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T Bartel

Publications and source records attributed to T Bartel.

At least 37 records · Page 2Linked to original sources
PubMed2000

Tissue Doppler imaging: a new technique for assessment of pseudonormalization of the mitral inflow pattern.

Left ventricular diastolic dysfunction (LVDD) is a frequent cause of heart failure. Doppler echocardiography has become the method of choice for the noninvasive evaluation of LVDD. However, pseudonormalization (PN) of the mitral inflow often presents a diagnostic challenge in clinical practice. In this setting, we sought to define the role of tissue Doppler imaging (TDI) of the septal mitral annulus. Echocardiography was performed in 36 consecutive subjects (age 59 +/- 10 years). Eighteen of these had diagnosed coronary artery disease (CAD) with recent onset of symptoms (within 3 months), 18 had clinical suspicion of CAD, and 15 had symptoms of heart failure (New York Heart Association [NYHA] Class 2.4 +/- 0.5). The mitral inflow profile (E, A, E/A) was measured by pulsed Doppler, and the deceleration time (DT) and the isovolumic relaxation time (IVRT) were calculated. Peak diastolic velocities of the septal mitral annulus (E(T), A(T), E(T)/A(T)) and the time interval from Q in the ECG to the onset of E(T) were derived from pulsed TDI. Left heart catheterization was performed for direct measurement of left ventricular end-diastolic pressure (LVEDP). PN defined by an E/A ratio > 1 and an LVEDP > or = 16 mmHg was found in nine patients. All patients with PN had symptoms of heart failure (NYHA Class 2.8 +/- 0.5). Patients with and without PN did not differ with respect to the E/A ratio (1.29 +/- 0.44 vs 1.16 +/- 0.23, P = ns), DT (182 +/- 38 msec vs 205 +/- 42 msec, P = ns), and IVRT (88 +/- 24 msec vs 92 +/- 18 msec, P = ns). In the group with PN, a significant reduction of E(T) (5.6 +/- 1.8 cm/sec vs 8.8 +/- 2. 9 cm/sec, P < 0.05) and E(T)/A(T) (0.5 +/- 0.16 vs 0.82 +/- 0.37, P < 0.05) was detected. In the PN group, the Q-E(T) interval was prolonged (404 +/- 48 msec vs 346 +/- 50 msec, P < 0.05). Receiver operating characteristic curve analysis for E(T) yielded an area under the curve of 0.78 +/- 0.06 (P = 0.034) for separating patients with versus without PN. When the combination of E(T) < 7 cm/sec and E(T)/A(T) < 1 was used as cutpoint, PN could be identified with a sensitivity of 83% and a specificity of 79%. There was no significant relation between LVEDP and either E(T) (r = 0.32, P > 0. 2) or the Q-E(T) interval (r = 0.14, P > 0.5). In conclusion, E(T) and the Q-E(T) interval appear to be useful parameters for assessing LV diastolic dysfunction in symptomatic patients with a pseudonormal mitral inflow pattern and elevated filling pressures.

Aged↗
PubMed2000

Tei-index in patients with mild-to-moderate congestive heart failure.

