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1. Relative Prognostic Importance of Left and Right Ventricular Ejection Fraction in Patients With Cardiac Diseases

   Publication date: Available online 7 August 2019

   Source: Journal of the American Society of Echocardiography

   Author(s): Elena Surkova, Denisa Muraru, Davide Genovese, Patrizia Aruta, Chiara Palermo, Luigi P. Badano

   Background

   The study aimed (1) to assess the prognostic value of three-dimensional echocardiography (3DE) derived right ventricular (RV) ejection fraction (EF) and (2) to evaluate relative prognostic importance of reduced and preserved left ventricular (LV) EF and RVEF to predict all-cause mortality and cardiac death in a large cohort of patients with cardiac diseases.

   Methods

   LV and RV volumes and EF were assessed by 3DE in 394 patients with various cardiovascular diseases. Patients were divided into four groups: (1) normal LVEF (≥50%) and normal RVEF (≥45%), n = 183; (2) reduced LVEF (<50%) and normal RVEF (≥45%), n = 75; (3) normal LVEF (≥50%) and reduced RVEF (<45%), n = 61; (4) reduced LVEF (<50%) and reduced RVEF (<45%), n = 75. The patients were followed up for 3.7 ± 1.1 years.

   Results

   Reduced 3DE-derived RVEF was associated with all-cause mortality (P < .0001). The four groups had significantly different survival (P < .0001). Both all-cause mortality and cardiac death in patients with reduced RVEF and normal LVEF were significantly higher than in those with reduced LVEF and normal RVEF (P = .0007 and P = .0091, respectively) and did not differ significantly from patients with reduced EF of both ventricles (P = .2198 and P = .0846, respectively).

   Conclusions

   Reduced 3DE-derived RVEF was associated with all-cause mortality and cardiac death in patients with various cardiovascular diseases. Impairment of RVEF carried a significantly higher risk of mortality independent of LVEF.

2. The Dangerous Patent Foramen Ovale: Device Closure for Stroke Patients with High-Risk Patent Foramen Ovale

   Publication date: Available online 1 August 2019

   Source: Journal of the American Society of Echocardiography

   Author(s): Mohammad K. Mojadidi, Muhammad O. Zaman, Fabian Nietlispach, Jonathan M. Tobis, Bernhard Meier

3. Point of Care Use of an Appropriate Use Criteria Smartphone App for Echocardiography

   Publication date: August 2019

   Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

   Author(s): Paul Obeng-Okyere, Tsering Norbu, Harvey Hahn

4. Performance of Comprehensive Transesophageal Echocardiography: Quality Improvement Through Educational Intervention

   Publication date: August 2019

   Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

   Author(s): Tiffany Chen, Selma Carlson, Amy Cheney, Todd Zwink, Rosario V. Freeman, James N. Kirkpatrick

5. Left Atrial Volumes and Phasic Function in Healthy Children: Reference Values Using Real-Time Three-Dimensional Echocardiography

   Publication date: August 2019

   Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

   Author(s): Katharina Linden, Franziska Goldschmidt, Kai Thorsten Laser, Christian Winkler, Hermann Körperich, Robert Dalla-Pozza, Johannes Breuer, Ulrike Herberg

   Background

   Evaluation of left atrial (LA) size and function is important in congenital and acquired pediatric cardiac disease. Real-time three-dimensional echocardiography (3DE) offers noninvasive assessment of cardiac volumes and phasic function independent of geometric assumptions. The aim of this prospective multicenter study was to establish pediatric reference values for LA 3DE volumes and phasic function based on a large cohort of healthy children.

   Methods

   LA data sets of 432 subjects (0 days-222 months) were analyzed prospectively using a vendor-independent software. LA volumes (maximal [Vmax], minimal [Vmin], and before atrial contraction) as well as phasic function (active and passive emptying fraction [EF]) were assessed. For volumes, sex-specific reference values, percentiles, and z-scores were calculated by the LMS method of Cole and Green.

   Results

   Absolute volumes increased with age and body surface area. Active EF and relative duration of atrial emptying tended to increase with increasing R-R intervals, while passive EF decreased. Reproducibility of volumes was very good (intra- and interobserver variability for Vmax and Vmin (mean bias ± SD, 0.1 ± 0.9 mL and 0.7 ± 2.8 mL). Volumes were well correlated with cardiac magnetic resonance measurements showing known underestimation of volumes by 3DE (mean bias ± SD, Vmax –14.2 ± 14 mL; Vmin –11.5 ± 10 mL).

   Conclusions

   Pediatric LA volumes and phasic function indices were reproducibly measured by 3DE. The provided pediatric reference values can be the basis for evaluation of the LA by 3DE and contribute to detection of LA dysfunction and follow-up of patients with congenital heart diseases.

