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1.
Int J Cardiovasc Imaging ; 35(9): 1627-1636, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31041633

RESUMO

Intraventricular velocity distribution reflects left ventricular (LV) diastolic function and can be measured non-invasively by flow mapping technologies. We designed our study to compare intraventricular velocities and gradients, obtained by vector flow mapping (VFM) technology during early diastole in consecutive patients diagnosed with mild and advanced diastolic dysfunction at echocardiography and a control group with a purpose to validate the hypothesis of relationship between new parameters and severity of diastolic dysfunction and conventional markers of elevated LV filling pressure. Two-dimensional streamline fields were obtained using VFM technology in 121 subjects (57 with normal diastolic function, 38 with mild diastolic dysfunction and 26 with advanced diastolic dysfunction). We measured several velocities and calculated a gradient along the selected streamline, which we compared between groups and correlated them with conventional echocardiographic parameters. Apical intraventricular velocity gradient (GrIV) was the lowest in control group, followed by mild and advanced diastolic dysfunction groups (5.3 ± 1.9 vs. 6.8 ± 2.5 vs. 13.6 ± 5.0/s, p < 0.001) and showed good correlation with E/e' (r = 0.751, p < 000.1). GrIV/e' ratio was the strongest single predictor of severity of diastolic dysfunction. Different degrees of diastolic dysfunction affect the Intraventricular velocity behavior during early diastole obtained by VFM. GrIV could discriminate between groups with different levels of diastolic dysfunction and was closely associated with classical echocardiographic indices of elevated LV filling pressure. GrIV/e' ratio has a potential to become a single parameter needed to assess left ventricular diastolic function.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Doppler de Pulso/métodos , Interpretação de Imagem Assistida por Computador/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Pressão Ventricular , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Dados Preliminares , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/fisiopatologia
2.
Cardiovasc Ultrasound ; 17(1): 5, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30944001

RESUMO

BACKGROUND: Three-dimensional color flow Doppler (3DCF) is a new convenient technique for cardiac output (CO) measurement. However, to date, no one has evaluated the accuracy of 3DCF echocardiography for CO measurement after cardiac surgery. Therefore, this single-center, prospective study was designed to evaluate the reliability of three-dimensional color flow and two-dimensional pulse wave Doppler (2D-PWD) transthoracic echocardiography for estimating cardiac output after cardiac surgery. METHODS: Post-cardiac surgical patients with a good acoustic window and a low dose or no dose of vasoactive drugs (norepinephrine < 0.05 µg/kg/min) were enrolled for CO estimation. Three different methods (third generation FloTrac/Vigileo™ [FT/V] system as the reference method, 3DCF, and 2D-PWD) were used to estimate CO before and after interventions (baseline, after volume expansion, and after a dobutamine test). RESULTS: A total of 20 patients were enrolled in this study, and 59 pairs of CO measurements were collected (one pair was not included because of increasing drainage after the dobutamine test). Pearson's coefficients were 0.260 between the CO-FT/V and CO-PWD measurements and 0.729 between the CO-FT/V and CO-3DCF measurements. Bland-Altman analysis showed the bias between the absolute values of CO-FT/V and CO-PWD measurements was - 0.6 L/min with limits of agreement between - 3.3 L/min and 2.2 L/min, with a percentage error (PE) of 61.3%. The bias between CO-FT/V and CO-3DCF was - 0.14 L/min with limits of agreement between - 1.42 L /min and 1.14 L/min, with a PE of 29.9%. Four-quadrant plot analysis showed the concordance rate between ΔCO-PWD and ΔCO-3FT/V was 93.3%. CONCLUSIONS: In a comparison with the FT/V system, 3DCF transthoracic echocardiography could accurately estimate CO in post-cardiac surgical patients, and the two methods could be considered interchangeable. Although 2D-PWD echocardiography was not as accurate as the 3D technique, its ability to track directional changes was reliable.


