- Email: [email protected]
Left atrial volume as a new indicator of atrial function
A144
48th Annual
Scientific
Meeting
Heart,
of CSANZ
LEFT ATRIAL VOLUME AS A NEW INDICATO; OF ATRIAL FUNCTION. L. Thomas *‘. D.Y.C Leune . B Schille3 and D.L. Ross’. ‘UCSF, San Francisco, USA,“Liverpool Hospital, Sydney, Australia and ’ Westmead Hospital, Sydney, Australia. Accurate estimation of atrial function is relevant for assessing various new methods of treating atrial fibrillation. However, there is no universally accepted parameter of atrial function and the use of mitral inflow A wave velocity as a marker of left attial (LA) function has not been validated. We performed echocardiograms on 45 patients in sinus rhythm without significant valvular abnormalities. 30 had normal left ventricular (LV) function (Groupl) and 15 had LV hypertrophy * LV dysfunction (Group 2). From apical 2 and 4 chamber views using the modified biplane method of discs, we measured maximum LA volume in ventricular systole (LAESV) and minimum LA volume in ventricular diastole (LAEDV). LA stroke volume (LASV) was calculated as LAESVLAEDV and LAEF calculated as ( LASVi LAESV)X 100%. Peak mitral inflow A wave velocity and velocity time integral (VTI) and atrial fraction ( [A wave VTI/ Total mitmI inflow VTIjX 100%) were also measured. Results: Group 2 had a significantly larger LAESV compared with Group l(74.5iS.4 Vs 52* 3 ml, @.004).There was a significant correlation between the LAESV and LASV in both Group 1 (r=O.93, P
Lung
and Circulation
2000; 9
ECHOCARDIOGRAPHIC PREDICTORS OF SEVERE REGURITATION FOLLOWING PTMV S.Rov*. G.Crannev. N.Jepson. G.Nashed, R.Allan and R.M.McCredig Eastern Heart Clinic and Prince of Wales Hospital, Sydney, NSW.
MITRAL
Percutaneous mitral valvuloplasty is the preferred intervention in patients with symptomatic mitral stenosis. An echocardiographic score, comprising valve mobility, thickening of the subvalvular apparatus, leaflet thickening, and calcification, has been identified as a means ofpredicting successfi~l outcome of PTMV, primarily with regard to an increase in the mitral valve area, ‘and long t&m benefit derived from this procedure. Little data however is available concerning prediction ofprocedure related mitral regurgitation following PTMV, by echocardiographic parameters. At The Prince Henry Hospital and the Eastern Heart Clinic, a programme of PTMV has seen 379 patients undergo this procedure between May 1988 and January 2000 using initially a double balloon and since 1990, the Inoue balloon technique. Of these, 13 patients (3.5%), developed mitral regurgitation following valvulopasty , 1 died and12 proceeded to surgical intervention during the same hospital admission. Analysis of the pre-procedure echo was possible in 12 of these patients, using the conventional echocardiographic score for mitral stenosis.The most consistent pre-procedure fading in this subgroup of patients with PTMV induced MR was thickening and shortening of the subvalvular apparatus. The most common surgical fading at the time of valve replacement was a tear in either leaflet almost always associated with severe fusion, thickening and shortening of the subvalwlar apparatus, but not necessarily severe thickening and calcification of the leaflets, and occasionally, papillary muscle or chordal disruption. Our series suggests that extensive rheumatic disease of the subvalvular apparatus is the most useful echocardiographic predictor of severe mitral regurgitation post PTMV. In patients with this pattern of mitral stenosis, careful consideration should be given to the choice of initial intervention.
THE ROLE OF DOPPLER TISSUE ECHOCARDIOGRAPHY IN THE EARLY ASSESSMENT OF CARDIAC HAEMOCHROMATHOSIS. P. Palka? G. McDon&. L. Pi&&. A. Lm Departments of Cardiology, Gastroenterology, and Haematology; The Prince Charles Hospital, The Royal Brisbane Hospital & Mater Adult Hospital, Brisbane, Qld.
AUTOMATED EDGE-DETECTION FOR MEASUREMENT OF BRACHIAL REACTIVITY: COMPARISON OF INTER- AND INTRAOBSERVER CONCORDANCE WITH MANUAL MEASUREXENT. B * * su C Case. R I&m&y. TH Marwi& Princess Alexandra Hospital, University of Queensland, Brisbane, Qld.