BACKGROUND: Congestive heart failure is related to contraction and relaxation abnormalities of the ventricle. Isolated analysis of either mechanism may not be reflective of overall cardiac dysfunction. A combined myocardial performance index (isovolumic contraction time plus isovolumic relaxation time divided by ejection time, 'Tei-Index') has been described which may be more effective for analysis of global cardiac dysfunction than systolic and diastolic measures alone. It was the aim of the present investigation to evaluate the Tei-Index against invasive examination. METHODS AND RESULTS: Eighty-one subjects were included in a consecutive manner, among 125 patients undergoing left heart catheterization for invasive measurement of left ventricular end-diastolic pressure; 43 patients had congestive heart failure (35 male, 8 female, 68+/-6 years) defined by NYHA functional class >/=2 (mean 2.5+/-0.5) and left ventricular end-diastolic pressure >/=16 mmHg (mean 20+/-4) and 38 subjects (32 male, 6 female, 66+/-5 years) without symptoms of heart failure (NYHA functional class I) and with normal left ventricular end-diastolic pressure (mean 12+/-3 mmHg) served as a control group. Using conventional echo-Doppler methods, parameters assessed were: ejection fraction, peak velocities of early (E) and late (A) diastolic filling, the E/A ratio, deceleration time, isovolumic contraction time, isovolumic relaxation time and ejection time. The Tei-Index was obtained by subtracting ejection time from the interval between cessation and onset of the mitral flow. The control group and patients with congestive heart failure did not differ with respect to the E/A ratio (0.86+/-0.27 vs 0.90+/-0.44, P=ns), deceleration time (203+/-42 ms vs 206+/-36 ms, P=ns) and isovolumic relaxation time (97+/-16 ms vs 94+/-26 ms, P=ns). The ejection fraction was slightly reduced in patients with congestive heart failure (46+/-11% vs 55+/-8%, P<0.05). The Tei-Index was easily and reproducibly measured in all subjects. The mean value of the Tei-Index was significantly different between the control group and patients with congestive heart failure (0.39+/-0.10 vs 0.60+/-0.18, P<0.001). Receiver operating characteristic curve analysis for the Tei-Index yielded an area under the curve of 0.88+/-0.038. Using a Tei-Index >/=0.47 as the cutpoint, congestive heart failure was identified with a sensitivity of 86% and a specificity of 82%. No correlation was observed between the Tei-Index and heart rate (r=0.22, P=ns), systolic blood pressure (r=0.16, P=ns) or diastolic blood pressure (r=0.08, P=ns). The Tei-Index was significantly related to left ventricular end-diastolic pressure (r=0.46, P<0.01). CONCLUSION: The Tei-Index is a sensitive indicator of overall cardiac dysfunction in patients with mild-to-moderate congestive heart failure. The Tei-Index is easily obtained and may be used in the work-up of patients with suspected cardiac dysfunction.

Aged↗
PubMed2000

Size of emptied plaque cavity following spontaneous rupture is related to coronary dimensions, not to the degree of lumen narrowing. A study with intravascular ultrasound in vivo.

OBJECTIVE: To identify any potential relations between the size of an emptied plaque cavity and the remodelling pattern, plaque or vessel dimensions, lumen narrowing, and other ultrasonic lesion characteristics. DESIGN: Intravascular ultrasound was used to examine prospectively 51 ruptured ulcerated coronary plaques. Cross sectional area measurements comprised lumen, vessel, plaque, and emptied plaque cavity. Lumen narrowing was calculated as 1 - (lesion lumen area/reference lumen area) x 100%. A remodelling index was calculated as lesion vessel area/reference vessel area, and plaques were divided into those with values > 1.05 (group A) and </= 1.05 (group B). RESULTS: Of the total of 51 plaques, 36 (71%) were assigned to group A and 15 (29%) to group B. In neither group was there a significant difference in reference dimensions and lumen narrowing. However, lesion vessel (mean (SD): 22.6 (8.1) mm(2) v 17. 5 (4.3) mm(2); p = 0.006) and plaque areas (15.8 (6.2) mm(2) v 12.8 (3.2) mm(2); p = 0.03) were greater in group A than in group B. The cavity inside the plaque was larger in group A than in group B (2.8 (1.6) mm(2) v 1.8 (0.9) mm(2); p = 0.007) and showed a positive linear relation with lesion and reference vessel size (r = 0.58 and 0.56, respectively; p < 0.001), but not with lumen narrowing. CONCLUSIONS: The size of the emptied cavity inside ruptured plaques is on average larger in lesions with adaptive vascular remodelling, and shows a linear relation with lesion plaque and vessel size and with the reference dimensions, but not with the degree of lumen narrowing.

Adult↗
PubMed1999

Usefulness of motion patterns indentified by tissue Doppler echocardiography for diagnosing various cardiac masses, particularly valvular vegetations.

