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Elevated B-Type Natriuretic Peptide Values in Patients with Cardiac Dysfunction and Liver Cirrhosis
Abstracts significantly lower (P , 0.05) in rheumatic patients, while LA, C3Ds and A2Ds were obviously higher (P , 0.05).The MVCI and MVOI of rheumatic patients were not linearly related (r , 0.65). Conclusion: The MVCI can be obtained using QLab software with high feasibility; it could be a quantitative indicator for evaluating the mitral valve of rheumatic patients.
P 130 se Impact of Intraoperative Epicardial Real-Time ThreeDimensional Echocardiography as a Surgical Guide on Systemic Atrioventricular Valve Plasty of Congenital Heart Disease K. Takigiku,1 S. Yasukochi,2 H. Matsui2 1 Pediatric Cardiology, Nagano Children’s Hospital, Azumino/JP, 2 Nagano Children’s Hospital, Azumino/JP Purpose: The aim of the study is to assess the feasibility and accuracy of intraoperative epicardial RT3DE (IERT3DE) for obtaining anatomical information of systemic atrioventricular valve as a surgical guide in congenital heart disease. Material & Methods: We performed IERT3DE (IE33, Phillips) in ten patients with congenital heart disease at a median age of 2.3 years (6days-8years, single right ventricle:4, AVSD:1, DORV:2, HLHS:2, ASD:1). We obtained full volume images with high frame rate (more than 30Hz) by using X7-2 matrix array transducer. We reconstructed 3D images of atrioventricular valve with a computer workstation (QLab) in an operating room and compared these with the 2D images and surgical findings. Results: In nine patients (90%), we obtained images of good quality and rapidly could crop 3D images as surgeon’s views within 15 min. All the findings from 3D reconstructed images influenced the actual valve plasty, when compared with those of 2D images. Especially, in common atrioventricular valve with complex cardiac anormaly, we could grasp the accurate size and position of four or five valves and the cause of regurgitation. Conclusion: IERT3DE can provide good quality images with high frame rate for viewing valve morphology and is a feasible technique for facilitating surgical planning.
P 131 se Real-Time Three-Dimensional Echocardiography in Estimation of Prosthetic Valves G. Nartsissova Functional and Ultrasound Diagnostic Laboratory, Novosibirsk Research Institute of Circulation Pathology, Novosibirsk/RU Purpose: To investigate possibilities of real-time three-dimensional echocardiography (3DE) in comparison with two-dimensional echocardiography (2DE) for evaluation of prosthetic valves of the heart. Material & Methods: 2DE and 3DE were performed using Vivid 7 Dimension (GE) with matrix transducers M4S, 3V. 3DE was taken using sector mode, full volume, 9 slices, color Doppler. Twenty patients with mechanical and biological prosthetic valves of the heart were examined. Ten had prosthetic valvule dysfunction. Results: At volumetric reconstruction, it was possible to investigate more precisely the details of valves and framework of annulus. Using nine slices at different levels, the movement estimation of elements was possible at bicuspid prosthetic valves. In real time, we observed the absence of movement of leaflets of dysfunctional bioprosthetic or mechanical valves, thrombosis and pannus. In one case, the 3D sector views demonstrated the details of mechanical prosthetic aortic valve.
S109
On addition of full volume and nine slices, vegetations and valvular obstruction were found. Using sector 3DE, we diagnosed a thrombosis of the bioprosthetic valve in the tricuspid position in a patient with a burn sepsis. Color Doppler with 3D imaging has provided improved visualization of pathological regurgitated jet for assessment of convergence and vena contracta of dysfunctional bioprosthetic valve. Conclusion: Three-dimensional echocardiography in real time provides a better estimation of anatomical and functional details of prosthetic valves in comparison with 2D echo.