   Graphical abstract

   

6. Serial Changes in Right Ventricular Systolic Function Among Rejection-Free Children and Young Adults After Heart Transplantation

   Publication date: August 2019

   Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

   Author(s): Jamie K. Harrington, Marc E. Richmond, Kristal L. Woldu, Nikhil Pasumarti, Serge Kobsa, Lindsay R. Freud

   Background

   Evolution of right ventricular (RV) systolic function after pediatric heart transplantation (HT) has not been well described.

   Methods

   We analyzed echocardiograms performed over the first year after HT among children and young adults who remained rejection-free. Ninety-six patients (median age 7.1 [0.1-24.4] years at HT) were included: 22 infants (≤1 year) and 74 noninfants (>1 year). Two-dimensional tricuspid annular plane systolic excursion (TAPSE), tissue Doppler-derived tricuspid annular systolic velocity (S'), fractional area change (FAC), myocardial performance index (MPI), and two-dimensional speckle-tracking-derived RV global longitudinal (GLS) and free wall strain (FWS) were assessed.

   Results

   All measures of RV function were impaired immediately after HT and significantly improved over the first year: TAPSE z-score (–8.15 ± 1.88 to –3.94 ± 1.65, P < .0001), S' z-score (–4.30 ± 1.36 to –2.28 ± 1.33, P < .0001), FAC (24.37% ± 7.71% to 42.02% ± 7.09%, P < .0001), MPI (0.96 ± 0.47 to 0.41 ± 0.22, P < .0001), GLS (–10.37% ± 3.86% to –21.05% ± 3.41%, P < .0001), and FWS (–11.2% ± 4.08% to –23.66% ± 4.13%, P < .0001). By 1 year post-HT, TAPSE, S', GLS, and FWS, remained abnormal, whereas FAC and MPI nearly normalized. Patients transplanted during infancy demonstrated better recovery of RV systolic function.

   Conclusions

   Although RV systolic function improved over the first year after HT in children and young adults without rejection, measures that assess longitudinal contractility remained abnormal at 1 year post-HT. These findings contribute to our understanding of RV myocardial contractility after HT in children and young adults and improve our ability to assess function quantitatively in this population.

7. Aortic Root Geometric and Dynamic Changes After Device Closure of Interatrial Shunts

   Publication date: August 2019

   Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

   Author(s): Mohammad Abdelghani, Martina Nassif, Rianne H.A.C.M. de Bruin-Bon, Ali M. Al-Amin, Mohammed S. El-Baz, Sahar A.O. El-Shedoudy, Barbara J.M. Mulder, Robbert J. de Winter, Berto J. Bouma

   Background

   The spatial relationship between atrial septal occluders and the aorta and the subsequent impact on the geometry and mechanics of the aortic root have been underinvestigated. The aim of this study was to evaluate occluder-aorta interaction after device closure of an atrial septal defect (ASD) or a patent foramen ovale (PFO) using three-dimensional transesophageal echocardiography and two-dimensional speckle-tracking echocardiography.

   Methods

   In 65 adult patients (mean age, 47 ± 14 years; 71% women) who underwent ASD (n = 35) or PFO (n = 30) closure with the Amplatzer Septal Occluder or Amplatzer PFO Occluder, occluder-aorta contact was evaluated on three-dimensional transesophageal echocardiography and defined as continuous, intermittent, or absent. Sinus of Valsalva diameter, height, eccentricity, and strain were measured before and immediately after occluder implantation.

   Results

   The occluder/total septal length and occluder/body surface area ratios were significantly larger after PFO than after ASD closure. The occluder was in contact with the aorta in 93.8% of cases (ASD, 91.4%; PFO, 96.7%). After ASD closure, occluder-aorta contact was very common, in patients with an aortic rim < 5 mm (100%) and those with an aortic rim ≥ 5 mm (79%). However, continuous occluder-aorta contact was more frequent in those with an aortic rim < 5 mm (95% vs 50%). Factors influencing aortic root strain after occluder implantation included the pattern of occluder-aorta relationship and the occluder/body surface area ratio.

   Conclusions

   Most interatrial septal occluders are in contact with the aortic root, even in patients with ASDs with a sufficient aortic rim and in patients with PFOs. However, continuous occluder-aorta contact is more likely in patients with ASDs with a deficient aortic rim. The pattern of occluder-aorta relationship and the occluder/body surface area ratio affect aortic root strain.

8. Safety of Transesophageal Echocardiography in Patients with Thrombocytopenia

   Publication date: August 2019

   Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

   Author(s): Danai Kitkungvan, Divya Kalluru, Abhishek Lunagariya, Liza Sanchez, Syed Wamique Yusuf, Saamir Hassan, Nicolas Palaskas, Elie Mouhayar, Jose Banchs

   Background

   According to current literature and guidelines, thrombocytopenia is considered a relative contraindication for performing transesophageal echocardiogram (TEE). In cancer patients, thrombocytopenia is frequently present. No prior studies have assessed the safety and complications of TEE in a thrombocytopenic population.

