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1.
Strain Echocardiography to Predict Postoperative Atrial Fibrillation.
Sánchez, FJ, Pueyo, E, Diez, ER
International journal of molecular sciences. 2022;(3)
Abstract
Postoperative atrial fibrillation (POAF) complicates 15% to 40% of cardiovascular surgeries. Its incidence progressively increases with aging, reaching 50% in octogenarians. This arrhythmia is usually transient but it increases the risk of embolic stroke, prolonged hospital stay, and cardiovascular mortality. Though many pathophysiological mechanisms are known, POAF prediction is still a hot topic of discussion. Doppler echocardiogram and, lately, strain echocardiography have shown significant capacity to predict POAF. Alterations in oxidative stress, calcium handling, mitochondrial dysfunction, inflammation, fibrosis, and tissue aging are among the mechanisms that predispose patients to the perfect "atrial storm". Manifestations of these mechanisms have been related to enlarged atria and impaired function, which can be detected prior to surgery. Specific alterations in the atrial reservoir and pump function, as well as atrial dyssynchrony determined by echocardiographic atrial strain, can predict POAF and help to shed light on which patients could benefit from preventive therapy.
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2.
Pre- and Postoperative Imaging of the Aortic Root.
Hanneman, K, Chan, FP, Mitchell, RS, Miller, DC, Fleischmann, D
Radiographics : a review publication of the Radiological Society of North America, Inc. 2016;(1):19-37
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Abstract
Three-dimensional datasets acquired using computed tomography and magnetic resonance imaging are ideally suited for characterization of the aortic root. These modalities offer different advantages and limitations, which must be weighed according to the clinical context. This article provides an overview of current aortic root imaging, highlighting normal anatomy, pathologic conditions, imaging techniques, measurement thresholds, relevant surgical procedures, postoperative complications and potential imaging pitfalls. Patients with a range of clinical conditions are predisposed to aortic root disease, including Marfan syndrome, bicuspid aortic valve, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Various surgical techniques may be used to repair the aortic root, including placement of a composite valve graft, such as the Bentall and Cabrol procedures; placement of an aortic root graft with preservation of the native valve, such as the Yacoub and David techniques; and implantation of a biologic graft, such as a homograft, autograft, or xenograft. Potential imaging pitfalls in the postoperative period include mimickers of pathologic processes such as felt pledgets, graft folds, and nonabsorbable hemostatic agents. Postoperative complications that may be encountered include pseudoaneurysms, infection, and dehiscence. Radiologists should be familiar with normal aortic root anatomy, surgical procedures, and postoperative complications, to accurately interpret pre- and postoperative imaging performed for evaluation of the aortic root. Online supplemental material is available for this article.
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3.
Integrating Biomarkers and Imaging for Cardiovascular Disease Risk Assessment in Diabetes.
Tehrani, DM, Wong, ND
Current cardiology reports. 2016;(11):105
Abstract
Cardiovascular disease (CVD) risk assessment has changed substantially in recent years. While older guidelines considered diabetes a coronary disease risk equivalent, more recent guidelines recommend risk stratification on the basis of global risk scoring to target intensity of therapy. While patients with diabetes as a whole are at greater risk for CVD events, these patients may also benefit from risk stratification based on circulating biomarkers like high-sensitivity C-reactive protein, high-sensitivity cardiac troponin T, and N-terminal pro-B-type natriuretic peptide, as well as newer imaging modalities (coronary artery calcium, carotid intima-media thickness, and myocardial perfusion imaging). The addition of these CVD risk assessment modalities could play an important role for deciding how aggressive a physician should be with pharmacological therapy. Here, we discuss many of the current recommendations of CVD risk assessment in patients with diabetes including newer modalities for CVD risk assessment.
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4.
Clinical implications of pulmonary shunting on saline contrast echocardiography.
