trombosis/prevención & control , Resultado del Tratamiento , UltrasonografíaAsunto(s)
Cardiomiopatía Hipertrófica/diagnóstico por imagen , Ecocardiografía/métodos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Cardiomiopatía Hipertrófica/cirugía , Angiografía Coronaria , Cardioversión Eléctrica , Electrocardiografía , Femenino , Humanos , Hipertrofia Ventricular Izquierda/cirugía , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION AND OBJECTIVES: The study of myocardial mechanics has a potential role in the detection of cardiac involvement in patients with amyloidosis. This study aimed to characterize 3-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics in light chain amyloidosis and examine their relationship with brain natriuretic peptide. METHODS: In patients with light chain amyloidosis, left ventricular longitudinal and circumferential strain (n=40), and right ventricular longitudinal strain and radial displacement (n=26) were obtained by 3-dimensional-speckle tracking echocardiography. Brain natriuretic peptide levels were determined. RESULTS: All myocardial mechanics measurements showed differences when compared by brain natriuretic peptide level tertiles. Left and right ventricular longitudinal strain were highly correlated (r=0.95, P<.001). Left ventricular longitudinal and circumferential strain were reduced in patients with cardiac involvement (-9±4 vs -16±2; P<.001, and -24±6 vs -29±4; P=.01, respectively), with the most prominent impairment at the basal segments. Right ventricular longitudinal strain and radial displacement were diminished in patients with cardiac involvement (-9±3 vs -17±3; P<.001, and 2.7±0.8 vs 3.8±0.3; P=.002). On multivariate analysis, left ventricular longitudinal strain was associated with the presence of cardiac involvement (odds ratio = 1.6; 95% confidence interval, 1.04 to 2.37; P=.03) independent of the presence of brain natriuretic peptide and troponin I criteria for cardiac amyloidosis. CONCLUSIONS: Three-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics are increasingly altered as brain natriuretic peptide increases in light chain amyloidosis. There appears to be a strong association between left ventricular longitudinal strain and cardiac involvement, beyond biomarkers such as brain natriuretic peptide and troponin I.
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Amiloidosis/diagnóstico , Cardiomiopatías/diagnóstico , Ecocardiografía Tridimensional/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Contracción Miocárdica/fisiología , Función Ventricular Izquierda/fisiología , Función Ventricular Derecha/fisiología , Amiloidosis/fisiopatología , Cardiomiopatías/fisiopatología , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever. METHODS AND RESULTS: To achieve this goal, the American Heart Association's Council on Cardiovascular Disease in the Young and its Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee organized a writing group to comprehensively review and evaluate the impact of population-specific differences in acute rheumatic fever presentation and changes in presentation that can result from the now worldwide availability of nonsteroidal anti-inflammatory drugs. In addition, a methodological assessment of the numerous published studies that support the use of Doppler echocardiography as a means to diagnose cardiac involvement in acute rheumatic fever, even when overt clinical findings are not apparent, was undertaken to determine the evidence basis for defining subclinical carditis and including it as a major criterion of the Jones criteria. This effort has resulted in the first substantial revision to the Jones criteria by the American Heart Association since 1992 and the first application of the Classification of Recommendations and Levels of Evidence categories developed by the American College of Cardiology/American Heart Association to the Jones criteria. CONCLUSIONS: This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement.
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Ecocardiografía Doppler , Fiebre Reumática/diagnóstico por imagen , Enfermedad Aguda , American Heart Association , Artritis Reactiva/etiología , Corea/etiología , Diagnóstico Diferencial , Salud Global , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Miocarditis/diagnóstico por imagen , Miocarditis/epidemiología , Recurrencia , Fiebre Reumática/diagnóstico , Fiebre Reumática/epidemiología , Cardiopatía Reumática/diagnóstico por imagen , Cardiopatía Reumática/epidemiología , Riesgo , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Evaluación de Síntomas , Estados Unidos , Poblaciones VulnerablesRESUMEN
BACKGROUND: Right ventricular failure (RVF) is associated with significant morbidity after left ventricular assist device (LVAD) surgery. Hemodynamic, clinical, and 2-dimensional echocardiographic variables poorly discriminate patients at risk of RVF. We examined the utility of 3-dimensional echocardiography (3DE) right ventricular (RV) volumetric assessment to identify patients at risk for RVF. METHODS AND RESULTS: RVF was defined as the need for inotropic infusion for >14 days after LVAD surgery or the need for biventricular assist device support. Preoperative RV volumes and ejection fraction (EF) were measured, blinded to clinical data, from transthoracic 3DE full volume data sets in 26 patients. Baseline variables and 3DE RV indices were compared between patients with and without RVF. Twenty-four patients received continuous-flow LVADs, and 2 required biventricular support devices. Ten patients required prolonged inotropes after LVAD placement. Baseline characteristics associated with RVF included higher right atrial pressure, higher right atrial pressure to pulmonary capillary wedge pressure ratio, and lower cardiac index and RV stroke work index (RVSWI). Echocardiographic indices associated with RVF included 3DE indexed RV end-diastolic and end-systolic volumes (RVEDVI and RVESVI) and RV ejection fraction (RVEF). The relationship between 3DE quantification of RV volumes and the development of RVF was independent from RVSWI: RVEDVI: odds ratio (OR) 1.16, 95% confidence interval (CI) 1.00-1.33 (P = .04); RVESVI: OR 1.14, 95% CI 1.01-1.28 (P = .03). CONCLUSIONS: Quantitative 3DE is a promising method for pre-LVAD RV assessment. RV volumes assessed by 3DE are predictive of RVF in LVAD recipients independently from hemodynamic correlates of RV function.