Assuntos
Débito Cardíaco/fisiologia , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Tridimensional/métodos , Cardiopatias/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
3.
Echocardiography ; 36(5): 1009-1013, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31002180

RESUMO

Coronary artery fistula (CAF) is a rare malformation and is seldom reported during pregnancy. Right coronary artery fistula commonly drains into the right ventricle, right atrium, or pulmonary artery. We describe here a rare case of fetal CAF draining into the left ventricle using cross-sectional and color Doppler echocardiography. We also summarized our experience in the diagnosis of this uncommon malformation, in which tracing the origin, course, and outlet of the abnormal intra-cardiac flow played a key role.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler em Cores/métodos , Fístula/diagnóstico por imagem , Fístula/embriologia , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Coração Fetal/anormalidades , Coração Fetal/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , Gravidez
4.
Echocardiography ; 36(5): 1017-1018, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31025758

RESUMO

In the current manuscript, we report an unusual case of a young 18-year-old woman who survived an out-of-hospital cardiac arrest secondary to Bland-White-Garland syndrome. Her transthoracic echocardiogram showed an abnormal color Doppler flow-pattern within the myocardium indicative of coronary fistulous flow that prompted further evaluation with coronary CT angiography, which confirmed the diagnosis. Our case serves not only as a reminder to consider coronary artery anomalies as a cause of sudden cardiac death in young individuals but also as a prompt to investigate unusual echocardiographic findings with alternative imaging when the diagnosis may not be initially clear.


Assuntos
Síndrome de Bland-White-Garland/complicações , Síndrome de Bland-White-Garland/diagnóstico por imagem , Ecocardiografia Doppler em Cores/métodos , Parada Cardíaca/etiologia , Adolescente , Angiografia Coronária/métodos , Diagnóstico Diferencial , Feminino , Coração , Humanos
5.
Int Heart J ; 60(3): 778-783, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019166

RESUMO

Echocardiographic detection of abnormalities occurring medially and distally in coronary arteries is uncommon and is not well recognized. Herein, we describe an 87-year-old woman with two distinct aneurysms involving a branch of the left anterior descending coronary artery (LAD), one of which communicated with the pulmonary artery (PA). Initially determined via transthoracic echocardiography (TTE), these findings were subsequently validated by coronary computed tomography angiography (CTA). We also present a review of the published studies of multiple coronary artery aneurysms (CAAs) exceeding 20 mm in diameter, focusing on the location, etiology, symptoms, and common ultrasonic characteristics of 30 cases. Echocardiography is a valuable, noninvasive technique for initial detection, monitoring, and follow-up of CAAs, serving to direct further diagnostics.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia/métodos , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada/métodos , Aneurisma Coronário/patologia , Angiografia Coronária/métodos , Vasos Coronários/patologia , Feminino , Humanos
7.
Congenit Heart Dis ; 14(4): 628-637, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30843655

RESUMO

AIMS: Reliable evaluation of the severity and consequences of pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate between moderate and severe PR, using phase contrast cardiac magnetic resonance imaging (CMR) as gold standard. METHODS AND RESULTS: In this cross-sectional study, 45 TOF patients with both echocardiographic and CMR measurements of PR were enrolled. All quantitative and semiquantitative echocardiographic measurements such as pressure half time (PHT), Color flow jet width (CFJW), ratio CFJW/right ventricle outflow tract (RVOT) diameter, PR index and the presence of early termination of the PR jet, end-diastolic antegrade flow and diastolic backflow in main pulmonary artery (MPA), and PA branches correlated significantly with PR fraction on CMR. Qualitative assessment with color flow on echocardiography overestimated PR Multivariate linear regression analysis identified the ratio of CFJW/RVOT diameter and PHT as independent predictors of PR fraction. Accuracy of echo parameters was tested to differentiate between mild-to-moderate and severe PR Combining different echocardiographic parameters increased sensitivity and specificity. The addition of diastolic flow reversal in the PA branches to PHT below 167 milliseconds increased the NPV from 87% to 89% and PPV from 62% to 76%. CONCLUSIONS: Comparison with CMR confirms that echocardiographic parameters are reliable in predicting PR severity. Combined measurement of diastolic flow reversal in the pulmonary artery branches and PHT is reliable in the detection of severe PR in the follow-up of TOF patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ecocardiografia Doppler em Cores/métodos , Imagem Cinética por Ressonância Magnética/métodos , Complicações Pós-Operatórias , Insuficiência da Valva Pulmonar/diagnóstico , Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Função Ventricular Direita/fisiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico , Fatores de Tempo , Adulto Jovem
8.
Cardiovasc Ultrasound ; 17(1): 4, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30823923