P 132 se Dopplerographic Time-Interval T(E-Ea) in Evaluation of Left Ventricular Diastolic Function in Children with Acute Lymphoblast Leucosis During Polychemotherapy A. A. Savisko, N. J. Nelassov, S. P. Parmon, E. D. Teplyakova, N. Tarasova Ultrasound, Rostov State Medical University, Rostov-on-Don/RU Purpose: We have shown previously that reflected high intensity motion signals (RIMS) registered by conventional pulsed wave Doppler can be utilized for detection of left ventricular diastolic dysfunction (DD). In this study, we decided to analyze if new dopplerographic time interval parameter T(E-Ea) (time between onset of peak E of transmitral flow and onset of peak Ea of RIMS) can help in detection of initial cardiotoxic effect of polychemotherapy in the form of mild DD in children with acute lymphoblast leukosis. Material & Methods: Pulsed wave dopplerography was performed in 47 healthy children and 94 children with acute lymphoblast leukosis during polychemotherapy. Cardiac probe was placed in an apical position and the sample volume was moved between the tips of mitral leaflets. Sensitivity and diagnostic efficacy of T(E-Ea) and traditional transmitral ratio E/A in the detection of DD were compared. Results: Normal value of T(E-Ea) was 20.4 6 8.5 ms. The analysis revealed that conventional cutoff value of E/A , 1.0 and cutoff value of new parameter T(E-Ea) . 28 ms can separate children with and without mild DD with sensitivity 4.3 and 74.5% (p , .00001) and diagnostic efficacy of 36.2 and 78.0% (p , .00001), respectively. Conclusion: New dopplerographic time interval T(E-Ea) can detect cardiotoxic drug effects in the form of mild diastolic disturbances in children with acute lymphoblast leukosis during polychemotherapy. New Doppler parameter is much more sensitive in detection of diastolic disturbances than traditional E/A ratio.
P 133 se Elevated B-Type Natriuretic Peptide Values in Patients with Cardiac Dysfunction and Liver Cirrhosis M. I. Muntean, D. Georgescu, L. Coceala Internal Medicine Nr.1, UMF Timisoara, Timisoara/RO Purpose: B-type natriuretic peptide (BNP) is widely used in clinical practice as a sensitive and specific biomarker for left ventricular dysfunction. In recent years, many studies demonstrate that patients with liver cirrhosis develop a cirrhosis-related cardiomyopathy. The purpose of this study is to investigate the presence of cardiac dysfunction in patients with liver cirrhosis using the BNP measurement and its correlation to the LV systolic and diastolic function. Material & Methods: A total number of 32 patients with liver cirrhosis in Child-Pugh stage IV, including 9 women (28%) and 23 men (72%), with an average age of 57.7+/-12.8 years, were screened in our clinic
S110
Ultrasound in Medicine and Biology
for BNP values and subsequently referred for the evaluation of systolic and diastolic LV function to our echocardiography laboratory. Results: In 27 (84%) of all patients, a diastolic LV dysfunction was demonstrated. In ten (31%) patients, we could find a diminished left ventricular ejection fraction, indicating an LV systolic dysfunction. In 14 (44%) patients, elevated BNP values (.300pg/ml) could be determined. There was a strong correlation between the LVEF and the BNP values in all the patients Conclusion: Our study shows that cardiac involvement in end-stage liver cirrhosis is a rather common finding. Most of the patients develop a diastolic dysfunction of the left ventricle, but overt LV systolic dysfunction is also noted in many of the patients with liver cirrhosis. P 134 se Role of Echocardiography in Emergency Diagnosis T. K. Nguyen Cardiology, MEDIC Medical Center, HCM city/VN Purpose: We confirm that echocardiography is useful in emergency diagnosis. Material & Methods: We present cases that include pulmonary embolism, right ventricular myocardial infarction, cardiac tamponade, left atrial appendage thrombus in stroke patient, hemolytic anemia caused by paravalvular leak in mechanical valve and vegetation in an infectious endocarditis patient. Results: We show the images of echocardiography and discuss about these cases that were guided by transthoracic and transesophageal echocardiography to have a quick diagnosis and added blood test, ECG, computed tomography or digital subtraction angiography to confirm the diagnosis. Conclusion: The role of echocardiography in immediate assessment and monitoring of unstable patients is recognized and advocated. Echocardiography provides a quick and exact diagnosis and treatment of critical patients.
