2024 CSANZ Position Statement on Indications, Assessment and Monitoring of Structural and Valvular Heart Disease With Transthoracic Echocardiography in Adults.

Transthoracic echocardiography (TTE) is the most widely available and utilised imaging modality for the screening, diagnosis, and serial monitoring of all abnormalities related to cardiac structure or function. The primary objectives of this document are to provide (1) a guiding framework for treating clinicians of the acceptable indications for the initial and serial TTE assessments of the commonly encountered cardiovascular conditions in adults, and (2) the minimum required standard for TTE examinations and reporting for imaging service providers. The main areas covered within this Position Statement pertain to the TTE assessment of the left and right ventricles, valvular heart diseases, pericardial diseases, aortic diseases, infective endocarditis, cardiac masses, pulmonary hypertension, and cardiovascular diseases associated with cancer treatments or cardio-oncology. Facilitating the optimal use and performance of high quality TTEs will prevent the over or under-utilisation of this resource and unnecessary downstream testing due to suboptimal or incomplete studies.

Third-Generation Transcatheter Aortic Heart Valve with Reverse Parachute Sealing Cuff in Patients with Aortic Valve Disease.

BACKGROUND: The Navitor (Abbott Inc, IL, USA) transcatheter heart valve is a novel third-generation self-expanding bioprosthesis with specific features to mitigate paravalvular regurgitation (PVR). Owing to its novelty, there is a paucity of data on its application in clinical practice. METHODS: Consecutive cohort analysis of the use of the Navitor system in an as-treated clinical setting at a quaternary heart hospital. RESULTS: Sixty consecutive non-clinical trial patients treated with Navitor were identified. All patients underwent a successful procedure. The mean age was 79.3 years (±SD 7.82), 56.67% (n=34) were female, and the mean STS score was 4.87 (±SD 5.70). At 30 days post-procedure, all patients were alive with no readmissions for heart failure. One patient had a major vascular complication (1.7%). Four patients (7.14% of patients without a pre-existing pacemaker) received a new permanent pacemaker. Two patients (3.4%) had a non-disabling stroke. PVR at 30 days was trivial or none in 75% of patients, and no patient had worse than mild PVR. CONCLUSIONS: The Navitor system in this as-treated cohort was associated with favourable clinical, haemodynamic, and safety outcomes.

District-scale surface temperatures generated from high-resolution longitudinal thermal infrared images.

This paper describes a dataset collected by infrared thermography, a non-contact, non-intrusive technique to acquire data and analyze the built environment in various aspects. While most studies focus on the city and building scales, an observatory installed on a rooftop provides high temporal and spatial resolution observations with dynamic interactions on the district scale. The rooftop infrared thermography observatory with a multi-modal platform capable of assessing a wide range of dynamic processes in urban systems was deployed in Singapore. It was placed on the top of two buildings that overlook the outdoor context of the National University of Singapore campus. The platform collects remote sensing data from tropical areas on a temporal scale, allowing users to determine the temperature trend of individual features such as buildings, roads, and vegetation. The dataset includes 1,365,921 thermal images collected on average at approximately 10-second intervals from two locations during ten months.

Quantifying the effectiveness of desk dividers in reducing droplet and airborne virus transmission.

The utilization of physical dividers has been recommended as a practical approach to reducing the droplet and aerosol transmissions of the COVID-19 virus (SARS-CoV-2). This study conducted a series of experiments using video recording with a high-speed camera, particle image velocimetry (PIV) technique, and concentration measurements. The effectiveness of Perspex desk dividers impeding the transient transmission during coughing in five representative layouts was investigated. The results showed that the divider effectively protected the exposed person from an infector's cough seated in a face-to-face arrangement at a distance of 1.5 m. The aerosol concentration at the breathing zone was reduced by 99% compared to the layout without dividers. However, the reflection of aerosols from the dividers increased the exposure risk to the person seated beside the infector. Such risk was substantially reduced if the dividers were placed parallel between the infector and exposed person seated side-by-side. When the exposed person was staggered (face-to-face but displaced sideways laterally) to the infector with a 0.55-m lateral distance, the dividers reduced the potential exposure at the breathing zone by 60%. Considering the effectiveness in exposure reduction, the staggered configuration of desk dividers between the infector and exposed persons offers the best reduction to exposure.

