Biomedical subjects

Paolo Trambaiolo

Publications and source records attributed to Paolo Trambaiolo.

11 recordsLinked to original sources

PubMed2006

Potential clinical perspectives of Doppler myocardial imaging and strain rate imaging during stress echocardiography.

Stress echocardiography has become a common non-invasive test in patients with chest pain and known or suspected coronary artery disease, but, as with exercise electrocardiography, it shows several major limitations. Analysis of gray-scale images based on subjective visual interpretation of wall motion and thickening has considerable variability even among experts. Doppler myocardial imaging and strain rate imaging echocardiography provides additional information in comparison with conventional echocardiography. These techniques provide quantification of regional wall motion at rest and during stress. Quantification of both systolic and diastolic myocardial function by either Doppler myocardial imaging or strain rate imaging mapping during dobutamine stress test has been shown to be a feasible, accurate, non-invasive tool that should be considered to be a sensitive alternative to the present echocardiographic and scintigraphic imaging techniques for stress tests. Time consuming off-line analysis of color images is required in the present state of technology. However, these non-invasive techniques are rapidly evolving and expanding. Further refinements in signal processing and quantitative analysis are likely in the near future.

Blood Flow Velocity↗

PubMed2006

Echocardiographic estimation of pulmonary pressures.

Cardiac ultrasound plays a pivotal role in assessing pulmonary artery pressures. Estimation of right atrial pressure can be derived from the dimensions and respiratory variation of the inferior vena cava and Doppler modalities provide an accurate and comprehensive evaluation of right ventricular and pulmonary artery pressures. Peak pulmonary artery pressure can be calculated from continuous wave Doppler sampling of the tricuspid regurgitant jet, while pulsed wave Doppler sampling of the pulmonary regurgitant jet allows evaluation of mean and diastolic pulmonary artery pressures. In patients with tricuspid regurgitation that is either absent or not adequately detectable by Doppler method, Doppler right ventricular outflow tract investigation can be helpful. Recent data indicate that analysis of right ventricular function using myocardial Doppler echocardiography may also provide new insights for the non-invasive estimation of pulmonary artery pressures. In particular, right ventricular isovolumic relaxation time measured by myocardial Doppler echocardiography at the tricuspid annulus may provide an alternative method for estimating pulmonary artery pressure, especially in patients with tricuspid regurgitation not detectable or spectral Doppler not properly interpretable.

Atrial Function, Right↗

PubMed2006

[Mitral valve prolapse].

Mitral valve prolapse (MVP) is still a clinical challenging problem. In this report, we review the main characteristics of this entity. Epidemiology of MVP, which relies on the diagnostic criteria adopted, and the incidence of complications, both arrhythmic and structural, are influenced by the characteristics of the population studied, which may lead to bias in data interpretation. Even the definition of MVP may differ according to the cardiologist's or cardiac surgeon's point of view. Usually, cardiologists define MVP as the protrusion of all or part of the mitral leaflets into the left atrium, independent of maintenance of coaptation. Therefore, using this definition, mitral regurgitation is considered as a complication rather than a diagnostic criterion. Arrhythmias, either supraventricular or ventricular, are other possible complications, mostly not life-threatening and associated with myxomatous degeneration of the valve. Diagnosis of MVP is based on echocardiography, which provides detailed anatomic and functional evaluation of the affected valve. Leaflet thickness and motion as well as presence and severity of mitral regurgitation can be assessed, with important diagnostic and prognostic implications. Echocardiographic evaluation of the mitral valve requires a systematic approach in order to define the leaflet/scallop involved and the mechanisms of mitral regurgitation. To this aim, three-dimensional reconstruction may add further insights into objective rendering of mitral valve pathology. Finally, surgical timing in mitral regurgitation due to MVP is an evolving issue and the likelihood of surgical repair is a crucial factor in the optimal timing of surgical intervention, especially in asymptomatic patients with severe mitral regurgitation.

Echocardiography, Three-Dimensional↗

PubMed2006

[Selection of patients undergoing cardiac resynchronization therapy: role of echocardiography].

Patients with heart failure, marked systolic dysfunction and dys-synchronous myocardial contraction are at increased risk for exacerbated pump failure and arrhythmias, and suffer higher mortality rates. In these patients, cardiac resynchronization therapy (CRT), achieved by a biventricular pacing, can lead to clinical improvement, reverse left ventricular remodeling and prolonged survival, although a substantial subset of non-responders has been reported. The electrocardiographic QRS width does not predict long-term CRT benefit, while direct measures of mechanical dyssynchrony obtained by various ultrasound techniques have been shown to have a better predictive value. However, currently there is no consensus on the optimal ultrasound technique to use for assessing mechanical dyssynchrony and select candidates for CRT. In this review, the clinical role of both conventional and new ultrasound techniques applied to the study of cardiac dyssynchrony will be discussed, focusing on patient selection for CRT.

Cardiac Pacing, Artificial↗

PubMed2005

Bedside diagnosis and follow-up of patients with pleural effusion by a hand-carried ultrasound device early after cardiac surgery.

