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See detailMultiplane two-dimensional versus real time three-dimensional transesophageal echocardiography in ischemic mitral regurgitation.
Fattouch, K.; Castrovinci, S.; Murana, G. et al

in Echocardiography (2011)

OBJECTIVES: Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) has been suggested to be a valuable technique for the evaluation of the mechanisms of ischemic mitral regurgitation ... [more ▼]

OBJECTIVES: Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) has been suggested to be a valuable technique for the evaluation of the mechanisms of ischemic mitral regurgitation (IMR). Studies comparing multiplane two-dimensional (2D) with 3D TEE reconstruction of the mitral valve using the new mitral valve quantification (MVQ) software are lacking. We undertook a prospective comparison between multiplane 2D and 3D TEE for the assessment of IMR. METHODS: We evaluated echocardiographically 45 patients with IMR who underwent mitral valve surgery in our institution. 2D and 3D TEE examinations followed by a 3D offline assessment of the mitral valve apparatus were performed in all patients. Offline analysis of mitral valve apparatus was conducted with QLAB-MVQ. RESULTS: 3D TEE image acquisitions were performed in a short period of time and were feasible in all patients. Real time 3D TEE imaging was superior to 2D in identifying specific mitral scallops (A1, A3, P1, P3) and commissures. When compared with 2D TEE, 3D offline reconstruction of the mitral valve allows an accurate quantification of the shape and diameters of the mitral annulus. Both approaches provide almost similar values for the tenting area and the coaptation depth. The 3D approach gave the advantage of direct calculation of the leaflets angles, tenting volume, and surface of the leaflets. The interpapillary muscles distance at the level of the papillary muscle head was greater in 2D than in 3D. CONCLUSIONS: 3D TEE imaging provides valuable and complementary information to multiplane 2D TEE for the assessment of patients with IMR. [less ▲]

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See detailContractile reserve assessed using dobutamine echocardiography predicts left ventricular reverse remodeling after cardiac resynchronization therapy: prospective validation in patients with left ventricular dyssynchrony.
Sénéchal, Mario; Lancellotti, Patrizio ULg; Magne, Julien ULg et al

in Echocardiography (2010), 27(6), 668-76

Background: The presence of viable myocardium may predict response to cardiac resynchronization therapy (CRT). The aim of this study is to evaluate in patients with left ventricular (LV) dyssynchrony ... [more ▼]

Background: The presence of viable myocardium may predict response to cardiac resynchronization therapy (CRT). The aim of this study is to evaluate in patients with left ventricular (LV) dyssynchrony whether response to CRT is related to myocardial viability in the region of the pacing lead. Methods: Forty-nine consecutive patients with advanced heart failure, LV ejection fraction < 35%, QRS duration > 120 ms and intraventricular asynchronism ≥ 50 ms were included. Dobutamine stress echocardiography was performed within the week before CRT implantation. Resting echocardiography was performed 6 months after CRT implantation. Viability in the region of LV pacing lead was defined as the presence of viability in two contiguous segments. Response to CRT was defined by evidence of reverse LV remodeling (≥15% reduction in LV end-systolic volume). Results: Thirty-one patients (63%) were identified as responders at follow-up. The average of viable segments was 5.9 ± 2 in responders and 3.2 ± 3 in nonresponders (P = 0.0003). Viability in the region of the pacing lead had a sensitivity of 94%, a specificity of 67%, a positive predictive value of 83%, and a negative predictive value of 86% for the prediction of response to CRT. Conclusions: In patients with LV dyssynchrony, reverse remodeling after CRT requires viability in the region of the pacing lead. This simple method using echocardiography dobutamine for the evaluation of local viability (i.e., viability in two contiguous segments) may be useful to the clinician in choosing the best LV lead positioning. [less ▲]

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See detailUsefulness and limitation of dobutamine stress echocardiography to predict acute response to cardiac resynchronization therapy.
Sénéchal, Marie; Lancellotti, Patrizio ULg; Garceau, P. et al

in Echocardiography (2010), 27(1), 50-57

Background: It has been hypothesized that a long-term response to cardiac resynchronization therapy (CRT) could correlate with myocardial viability in patients with left ventricular (LV) dysfunction ... [more ▼]

Background: It has been hypothesized that a long-term response to cardiac resynchronization therapy (CRT) could correlate with myocardial viability in patients with left ventricular (LV) dysfunction. Contractile reserve and viability in the region of the pacing lead have not been investigated in regard to acute response after CRT. Methods: Fifty-one consecutive patients with advanced heart failure, LV ejection fraction ≤ 35%, QRS duration > 120 ms, and intraventricular asynchronism ≥ 50 ms were prospectively included. The week before CRT implantation, the presence of viability was evaluated using dobutamine stress echocardiography. Acute responders were defined as a ≥15% increase in LV stroke volume. Results: The average of viable segments was 5.8 ± 1.9 in responders and 3.9 ± 3 in nonresponders (P = 0.03). Viability in the region of the pacing lead had an excellent sensitivity (96%), but a low specificity (56%) to predict acute response to CRT. Mitral regurgitation (MR) was reduced in 21 patients (84%) with acute response. The presence of MR was a poor predictor of response (sensibility 93% and specificity 17%). However, combining the presence of MR and viability in the region of the pacing lead yields a sensibility (89%) and a specificity (70%) to predict acute response to CRT. Conclusion: Myocardial viability is an important factor influencing acute hemodynamic response to CRT. In acute responders, significant MR reduction is frequent. The combined presence of MR and viability in the region of the pacing lead predicts acute response to CRT with the best accuracy. [less ▲]

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See detailThe value of 2D strain imaging during stress testing
Moonen, Marie ULg; Lancellotti, Patrizio ULg; Zacharakis, Dimitrios et al

in Echocardiography (2009), 26(3), 307

Stress echocardiography is increasingly used but its major limitation is the subjective interpretation of wall motion changes requiring experience. Speckle tracking enables simultaneous evaluation of ... [more ▼]

Stress echocardiography is increasingly used but its major limitation is the subjective interpretation of wall motion changes requiring experience. Speckle tracking enables simultaneous evaluation of radial, longitudinal, and circumferential myocardial deformation. Recently, two-dimensional (2D) strain has been found to be as reliable as sonomicrometry for the assessment of left ventricular (LV) regional function. In the presence of inducible ischemia, longitudinal and circumferential abnormalities preceed the decrease in radial deformation. Optimal cutoffs have been obtained from 2D strain rate (SR) at peak dobutamine stress to predict coronary artery disease. However, 2D strain rate does not yet provide incremental accuracy to visual interpretation by experts. Speckle tracking strain could be useful to better identify contractile reverse and biphasic response of viable myocardium but there are not yet clinical studies published in this setting. Preliminary results suggest that 2D strain obtained during exercise could be useful in asymptomatic patients with severe aortic stenosis or organic mitral regurgitation (MR). In conclusion, the reliability and clinical importance of 2D strain during stress will be specified by further investigations. [less ▲]

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See detailA simple Doppler echocardiography method to evaluate pulmonary capillary wedge pressure in patients with atrial fibrillation
Sénéchal, M.; O'Connor, K.; Deblois, J. et al

in Echocardiography (2008), 25(1), 57-63

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