Current role of echocardiography in cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.

Noninvasive evaluation of right hemodynamics in carcinoid heart disease: A case report.

We report the case of a 67-year-old woman with a carcinoid tumor of midgut origin who developed carcinoid heart disease and died because of bowel perforation. Echocardiography allowed the diagnosis, recognizing the typical abnormalities of tricuspid and pulmonary valve leaflets. The sonographic examination also evidenced peculiar alterations of the right heart hemodynamics: end-diastolic reversal of flow at the level of the pulmonary valve, reduced respiratory excursion without enlargement of the inferior vena cava, and biphasic hepatic venous flow without respiratory variation. Echocardiography allowed both the diagnosis and the accurate assessment of the hemodynamic consequences of the disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:355-361, 2017.

Current views on anthracycline cardiotoxicity.

Anthracyclines are well established and effective anticancer agents used to treat a variety of adult and pediatric cancers. Unfortunately, these drugs are also among the commonest chemotherapeutic agents that have been recognized to cause cardiotoxicity. In the last years, several experimental and clinical investigations provided new information and perspectives on anthracycline-related cardiotoxicity. In particular, molecular mechanisms of cardiotoxicity have been better elucidated, early diagnosis has improved through the use of advanced noninvasive cardiac imaging techniques, and emerging data indicate a genetic predisposition to develop anthracycline-related cardiotoxicity. In this article, we review established and new knowledge about anthracycline cardiotoxicity, with special focus on recent advances in cardiotoxicity diagnosis and genetic profiling.

[Heart failure with mid-range ejection fraction. Looking for Middle Earth?] / Scompenso cardiaco con frazione di eiezione intermedia. Alla ricerca della Terra di Mezzo?

The latest guidelines of the European Society of Cardiology have proposed a classification of heart failure based on left ventricular ejection fraction. Three distinct groups have been identified: heart failure with ejection fraction ≥50%, between 40 and 49%, and <40%. This classification has the advantage to be simple but it has been criticized because it is not clear whether the mid-range ejection fraction group is an independent category or just a transition phase between the other two groups. The purpose of this article is to discuss the characteristics and prognosis of mid-range ejection fraction heart failure on the basis of current evidence.

[Role of echocardiography in the assessment of cancer-related cardiac dysfunction]. / Ruolo dell'ecocardiografia per la valutazione della disfunzione ventricolare sinistra da trattamenti oncologici.

The use of echocardiography for the assessment of patients undergoing potentially cardiotoxic cancer treatments and for follow-up of treated patients is increasing and has become a significant public health problem due to the need for repeated examinations over time. Despite the technological advances of echocardiography, there are still uncertainties about how best to use this technique to identify and guide the management of cardiotoxicity. The purpose of this article is to discuss the role of echocardiography in the study of ventricular dysfunction due to cancer treatments, with the aim to clarify the main echocardiographic information to be provided, the methods to apply and the strategies to implement to streamline as much as possible the use of echocardiography in the field of cardioncology.

Left Ventricle Relative Apical Sparing in Cardiac Amyloidosis.

Amyloidosis is a disease characterized by the extracellular deposition of the protein amyloid. It is a multiorgan disease, and cardiac involvement is not uncommon, generally in the form of a restrictive cardiomyopathy. Typical aspects of cardiac amyloidosis have been described at echocardiography and magnetic resonance imaging (MRI). In particular, the relative apical sparing at two-dimensional speckle-tracking echocardiography has been reported to be specific for cardiac amyloidosis. In our case, we report for the first time that this echocardiographic sign is related to lack of hyperenhancement at late gadolinium enhancement imaging in cardiac MRI.

Early Speckle-tracking Echocardiography Predicts Left Ventricle Remodeling after Acute ST-segment Elevation Myocardial Infarction.