RESUMO

BACKGROUND: Professor Xinfang Wang first introduced the clinical application of trans nose pharynx esophagus echocardiography (TNPEE) in 2014. Subsequently, we developed the technology. In the present study we assess the feasibility of TNPEE in the ultrasonic diagnosis. METHODS: Select patients suitable for TNPEE examination. After obtaining written consent of patients or their families, oral dacronin hydrochloride gel local anesthesia was given 10-15 min before examination. The nostrils were disinfected and then smeared with tetracaine hydrochloride gel, which acted as local anesthesia and lubrication. The probe was inserted gently through the nostrils and entered the esophagus through the nasal cavity and pharynx. TNPEE is similar to transoral esophagus echocardiography (TOEE) after the probe reaches the esophagus. RESULTS: TNPEE was performed in 103 patients. Forty-five patients (43.7%) underwent the examination successfully, 46 patients (44.7%) failed because of objective reasons, 12 patients midway refused to accept the examination and cancelled the examination, accounting for 11.6%, 11 patients (12.1%) suffered from epistaxis. Of all the patients with epistaxis, 9 had taken anticoagulant drugs, accounting for 82% of the patients with epistaxis. The vital signs of all patients were stable and no serious complications occurred. CONCLUSION: Compared with TOEE, TNPEE can cause less nausea and vomiting reaction, and patients take longer time to undergo examination, which is conducive to more detailed examination. However, TNPEE has a high requirement for the probe, and its success rate is relatively low. It is easy to cause nasal bleeding in patients, so its wide clinical application is limited.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Transesofagiana/métodos , Cardiopatias/diagnóstico , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Faringe , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
Echocardiography ; 36(3): 558-566, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30726568

RESUMO

OBJECTIVES: The purpose of this study was to investigate the relationship between the vortex in left ventricle (LV) during the isovolumic contraction (IVC) period and the preejectional flow velocity in LV outflow tract (VLVOT ). METHODS: Color Doppler loops were acquired for vector flow mapping in apical long-axis view in 76 patients with dilated cardiomyopathy, 61 patients with coronary artery disease and 36 healthy controls. RESULTS: All normals exhibited an IVC vortex reaching the LV base. VLVOT was significantly related to IVC vortex area flux, transmitral A velocity, mitral annular a' velocity and E/e' ratio, respectively. Transmitral A velocity was the only independent predictor of VLVOT (R2  = 0.292, P = 0.001). In patients the IVC vortex could reach the LV base, middle, or apex. VLVOT was significantly related to range, area and area flux of the IVC vortex, LV size, LVEF, mitral annular velocities, E/e' ratio, transmitral A velocity, and IVC time, respectively. Range and corrected area flux of the IVC vortex, LV end-systolic short diameter, and IVC time were independent predictors of VLVOT (R2  = 0.608, P < 0.001). CONCLUSIONS: In normals, the transmitral A velocity (momentum) is efficiently transferred from mitral orifice to LV outflow tract by a normally formed IVC vortex, and transmitral A velocity is the only independent predictor of VLVOT . However, in patients with a wide range of LV enlargement and dysfunction, the momentum transfer is associated with not only the LV dimension and function, but also the range and volume of the IVC vortex.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia Doppler em Cores/métodos , Contração Miocárdica/fisiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo/fisiologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
10.
Int J Comput Assist Radiol Surg ; 14(4): 577-586, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30798510