Transiently elevated estimated pulmonary pressures in a patient with complete heart block undergoing permanent pacing: a case report.

BACKGROUND: Complete heart block (CHB) is a frequent cause for acute admission in older patients with significant cardiac conduction disease. Common presenting symptoms are syncope and dyspnoea. Some patients may exhibit clinical and radiological signs of left ventricular (LV) decompensation, despite preserved LV ejection fraction on transthoracic echocardiography (TTE) and absent pre-existing LV dysfunction. CASE SUMMARY: In this clinical report, we present a case of CHB associated with transient but severe elevation in pulmonary artery systolic pressure, measured as the equivalent right ventricular systolic pressure (RVSP = 99 mmHg) by TTE in the absence of right ventricular outflow tract obstruction, that subsequently 'normalized' after implantation of a permanent pacemaker. After searching our echocardiogram database, we did find other cases with similar findings. DISCUSSION: There is limited literature describing transient acute elevation in estimated pulmonary pressures in the setting of new CHB that is subsequently reversed by permanent pacing. The true prevalence and mechanism of transient estimated pulmonary pressure as a result of CHB remains unknown. Based on our limited assessment, we postulate that the acute elevation in estimated pulmonary pressures is predominantly related to a compensatory augmentation of RV stroke volume and is caused by the underlying bradycardia and need to maintain forward cardiac output. This phenomenon may require further investigation and validation in future studies.

Contemporary Imaging of Aortic Stenosis.

Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.

An unusual cause of pulmonary edema.

Primary cardiac tumors are rare malignancies. Patients may present with congestive cardiac failure due to intracavitary obstruction to blood flow, valvular dysfunction, embolic phenomena, local invasion resulting in arrhythmias, pericardial involvement, constitutional symptoms, or paraneoplastic syndromes. We describe the case of a previously fit 79-year-old woman who presented with acute pulmonary edema due to a large left atrial pleomorphic sarcoma causing severe functional mitral stenosis. She underwent palliative debulking surgery with good symptomatic relief.

Clinical application and laboratory protocols for performing contrast echocardiography.

Technically difficult echocardiographic studies with suboptimal images remain a significant challenge in clinical practice despite advances in imaging technologies over the past decades. Use of microbubble ultrasound contrast for left ventricular opacification and enhancement of endocardial border detection during rest or stress echocardiography has become an essential component of the operation of the modern echocardiography laboratory. Contrast echocardiography has been demonstrated to improve diagnostic accuracy and confidence across a range of indications including quantitative assessment of left ventricular systolic function, wall motion analysis, and left ventricular structural abnormalities. Enhancement of Doppler signals and myocardial contrast echocardiography for perfusion remain off-label uses. Implementation of a contrast protocol is feasible for most laboratories and both physicians and sonographers will require training in contrast specific imaging techniques for optimal use. Previous concerns regarding the safety of contrast agents have since been addressed by more recent data supporting its excellent safety profile and overall cost-effectiveness.

Echocardiography and vascular ultrasound: new developments and future directions.

There have been major technological advances in echocardiography over the past decade. New and robust measures of myocardial function, both systolic and diastolic, have been identified and extensively evaluated. Some of the new measures such as annular velocities by tissue Doppler imaging have become an integral part of the echocardiographic examination, and other measures such as strain and strain rate have yet to be widely adopted. Three-dimensional (3D) echocardiography has evolved greatly since its introduction in the 1980s. Currently, its main clinical application is the perioperative assessment of the mitral valve. Though 3D echocardiography provides superior quantification of cardiac chamber size, its adoption has been limited by the lack of robust automated data analysis software with smooth integration of analysis packages into clinical workstations and suboptimal temporal and spatial resolution. With advancement in electronics and miniaturization, these limitations can be overcome. The history of contrast echocardiography is long and arduous. Use of a microbubble contrast for left ventricular opacification has become commonplace in most echocardiographic laboratories, but the routine use of microbubble contrast for myocardial perfusion will require standardization of the procedure and/or development of new contrast agents. The applications of 3D and microbubble contrast are also under active evaluation in vascular ultrasound. This review summarizes the current and future applications of these exciting developments in echocardiography and vascular ultrasound.