Evaluation of right ventricular functions in patients with ischemic cardiomyopathy by speckle-tracking echocardiography.

BACKGROUND: It is widely recognized that the right ventricle plays a significant role in the prognosis of numerous diseases. However, the assessment of right ventricular function (RV) has not been given much attention until recently. This study used speckle-tracking echocardiography (STE) to assess RV functions in ischemic cardiomyopathy (ICM) patients. RESULTS: This study included 74 patients diagnosed with ischemic cardiomyopathy (ICM) and an ejection fraction (EF) of less than 50%. Although all the selected patients had normal RV systolic function by tricuspid annular plane systolic excursion (TAPSE), a considerable percentage of them had subtle RV systolic dysfunction, which could be identified by right ventricular free wall longitudinal strain (RV FWLS) (36.5%) and right ventricular global longitudinal strain (RV GLS) (55.4%). Moreover, the mean RV FWLS was significantly higher than RV GLS (- 20.4 ± 5.08% vs. - 17.5 ± 6.89%), respectively. Advanced left ventricle (LV) adverse remodeling was associated with subtle RV dysfunction. Using multivariate regression analysis, increased E/e' (p = 0.016, CI 1.135-3.423) and RV myocardial performance index (MPI) (p = 0.007, CI 0.000-0.007) were identified as independent factors of impaired RV FWLS with the greatest effectiveness. CONCLUSION: When standard RV measures are normal in patients with ICM, RV systolic strain analysis offers an incremental utility to detect subtle abnormalities in RV function, especially in resource-constrained settings where cardiac magnetic resonance (CMR) is not practical.

Incremental value of P-wave indices for predicting left atrial dysfunction in patients with primary mitral regurgitation using speckle tracking echocardiography.

The correlation of P wave indices on surface ECG and phasic LA dysfunction in patients with significant primary mitral regurgitation (MR) due to the adverse LA adaptive structural and functional changes needs to be more studied. This study aims to investigate the diagnostic value of P wave indices to predict LA function assessed both by volumetric analysis using 3-dimensional (3D)echocardiography, and by strain analysis using speckle tracking echocardiography. (STE). The study included 107 subjects, we measured maximum P-duration (Pmax), P dispersion (PD), and V1 negative terminal force (V1-NTF) (negative duration x negative amplitude) on surface ECG. Both Basic and Dynamic LA volumes (LAV) during reservoir, conduit, and contractile phases were measured. The global LA strain and strain rate parameters were calculated By STE. LA ejection fraction (LAEF) and ejection force were also calculated.V1-NTF showed a significant positive correlation while P-max a significant negative correlation with global peak atrial longitudinal strain (GPALS) (r = 0.75; P < 0.001 and r = - 0.72; P < 0.001 respectively). Using ROC curve analysis, Pmax > 110 ms, 1-NTF ≥ 4 ms.mV and P notching > 40 ms had a sensitivity of 90%, 95% and 50% and a specificity of 87.4%, 94.3% and 100% respectively in predicting GPALS ≤ 30%. P notching > 40 ms was associated with severe LA dysfunction. ECG P wave indices represent a simple bedside tool that could have an incremental role in predicting LA dysfunction as well as size in patients with significant primary MR.

Importance of left atrial mechanical function as a predictor of atrial fibrillation risk following cardiac surgery.

Postoperative atrial fibrillation (POAF) after cardiac surgery is a major health problem that is associated with a significant financial burden and increased early morbidity and mortality. We investigated the accuracy of new echocardiographic derived indices to predict patients at higher risk of developing POAF. 84 consecutive patients (age 57.9 ± 6.9, 32% female) hospitalized for isolated CABG underwent comprehensive echocardiographic evaluation before surgery. Left atrial (LA) function was quantified through the assessment of phasic LA volumes to calculate LATEF. Speckle tracking echocardiography STE was used to measure LA reservoir strain, conduit strain and booster strain. Patients who developed POAF had increased LA volumes and impaired LA functions assessed by both the volumetric phasic changes and STE. By univariable analysis, all LA function parameters significantly predicted POAF. Multivariate regression analysis showed that age (P = 0.03, OR 1.134, 95% CI 1.012-1.271) and LATEF (P = 0.001, OR 0.814, 95% CI 0.725-0.914) were strong independent factors for POAF with LATEF showing the highest predictive accuracy. After multivariable adjustment to include LA strain indices to the base model, LA contractile strain LACtS (23.93 ± 4.19 vs 37.0 ± 3.35, p < 0.001) was the best discriminated for the highest predictive accuracy (OR 0.429, 95% CI 0.26-0.708). The ROC Curve was calculated for the greatest performance for prediction of POAF (AUC LACtS: 0.992; LATEF: 0.899). Adding new left atrial mechanics parameters is a more sensitive, independent tool that provides an incremental predictive value to discriminate patients at more risk for POAF.

Characterization of the interatrial septum by high-field cardiac MRI: a comparison with multi-slice computed tomography.