This study sought to test whether anomalous cardiac and aortic structures can be differentiated from native tissue and artifacts by physical properties of tissue motion using transesophageal tissue Doppler echocardiography (TDE). TDE was employed in 85 consecutive patients after anomalous structures had been detected by conventional transesophageal echocardiography (TEE). The control group consisted of 40 randomized patients. Certainty of diagnosis was divided into 4 categories, and TDE signals were related to particular anomalous structures by a blinded second observer. A mechanical model of a beating ventricle was constructed and suspended in a water bath. Synthetic material was utilized to simulate anomalous intracavitary structures with varying shape, consistency, and attachment. Incoherent motion was present in endocarditic vegetations, freely oscillating thrombi, fourth-degree aortic plaques, Chiari network, valvular prolapse, tumors, and in normal valve leaflets and papillary muscles. Within 15 seconds vegetations could be detected in 17 patients (68%) using TDE versus 5 patients (20%) using only conventional imaging. Coherent motion with a phase difference occurred due to damped oscillation. This phenomenon occurred in 5 patients with thrombi of the left atrial appendage (100%), in 3 ventricular clots (75%), and in 2 hypernephroma in the right atrium (100%). Rapid identification of clots could be achieved in 15 patients (71%) versus 12 patients (57%). Concordant motion was shown in third-degree aortic plaques, postrheumatic valvular lesions, and aortic intramural hematomas, but diagnostic benefit could not be demonstrated. In 41 patients (48%) histopathologic and intraoperative results confirmed echocardiographic findings. Motion patterns could be reproduced independently of the heart rate by model experiments. This study demonstrates that TDE expedites the detection of vegetations in infective endocarditis. Diagnostic certainty can be increased as well for thrombus formations.

Adult↗
PubMed1999

M-mode analysis of mitral annulus motion for detection of pseudonormalization of the mitral inflow pattern.

Left ventricular (LV) diastolic dysfunction is a frequent cause of heart failure. Doppler echocardiography has become the method of choice for the noninvasive evaluation of LV diastolic dysfunction. However, pseudonormalization of mitral inflow often presents a diagnostic problem in clinical practice. We sought to define the role of mitral annulus motion in this setting. We performed echocardiography in 36 consecutive subjects (age 59 +/- 10 years). Eighteen had recently (within 3 months) been diagnosed with coronary artery disease, 18 had clinical suspicion of coronary artery disease, and 15 had symptoms of heart failure (New York Heart Association class 2.4 +/- 0.5). The amplitude (E(M)) and the slope (slope E) of early diastolic motion of the septal mitral annulus were derived from M-mode analysis. Left heart catheterization was performed for direct measurement of LV end-diastolic pressure. Pseudonormalization defined by an E/A ratio > 1 and a LV end-diastolic pressure > or = 16 mm Hg was found in 9 patients. All patients with pseudonormalization were symptomatic (New York Heart Association class 2.8 +/- 0.5). Patients with and without pseudonormalization did not differ with respect to the E/A ratio (1.29 +/- 0.44 vs 1.16 +/- 0.23, p = NS), deceleration time (182 +/- 38 vs 205 +/- 42 ms, p = NS), and isovolumic relaxation time (88 +/- 24 vs 92 +/- 18 ms, p = NS). In the group with pseudonormalization, a significant reduction of E(M) (3.9 +/- 1.6 vs 5.7 +/- 1.5 mm, p = 0.008) and slope E (24.5 +/- 11.8 vs 43.9 +/- 7.7 mm/s, p <0.001) was detected. Using E(M) <4.3 mm and slope E <35 mm/s as cut points, sensitivity and specificity for the detection of pseudonormalization were 66% and 82% for E(M) and 77% and 87% for slope E, respectively. There was no significant relation between LV end-diastolic pressure as a measure of preload and either E(M) (r = 0.44, p >0.5) or slope E (r = 0.30, p >0.2). Thus, E(M) and slope E may be preload-independent tools for assessing LV diastolic dysfunction in symptomatic patients with a pseudonormal mitral inflow pattern and elevated filling pressures.

Adult↗
PubMed1999

[Analysis of mitral annulus excursion with tissue Doppler echocardiography (tissue Doppler echocardiography = TDE). Noninvasive assessment of left ventricular, diastolic dysfunction].