Velthuis, S, Buscarini, E, Gossage, JR, Snijder, RJ, Mager, JJ, Post, MC
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2015;(3):255-63
Abstract
Pulmonary right-to-left shunting can be encountered using transthoracic contrast echocardiography (TTCE) with agitated saline. Diseases associated with pulmonary shunting on saline TTCE include hereditary hemorrhagic telangiectasia (HHT), hepatopulmonary syndrome, and some congenital heart defects after partial or complete cavopulmonary anastomosis. Furthermore, small pulmonary shunts on saline TTCE are also documented in a proportion of healthy individuals. Pulmonary shunting carries the risk for severe neurologic complications due to paradoxical embolization. In HHT, additional chest computed tomography is recommended in case of any pulmonary shunt detected on saline TTCE, to evaluate the feasibility for transcatheter embolotherapy of pulmonary arteriovenous malformations. Furthermore, antibiotic prophylaxis is advised in case of any pulmonary shunt on saline TTCE to prevent brain abscesses after procedures with risk for bacteremia. The present review provides an overview of important aspects of pulmonary shunting and its detection using saline TTCE. Furthermore, advances in understanding the clinical implications of different pulmonary shunt grades on saline TTCE are described. It appears that small pulmonary shunts on saline TTCE (grade 1) lack any clinical implication, as these shunts cannot be used as a diagnostic criterion for HHT, are not associated with an increased risk for neurologic complications, and represent pulmonary arteriovenous malformations too small for subsequent endovascular treatment. This implies that additional chest computed tomography could be safely withheld in all persons with only small pulmonary shunts on saline TTCE and sets the stage for further discussion about the need for antibiotic prophylaxis in these subjects. Besides further optimization of the current screening algorithm for the detection of pulmonary arteriovenous malformations in HHT, these observations can be of additional clinical importance in other diseases associated with pulmonary shunting and in those healthy individuals with documented small pulmonary shunts on saline TTCE.
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5.
Saline Contrast Echocardiography in the Era of Multimodality Imaging--Importance of "Bubbling It Right".
Gupta, SK, Shetkar, SS, Ramakrishnan, S, Kothari, SS
Echocardiography (Mount Kisco, N.Y.). 2015;(11):1707-19
Abstract
Saline contrast echocardiography is an established imaging modality. Logical interpretation of a carefully performed study is vital to realize its diagnostic potential. In this review, we discuss utility of saline contrast echocardiography in evaluation of various pathologies within and outside the heart other than a patent foramen ovale.
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6.
Echocardiographic examination of the posterior atrioventricular groove.
Silbiger, JJ
Echocardiography (Mount Kisco, N.Y.). 2014;(2):223-33
Abstract
Abnormalities of the posterior atrioventricular (AV) groove may be mischaracterized or overlooked in the course of routine echocardiographic imaging. Vascular abnormalities in this location include plethora of the coronary sinus and ectasia of the circumflex coronary artery. Excess accumulation of calcium (mitral annular calcification) and of fat (lipomatosis of the posterior AV groove) may also occur in this region. Masses (tumors or thrombus) arising from the floor of the left atrium or extrinsic to it (hiatal hernia, lymph nodes) may occupy the posterior AV groove. Abnormalities of the left ventricle, including aneurysms and pseudoaneurysms may present as masses in the posterior AV groove. This article discusses the echocardiographic features, differential diagnosis, and clinical significance of these abnormalities.
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7.
The diagnosis and treatment of acute pulmonary embolism.
Schellhaass, A, Walther, A, Konstantinides, S, Böttiger, BW
Deutsches Arzteblatt international. 2010;(34-35):589-95
Abstract
BACKGROUND Pulmonary embolism (PE) is a cardiovascular emergency with high morbidity and mortality. METHODS Review of relevant literature retrieved by a selective Medline search, including current guidelines. RESULTS Hemodynamically unstable patients are considered to have high-risk PE, whereas hemodynamically stable patients are considered to have non-high-risk PE. After classification into one of these two risk groups, patients undergo further diagnostic evaluation for PE according to the appropriate risk-adapted algorithm. Patients who are in cardiogenic shock or have persistent arterial hypotension (high-risk PE) should undergo multidetector computed tomography (MDCT) or echocardiography at once, so that a PE, if present, can be treated immediately by thrombolysis. For hemodynamically stable patients with non-high-risk PE the proper diagnostic strategy is determined by the clinical probability of PE, which can be calculated with the aid of validated scoring systems and is based on both MDCT and D-dimer levels. For further risk stratification in hemodynamically stable patients, tests are performed to detect right ventricular dysfunction or myocardial injury, either of which indicates intermediate-risk PE. In addition to specific therapy, patients with high-risk PE, patients at high risk for hemorrhage and these with severe renal insufficiency should be anticoagulated with unfractionated heparin. All other patients should be treated with low-molecular-weight heparin or fondaparinux. Thereafter, long-term oral anticoagulation with vitamin K antagonists is recommended. CONCLUSION Modern algorithms have considerably simplified the diagnosis and treatment of acute PE. It would be desirable for these algorithms to be rapidly implemented in routine practice, because speedy diagnosis and immediate treatment can lower the morbidity and mortality associated with PE.