Volume 37, Number 8S, 2011 was investigated during TASH. Patients were evaluated (follow-up 1 and 3 months) by transthoracic echocardiography and MRI. Results: The echocardiographic pressure gradient (at rest) was 53.5 mmHg before (between 33 and 83) and 23.5 mmHg after TASH. The septum thickness decreased significantly (after 1 month). The quantity of injected ethanol was correlated with the size of the abblated tissue area as assessed with perfusion echocardiography. Conclusion: We conclude that the UCA-based perfusion echocardiography is able to determine the area of abblation during TASH.
P 136 ee Echocardiography in Case of Emergency T. Q. H. Le,1 H. T. Phan2 1 Cardiology, MEDIC Medical Center, HCM/VN, 2Radiology, MEDIC Medical Center, HCM/VN Learning Objectives: To understand the role of echocardiography in emergency situations. Background: Echocardiography is a noninvasive tool, helps immediate online image analysis and provides extensive yield of data such as structural, functional and hemodynamic information. Imaging Findings or Procedure Details: In the context of emergency with suspicion of heart disease, echocardiography plays an important role because it can rule out or confirm cardiovascular reasons. If cardiovascular reasons are confirmed, echocardiography is useful to triage patients as well as to choose the optimal technique for treatment. If cardiovascular reasons are ruled out, echocardiography is helpful for the detection of lesions in other organs, for example pleural and lung disease. Recently, much progress in heart ultrasound such as tissue Doppler imaging and kinetic imaging has helped in quick and accurate diagnosis during emergency. Conclusion: The role of echocardiography in case of emergency is undeniable; it helps to decide on who needs Hospital admission. Urgent evaluation of the diagnosis leads to planning for appropriate intervention, improvement in the course of disease and chances of survival.
P 135 se Determination of Success of Transcoronary Ablation of Septum Hypertrophy in Patients with Hypertrophic Obstructive Cardiomyopathy by Perfusion Echocardiography J. Schuemmelfeder,1 F. Gietzen,2 S. Hamid,1 U. Bakowsky3 1 Department of Cardiology, St. Georg Hospital Eisenach, Eisenach/DE, 2 Department of Cardiology, Centre of Cardiovascular Medicine, Bad Neustadt/Saale/DE, 3Pharmaeutical Technology and Biopharmaceutics, University of Marburg, Marburg/DE Purpose: Since the late 1990s, transcoronary ablation of the septum hypertrophy (TASH) has been established as a standard procedure in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Actually, there are two different strategies to determine the success of the TASH procedure: i) the anatomical approach, guided by echocardiography and ii) the functional approach, comparing the resting and the provocable gradient in the left ventricular outflow. To overcome the limitations of these established methods, the aim of this study was to visualize the feasibility, success and short-term results of TASH on the basis of ultrasoeund contrast agent (UCA)-based echocardiography in comparison with cardiac catheterization and cardiac MRI. Material & Methods: In this in vivo study, ten patients with HOCM were treated with TASH. After occluding the septal branch with the balloon catheter, we injected the UCA intravenously and the perfusion
P 137 se Pericardial Agenesis M. A. Sotcan,1 M. Enache,1 C. V. Jurcut,1 M. Iriciuc,2 I. Copaci,1 R. Jurcut3 1 Internal Medicine, Central Military Hospital, Bucharest/RO, 2 Radiology, Central Military Hospital, Bucharest/RO, 3Cardiology, IBCV ‘‘CC ILIESCU’’, Bucharest/RO Purpose: We report the case of a 37-year-old woman with completel pericardial agenesis. Material & Methods: A young female patient presented with a history of atypical chest pain. She was otherwise fit and well and medication free. Results: Transthoracic echocardiography revealed unusual echocardiographic window, abnormal ventricular septal motion and an abnormal anteroposterior cardiac movement within the thoracic cavity. Computed tomography examination showed prominence of the main pulmonary artery and the interposition of the lung tissue between the aorta and the main pulmonary artery thus confirming the diagnosis. Conclusion: Pericardial agenesis is a rare anomaly, difficult to diagnose. Its evolution is usually benign. However, on rare occasions, partial defects have been the cause of sudden death.
