Two-dimensional strain echocardiography-derived left ventricular ejection fraction, volumes, and global systolic dyssynchrony index: Comparison with three-dimensional echocardiography.

BACKGROUND: Three-dimensional (3D) echocardiography is the most accurate echocardiographic method for ventricular chamber quantification. It is unclear how two-dimensional (2D) techniques perform against 3D technology and whether 2D methods can be extrapolated to obtain 3D data. METHODS: Retrospective review of transthoracic echocardiography was performed, with comparison of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and 2D strain-derived global longitudinal strain (GLS) and synchrony index. RESULTS: One-hundred patients were identified. Using 3D echocardiography as reference standard, good correlation was noted with 2D strain-derived EF (r = 0.89, P < 0.01) and with 2D standard biplane EF (r = 0.90, P < 0.01) and similarly for EDV (r = 0.84 and r = 0.81, respectively, both P < 0.01). Two-dimensional strain-derived EDV by 8% and 2D biplane-derived EDV underestimated by 8% (P < 0.01). In relation to 3D EF, 2D strain underestimated by 2% and 2D standard biplane overestimated by 2% (P < 0.01). There was a negative correlation between GLS and 3D EF (r = 0.84, P = 0.001). On multivariate analysis, 3D EF could be derived from 2D strain [3D EF = 34.345 + (0.125 * EDV) + (-0.289 * ESV) + (-1.141 * GLS)]. Three-dimensional echocardiography-derived synchrony parameter (ie, standard deviation from mean time to minimum systolic volume from 16 subvolumes) did not correlate with 2D strain-derived synchrony index (r = 0.171). CONCLUSIONS: Two-dimensional standard biplane and 2D strain EF and EDV strongly correlate with 3D EF and EDV. Although 2D methods are predictive of 3D findings, over- and underestimations may occur. Three-dimensional echocardiography should be used when available.

Frequent premature atrial contractions impair left atrial contractile function and promote adverse left atrial remodeling.

OBJECTIVES: This study assessed if frequent premature atrial contractions (PACs) were associated with decreased left atrial (LA) strain and adverse remodeling. BACKGROUND: Left atrial dysfunction and enlargement increases risk of stroke. If frequent PACs cause LA dysfunction and remodeling, PAC suppressive therapy may be beneficial. METHODS: Inclusion criteria were age ≥18 years and sinus rhythm. Exclusion criteria were atrial fibrillation or any etiology for LA enlargement. Hundred and thirty-two patients with frequent PACs (≥100/24 hours) by Holter were matched to controls. Speckle tracking strain of the left atrium was performed from the 4-chamber view. Strain measurements were LA peak contractile, reservoir and conduit strain and strain rates. RESULTS: In the frequent PAC vs control group, PACs were more frequent (1959 ± 3796 vs 28 ± 25/24 hours, P < .0001). LA peak contractile strain was reduced in the group with frequent PACs vs controls (-7.85 ± 4.12% vs -9.33 ± 4.45%, P = .006). LA peak late negative contractile strain rate was less negative in the frequent PAC vs control group (-0.63 ± 0.27 s-1 vs -0.69 ± 0.32 s-1 , P = .051). LA reservoir and conduit strain and strain rates did not differ. LA volume index (LAVI) was larger in the frequent PAC vs control group (26.6 ± 7.8 vs 24.6 ± 8.8 mL/m2 , P < .05). Frequent PACs were an independent predictor of reduced LA peak contractile strain and reduced LA peak late negative contractile strain rate. CONCLUSIONS: Patients with frequent PACs have reduced LA peak contractile strain and strain rates and larger LAVI compared to controls. Frequent PACs are an independent predictor of reduced LA peak contractile strain and strain rate. These findings support the hypothesis that frequent PACs impair LA contractile function and promote adverse LA remodeling.

Colon manometry proves that perception of the urge to defecate is present in children with functional constipation who deny sensation.

BACKGROUND AND OBJECTIVE: Children with functional constipation often state an inability to sense an urge to defecate and/or inability to feel incontinence. We used colon manometry to assess whether there was a sensory abnormality in patients who denied sensation. METHODS: A physician observed all of the colon manometries in the preceding 20 years, and included behavioral observations in the procedure reports. We reviewed the charts of these patients. RESULTS: Of 150 subjects with normal manometry and a diagnosis of functional constipation, 56 volunteered that they had no urge to defecate or complained of abdominal pain. For all who denied sensation, the first high-amplitude propagating colonic contraction (HAPC) was associated with retentive posturing and facial grimaces. When queried, all reported they felt nothing. The examiner explained the HAPC was causing pain, and informed the child that the pain would resolve if they defecated. With subsequent HAPCs, every patient acknowledged an urge to defecate and successfully defecated. Most agreed that a similar pain sensation was present daily, but was misinterpreted to be abdominal pain. CONCLUSIONS: Colon manometry may be useful not only for objective findings to discriminate neuromuscular disease from functional symptoms but also to understand psychological issues and aid in helping the child and family understand the maladaptive behaviors in functional constipation.

Management and long-term outcomes associated with recalled implantable cardioverter-defibrillator leads: A multicenter experience.

BACKGROUND: No comparative study of outcomes in Riata and Sprint Fidelis leads undergoing lead extraction (LE), lead abandonment (LA), and generator change only (GC) has been published. OBJECTIVES: Determine outcomes (major complications [MC]; death, extended hospitalization, or rehospitalization within 60 days [RH]; lead malfunction) of LE, LA, and GC for recalled leads. METHODS: Retrospective, multicenter, comparative study. RESULTS: A total of 298 LE, 85 LA, and 310 GC were performed. In the clinical setting of a lead intervention, there was no difference in a composite of MC, death, RH, lead revision, inappropriate shocks, or device infection between LE and LA groups (15% vs 22%, P = .140). In the clinical setting of a device at elective replacement interval (ERI), there were significantly more acute events at 60 days (MC, death, and RH) in the LE and LA groups at 15.4% (4) and 15.4% (4), and this was significantly (P = .017) higher than the GC group at 5.1% (16). There was no difference (P = 1.000) in the composite of MC, death, RH, lead malfunction, lead revisions, device infections, or inappropriate shocks between LE, LA, and GC groups at 15.4% (4), 15.4% (4), and 17.4% (54), respectively. Following generator change, 14 of 175 Fidelis leads and 3 of 135 Riata leads failed over a total of 12,714 months of follow-up. CONCLUSIONS: The failure rate of recalled leads was substantially lower compared to previous reports. It may be prudent to perform generator change only when the device is at ERI, especially when the recalled lead has historical performance that likely outweighs the risks of extraction/abandonment.