scholarly journals Πρόβλεψη ανταπόκρισης στη θεραπεία καρδιακού επανασυγχρονισμού με υπερηχογραφικά κριτήρια σε ασθενείς με καρδιακή ανεπάρκεια

2020 ◽  
Author(s):  
Εμμανουήλ Πουλιδάκης
Keyword(s):  
Wall Motion ◽  
Circumferential Strain ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Time To Peak ◽  
Mode 2 ◽  
Apical Rocking ◽  
Septal Flash

Ιστορικό: Η μη ανταπόκριση στη θεραπεία καρδιακού επανασυγχρονισμού (ΘΚΕ) παραμένει ένα ζήτημα, παρά τη βελτίωση των κριτηρίων επιλογής. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση του ρόλου της ηχωκαρδιογραφίας για την επιλογή ασθενών που θα έχουν ανταπόκριση ή καθυστερημένη ανταπόκριση σε ΘΚΕ, χρησιμοποιώντας παραμέτρους δυσυγχρονισμού και εφαρμογές δυναμικής ηχωκαρδιογραφίας. Μέθοδοι: 106 ασθενείς με συμπτωματική καρδιακή ανεπάρκεια εξετάστηκαν πριν, 6 μήνες μετά και 2 έως 4 χρόνια μετά την εφαρμογή του ΘΚΕ. Η ινότροπη συστολική εφεδρεία (ΙΣΕ) και η βιωσιμότητα του οπισθίου τοιχώματος της αριστερής κοιλίας (ΟΤΑΚ) μελετήθηκαν με δυναμική ηχωκαρδιογραφία. Ο δυσυγχρονισμός εκτιμήθηκε με: 1) Καθυστέρηση κίνησης μεταξύ διαφραγματικού και οπισθίου τοιχώματος (Septal-to-posterior wall motion delay - SPWMD με m-mode 2) Καθυστέρηση μεταξύ διαφραγματικού και πλαγίου τοιχώματος (Septal to lateral wall delay -SLD) από το TDI 3) Διακοιλιακή μηχανική καθυστέρηση (Interventricular mechanical delay -IVMD) 4) Διαφορά στο χρόνο μέχρι τη μέγιστη κυκλοτερή παραμόρφωση (Difference in time to peak circumferential strain -TmaxCS) με ηχωκαρδιογραφία ιχνηλάτησης σημείων 5) «Ταλάντωση κορυφής» (Apical rocking - ApR) και «αναλαμπή μεσοκοιλιακού διαφράγματος» (septal flash - SF) με οπτική εκτίμηση. Αποτελέσματα: Σε έξι μήνες υπήρχαν 54 άτομα που ανταποκρίθηκαν, και δώδεκα επιπλέον άτομα είχαν καθυστερημένη ανταπόκριση. Το TmaxCS είχε τη μεγαλύτερη προγνωστική αξία, με μια περιοχή κάτω από την καμπύλη (AUC) 0,835, ακολουθούμενο από την συνδυασμένη παρουσία ΙΣΕ και βιωσιμότητας του ΟΤΑΚ (AUC 0,799), το m-mode (AUC = 0,775) και την παρουσία ApR ή/και SF (AUC = 0.772). Η προγνωστική ικανότητα του ApR και του ICR αυξάνεται εάν συμπεριληφθούν και τα άτομα με καθυστερημένη ανταπόκριση. Η απόδοση των παραμέτρων δυσυγχρονισμού ενισχύεται, σε ασθενείς με ΙΣΕ και βιωσιμότητα του ΟΤΑΚ. Συμπέρασμα: Η δυναμική ηχωκαρδιογραφία και οι παράμετροι δυσυγχρονισμού είναι απλοί και αξιόπιστοι δείκτες πρόβλεψης της απόκρισης στη ΘΚΕ, εντός 6μήνου ή καθυστερημένα. Μια σταδιακή προσέγγιση με μια αρχική εκτίμηση ΙΣΕ και βιωσιμότητας και, εάν αυτή είναι θετική, μια περαιτέρω ανάλυση δυσυγχρονισμού, θα μπορούσε να βοηθήσει στην λήψη αποφάσεων σε αμφιλεγόμενες κλινικά περιπτώσεις.