P 130 se Impact of Intraoperative Epicardial Real-Time ThreeDimensional Echocardiography as a Surgical Guide on Systemic Atrioventricular Valve Plasty of Congenital Heart Disease K. Takigiku,1 S. Yasukochi,2 H. Matsui2 1 Pediatric Cardiology, Nagano Children’s Hospital, Azumino/JP, 2 Nagano Children’s Hospital, Azumino/JP Purpose: The aim of the study is to assess the feasibility and accuracy of intraoperative epicardial RT3DE (IERT3DE) for obtaining anatomical information of systemic atrioventricular valve as a surgical guide in congenital heart disease. Material & Methods: We performed IERT3DE (IE33, Phillips) in ten patients with congenital heart disease at a median age of 2.3 years (6days-8years, single right ventricle:4, AVSD:1, DORV:2, HLHS:2, ASD:1). We obtained full volume images with high frame rate (more than 30Hz) by using X7-2 matrix array transducer. We reconstructed 3D images of atrioventricular valve with a computer workstation (QLab) in an operating room and compared these with the 2D images and surgical findings. Results: In nine patients (90%), we obtained images of good quality and rapidly could crop 3D images as surgeon’s views within 15 min. All the findings from 3D reconstructed images influenced the actual valve plasty, when compared with those of 2D images. Especially, in common atrioventricular valve with complex cardiac anormaly, we could grasp the accurate size and position of four or five valves and the cause of regurgitation. Conclusion: IERT3DE can provide good quality images with high frame rate for viewing valve morphology and is a feasible technique for facilitating surgical planning.
P 131 se Real-Time Three-Dimensional Echocardiography in Estimation of Prosthetic Valves G. Nartsissova Functional and Ultrasound Diagnostic Laboratory, Novosibirsk Research Institute of Circulation Pathology, Novosibirsk/RU Purpose: To investigate possibilities of real-time three-dimensional echocardiography (3DE) in comparison with two-dimensional echocardiography (2DE) for evaluation of prosthetic valves of the heart. Material & Methods: 2DE and 3DE were performed using Vivid 7 Dimension (GE) with matrix transducers M4S, 3V. 3DE was taken using sector mode, full volume, 9 slices, color Doppler. Twenty patients with mechanical and biological prosthetic valves of the heart were examined. Ten had prosthetic valvule dysfunction. Results: At volumetric reconstruction, it was possible to investigate more precisely the details of valves and framework of annulus. Using nine slices at different levels, the movement estimation of elements was possible at bicuspid prosthetic valves. In real time, we observed the absence of movement of leaflets of dysfunctional bioprosthetic or mechanical valves, thrombosis and pannus. In one case, the 3D sector views demonstrated the details of mechanical prosthetic aortic valve.
S109
On addition of full volume and nine slices, vegetations and valvular obstruction were found. Using sector 3DE, we diagnosed a thrombosis of the bioprosthetic valve in the tricuspid position in a patient with a burn sepsis. Color Doppler with 3D imaging has provided improved visualization of pathological regurgitated jet for assessment of convergence and vena contracta of dysfunctional bioprosthetic valve. Conclusion: Three-dimensional echocardiography in real time provides a better estimation of anatomical and functional details of prosthetic valves in comparison with 2D echo.