BACKGROUND: Prediction of the left ventricular remodeling (LVR) after ST-segment elevation myocardial infarction (STEMI) in patients treated with effective myocardial reperfusion is challenging. METHODS: Forty-one consecutive patients (36 males, age 59 ± 10 years) with STEMI who underwent effective (TIMI III) primary coronary angioplasty were enrolled. All patients had an echocardiography and cardiac magnetic resonance (CMR) study within 72 h from revascularization. Three echocardiographic parameters including LV ejection fraction (EF), global longitudinal strain (GLS) and severe altered longitudinal strain (SAS) area by two-dimensional speckle-tracking echocardiography (2D-STE) and 3 CMR indices including LV global function index (LV-GFI), myocardial salvage index (MSI), and microvascular obstruction (MVO) were calculated. LVR was defined as an increase in CMR LV end-diastolic volume (EDV) >15% after 6 months. RESULTS: Of 41 patients, 10 (24%) had LVR (LV-EDV from 145.1 ± 29.3 to 185.9 ± 49.8 ml, P < 0.001). A significant correlation with LV-EDV variation was found for baseline SAS area (r = 0.81), LV-GFI (r = -0.56), MVO (r = 0.55), EF (r = -0.42), GLS (r = 0.42), not for MSI (r = -0.25). At the multivariable analysis, a significant correlation remained only for the SAS area. The receiver-operating characteristic curve analysis showed that a baseline SAS area ≥15% predicts LVR with a sensitivity of 80.0% and a specificity of 90.3%. CONCLUSIONS: The SAS area evaluated by 2D-STE early in acute STEMI is a valuable predictor of LVR after 6 months. Further investigations are needed to verify its value in predicting patient survival.

[Echocardiographic assessment of mitral regurgitation in the perspective of valve repair]. / Valutazione ecocardiografica dell'insufficienza mitralica nella prospettiva della riparazione valvolare.

Echocardiography is the most used imaging technique for the study of patients with mitral regurgitation because of its wide distribution, non-invasiveness and ability to provide diagnostic, functional, hemodynamic and prognostic evaluations. Also, echocardiography can provide essential information on surgical and percutaneous reparability of the regurgitant valve and can guide the surgical and interventional indications relative to valve repair. However, the echocardiographic study is not always appropriately performed in clinical practice and based on a surgery perspective. Therefore, the purpose of this article is to describe how to best use echocardiography for evaluation of patients with mitral regurgitation, highlighting the advantages and limitations of this technique before and after surgical or interventional repair.

Left ventricle remodeling in patients with ß-thalassemia major. An emerging differential diagnosis with left ventricle noncompaction disease.

To differentiate left ventricle non-compaction (LVNC) from hypertrabeculated myocardium due to LV remodeling in ß-thalassemia major (ß-TM) patients, cardiac magnetic resonance (CMR) images of 38 ß-TM patients and 10 LVNC patients were compared using 3 diagnostic criteria: ratio of diastolic segmental non-compacted to compacted myocardium (NC/C ratio) >2.5, percentage of non-compacted LV mass (NC-LVM%) >20% and >25% of global LV mass. Specificity of NC/C ratio of >2.5 was the lowest (58%) and of NC-LVM% of >25% the highest (93%). A NC-LVM% >20% showed sensitivity 100% and specificity 87%. Disease differentiation depends on the selected CMR criterion and is better with NC-LVM%.

Left Ventricular Lead Position Guided by Parametric Strain Echocardiography Improves Response to Cardiac Resynchronization Therapy.

BACKGROUND: There is still a significant proportion of patients with heart failure who fail to improve after cardiac resynchronization therapy (CRT). The investigators used parametric two-dimensional speckle-tracking echocardiography with polar plots of the amplitude and timing of left ventricular (LV) longitudinal strain to guide implantation of the LV lead, with the aim of increasing CRT response. METHODS: Sixty-four patients who underwent LV lead implantation guided by two-dimensional speckle-tracking echocardiography (study group) and 64 patients treated with standard CRT implantation (control group) were retrospectively analyzed in this study. A positive response to CRT was defined as a reduction of ≥15% in LV end-systolic volume 6 months after implantation. Parametric two-dimensional speckle-tracking echocardiographic evaluation was associated with myocardial end-diastolic wall thickness assessment for recognition of nonviable or irreversibly damaged myocardial tissue. RESULTS: Compared with the control group, the number of responders increased in the study group (75% vs 48%, P = .002) and in the subgroups of nonischemic (85% vs 59%, P = .022) and ischemic (65% vs 38%, P = .032) patients. The magnitude of echocardiographic LV response also increased in the overall study group and subgroups. In the ischemic patients, the size of transmural scar area correlated with LV reverse remodeling (r = 0.693, P < .001). CONCLUSIONS: Echocardiography-guided LV lead implantation on the basis of parametric polar plots of LV longitudinal myocardial strain increases both the number of responders and the magnitude of echocardiographic response to CRT. In ischemic patients, size of transmural scar tissue negatively affects CRT response, even when LV lead position is optimized.

Implantable cardioverter defibrillator management: an update.

Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures. Also, ICD backface such as infections and other complications will be discussed. Finally, we will focus on interesting future perspectives for this setting of patients.