BACKGROUND: Mitral inflow velocity, deceleration time, and isovolumic relaxation time recorded by Doppler echocardiography have been widely used to evaluate left ventricular diastolic function but are affected by age, heart rate, loading conditions, and other factors. The diastolic mitral anulus velocity assessed by tissue Doppler echocardiography (TDE) was suggested to provide additional information about LV relaxation less affected by filling pressures. AIM OF THE STUDY: This study was designed to assess the clinical utility of mitral anulus velocity in the evaluation of left ventricular diastolic function. PATIENTS AND METHODS: Three groups of patients with a systolic ejection fraction > 45% were separated: 10 normal volunteers (60 +/- 10 y, CON group), 15 asymptomatic patients with known coronary artery disease (60 +/- 11 y, CAD group) and 15 patients with long-term arterial hypertension and heart failure symptoms (58 +/- 9 y, HYP group). The mitral inflow profile (E, A, E/A) was measured by pulsed Doppler, and the deceleration time (DT) and the isovolumic relaxation period (IVRT) were calculated. Systolic, early, and late diastolic velocities of the septal mitral anulus (ST, ET, AT, ET/AT) were assessed by pulsed TDE. All study subjects had invasive measurements of left ventricular end diastolic filling pressures during left heart catheterization. RESULTS: In the AH group, ET (6.9 +/- 4.8 cm/s) and ET/AT (0.71 +/- 0.28) were reduced compared to the CON group (11.7 +/- 4.7 cm/s and 1.11 +/- 0.36, p < 0.05, respectively) and the CAD group (8.9 +/- 5.4 cm/s and 0.85 +/- 0.26, respectively, p = ns). The groups did not differ with respect to the mitral E/A ratio, the deceleration time and the isovolumic relaxation time. LVED in the HYP group (16 +/- 8 mm Hg) was elevated compared to the CON group (8 +/- 3, p < 0.05) and the CAD group (12 +/- 6 mm Hg, p = ns). No correlation was found between ET and LVED (r = 0.26). When the combination of mitral E/A ratio > 1 with LVED > or = 15 mm Hg was classified as pseudonormalization, the pseudonormalization could be identified by a peak early diastolic mitral anulus velocity (ET) < 7 cm/s and an ET/AT ratio < 1 with a sensitivity of 77% and a specificity of 88%. CONCLUSIONS: The early diastolic mitral anulus velocity assessed by TDE (ET) is a preload-independent index of LV relaxation. TDE permits the detection of diastolic dysfunction in patients with a pseudonormal mitral inflow and elevated filling pressures.

Adult↗
PubMed1999

Improved high-frequency transthoracic flow velocity measurement in the left anterior descending coronary artery after intravenous peripheral injection of levovist.

New ultrasonic technology allows noninvasive measurement of the flow in the distal left anterior descending coronary artery. The goal of this study was to validate transthoracic determination of coronary flow velocity with the intracoronary Doppler flow wire technique. In 20 patients with normal coronary arteries, 2 intracoronary and 2 comparative transthoracic Doppler measurements (TTDMs) of the average peak velocity (APV) and the mean systolic and diastolic velocities were performed. The diastolic/systolic ratio was calculated. Blood flow velocity was determined in the distal left anterior descending coronary artery with a Doppler guide wire. Color Doppler and subsequent pulsed wave Doppler readings in an optimal left lateral position were available within 1 hour after completion of the invasive examinations. TTDM were performed during continuous administration of 2.0 g of contrast agent. A modified apical view was obtained from the fourth or fifth intercostal space, and a high-frequency transducer was used (7 MHz for 2-dimensional and 6 MHz for color Doppler imaging; 3.5 MHz for pulsed wave Doppler readings). The Doppler flow signal quality was graded from I to III (I = no flow mapping obtainable, II = poor quality, III = Doppler signals with a well-defined outline). In 13 (65%) patients, 26 TTDMs revealed signal quality of grade III. APV was calculated to be within normal limits (APVecho = 19.96 +/- 7.62 cm/s vs APVinvasive = 20.77 +/- 7.87 cm/s). APVecho correlated well with APVinvasive (r = 0.85, y = 0.82x + 2.85, P <.001). The mean difference between APVecho and APVinvasive (Bias) was -0.81 +/- 4.23 cm/s. No correlation was found between invasive and noninvasive measurements of diastolic/systolic velocity ratios (P >.05). High-frequency TTDM provides reliable data on APV in the majority of patients. It has the potential to be introduced as a relevant screening test for follow-up of patients after interventional treatment.