OBJECTIVES: The aim of this study was to assess the potential value of hand-carried ultrasound (HCU) devices in the diagnosis and follow-up of patients with pleural effusion (PE) after cardiac surgery. METHODS: Seventy consecutive patients were evaluated at bedside early after cardiac surgery, in the upright sitting position, using an HCU device on hospital admission and every 3 days until hospital discharge. The posterior chest wall was scanned along the paravertebral, scapular, and posterior axillary lines. For each hemithorax, an effusion index was derived as the sum of the intercostal spaces between the lower and upper limits of the PE along the lines of scanning, divided by 3. A standard chest radiograph was performed in all patients on hospital admission and at hospital discharge, and was qualitatively scored (0, absent; 1, small; 2, large PE). The findings of the HCU device and radiograph were compared using kappa statistics and the Kruskal-Wallis test. RESULTS: A chest ultrasound was feasible in all patients (mean [+/- SD] time, 5 +/- 2 min). Compared with the chest ultrasound, a physical examination showed a sensitivity of 69% and a specificity of 77%. On hospital admission, the HCU device detected a PE in 72 of 140 hemithoraxes. Agreement with the finding of the radiograph was 76% (kappa = 0.52). In 15 hemithoraxes, the HCU device revealed a PE that had not been diagnosed using the radiograph. Conversely, in 18 hemithoraxes a PE that had been diagnosed with a radiograph was not confirmed by the HCU device. The correlation between ultrasound and radiographic scores was statistically significant (p < 0.001). At hospital discharge, a PE was present in 31 of 140 hemithoraxes according to the findings of the HCU device, and in 38 of 140 hemithoraxes according to the findings of the radiograph (agreement, 78%; kappa = 0.44). CONCLUSIONS: In patients early after cardiac surgery, HCU devices allow rapid PE detection and improve the clinical diagnosis. Compared to a radiograph, this method offers the unique advantage of the bedside evaluation of patients without the need for radiation exposure.

Aged↗

PubMed2004

[Digital echocardiography laboratory].

The implementation of a digital echocardiography laboratory exists today using the DICOM (Digital Imaging Communication in Medicine) standard to acquire, store and transfer echocardiographic digital images. The components of a laboratory include: 1) digital echocardiography machines with DICOM output, 2) a switched high-speed local area network, 3) a DICOM server with abundant local storage, and 4) a software to manage image and measurement information. The aim of this article was to describe the critical components of a digital echocardiography laboratory, discuss strategies for implementation, and describe some of the pitfalls that we encountered in our own implementation of the digital third level echocardiography laboratory.

Ambulatory Care Facilities↗

PubMed2003

Biventricular pacing in heart failure: back to basics in the pathophysiology of left bundle branch block to reduce the number of nonresponders.

Cardiac resynchronization therapy is a novel nonpharmacologic approach to treating patients who have advanced heart failure with left bundle branch block (LBBB). Such a therapy is based on the original theory that synchronous biventricular pacing is able to reduce the interventricular delay caused by LBBB in patients with heart failure. Although there is convincing evidence that biventricular pacing increases the left ventricular ejection fraction, decreases mitral regurgitation, and improves symptoms caused by heart failure, the percentage of nonresponders to such therapy has been described as high as about one third of patients with heart failure having LBBB. Factors responsible for this relatively high prevalence are reviewed, the most important of them probably being left intraventricular dyssynchrony, which can persist after biventricular pacing, notwithstanding right and left interventricular resynchronization. Such a dyssynchrony, as evaluated by tissue Doppler imaging, may be because of the discordance between the site of the left ventricular pacing and the site of the left ventricular delay. Therefore, to characterize the pathophysiologic pattern of LBBB, the investigators suggest an assessment of the electromechanical dysfunction with a noninvasive reliable technique, such as tissue Doppler imaging, which can be repeated after biventricular pacing.

Bundle-Branch Block↗

PubMed2003

Asymptomatic malposition of a pacing lead in the left ventricle: the case of a woman untreated with anticoagulant therapy for eight years.

We report the case of a woman with a low-rate atrial fibrillation and a wire lead inadvertently inserted in the left ventricle through an ostium secundum defect. The malposition of the lead was diagnosed 8 years after the procedure on the basis of the presence of a right bundle branch block pattern of the paced QRS, at echocardiography and at chest X-ray. The patient, who was neither on antiaggregant nor anticoagulant therapy, was asymptomatic. Biventricular pacing is a useful tool in the therapy of patients with severe chronic heart failure and intraventricular conduction delay but the insertion of the lead in the left ventricle through the coronary sinus is not always feasible. Because a patent foramen ovale is a frequent occurrence in the adult population, we suggest that in case of an unsuccessful catheterization of the coronary sinus, the physician should search for a patent foramen ovale through which to introduce the wire lead into the left ventricle, especially if the patient is already receiving anticoagulant therapy.

Aged↗

PubMed2002

Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing.