RESUMO

PURPOSE: The goal of this study was to develop an algorithm that enhances the temporal resolution of two-dimensional color Doppler echocardiography (2D CDE) by reordering all the acquired frames and filtering out the frames corrupted by out-of-plane motion and arrhythmia. METHODS: The algorithm splits original frame sequence into the fragments based on the correlation with a reference frame. Then, the fragments are aligned temporally and merged into a resulting sequence that has higher temporal resolution. We evaluated the algorithm with 10 animal epicardial 2D CDE datasets of the right ventricle and compared it with the existing approaches in terms of resulting frame rate, image stability and execution time. RESULTS: We identified the optimal combination of alternatives for each step, which resulted in an increase in frame rate from 14 ± 0.87 to 238 ± 93 Hz. The average execution time was 7.23 ± 0.48 s in comparison with 0.009 ± 0.001 s for ECG gating and 1167.37 ± 587.85 s for flow reordering. Our approach demonstrated a significant (p < 0.01) increase in image stability compared with ECG gating and flow reordering. CONCLUSION: This work presents an offline algorithm for temporal enhancement of 2D CDE. Unlike previous frame reordering approaches, it can filter out-of-plane or corrupted frames, increasing the quality of the results, which substantially increases diagnostic value of 2D CDE. It can be used for high-frame-rate intraoperative imaging of intraventricular and valve regurgitant flows and is potentially modifiable for real-time use on ultrasound machines.


Assuntos
Algoritmos , Arritmias Cardíacas/diagnóstico , Ecocardiografia Doppler em Cores/métodos , Ventrículos do Coração/diagnóstico por imagem , Aumento da Imagem/métodos , Humanos , Reprodutibilidade dos Testes
11.
Echocardiography ; 36(4): 800-802, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30693549

RESUMO

Restrictive atrial communication is rarely reported in tricuspid atresia but when present it can lead to important morbidity. We describe two fetuses with tricuspid atresia with restrictive foramen ovale who were found to have fetal growth failure. Fetal echocardiography detected a restrictive atrial communication by flow acceleration on color Doppler and significant right atrial dilation in one patient; the atrial septum was not well interrogated in the other patient. Restrictive foramen ovale in tricuspid atresia may be associated with fetal growth failure. Color Doppler interrogation of the atrial septum on fetal echocardiogram may help identify this condition prenatally.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Retardo do Crescimento Fetal/etiologia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Atresia Tricúspide/complicações , Ultrassonografia Pré-Natal/métodos , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Forame Oval/diagnóstico por imagem , Humanos , Gravidez , Atresia Tricúspide/diagnóstico por imagem
12.
Echocardiography ; 36(1): 164-169, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620100

RESUMO

Recent studies lend credibility to the notion that lone atrial fibrillation (AF) can cause functional mitral regurgitation (MR), commonly referred to as atrial functional MR (AF-MR). The conventional view holds that left atrial enlargement associated with AF causes annular dilatation which gradually moves the mitral valve leaflets apart resulting in inadequate coaptation and regurgitation. Recent findings, however, suggest that AF-MR is not solely related to left atrial remodeling, but that important structural and functional abnormalities of the left ventricle also play a role in its pathogenesis.


Assuntos
Fibrilação Atrial/complicações , Remodelamento Atrial/fisiologia , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Ecocardiografia Doppler em Cores/métodos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Ventrículos do Coração/patologia , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia
13.
Int Heart J ; 60(2): 482-488, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30626768

RESUMO

Unicuspid aortic valve (UAV) is an extremely rare form of congenital cardiac malformation, leading to aortic stenosis (AS), aortic regurgitation (AR), or both. We report the case of a 55-year-old man with unicommissural UAV associated with severe AS and mild AR using different multimodality imaging approaches. The excised UAV isolated after aortic valve replacement exhibited an eccentric "teardrop" opening with a slit-shaped unicommissural structure. Raman spectroscopic results indicated that 3 unevenly distributed components were deposited on the surface of the UAV, in which calcium hydroxyapatite and type-B carbonate apatite were the predominate components deposited on the surface, leading to severe AS formation.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Valva Aórtica , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Imagem Multimodal/métodos , Angiografia/métodos , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Transesofagiana/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Espectral Raman/métodos , Volume Sistólico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Int J Cardiovasc Imaging ; 35(5): 761-769, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30511193