Blood Flow Velocity↗
PubMed1999

Tissue Doppler imaging (TDI) for on-line detection of regional early diastolic ventricular asynchrony in patients with coronary artery disease.

Diastolic filling of the left ventricle is often impaired in patients with coronary artery disease (CAD) in the absence of systolic wall motion abnormalities or previous myocardial infarction. The current study was designed to assess the ability of tissue Doppler imaging (TDI) for on-line detection of regional diastolic wall motion abnormalities to identify CAD in patients with preserved systolic function. 20 normal subjects (age 51 +/- 13 years) and 17 CAD patients with normal systolic function and > or = 70% luminal narrowing of the LAD (age 56 +/- 11 years) were included. Coronary anatomy was unknown to the echocardiographer. In the parasternal short axis and the apical 4-chamber-view, peak tissue velocities of the anterior/inferior and the midseptal/midlateral LV segments during rapid ejection (RE), isovolumic relaxation (IR), rapid filling (RF) and atrial contraction (AC) were analyzed by color-M-Mode-TDI. In the apical view, in 13 of 35 (37%) patients with adequate recordings, myocardial asynchrony was detected during IR: while the septum was moving inwards (red color-coding), the lateral wall was moving outwards (blue/green coding). In the remaining 22 patients (63%) a slow, synchronous outward motion of septum and lateral wall with homogeneous color-coding (blue/green) was seen. Unblinding of the coronary status revealed a critical LAD stenosis in all 13 patients (100%) with myocardial asynchrony. Analysis of midseptal peak velocities during IR revealed positive velocities (1.22 +/- 1.64 cm/s) in CAD patients and negative velocities (-1.39 +/- 0.81 cm/s) in normal subjects. Thus, TDI allowed for the on-line detection of early diastolic asynchrony in 13 of 16 (82%) patients with critical LAD-narrowing. Due to the rapid assessment of regional wall motion abnormalities, TDI might help to identify CAD in patients with normal systolic function.

Aged↗
PubMed1998

[Improved structure identification with tissue Doppler echocardiography].

Tissue Doppler echocardiography (TDE) has been shown to be of particular value in patients with impaired myocardial function. Recently, the technique was successfully employed to localize the ventricular insertion of accessory atrioventricular pathways. The identification of abnormal cardiac structures is coming up now as a new field of clinical interest. The purpose of this study was to differentiate anomalous cardiac and aortic from native structures by physical properties of tissue motion using transesophageal TDE. Characteristic motion patterns of anomalous structures have not been described in detail and tissue Doppler findings have not been associated with clinical features up to now. Forty consecutive patients were included after anomalous cardiac or vascular structures had been detected by conventional transesophageal echocardiography (TEE). A control group consisted of 20 subjects. Rapidity of diagnosis in anomalous structures was divided into 3 categories, and TDE signals were related to particular pathology by a blinded, 2nd observer. Three different motion patterns could be defined: incoherent motion due to free oscillation of an anomalous structure which is independent of the surrounding tissue (Figure 1b); coherent motion with a phase difference meaning that motion depends on the motion of the surrounding tissue but is out of phase (Figure 2); concordant motion showing no difference in direction, velocity, or phase of motion compared with the surrounding tissue. Incoherent motion was present in endocarditic vegetations, 4th degree aortic plaques, Chiari network, valvular prolapse, intracavitary tumors, and freely oscillating thrombi as well as in normal valve leaflets and papillary muscles. Especially if endocarditic vegetations are present its incoherent motion facilitates to recognize these small structures. The colorcode of this motion pattern demarcates the vegetation reliably from the surrounding tissue (Figure 1b). Within 15 seconds vegetations could be detected in 9 (82%) vs 2 (18%) patients employing only conventional imaging. Using conventional echocardiographic approaches detection of vegetations is frequently hindered by their small size and minor echo intensity (Figure 1a). In contrast, size and echo intensity do not affect the tissue Doppler signal. Normal papillary muscles and distal portions of the mitral and tricuspid valves were demonstrated to regularly meet the criterion of incoherent tissue motion in the control group. In part, this was also observed with respect to the aortic and pulmonary valves. In valvular tissue incoherent motion was caused by passive floating, whereas papillary muscles show an active inverse motion for short time intervals. Nevertheless, physiologic incoherent motion did not lead to any false differential diagnosis. The phase difference of coherent motion results from damped oscillation. This phenomenon was visualized by tissue Doppler M-mode in 5 thrombi of the left atrial appendage (LAA) (100%) and in 1 ventricular thrombus (50% of all clots). Concordant motion was shown in 3rd degree aortic plaques and postrheumatic and calcified vegetations. These structures were found to be completely embedded or closely attached, so that their passive motion corresponded to the motion of the surrounding regular tissue. Detection and assessment of anomalous structures are based on their motion patterns which can be synchronous or asynchronous in comparison with the surrounding tissue. Another goal of this investigation was to test if the sensitivity of TEE to spontaneous echo contrast can be improved using TDE. In 21 patients presenting with left atrial dilation (left atrial diameter > 44 mm) due to mitral stenosis (n = 8), mitral regurge (n = 5), arterial hypertension (n = 5) and multiple valvular disease (n = 3) fundamental multiplane TEE and transesophageal TDE were performed with standardized gain setting. The control group consisted of 20 randomized individuals with normal left