BACKGROUND: Assessment of the interatrial septum (IAS) has become an attractive area of interest for a variety of important interventional procedures. Newer imaging modalities like multi-slice computed tomography (MSCT) and cardiac MRI (CMR) can provide higher resolution and wider field of view than echocardiography. Moreover, high-field (3-Tesla) CMR can even enhance spatial and temporal resolution. The characteristics of the interatrial septum were retrospectively studied in 371 consecutive subjects (201 men, 31-73 years old) in whom MSCT was performed primarily for non-invasive evaluation of the coronary arteries. All subjects underwent both MSCT and MRI scans within 0-30 day's interval. A 3D volume covering the whole heart was acquired across the heart with and without contrast enhancement. Also, patients underwent cardiac MSCT examinations using 64-row MSCT scanners. RESULTS: The mean scan time of MSCT was 10.4 ± 2.8 s and 9.7 ± 2.9 min for CMR. The mean length of IAS by CMR and CT was 39.65 ± 4.6 mm and 39.28 ± 4.7 mm, respectively. The mean maximal thickness of IAS by CMR and CT was 3.1 ± 0.97 mm and 3.15 ± 0.95 mm, respectively. The mean thickness of fossa ovalis by CMR and CT was 1.04 ± 0.36 mm and 1.04 ± 0.44 mm, respectively. The mean length of fossa ovalis by CMR and CT was 12.8 ± 3.7 mm and 12.8 ± 3.5 mm, respectively. Finally, the mean angle of IAS by CMR and CT was identical (155 ± 9.2°). Measurements of various morphological features of IAS showed no statistically significant difference between CMR and CT, with an excellent correlation and close relationship regarding IAS length, maximal IAS thickness, fossa ovalis thickness, fossa ovalis length, and IAS angle (r = 0.98, 0.98, 0.95, 0.96, and 0.92, respectively). CONCLUSION: Whole-heart 3D acquisition at 3-T MRI using a free-breathing technique provides a valuable non-invasive imaging tool for excellent assessment of the interatrial septum-as compared to MSCT-that may have significant clinical implication for diagnostic purposes and therapeutic interventional procedures, as it may facilitate planning, improve outcome, and shorten its duration.

Short term outcome of thoracic endovascular aortic repair in patients with thoracic aortic diseases.

AIM AND BACKGROUND: Open surgical repair for thoracic aortic diseases is associated with a high perioperative mortality and morbidity. Most of type B aortic dissections are uncomplicated and are medically treated which carries a high mortality rate. Thoracic endovascular aortic repair is the first-line therapy for isolated aneurysms of the descending aorta and complicated type B aortic dissection. The aim of this study is to test the safety of early thoracic endovascular aortic repair in patients with uncomplicated type B aortic dissection and patients with thoracic aortic aneurysms. METHODS: A total of 30 patients (24 men and 6 females; mean age 59 ±â€¯8 years) with uncomplicated type B aortic dissection and descending thoracic aortic aneurysm who underwent endovascular aortic repair in National Heart Institute and Cairo University hospitals were followed up. Clinical follow-up data was done at one, three and twelve months thereafter. Clinical follow-up events included death, neurological deficits, symptoms of chronic mal-perfusion syndrome and secondary intervention. Multi-slice computed tomography was performed at three and six months after intervention. RESULTS: Of the 30 patients, 24 patients had aortic dissection, and 6 patients had an aortic aneurysm. 7 patients underwent hybrid technique and the rest underwent the basic endovascular technique in whom success rate was 100%. Two patients developed type I endoleak, however both improved after short term follow up. The total mortality rate was 10% throughout the follow-up. Both death and endoleak occurred in subacute and chronic cases, while using TEVAR in acute AD and aneurysm showed no side effects. Early thoracic endovascular aortic repair showed better results and less complications. CONCLUSION: Along with medical treatment, early thoracic endovascular aortic repair in uncomplicated type B aortic dissections and thoracic aortic aneurysms is associated with better outcome.

The degree of hair graying as an independent risk marker for coronary artery disease, a CT coronary angiography study.

BACKGROUND: Cardiovascular disease is a leading cause of death worldwide. Aging is an unavoidable coronary risk factor and is associated with dermatological signs that could be a marker for increased coronary risk. We tested the hypothesis that hair graying as a visible marker of aging is associated with risk of coronary artery disease (CAD) independent of chronological age. METHODS: This cross-sectional study included 545 males who underwent a computed tomography coronary angiography (CTCA) for suspicious of CAD, patients were divided into subgroups according to the percentage of gray/white hairs (Hair Whitening Score, HWS: 1-5) and to the absence or presence of CAD. RESULTS: CAD was prevalent in 80% of our studied population, 255 (46.8%) had 3 vessels disease with mean age of 53.2 ± 10.7 yrs. Hypertension, diabetes and dyslipidemia were more prevalent in CAD group (P = 0.001, P = 0.001, and P = 0.003, respectively). Patients with CAD had statistically significant higher HWS (32.1% vs 60.1%, p < 0.001) and significant coronary artery calcification (<0.001). Multivariate regression analysis showed that age (odds ratio (OR): 2.40, 95% confidence interval (CI): [1.31-4.39], p = 0.004), HWS (OR: 1.31, 95% CI: [1.09-1.57], p = 0.004), hypertension (OR: 1.63, 95% CI: [1.03-2.58], p = 0.036), and dyslipidemia (OR: 1.61, 95% CI: [1.02-2.54], p = 0.038) were independent predictors of the presence of atherosclerotic CAD, and only age (p < 0.001) was significantly associated with HWS. CONCLUSIONS: Higher HWS was associated with increased coronary artery calcification and risk of CAD independent of chronological age and other established cardiovascular risk factors.