RESUMO

Previously we introduced and validated the average pixel intensity (API) method for grading mitral regurgitation (MR) in a heterogeneous MR population. We now investigated the feasibility and added value of the API method more specifically in patients with functional MR (FMR). We consecutively enrolled 283 patients with pure FMR. Transthoracic echocardiography was performed and MR was assessed using the API method and guideline-recommended parameters, including color Doppler, vena contracta width (VCW) and proximal isovelocity surface area (PISA)-based methods. The API method had an applicability of 98% in this FMR cohort, which was significantly higher than VCW (84%) and PISA-based methods (75%). Overall, the API method had significant correlations with direct parameters of FMR severity, ejection fraction, atrial and ventricular dimensions, pulmonary pressures and New York Heart Association class. Analysis of the API dynamics during MR revealed a typical pattern with early and late systolic peaks in API and a midsystolic nadir, which matched the temporal changes of the effective regurgitant orifice (ERO) during FMR. Based on ROC curves of established FMR severity cut-offs, an API value of 125 au was considered the optimal cut-off to determine severe MR. Interestingly, this API severity cut-off is similar to the API severity cut-off for MR in degenerative MR (DMR), despite different EROA/RV cut-offs in current ESC guidelines for FMR and DMR. The API method is an easy, fast and feasible parameter for grading FMR and may complement the multiparametric assessment of FMR in daily clinical practice.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Interpretação de Imagem Assistida por Computador/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Estudos de Viabilidade , Hemodinâmica , Humanos , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes
15.
Int J Cardiovasc Imaging ; 35(3): 461-468, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30377892

RESUMO

The aim of this study was to evaluate the diagnostic performance of the diastolic retrograde ratio in the descending aorta in patients with aortic regurgitation (AR) by vector flow mapping (VFM). Conventional Doppler echocardiography and VFM were performed in 73 patients with various degrees of AR and 40 controls. AR severity was assessed by an expert using the currently recommended integrative approach, including vena contracta width (VCW), jet width to left ventricular outflow tract (jet width/LVOT) ratio, and effective regurgitant orifice area (EROA). The retrograde ratio, derived as the quotient of backward flow volume (VFb) and forward flow volume (VFf) in the descending aorta, was measured using VFM. The diastolic retrograde ratio was found to increase across groups of subjects with absent (6.1 ± 4.0%), mild (21.3 ± 8.2%), moderate (43.6 ± 9.4%), and severe (70.5 ± 10.5%) AR. Furthermore, in a linear correction model, the retrograde ratio correlated strongly with the VCW (r = 0.930, P < 0.001), jet width/LVOT ratio (r = 0.884, P < 0.001), and EROA (r = 0.927, P < 0.001). In the receiver operating characteristic curve, the retrograde ratio had an area under the curve of 0.958 for a diagnosis of severe AR (SEM: 0.0205, P < 0.0001). A retrograde ratio > 56% indicated severe AR with a sensitivity of 93% and a specificity of 89%, whereas a value > 59% indicated severe AR with a sensitivity of 96% and a specificity of 82%. The retrograde ratio in the descending aorta is useful in identifying AR severity. This accurate and simple quantitative parameter should be incorporated in the comprehensive evaluation of AR.


Assuntos
Aorta/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Doppler em Cores/métodos , Hemodinâmica , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Aorta/fisiopatologia , Insuficiência da Valva Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Doença Crônica , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
16.
Congenit Heart Dis ; 14(1): 21-26, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30548469

RESUMO

OBJECTIVE: There is no consensus on the definition of a hemodynamically significant patent ductus arteriosus (hsPDA). In this review article, our objective is to discuss the main variables that one should consider when determining the hemodynamic significance of a PDA. RESULTS: We describe the various approaches that have been utilized over time to define an hsPDA and discuss the strengths and weaknesses of each echocardiographic index. Finally, we propose a comprehensive and individualized approach in determining the hemodynamic significance of the PDA. CONCLUSION: There are several PDA-related clinical, echocardiographic, and other objective variables to take into consideration when defining an hsPDA. However, vulnerability based on gestational or chronological age is an important contributor as well.