Aorta, Thoracic↗
PubMed1998

[Asynchrony of ventricular contraction and relaxation--pathophysiologically recognized phenomenon, now can be clinically assessed].

When regional myocardial dysfunction is present, the physiological pattern of ventricular filling and contraction is impaired. During acute coronary occlusion, characteristic changes are observed in the ischemic myocardial segment: the amplitude of the systolic wall thickening is reduced (hypokinesia), then virtually absent (akinesia) and finally replaced by a paradoxical outward motion (dyskinesia). The maximum amplitude is reached in early diastole ("post-ejection thickening"). Since hyperkinesis develops in the normal region, the ischemic and the normal region contract asynchronously. Experimentally left ventricular asynchrony can be detected by means of subendo- and subepicardially implanted ultrasonic crystals ("sonomicrometry") or by the analysis of the phase difference of the first Fourier harmonic of dysfunctional versus control myocardial wall motion. In the clinical setting, digitized cineventriculography, radionuclide angiography and digitized M-mode echocardiography were used to assess left ventricular asynchrony in patients with coronary artery disease and hypertrophic cardiomyopathy. However, these imaging modalities are time-consuming and require complicated off-line analysis. Tissue Doppler echocardiography (TDE) is a new ultrasound modality that is based on color Doppler principles and allows for quantification of myocardial wall motion velocity by detection of consecutive phase shifts of the ultrasound signal reflected from the myocardium. The Doppler signals are displayed as a color or pulsed Doppler image by rejecting low-amplitude echoes from the blood pool due to changes in thresholding and filtering algorithms. In addition, the ability to measure low velocity is improved in the TDE system so that the lowest measurable velocity is 0.2 cm/s, a velocity level associated with cardiac tissue motion (Table 1). Due to its high temporal and spatial resolution, TDE provides valuable information on regional myocardial wall motion during different intervals of the cardiac cycle. In healthy subjects, patients with coronary artery disease and patients with hypertrophic cardiomyopathy, tissue Doppler echocardiography was used to assess myocardial synchrony/asynchrony on a 2-fold temporal and spatial analysis. Peak myocardial velocities in different myocardial regions were detected during rapid ejection, isovolumic relaxation, rapid filling and atrial contraction (Figure 1). In the apical view, during the isovolumic relaxation time (IVRT) healthy subjects showed slow, synchronous outward motion of the septum and the lateral wall with homogeneous color-encoding (blue/green, Figure 2). Analysis of peak velocities revealed low, negative velocities in both the septum and the lateral wall (Figure 3). In patients with a significant luminal narrowing of the LAD myocardial asynchrony was detected during the isovolumic relaxation period: while the septum was moving inwards (red color-encoding with low, positive velocities), the lateral wall was moving outwards (blue/green encoding, low, negative velocities). A representative example of a patient with CAD is given in Figure 4. The M-mode analysis of the abnormally contracting interventricular septum reveals positive peak tissue velocities during the isovolumic relaxation period (Figure 5). In hypertrophic cardiomyopathy, TDE was able to detect an abnormal inward motion of the interventricular septum during IVRT and a delay in the onset of rapid filling (Figure 6). Thus, tissue Doppler echocardiography is a feasible method for the on-line detection of myocardial asynchrony. Sensitivity and specificity of the findings have to be explored in further, prospectively randomized trials.