OBJECTIVES: The goal of this study was to compare the efficacy of biventricular pacing (BIV) at the most delayed wall of the left ventricle (LV) and at other LV walls. BACKGROUND: Biventricular pacing could provide additional benefit when it is applied at the most delayed site. METHODS: In 31 patients with advanced nonischemic heart failure, the activation delay was defined, in blind before BIV, by regional noninvasive Tissue Doppler Imaging as the time interval between the end of the A-wave (C point) and the beginning of the E-wave (O point) from the basal level of each wall. The left pacing site was considered concordant with the most delayed site when the lead was inserted at the wall with the greatest regional interval between C and O points (CO(R)). After BIV, patients were divided into group A (13/31) (i.e., paced at the most delayed site) and group B (18/31) (i.e., paced at any other site). RESULTS: After BIV, in all patients LV end-diastolic (LVEDV) and end-systolic (LVESV) volumes decreased (p = 0.025 and 0.001), LV ejection fraction (LVEF) increased (p = 0.002), QRS narrowed (p = 0.000), New York Heart Association class decreased (p = 0.006), 6-min walked distance (WD) increased (p = 0.046), the interval between closure and opening of mitral valve (CO) and isovolumic contraction time (ICT) decreased (p = 0.001 and 0.000), diastolic time (EA) and Q-P(2) interval increased (p = 0.003 and 0.000), while Q-A(2) interval and mean performance index (MPI) did not change. Group A showed greater improvement over group B in LVESV (p = 0.04), LVEF (p = 0.04), bicycle stress testing work (p = 0.03) and time (p = 0.08) capacity, CO (p = 0.04) and ICT (p = 0.02). CONCLUSIONS: After BIV, LV performance improved significantly in all patients; however, the greatest improvement was found in patients paced at the most delayed site.

Bundle-Branch Block↗

PubMed2002

Assessment of left atrial appendage wall velocities by transesophageal tissue Doppler echocardiography: a clinical study in patients with sinus rhythm.

To assess left atrial appendage (LAA) wall velocities, 42 patients in sinus rhythm underwent tissue Doppler interrogation during a clinically indicated transesophageal echocardiography. Color Doppler (B-mode and M-mode) and pulsed Doppler of LAA walls were obtained and analyzed in all patients. Color-coded tissue Doppler rendered a qualitative assessment of LAA wall, depicting both the timing and the sequence of LAA contraction. With pulsed Doppler interrogation, a triphasic signal was recorded in all patients, consisting of a positive wave (D1), followed by a biphasic wave (positive D2 and negative D3). Peak velocities of D1, D2, and D3 were 6.1 +/- 2, 20.1 +/- 7, and 16.1 +/- 5 cm/s, respectively. Mean coefficient of variation of LAA wall velocities was 6%, significantly lower than that of LAA percentage area change (29%). Compared with patients with abnormal relaxation, patients with normal mitral inflow had higher D1 peak velocities (7.3 +/- 1.2 vs 4.3 +/- 1 cm/s, respectively; P <.0001). Time sequence of ECG, LAA flow, and mitral inflow indicates that D1 component of LAA wall occurs in early diastole and is likely due to the upward movement of the mitral ring toward the base of the LAA wall. In conclusion, evaluation of LAA wall using tissue Doppler is feasible and reproducible. Although color tissue Doppler analysis allows a qualitative assessment, pulsed Doppler gives new quantitative insights for the comprehensive assessment of LAA wall dynamics, which complements the information obtained with flow interrogation.

Atrial Appendage↗

PubMed2002

[Tissue Doppler in the assessment of myocardial function in stress echocardiography].

Recently, stress echocardiography has emerged as a valuable tool for the diagnosis and evaluation of coronary artery disease, but its interpretation still remains subjective, relying on image quality and reader's experience. These problems could be overcome by quantitative analysis of wall motion. Tissue Doppler provides quantitative information on regional myocardial systolic and diastolic velocities that can be displayed either in spectral mode or color coded, reflecting the peak velocity increment induced by exercise or dobutamine administration. Pulsed wave tissue Doppler allows to measure regional instantaneous myocardial velocities with high temporal resolution and has been shown valuable for detecting stress-induced changes of both myocardial systolic and diastolic function. This method may also identify myocardial viability by measuring increase in systolic peak velocity at low-dose of dobutamine in dysfunctional myocardial segments. Color coded tissue Doppler resolves mean velocities with higher spatial resolution, and post-processing analysis of digital acquired images has been shown feasible and reproducible. Myocardial velocity gradient is a more sensitive parameter compared to the simple measurement of the peak endocardial systolic velocity for evaluating myocardial ischemia during dobutamine echocardiography. From the raw data, it is also possible to measure strain and strain rate. These new parameters have the potential to differentiate between wall motion and contractility, with obvious implications when applied to stress echocardiography. In conclusion, tissue Doppler is able to quantify regional myocardial function. After a large scale validation, this technique will be incorporated with stress echocardiography in clinical practice.

Diastole↗