Abstract 2477: Ventricular Synchrony can be Preserved by Right Ventricular Septal Pacing Compared with Right Ventricular Apical Pacing: Evaluation by Ultrasound Speckle-Tracking Imaging and Tissue Doppler Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Chisato Izumi ◽  
Shuichi Takahashi ◽  
Sumiyo Hashiwada ◽  
Hidetaka Hayashi ◽  
Jiro Sakamoto ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Speckle Tracking ◽  
Circumferential Strain ◽  
Radial Strain ◽  
Lateral Wall ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Speckle Tracking Imaging ◽  
Myocardial Velocity ◽  
Time To Peak

Objectives: Traditional right ventricular apical (RVA) pacing may induce ventricular dyssynchrony in patients with normal left ventricular (LV) function. The purpose of this study is to elucidate the influence of pacing sites on the ventricular dyssynchrony, using ultrasound speckle-tracking imaging and tissue Doppler imaging. Methods: We investigated 24 patients with normal LV function who underwent DDD pacemaker implantation. Right ventricular lead position was apex in 18 patients and septum in 6 patients. Radial strain and circumferential strain were measured using ultrasound speckle-tracking imaging (Vivid 7, GE) from short axis view at papillary muscle level. Myocardial velocity was measured by tissue Doppler imaging in mid-segments from apical 4-chamber view. The difference of time to peak radial strain, circumferential strain, and systolic myocardial velocity between septal and lateral wall were compared between during patients’ intrinsic rhythm and pacing rhythm, and between patients with RVA pacing and right ventricular septal (RVS) pacing. Results: In 18 patients with RVA pacing, difference of time to peak circumferential strain and systolic myocardial velocity between septal and lateral wall were larger during pacing rhythm than during patients’ intrinsic rhythm (circumferential strain: 118±57 vs 59±48msec, p<0.01, myocardial velocity: 75±47 vs 52±40msec, p<0.05). On the other hand, in 6 patients with RVS pacing, difference of time to peak radial strain, circumferential strain and systolic myocardial velocity during pacing rhythm were the same as those during patients’ intrinsic rhythm. Difference of time to peak circumferential strain between septal and lateral wall was smaller in patients with RVS pacing than patients with RVA pacing (37±50 vs 118±57msec, p<0.005). Conclusions: Ventricular synchrony can be preserved by RVS pacing compared with RVA pacing.

scholarly journals Analysis of Segmental Strain for the Detection of Chronic Ischemic Scars in Non-Contrast Cardiac MRI Cine Images: A Feasibility Study

2020 ◽  
Author(s):  
Malgorzata Polacin ◽  
Mihaly Karolyi ◽  
Matthias Eberhard ◽  
Alexander Gotschy ◽  
Bettina Baessler ◽  
...  
Keyword(s):  
Wall Motion ◽  
Circumferential Strain ◽  
Radial Strain ◽  
Scar Tissue ◽  
Remote Myocardium ◽  
Healthy Individuals ◽  
Polar Plot ◽  
Global Strain ◽  
Motion Assessment ◽  
Global Peak

Abstract Aims Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate the feasibility of scar detection in segmental strain calculations based on routinely acquired non-contrast cine images in patients with chronic infarcts.Methods Forty-six patients with chronic infarcts and scar tissue in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age- matched healthy controls (2 female, mean age 47 ± 13 years) were included. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Two independent blinded readers localized potentially infarcted segments in segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) and by visual wall motion assessment of cine images. Results Global strain values were reduced in patients compared to controls (GPCS p= 0.02; GPLS p= 0.04; GPRS p= 0.01). Patients with preserved ejection fraction showed also reduced GPCS compared to healthy individuals (p=0.04). In patients, mean SPCS was significantly impaired in subendocardially (- 5,4% +/- 2) and in transmurally infarcted segments (- 1,2% ± 3) compared to remote myocardium (-12,9% +/- 3, p= 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut- off value for SPCS for discriminating infarcted from remote myocardium of - 7,2 % with a sensitivity of 89,4 % and specificity of 85,7%. Mean SPRS was impeded in transmurally infarcted segments (15,9 % +/- 6) compared to SPRS of remote myocardium (31,4% +/- 5; p= 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16,6% with a sensitivity of 83,3% and specificity of 76,5%. 80.3 % of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Conclusion Global strain parameters are impaired in patients with chronic infarcts compared to healthy individuals. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected by visual wall motion assessment. Analysis of segmental circumferential strain shows a promising alternative for scar detection based on routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium.

