The inter-observer agreement in the assessment of carotid plaque neovascularization by contrast-enhanced ultrasonography: The impact of plaque thickness.

BACKGROUND: The interobserver agreement in the assessment of the grade of carotid plaque neovascularization by contrast-enhanced ultrasonography is poorly established. METHOD: We examined 140 carotid plaques in 66 patients (all patients had bilateral plaques, and 8 patients had 2 plaques on one side). We performed conventional and contrast-enhanced ultrasonography to analyze the presence of carotid plaque neovascularization, which was graded by two independent observers whose interobserver agreement (κ) was evaluated according to the thickness of carotid plaque. RESULTS: For all carotid plaques, the mean κ was 0.689 (95% confidence interval 0.604-0.774). It was 0.689 (0.569-0.808), 0.637 (0.487-0.787), and 0.740 (0.585-0.896), respectively for carotid plaques with maximal thickness <2 mm, from 2 mm to 3 mm, and >3 mm. CONCLUSION: The interobserver agreement for assessing carotid plaque neovascularization by using contrast-enhanced ultrasonography is substantial and acceptable for research purposes, regardless of the maximal thickness of the plaque.

Evaluation of left ventricular function, rotation, twist and untwist in patients with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a disease with an autosomal-dominant pattern of inheritance associated with a variety of disease courses, age of onset, symptom severity, left ventricular outflow obstruction and risk for sudden cardiac death. Left ventricular systolic function is typically normal in most HCM patients using conventional echocardiographic indexes; however, myocardial systolic and diastolic function are reduced, and the mechanism of myocardial dysfunction remains unclear. Echocardiography is an invaluable tool for the diagnosis and assessment of hemodynamic condition, evaluation of therapy and outcome, and follow-up of patients with HCM. The recent advent of speckle tracking imaging provides a novel index for the noninvasive assessment of left ventricular myocardial dysfunction, and has been confirmed by many studies. A search for original articles focusing on HCM and its associated twist and untwist mechanisms was performed in the MEDLINE and PubMed databases with no date restrictions. All articles identified were English-language, full-text publications. The reference lists of identified articles were also searched for additional articles and reviews.

Intravenous leiomyomatosis of the uterus with extension to the right heart.

A 42-year-old woman admitted with debilitation and engorgement both lower extremities. Transthoracic two-dimensional echocardiography, abdominal ultrasound and computerized tomography revealed a lobulated pelvic mass, a mass within right internal iliac vein, both common iliac vein, as well as the inferior vena cava, extending into the right atrium. In addition, echocardiography and abdominal ultrasound showed the tumor of right atrium and inferior vena cave has no stalk and has well-demarcated borders with the wall of right atrium and inferior vena cave. Hence, the presumptive diagnosis of IVL was made by echocardiography and abdominal ultrasound and the presumptive diagnosis of sarcoma with invasion in right internal iliac vein, both common iliac vein, the inferior vena cava, as well as the right atrium was made by multi-detector-row computerized tomography. The patient underwent a one-stage combined multidisciplinary thoraco-abdominal operation under general anaesthetic. Subsequently the pathologic report confirmed IVL.

A combination of left ventricular noncompaction and double orifice mitral valve.

A 24-year-old woman admitted with mild chest distress associated with activity without chest complaint for twenty days. Two orifices were visible at the level of the mitral valve with a transthoracic short-axis view of the two-dimensional and three-dimensional echocardiography. The left ventricle was mildly dilatated and the left ventricular wall was thickened, especially at the apex and anterolateral wall, and appeared sponge-like. There were numerous, excessively prominent trabeculations associated with intertrabecular recesses. Although the coexistence of NVM and DOMV could be a coincidence, we believe that both defects were probably caused by a developmental arrest of the left ventricular myocardium in the present case.

A combination of right ventricular hypertrabeculation/noncompaction and arrhythmogenic right ventricular cardiomyopathy: a syndrome?

A combination of ARVC and RV NVM/HVM, which is extremely rare, to our knowledge, is never reported. RV NVM/HVM could be the cause and consequence of ARVC, or RV NVM/HVM and ARVC could be a consequence of a certain undetermined cause. It must be kept in mind, however, that the interaction of NVM/HVM and ARVC could be in part of pathophysiology mechanism of the combination even if as a consequence of an underlying genetic factor.

Echocardiography in the diagnosis left ventricular noncompaction.

Echocardiography is the method of choice to establish a diagnosis and determine a treatment plan for patients with noncompaction of ventricular myocardium (NVM). The 2-dimentional echocardiography, 3-dimentional echocardiography, color Doppler echocardiography and contrast-enhanced echocardiography are of critical importance for diagnosis and family screening of NVM.

[Assessment of postsystolic shortening of left ventricle in dilated cardiomyopathy using tissue velocity imaging].

OBJECTIVE: To evaluate the postsystolic shortening (PSS) of different segments of left ventricle (LV) and its meanings in dilated cardiomyopathy (DCM). METHODS: Twenty-two normal controls and 14 DCM patients underwent tissue velocity imaging (TVI) to obtain the regional velocity profiles of 18 segments of LV. The peak velocities of isovolumic contraction phase (V(IC)), systolic phase (V(S)), and PSS (V(PSS)), the time of V(PSS) (T(PSS)) was measured and the ratio of V(PSS) to V(IC) (V(PSS)/V(IC)), and ratio of V(PSS) to V(S) (V(PSS)/V(S)) were calculated. The active and passive PSS were compared by the standard of V(PSS)/V(IC). RESULTS: Physiologic PSS was detected only in minority segments of normal subjects and pathologic PSS was detected in all segments of DCM patients. Compared with the physiologic PSS, The V(PSS), V(PSS)/V(IC), and V(PSS)/V(S) of the pathological PSS were increased and the T(PSS) of pathologic velocity of PSS (V(PSS)) were prolonged. Compared with the passive PSS segments, the V(PSS) and V(PSS)/V(S) of active PSS were increased and the T(PSS) of active V(PSS) segments were prolonged. CONCLUSION: PSS exists in LV, probably having relation with ischemia-like condition of myocardium in DCM patients. There are significant differences between physiologic and pathologic PSS, and between active and passive PSS.