P 132 se Dopplerographic Time-Interval T(E-Ea) in Evaluation of Left Ventricular Diastolic Function in Children with Acute Lymphoblast Leucosis During Polychemotherapy A. A. Savisko, N. J. Nelassov, S. P. Parmon, E. D. Teplyakova, N. Tarasova Ultrasound, Rostov State Medical University, Rostov-on-Don/RU Purpose: We have shown previously that reflected high intensity motion signals (RIMS) registered by conventional pulsed wave Doppler can be utilized for detection of left ventricular diastolic dysfunction (DD). In this study, we decided to analyze if new dopplerographic time interval parameter T(E-Ea) (time between onset of peak E of transmitral flow and onset of peak Ea of RIMS) can help in detection of initial cardiotoxic effect of polychemotherapy in the form of mild DD in children with acute lymphoblast leukosis. Material & Methods: Pulsed wave dopplerography was performed in 47 healthy children and 94 children with acute lymphoblast leukosis during polychemotherapy. Cardiac probe was placed in an apical position and the sample volume was moved between the tips of mitral leaflets. Sensitivity and diagnostic efficacy of T(E-Ea) and traditional transmitral ratio E/A in the detection of DD were compared. Results: Normal value of T(E-Ea) was 20.4 6 8.5 ms. The analysis revealed that conventional cutoff value of E/A , 1.0 and cutoff value of new parameter T(E-Ea) . 28 ms can separate children with and without mild DD with sensitivity 4.3 and 74.5% (p , .00001) and diagnostic efficacy of 36.2 and 78.0% (p , .00001), respectively. Conclusion: New dopplerographic time interval T(E-Ea) can detect cardiotoxic drug effects in the form of mild diastolic disturbances in children with acute lymphoblast leukosis during polychemotherapy. New Doppler parameter is much more sensitive in detection of diastolic disturbances than traditional E/A ratio.
P 133 se Elevated B-Type Natriuretic Peptide Values in Patients with Cardiac Dysfunction and Liver Cirrhosis M. I. Muntean, D. Georgescu, L. Coceala Internal Medicine Nr.1, UMF Timisoara, Timisoara/RO Purpose: B-type natriuretic peptide (BNP) is widely used in clinical practice as a sensitive and specific biomarker for left ventricular dysfunction. In recent years, many studies demonstrate that patients with liver cirrhosis develop a cirrhosis-related cardiomyopathy. The purpose of this study is to investigate the presence of cardiac dysfunction in patients with liver cirrhosis using the BNP measurement and its correlation to the LV systolic and diastolic function. Material & Methods: A total number of 32 patients with liver cirrhosis in Child-Pugh stage IV, including 9 women (28%) and 23 men (72%), with an average age of 57.7+/-12.8 years, were screened in our clinic
S110
Ultrasound in Medicine and Biology
for BNP values and subsequently referred for the evaluation of systolic and diastolic LV function to our echocardiography laboratory. Results: In 27 (84%) of all patients, a diastolic LV dysfunction was demonstrated. In ten (31%) patients, we could find a diminished left ventricular ejection fraction, indicating an LV systolic dysfunction. In 14 (44%) patients, elevated BNP values (.300pg/ml) could be determined. There was a strong correlation between the LVEF and the BNP values in all the patients Conclusion: Our study shows that cardiac involvement in end-stage liver cirrhosis is a rather common finding. Most of the patients develop a diastolic dysfunction of the left ventricle, but overt LV systolic dysfunction is also noted in many of the patients with liver cirrhosis. P 134 se Role of Echocardiography in Emergency Diagnosis T. K. Nguyen Cardiology, MEDIC Medical Center, HCM city/VN Purpose: We confirm that echocardiography is useful in emergency diagnosis. Material & Methods: We present cases that include pulmonary embolism, right ventricular myocardial infarction, cardiac tamponade, left atrial appendage thrombus in stroke patient, hemolytic anemia caused by paravalvular leak in mechanical valve and vegetation in an infectious endocarditis patient. Results: We show the images of echocardiography and discuss about these cases that were guided by transthoracic and transesophageal echocardiography to have a quick diagnosis and added blood test, ECG, computed tomography or digital subtraction angiography to confirm the diagnosis. Conclusion: The role of echocardiography in immediate assessment and monitoring of unstable patients is recognized and advocated. Echocardiography provides a quick and exact diagnosis and treatment of critical patients.