scholarly journals Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx

2013 ◽  
Vol 4 (1) ◽  
pp. 57-58
Author(s):  
Sagaya Raj ◽  
Shuaib Merchant ◽  
Azeem Mohiyuddin ◽  
P Arun
Keyword(s):  
Head And Neck ◽  
Clinical Presentation ◽  
Surgical Excision ◽  
Myxoid Liposarcoma ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Low Grade ◽  
Present Case Report ◽  
Case Presentation ◽  
Histologic Pattern

ABSTRACT Aims To describe an unusual presentation of myxoid liposarcoma of oropharynx and a brief review of literature. Introduction Liposarcomas of head and neck are very rare. Its treatment and prognosis mainly depends on the site and the histologic pattern of the tumor. Case presentation The present case report describes a 65-year-old male with complaints of dysphagia, dyspnea, and a peculiar complaint of mass in the throat which turned out to be a low-grade myxoid liposarcoma arising from right lateral wall of oropharynx extending intraluminal in the esophagus, compressing posterior wall of trachea. The mass was successfully excised surgically and postoperative period was uneventful and patient was asymptomatic 4 months after surgery. Conclusion Myxoid liposarcoma is a rare tumor in head and neck and surgical excision with adequate margin is the treatment of choice. How to cite this article Mohiyuddin A, Raj S, Merchant S, Arun P. Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx. Int J Head and Neck Surg 2013;4(1):57-58.

Abstract 15692: Voltage Mapping in Atrial Fibrillation vs Sinus Rhythm: Results From the Mavs Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Carola Gianni ◽  
Jerri A Cunningham ◽  
Sanghamitra Mohanty ◽  
CHINTAN TRIVEDI ◽  
Domenico G Della Rocca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Low Voltage ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Inferior Wall ◽  
Voltage Mapping ◽  
First Time ◽  
Mapping Catheter

Background: Left atrial (LA) scar can be identified with bipolar voltage mapping during sinus rhythm (SR). It is not clear whether the same voltage criteria can be applied during atrial fibrillation (AF). Objective: Aim of this study was to compare voltage maps performed in the same patient both in AF and SR. Methods: Voltage mapping was performed using a 10-pole circular mapping catheter in patients with non-paroxysmal AF undergoing first time RF ablation. For descriptive purposes, the LA was divided in 6 regions: septum, posterior wall (PW), inferior wall (IW), lateral wall, anterior wall, and roof. The threshold for low voltage was <0.5 mV (with a color range setting 0.2-0.5 mV). Mild “scar” was defined as an area low voltage 5-20%, moderate 20-35% and severe as >35%. Results: 16 patients (62% persistent AF, 38% longstanding persistent AF) were included in the study. The map density was comparable during AF and SR (mean points per map 551 vs 547, paired t test P = NS). 2 patients displayed normal voltage during both AF and SR. 14 patients showed areas of low voltage during AF, which were still present during SR in 8. All patients with mild “scarring” during AF (n = 4), showed normal voltage during SR. Of the 7 patients with moderate “scarring”, 2 patients showed normal voltage during SR, while in the remaining 5 “scarring” was only mild during SR. 3 patients showed extensive “scarring” during AF, which was only moderate during SR. During AF, areas of low voltage were more commonly observed in the PW (12/14) followed by the IW (6/14) and antero-septum (4/14); while in SR, in the antero-septum (4/8), PW (3/8) and IW (3/8). Interestingly, in all patients both the PW/IW and (less dramatically) the antero-septum showed more “scarring” during AF as compared to SR. Conclusion: Areas of low voltage are more severe and diffuse during AF when compared to SR. When areas of low voltage are detected during AF, they are more commonly seen in the PW, IW and antero-septal areas.