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8.
Assessment of pulmonary vasculature and right heart by invasive haemodynamics and echocardiography.
Hemnes, AR, Forfia, PR, Champion, HC
International journal of clinical practice. Supplement. 2009;(162):4-19
Abstract
Understanding the haemodynamical profile of the right ventricle and pulmonary circulation is critical to not only the initial evaluation of, but also the continued management of pulmonary hypertension. Despite advances in non-invasive imaging techniques, right heart catheterisation (RHC) remains the gold standard for diagnosis of pulmonary hypertension and its various causes. Even so, integration of invasive haemodynamical data with the echo-Doppler exam provides the most comprehensive assessment of the pathophysiology of pulmonary hypertension in the individual patient. Here, we review technical aspects of basic RHC as well as specialised procedures including exercise and fluid challenge in the evaluation of pulmonary hypertension. Interpretation of data in the context of pulmonary vascular disease is discussed. Echocardiographical assessment of the right ventricular structure and function in pulmonary vascular disease are discussed along with the integration of haemodynamical and echocardiographical data in the clinical context.
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9.
[The role of noninvasive methods of investigation in diagnosis of atherosclerosis].
Belenkov, IuN, Sergienko, VB
Kardiologiia. 2007;(10):37-44
Abstract
Visualization of the myocardium with the use of various high technologies gains more and more important significance in diseases of cardiovascular system. Large value for investigations of the heart and blood vessels have acquired methods of echocardiography, magnetic resonance tomography, spiral computed tomography, as well as large spectrum of methods of nuclear cardiology. Contemporary value of instrumental methods of investigation for diagnostics of atherosclerosis is discussed in this paper and diagnostic possibilities of various techniques for assessment of the state of myocardium, pathological changes of vascular wall and for visualization of atherosclerotic plaques (AP) are presented. Advantages and drawbacks of methods, their complex application for objective analysis of changes in AP and their clinical significance are considered. Special accent is made on early diagnosis of pathological derangements, because full value information allows making adequate decisions about subsequent curative measures. It is shown that detection and evaluation of early signs of atherosclerosis appears to be determining factor of efficacy of treatment. In patients without obvious symptoms of ischemic heart disease or at the background of postinfarction cardiosclerosis nuclear cardiology with assessment of myocardial perfusion by single photon emission computed tomography and positron emission tomography (PET) appears rather valuable for assessment of viability even when coronary arteries are unchanged. Important significance for detection of cardiosclerosis has also acquired spiral computed tomography, which allows to reveal calcium in blood vessels. The use of multislice computed tomography in perspective might partially replace coronary angiography especially for assessment of degree of stenoses and patency of grafts. On initial stages of atherosclerosis information on AP structure especially on the presence of inflammatory component is very important. Definite successes become noticeable with application of magnetic resonance tomography for detection of AP. However, probably, further perfection of equipment and methodological approaches with the use of novel contrasts is necessary. In this plane definite successes are achieved by PET and combined examinations by methods of PET/CT integrating advantages of both techniques.
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10.
Commonly used respiratory and pharmacologic interventions in the echocardiography laboratory.
Wesley Reagan, B, Helmcke, F, Kenneth Kerut, E
Echocardiography (Mount Kisco, N.Y.). 2005;(5):455-60