Volume 37, Number 8S, 2011 was investigated during TASH. Patients were evaluated (follow-up 1 and 3 months) by transthoracic echocardiography and MRI. Results: The echocardiographic pressure gradient (at rest) was 53.5 mmHg before (between 33 and 83) and 23.5 mmHg after TASH. The septum thickness decreased significantly (after 1 month). The quantity of injected ethanol was correlated with the size of the abblated tissue area as assessed with perfusion echocardiography. Conclusion: We conclude that the UCA-based perfusion echocardiography is able to determine the area of abblation during TASH.
P 136 ee Echocardiography in Case of Emergency T. Q. H. Le,1 H. T. Phan2 1 Cardiology, MEDIC Medical Center, HCM/VN, 2Radiology, MEDIC Medical Center, HCM/VN Learning Objectives: To understand the role of echocardiography in emergency situations. Background: Echocardiography is a noninvasive tool, helps immediate online image analysis and provides extensive yield of data such as structural, functional and hemodynamic information. Imaging Findings or Procedure Details: In the context of emergency with suspicion of heart disease, echocardiography plays an important role because it can rule out or confirm cardiovascular reasons. If cardiovascular reasons are confirmed, echocardiography is useful to triage patients as well as to choose the optimal technique for treatment. If cardiovascular reasons are ruled out, echocardiography is helpful for the detection of lesions in other organs, for example pleural and lung disease. Recently, much progress in heart ultrasound such as tissue Doppler imaging and kinetic imaging has helped in quick and accurate diagnosis during emergency. Conclusion: The role of echocardiography in case of emergency is undeniable; it helps to decide on who needs Hospital admission. Urgent evaluation of the diagnosis leads to planning for appropriate intervention, improvement in the course of disease and chances of survival.
P 135 se Determination of Success of Transcoronary Ablation of Septum Hypertrophy in Patients with Hypertrophic Obstructive Cardiomyopathy by Perfusion Echocardiography J. Schuemmelfeder,1 F. Gietzen,2 S. Hamid,1 U. Bakowsky3 1 Department of Cardiology, St. Georg Hospital Eisenach, Eisenach/DE, 2 Department of Cardiology, Centre of Cardiovascular Medicine, Bad Neustadt/Saale/DE, 3Pharmaeutical Technology and Biopharmaceutics, University of Marburg, Marburg/DE Purpose: Since the late 1990s, transcoronary ablation of the septum hypertrophy (TASH) has been established as a standard procedure in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Actually, there are two different strategies to determine the success of the TASH procedure: i) the anatomical approach, guided by echocardiography and ii) the functional approach, comparing the resting and the provocable gradient in the left ventricular outflow. To overcome the limitations of these established methods, the aim of this study was to visualize the feasibility, success and short-term results of TASH on the basis of ultrasoeund contrast agent (UCA)-based echocardiography in comparison with cardiac catheterization and cardiac MRI. Material & Methods: In this in vivo study, ten patients with HOCM were treated with TASH. After occluding the septal branch with the balloon catheter, we injected the UCA intravenously and the perfusion
P 137 se Pericardial Agenesis M. A. Sotcan,1 M. Enache,1 C. V. Jurcut,1 M. Iriciuc,2 I. Copaci,1 R. Jurcut3 1 Internal Medicine, Central Military Hospital, Bucharest/RO, 2 Radiology, Central Military Hospital, Bucharest/RO, 3Cardiology, IBCV ‘‘CC ILIESCU’’, Bucharest/RO Purpose: We report the case of a 37-year-old woman with completel pericardial agenesis. Material & Methods: A young female patient presented with a history of atypical chest pain. She was otherwise fit and well and medication free. Results: Transthoracic echocardiography revealed unusual echocardiographic window, abnormal ventricular septal motion and an abnormal anteroposterior cardiac movement within the thoracic cavity. Computed tomography examination showed prominence of the main pulmonary artery and the interposition of the lung tissue between the aorta and the main pulmonary artery thus confirming the diagnosis. Conclusion: Pericardial agenesis is a rare anomaly, difficult to diagnose. Its evolution is usually benign. However, on rare occasions, partial defects have been the cause of sudden death.