Cardiomyopathy, Hypertrophic↗
PubMed1998

Dynamic three-dimensional echocardiography using parallel slicing: a promising diagnostic procedure in adults with congenital heart disease.

In 18 of 77 adult patients presenting with congenital heart disease, three-dimensional conceptualization was found to be insufficient using two-dimensional echocardiographic imaging. In these individuals, three-dimensional image reconstruction from digitized parallel images was carried out, providing additional information in 14 of them. Three-dimensional echocardiography and volumetry may, especially in patients with atrial septal defect, cor triatriatum and corrected transposition of the great arteries, be an asset amplifying the diagnostic information yielded by conventional two-dimensional echocardiographic approaches.

Adolescent↗
PubMed1997

Quantitative tissue Doppler in comparison with two-dimensional and Doppler echocardiographic indices in normal subjects.

To assess normal values of left ventricular wall motion velocities with respect to sequential phases of the cardiac cycle 95 normal subjects (mean age 34+/-12 years) were examined using a recently developed method based on the computer software TDI-LaborR enabling a variable time and space related measurement of regional wall velocity from tissue Doppler (TD) images. The study population consisted of three age groups: 16-29 years (group 1, n=34 (36%)), 30-49 years (group 2, n=45 (49%)), >50 years (group 3, n=16 (17%)). Using TD M-mode of the left ventricular posterior wall the mean subendocardial and subepicardial velocity as well as the transmural myocardial velocity were determined for the rapid, slow and atrial filling phases as well as the systole. In addition, standard mitral inflow parameters-E and A velocities were determined by pulsed Doppler echocardiography. The left parasternal window was used. The subendocardial rapid filling and atrial filling myocardial velocity were found to be age significantly dependent. The myocardial rapid filling were correlated to early diastolic mitral inflow velocity and to the ratio of early and atrial flow velocities (r ranges from 0.23 to 0.36, P<0.01). We conclude that aging is accompanied by an increase of atrial filling compensating a reduced myocardial relaxation already before 50 years. Whereas mitral inflow velocities reflect diastolic function indirectly, it is directly indicated by TD myocardial velocity parameters.

Adolescent↗
PubMed1997

Dynamic three-dimensional echocardiography in the assessment of cor triatriatum.

Classic cor triatriatum sinistrum is a rare cardiac malformation to be found in the adult. One year after surgical correction of an atrial septal defect in a 55-year-old man, cor triatriatum sinistrum was diagnosed by transesophageal echocardiography. We compared transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization to dynamic three-dimensional echocardiography (3-D echo) which offers a new, noninvasive approach to determine the opening size between the accessory and the true left atrium. The findings by 3-D echo, confirmed by left heart catheterization, showed that the accessory membrane was not stenosing. Surgical correction was therefore not indicated in this patient.

Cardiac Catheterization↗
PubMed1997

[Quantitative tissue Doppler echocardiography in comparison with M-mode measurements in healthy probands].

Quantitative tissue Doppler echocardiography is a new diagnostic approach to left ventricular systolic performance. The aim of the present study was to validate a recently developed method based on the computer software TDI-Labor enabling a variable time and space related measurement of regional wall velocity from tissue Doppler images. Therefore, in 63 volunteers the mean velocity of a 2 mm thick subendocardial slice during the systolic ejection period was determined from frozen tissue Doppler M-mode images of the left ventricular posterior wall obtained using the left parasternal window. The same images were employed for comparative measurement of the mean endocardial velocity using the conventional M-mode slope approach. Tissue Doppler data of the subendocardial wall velocity were found to correspond closely to the mean endocardial wall velocity (y = 0.97x + 0.17; r = 0.77; p < 0.0001). The average wall motion gradient of the population was 1.33 +/- 0.35. Wall motion velocity and wall motion gradient were shown to be not age dependent. The new software approach to an improved analysis of wall motion offering any sized sample volumes and time intervals for wall velocity measurements can be regarded as an exact and easily feasible method. Further clinical and experimental investigations are needed to evaluate its diagnostic relevance to the detection of ischemia and other myocardial dysfunction.