Cardiac failure is the principal cause of death in Haemochrornatosis patients. There 1s a considerable interest in defining abnormalities of cardiac performance noninvasively in asymptomatic patients. Although cardiac dysfunction can be evaluated by conventional echocardiography (CE), fmdings are non-specific and insensitive to diagnose the early stage of the disease. Methods: A group of 10 asymptomatic Haemocbromatosis patients (age 41+17 yrs, 8 male; 7 primary, 3 secondary due to l’halassemia Major) and normal CE fmdings were examined using Doppler tissue echocardiography (DTE). 15 age-matched normals served as a control group. Using DTE, lateral mitral annulus velocity and myocardial velocity gradient (MVG) were measured in diastole. MVG represents a spatial distribution of transmyocardial velocities across the myocardium. Results: Haemochromatosis NOlIdS P Mean LV thickness (cm) 0.9 *0.2 0.9 *0.1 NS LV EF (X) 59*11 62 l 4 NS Peak E-wave (cmfs) 71*15 77 +10 NS Peak A-wave (cm/s) 58 +24 66+21 NS Peak E, (cm/s) 17.0 l 4.1 17.3 l 4.1 NS Peak A, (cm/s) 15.4 +8.2 17.7 h4.8 NS IR-MVG (is) +I.96 +0.39 -0.94 *oh4
The reproducibility of bracbial artery reactivity (BAR) relies on the ability to measure very small changes in lumen diameter between rest, hyperemia and after nitrate administration. We sought to compare automated measurement with edge-tracking sofhvare with manual measurement and also determine which method bad the highest concordance between observers. Methods: Two observers measured images from 120 pts who had undergone assessment of BAR. All images were digital cineloops acquired using an ATL HDI 5000 with a 12MHz vascular probe. Images were measured off-line using HDILab (ATL Carp, Bothell WA). Four images per patient were measured: rest, hyperemia, rest2, and GIN. Each image was measured using HDILab automated measurement (auto) which measures the leading edge of anterior and posterior endothelium and tracks this in sequential frames, and also manually (man), where a set of point to point measurements was averaged. Absolute measurements as well as percent change were compared and then compared against the mean for the observers. Results: Mean artery size was 4.tilmtn at rest. The BAR response varied from 36% to -32% for observer 1 and 33% to -55% for observer 2. Correlation between LDOT and distance for observers 1 and 2. and inter-observer correlation for automated and manual methods were all +O.Ol; Measurement Man vs auto 1 Man vs auto 2 Man 1 vs 2 Auto 1 vs 2 Rest 4.2* 1.0 0.98 0.96 0.95 0.94 Hyper 4.4 f 1.0 0.98 0.97 0.95 0.93 %Che 4.0 f 1.0 0.87 0.78 0.60 0.57 Gti-1 4.6k 1.0 1 0.99 1 0.97 1 0.97 1 0.96 %Chgl 8.0* 1.0 ) 0.89 1 0.81 1 0.66 1 0.58 The standard deviation from the mean was 5% for observer 1 and 7% for observer 2. The equivalent deviation between observers was 8% for manual and 10% for automated measurement. Conclusion: BAR measurements appear concordant between observers but both manual and automated methods show deviation from the mean.
48th Annual
Scientific
Meeting
Heart,
of CSANZ
LEFT ATRIAL VOLUME AS A NEW INDICATO; OF ATRIAL FUNCTION. L. Thomas *‘. D.Y.C Leune . B Schille3 and D.L. Ross’. ‘UCSF, San Francisco, USA,“Liverpool Hospital, Sydney, Australia and ’ Westmead Hospital, Sydney, Australia. Accurate estimation of atrial function is relevant for assessing various new methods of treating atrial fibrillation. However, there is no universally accepted parameter of atrial function and the use of mitral inflow A wave velocity as a marker of left attial (LA) function has not been validated. We performed echocardiograms on 45 patients in sinus rhythm without significant valvular abnormalities. 30 had normal left ventricular (LV) function (Groupl) and 15 had LV hypertrophy * LV dysfunction (Group 2). From apical 2 and 4 chamber views using the modified biplane method of discs, we measured maximum LA volume in ventricular systole (LAESV) and minimum LA volume in ventricular diastole (LAEDV). LA stroke volume (LASV) was calculated as LAESVLAEDV and LAEF calculated as ( LASVi LAESV)X 100%. Peak mitral inflow A wave velocity and velocity time integral (VTI) and atrial fraction ( [A wave VTI/ Total mitmI inflow VTIjX 100%) were also measured. Results: Group 2 had a significantly larger LAESV compared with Group l(74.5iS.4 Vs 52* 3 ml, @.004).There was a significant correlation between the LAESV and LASV in both Group 1 (r=O.93, P
Lung
and Circulation
2000; 9
ECHOCARDIOGRAPHIC PREDICTORS OF SEVERE REGURITATION FOLLOWING PTMV S.Rov*. G.Crannev. N.Jepson. G.Nashed, R.Allan and R.M.McCredig Eastern Heart Clinic and Prince of Wales Hospital, Sydney, NSW.