P2567First experience of non-invasive and invasive activation maps merge in carto system for topical diagnosis of focal arrhythmias

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Budanova ◽  
M Chmelevsky ◽  
S Zubarev ◽  
D Potyagaylo ◽  
L Parreira ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Operation Time ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Late Enhancement ◽  
Ablation Procedure ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Topical Diagnosis ◽  
Endocardial Surface

Abstract Background Correct preoperative topical diagnostics of atrial and ventricular arrhythmias allows for operation time reduction by facilitating the ablation target localization, especially in case of several ectopic sources. Purpose To implement a non-invasive electrocardiographic imaging (ECGI) technique in CARTO system for aiming at topical diagnostics of focal arrhythmias improving. Methods Twelve patients (m/f – 10/2, age (min–max) – 50,5 (32–71)) with focal arrhythmias underwent ECGI in combination with CT or MR imaging. Two subjects had atrial premature contractions (PAC), while ten patients suffered from ventricular premature contractions (PVC) with indications for ablation. Before the ablation procedure Carto LAT mapping was performed in all patients. Using ECGI epi-/endocardial polygonal models of the heart were created, isopotential and activation maps were calculated, uploaded into the Carto system and merged with the CARTO FAM models (Figure 1). Results For six patients with PVC and two patients with PAC, earliest activation zones (EAZs) anatomical locations obtained by invasive and non-invasive methods were the same (RVOT septum, RVOT lateral-anterior and RV lateral-basal walls, right aortic cusp, LVOT, coronary sinus (CS), CS ostium, RA posterior wall), and arrhythmias ablation was successful. Two patients featured coherent EAZs (RV lateral-basal wall and RVOT septum) but a negative ablation outcome. In one patient, EAZs were situated in different anatomical regions: CARTO showed the PVC EAZ in RV septum, whereas Amycard system identified endocardial surface of lateral-basal RV wall. In this patient, PVC was ablated partially. For another patient with MRI late enhancement area in LV lateral wall the EAZs were in the same LV segment but with mismatch in epi/endocardial surface. Conclusion Non-invasive and invasive activation maps merge can improve localization of ablation targets in focal arrhythmias, potentially increasing effectiveness of the EP procedure and reducing operation time.

P5429Mechanical dyssynchrony has a higher predictive value for CRT response than different ECG-based definitions of LBBB

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Beela ◽  
J Duchenne ◽  
J U Voigt
Keyword(s):  
Area Under The Curve ◽  
Response Prediction ◽  
Response To Therapy ◽  
Cardiac Resynchronization ◽  
Total Width ◽  
Systolic Volume ◽  
2D Echocardiography ◽  
Definition Of ◽  
Apical Rocking ◽  
Septal Flash