Adolescent↗
PubMed1997

Stress echocardiography: new techniques.

Stress echocardiography is frequently used to evaluate coronary artery disease, and also in quantitative assessment of right and left ventricular function or cardiac valve integrity in patients with cardiomyopathy or during chemotherapy. Various new ultrasound techniques in stress echocardiography are now playing a significant role in this important area of cardiological diagnostics. New methods of echocardiographic signal processing have been developed to provide more quantitative and reproducible information on cardiac function during stress. The most important are: (1) raw data analysis techniques for endocardial border detection (acoustic quantification, CK = colour kinesis), (2) tissue Doppler imaging for myocardial velocity analysis and (3) transpulmonary contrast agents (Albunex, Laevovist, BY 963) for improving endocardial border delineation and for future analysis of myocardial perfusion. Like all new techniques, they must first be subjected to comprehensive scientific assessment, and appropriate training should be given, taking into account physical and physiological limits. These limits will constantly be redefined as echocardiographic techniques continue to change presenting new challenges for the further development of ultrasound technology. In this review, the improved new techniques will be discussed in detail.

Animals↗
PubMed1996

Preoperative two- and three-dimensional transesophageal echocardiographic assessment of heart tumors.

BACKGROUND: Two-dimensional transesophageal echocardiography is the most widely used diagnostic approach in the rare entity of heart tumors. The aim of this study was to assess the diagnostic usefulness of three-dimensional echocardiography in comparison with the two-dimensional technique in a rare clinical setting. METHODS: Twenty-seven patients (18 women; mean age, 49.7 +/- 14 years) with a histologically proven diagnosis of a cardiac tumor were studied. The primary diagnosis was done by a two-dimensional transthoracic echocardiography (n = 9) and transesophageal echocardiography (n = 18). In addition, we performed three-dimensional transesophageal assessment in 5 patients with left atrial myxomas. The echocardiographic findings were compared with the intraoperative appearance and pathologic diagnosis. RESULTS: The echocardiographically suspected diagnosis of a heart tumor in 29 cases was histologically correct in 27 patients (myxomas, 20; epicardial lipoma, 1; malignant epicardial mesothelioma, 1; metastatic processes of hypernephromas, 2; and undifferentiated tumors of the pericardium, 3). Only the combination of multiplane transesophageal and three-dimensional echocardiography was able to demonstrate the shape, dimensions, location, origin, surface, three-dimensional movement, and involvement of valves and was most useful in the preoperative diagnosis and planning. CONCLUSIONS: Three-dimensional transesophageal echocardiography yields important additional clinical information and improves the operative planning. Three-dimensional echocardiography may become the best approach to study the anatomy and pathology of the heart as it provides an objective display of cardiac size and shape in heart tumors.

Adult↗
PubMed1996

Multiplane transoesophageal echocardiography is the only definitive ultrasound approach in adult supravalvular aortic stenosis.

This report describes a rare case of isolated supravalvular aortic stenosis (SVAS) in a 28 year-old female patient. A congenital heart defect, diagnosed at birth, was until 1994 suspected to be a valvular aortic stenosis (VAS). Cardiac catheterization led to the diagnosis of supravalvular aortic stenosis, which could easily be confirmed by multiplane but not by monoplane transoesophageal echocardiography (TEE). Precordial examinations had not revealed the vitium, probably because the SVAS is a rare malformation of the ascending aorta, but with multiplane TEE the aortic narrowing could be imaged clearly and pressure gradients comparable to those found with invasive measurements were established. The advantage of this non-invasive method for diagnosis and preoperative preparation are discussed in detail.

Adult↗