   Methods

   From January 2002 to December 2017, all patients who underwent TEE at MD Anderson Cancer Center in the nonoperative setting were included in the study. Patient characteristics, laboratory data, indications, and complications of TEE were obtained from medical records. Thrombocytopenia was defined as platelet count <100,000/μL prior to procedure. In this retrospective study, medical records were reviewed up to 30 days after procedure to search for possible complications related to TEE.

   Results

   During the study period, 2,345 TEE studies were performed. The mean age was 58.2 ± 15.3 years and 58.8% of patients were male. Thrombocytopenia was found in 814 patients (34.7%). More thrombocytopenic patients had hematologic malignancy, when compared with patients with normal platelet level (79.7% vs 30.2%; P < .001). The most common indication for TEE study was to evaluate for suspected endocarditis (48.0%) and was found more frequently in thrombocytopenic patients compared with those with normal platelet count (69.5% vs 36.5%; P < .001). Overall, 10 patients (0.4%) had complications related to TEE: eight minor oropharyngeal bleeding that did not require transfusion, one transient atrial fibrillation, and one esophageal perforation. There was no major bleeding, respiratory failure, or death related to TEE examination during the study period. Minor oropharyngeal bleeding was the only complication seen in thrombocytopenic patients (seven patients, 0.3%).

   Conclusions

   Thrombocytopenia is common in cancer patients undergoing TEE. TEE-related complications are minimal in patients with both normal or low platelet count. With appropriate patient preparation and careful probe manipulation, TEE can be safely performed in thrombocytopenic patients.

9. Repeated Echocardiograms Do Not Provide Incremental Prognostic Value to Single Echocardiographic Assessment in Minimally Symptomatic Patients with Chronic Heart Failure: Results of the Bio-SHiFT Study

   Publication date: August 2019

   Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

   Author(s): Victor J. van den Berg, Mihai Strachinaru, K. Martijn Akkerhuis, Sara Baart, Milos Brankovic, Alina A. Constantinescu, Jan Hein Cornel, Olivier C. Manintveld, Victor A.W.M. Umans, Dimitris Rizopoulos, Marcel L. Geleijnse, Eric Boersma, Bas M. van Dalen, Isabella Kardys

   Background

   We aimed to compare the prognostic value of a single “baseline” echocardiogram with repeated echocardiography in stable chronic heart failure (CHF) patients. We hypothesized that repeated echocardiograms would contain incremental prognostic information.

   Methods

   In the prospective Bio-SHiFT study, we performed 332 echocardiograms in 106 patients during a median follow-up of 2.3 years. The endpoint comprised HF hospitalization, left ventricular (LV) assist device implantation, heart transplantation, and cardiovascular death. We compared hazard ratios (HRs; adjusted for N-terminal pro-brain natriuretic peptide) from Cox models for the first available measurement with HRs from joint models, which model individual trajectories based on the repeated measurements and link these to the time-to-event data.

   Results

   The mean age of the patients was 58.1 years; 78.3% were male, 12.6% had New York Heart Association class >II, all had reduced ejection fraction, and the most common HF etiologies were cardiomyopathies (51%) and ischemia (40%). The endpoint occurred in 25 patients. Both the single measurements and the temporal trajectories were significantly associated with the endpoint (adjusted HR Cox model [95% CI] vs adjusted HR joint model [95% CI]): LV ejection fraction, 1.47 (0.93-2.31) vs 1.77 (1.13-2.93); diastolic LV diameter, 1.64 (1.09–2.47) vs 1.68 (1.12-2.57); systolic LV diameter, 1.72 (1.10-2.69) vs 1.68 (1.13-2.63); systolic left atrial diameter, 1.88 (1.18-3.00) vs 2.60 (1.48-4.97); E/A ratio, 2.73 (1.42-5.26) vs 3.87 (1.75-10.13); and E/e′ ratio, 2.30 (1.38-3.84) vs 2.99 (1.68-6.19). None of the trajectories from the investigated parameters showed worsening prior to events.

   Conclusions

   Although single baseline or repeatedly measured echocardiographic parameters were associated with the endpoint, all parameters remained on average stable during the 2.3 years of follow-up in this largely minimally symptomatic CHF cohort. Thus, regular echocardiographic monitoring of systolic or diastolic LV function within this time frame does not carry incremental prognostic information over a single baseline measurement.

10. Prolonged Systole and Reduced Ejection Fraction among Competitive Athletes: Slow and Low but Able to Go

    Publication date: August 2019

    Source: Journal of the American Society of Echocardiography, Volume 32, Issue 8

    Author(s): Aaron L. Baggish