Abstract Background/Aim To investigate the value of baseline assessment of mechanical dyssynchrony (Dyss) in predicting response to cardiac resynchronization therapy (CRT) in comparison to the classic ECG definition of left bundle branch block (LBBB) (Classic-def) as well as the recently proposed Sex- based definition (Sex-def.). Methods The baseline ECGs of 194 patients (31% females, 39% with ischemic cardiomyopathy, mean QRS width 159±25 ms and mean LVEF 29±8%) were investigated for identifying the criteria of LBBB before CRT implantation. Classic-def., defined as notched or slurred QRS complex in at least two of the leads I, aVL, V1, V2, V5 and V6 with a total width of at least 120 ms in addition to the absence of Q wave in lead I, V5 and V6 was identified in 74% of the study population. Sex-def. was identified in 69%, which is a QRS duration of at least 140 and 130 ms for men and women respectively with otherwise the same criteria of the Classic definition. Dyss was defined as the presence of either apical rocking and/or septal flash in 2D echocardiography prior to implantation. Volumetric response to CRT was defined as a reduction of at least 15% of the LV-end systolic volume (ESV) at follow up echocardiography (12±6 months after device implantation). Results Patient with baseline Dyss showed the highest response rates (76%) with a sensitivity of 88%, a specificity of 63% and an area under the curve (AUC) of 0.76 (P<0.001) compared to 70% (sensitivity 82%, specificity 47%, AUC 0.65, P<0.01) in patients with Sex-def. and 65% (sensitivity 84%, specificity 40%, AUC 0.62, P=0.01) in patients with Classic-def. (Figure A). Pairwise comparisons showed that the accuracy of the Sex-def. did not differ significantly from the Classic-def. in response prediction (AUC=0.65 vs. 0.62 for Sex-def. vs. Classic-def. respectively, P=0.27). Alternatively, Dyss showed a significantly higher accuracy in predicting response to therapy (AUC=0.76) as compared to Sex-def. and Classic-def. (P=0.02 and <0.01 respectively, Figure B). Mech. dyssynchrony vs. ECG-based LBBB Conclusion The presence of Apical rocking and/or septal flash before CRT is associated with better response to CRT as compared to various ECG definitions of LBBB. Although a Sex-based definition of LBBB showed a trend of better response to CRT as compared to the Classic definition, it was not statistically significant.

Incidence and pathological features of metachronous bladder cancer in prostate cancer patients treated with brachytherapy or radical prostatectomy in a single institution.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 111-111
Author(s):  
Kotaro Obayashi
Keyword(s):  
Bladder Cancer ◽  
Radical Prostatectomy ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Pathological Features ◽  
Chi Square ◽  
Left Wall ◽  
Tumor Number ◽  
Muscle Invasive ◽  
The Right

111 Background: Although previous studies have reported that the incidence of metachronous bladder cancer (MBC) is not significantly different after brachytherapy (BT) compared to radical prostatectomy (RP), few studies have reported differences in the pathological features (PF) of MBC between them. This study was conducted to clarify differences in the incidence and PF of MBC between BT and RP in our hospital. Methods: We reviewed 504 patients treated with BT and 471 referred patients treated with RP from 2006 to 2017 in our hospital. We checked the incidence of MBC in all patients and examined the PF including the tumor number, location within the bladder, histology, and time from BT or RP to the occurrence. The chi-square test and Mann-Whitney U test were performed to analyze the differences between the two groups. Results: After a median follow-up time of 66 months, a total of 8 cases of BC occurred in the BT group (1.6 %) and 5 in the RP group (1.1 %). The median time from initial treatment to the occurrence of MBC was 56 months (12-121) in BT and 71 months (4-126) in RP (p = 0.622). Average tumor number was not significantly different (BT:1.38, RP: 2.2, p = 0.265). The incidence of MBC in each location within the bladder for BT vs. RP was 4 vs 0 in the right wall, 3 vs 0 in the left wall, 0 vs 3 in the posterior wall, 0 vs 2 in the dome, and 1 vs 0 in the trigone. The incidence in the lateral wall was significantly higher in BT than in RP (p = 0.00466). There were 3 muscle-invasive cases in BT and 1 case in RP (p = 1.00). High-grade urothelial cancer occurred more in BT 8 than in RP 1 (p = 0.00699). Conclusions: The risk of MBC after BT appeared to be equivalent to patients after RP. MBC after BT occurred more in the lateral wall with worse PF compared to those after RP.

Color M-Mode Echocardiography Is More Reproducible than Conventional M-Mode Echocardiography for Septal-to-Posterior Wall Motion Delay Measurements

2008 ◽  
Vol 25 (8) ◽  
pp. 821-826 ◽  
Author(s):  
Vincent L. Sorrell ◽  
William D. Ross ◽  
Jeff Gregoire ◽  
Imran Ata
Keyword(s):  
Wall Motion ◽  
Posterior Wall
Sign in / Sign up

Export Citation Format

Share Document