Assuntos
Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia Doppler em Cores/métodos , Hemodinâmica/fisiologia , Recém-Nascido Prematuro , Permeabilidade do Canal Arterial/diagnóstico , Idade Gestacional , Humanos , Recém-Nascido
17.
J Med Ultrason (2001) ; 46(1): 63-68, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29948476

RESUMO

INTRODUCTION AND PURPOSE: Estimation of the contractility of the left ventricle during exercise is an important part of the rehabilitation protocol. It is known that cardiac contractility increases with an increase in heart rate. This phenomenon is called the force-frequency relation (FFR). Using wave intensity, we aimed to evaluate FFR noninvasively during graded exercise. METHODS: We enrolled 83 healthy subjects. Using ultrasonic diagnostic equipment, we measured wave intensity (WD), which was defined in terms of blood velocity and arterial diameter, in the carotid artery and heart rate (HR) before and during bicycle ergometer exercise. FFRs were constructed by plotting the maximum value of WD (WD1) against HR. We analyzed the variation among FFR responses of individual subjects. RESULTS: WD1 increased linearly with an increase in HR during exercise. The average slope of the FFR was 1.0 ± 0.5 m/s3 bpm. The slope of FFR decreased with an increase in body mass index (BMI). The slopes of FFRs were steeper in men than women, although there were no differences in BMI between men and women. CONCLUSIONS: The FFR was obtained noninvasively by carotid arterial wave intensity (WD1) and graded exercise. The slope of the FFR decreased with an increase in BMI, and was steeper in men than women.


Assuntos
Índice de Massa Corporal , Exercício/fisiologia , Contração Miocárdica/fisiologia , Adolescente , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiologia , Ecocardiografia Doppler em Cores/métodos , Eletrocardiografia/métodos , Teste de Esforço/métodos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Caracteres Sexuais , Função Ventricular Esquerda/fisiologia , Adulto Jovem
19.
Heart Vessels ; 34(2): 296-306, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30155660

RESUMO

Although the suction force that moves blood into the left ventricle during early diastole is thought to play an important role in diastolic function, there have been a few studies of this phenomenon in normal children. Suction force is measured as the intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG), which is calculated as IVPD divided by left ventricular length. The purpose of this study was to determine the suction force in infants, children, and adolescents using IVPD and IVPG. We included 120 normal children categorized into five groups based on age: G1 (0-2 years), G2 (3-5 years), G3 (6-8 years), G4 (9-11 years), and G5 (12-16 years). The total, basal, and mid-apical IVPD and IVPG were calculated using color M-mode Doppler imaging of the mitral valve inflow using the Euler equation. The total IVPD increased with age from G1 to G5 (1.75 + 0.51 vs. 2.95 + 0.72 mmHg, respectively; p < 0.001), due to an increase in mid-apical IVPD with constant basal IVPD. Although total IVPG was constant, mid-apical IVPG was larger in G5 than in G1 (0.21 + 0.06 vs. 0.16 + 0.07 mmHg/cm, respectively; p = 0.006). Total, basal, and mid-apical IVPDs were significantly correlated with age and the parameters of heart size and mitral annular e'. Mid-apical IVPG correlated with age and e' positively, but basal IVPG did with age negatively and did not with e'. The suction force increased at the mid-apical segment, correlating with increasing heart size and developing left ventricular relaxation, even after adjustment for left ventricular length.


Assuntos
Função do Átrio Esquerdo/fisiologia , Ecocardiografia Doppler em Cores/métodos , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Adolescente , Criança , Pré-Escolar , Diástole , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Valores de Referência
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