MITRAL
Percutaneous mitral valvuloplasty is the preferred intervention in patients with symptomatic mitral stenosis. An echocardiographic score, comprising valve mobility, thickening of the subvalvular apparatus, leaflet thickening, and calcification, has been identified as a means ofpredicting successfi~l outcome of PTMV, primarily with regard to an increase in the mitral valve area, ‘and long t&m benefit derived from this procedure. Little data however is available concerning prediction ofprocedure related mitral regurgitation following PTMV, by echocardiographic parameters. At The Prince Henry Hospital and the Eastern Heart Clinic, a programme of PTMV has seen 379 patients undergo this procedure between May 1988 and January 2000 using initially a double balloon and since 1990, the Inoue balloon technique. Of these, 13 patients (3.5%), developed mitral regurgitation following valvulopasty , 1 died and12 proceeded to surgical intervention during the same hospital admission. Analysis of the pre-procedure echo was possible in 12 of these patients, using the conventional echocardiographic score for mitral stenosis.The most consistent pre-procedure fading in this subgroup of patients with PTMV induced MR was thickening and shortening of the subvalvular apparatus. The most common surgical fading at the time of valve replacement was a tear in either leaflet almost always associated with severe fusion, thickening and shortening of the subvalwlar apparatus, but not necessarily severe thickening and calcification of the leaflets, and occasionally, papillary muscle or chordal disruption. Our series suggests that extensive rheumatic disease of the subvalvular apparatus is the most useful echocardiographic predictor of severe mitral regurgitation post PTMV. In patients with this pattern of mitral stenosis, careful consideration should be given to the choice of initial intervention.
THE ROLE OF DOPPLER TISSUE ECHOCARDIOGRAPHY IN THE EARLY ASSESSMENT OF CARDIAC HAEMOCHROMATHOSIS. P. Palka? G. McDon&. L. Pi&&. A. Lm Departments of Cardiology, Gastroenterology, and Haematology; The Prince Charles Hospital, The Royal Brisbane Hospital & Mater Adult Hospital, Brisbane, Qld.
AUTOMATED EDGE-DETECTION FOR MEASUREMENT OF BRACHIAL REACTIVITY: COMPARISON OF INTER- AND INTRAOBSERVER CONCORDANCE WITH MANUAL MEASUREXENT. B * * su C Case. R I&m&y. TH Marwi& Princess Alexandra Hospital, University of Queensland, Brisbane, Qld.
Cardiac failure is the principal cause of death in Haemochrornatosis patients. There 1s a considerable interest in defining abnormalities of cardiac performance noninvasively in asymptomatic patients. Although cardiac dysfunction can be evaluated by conventional echocardiography (CE), fmdings are non-specific and insensitive to diagnose the early stage of the disease. Methods: A group of 10 asymptomatic Haemocbromatosis patients (age 41+17 yrs, 8 male; 7 primary, 3 secondary due to l’halassemia Major) and normal CE fmdings were examined using Doppler tissue echocardiography (DTE). 15 age-matched normals served as a control group. Using DTE, lateral mitral annulus velocity and myocardial velocity gradient (MVG) were measured in diastole. MVG represents a spatial distribution of transmyocardial velocities across the myocardium. Results: Haemochromatosis NOlIdS P Mean LV thickness (cm) 0.9 *0.2 0.9 *0.1 NS LV EF (X) 59*11 62 l 4 NS Peak E-wave (cmfs) 71*15 77 +10 NS Peak A-wave (cm/s) 58 +24 66+21 NS Peak E, (cm/s) 17.0 l 4.1 17.3 l 4.1 NS Peak A, (cm/s) 15.4 +8.2 17.7 h4.8 NS IR-MVG (is) +I.96 +0.39 -0.94 *oh4
The reproducibility of bracbial artery reactivity (BAR) relies on the ability to measure very small changes in lumen diameter between rest, hyperemia and after nitrate administration. We sought to compare automated measurement with edge-tracking sofhvare with manual measurement and also determine which method bad the highest concordance between observers. Methods: Two observers measured images from 120 pts who had undergone assessment of BAR. All images were digital cineloops acquired using an ATL HDI 5000 with a 12MHz vascular probe. Images were measured off-line using HDILab (ATL Carp, Bothell WA). Four images per patient were measured: rest, hyperemia, rest2, and GIN. Each image was measured using HDILab automated measurement (auto) which measures the leading edge of anterior and posterior endothelium and tracks this in sequential frames, and also manually (man), where a set of point to point measurements was averaged. Absolute measurements as well as percent change were compared and then compared against the mean for the observers. Results: Mean artery size was 4.tilmtn at rest. The BAR response varied from 36% to -32% for observer 1 and 33% to -55% for observer 2. Correlation between LDOT and distance for observers 1 and 2. and inter-observer correlation for automated and manual methods were all +O.Ol; Measurement Man vs auto 1 Man vs auto 2 Man 1 vs 2 Auto 1 vs 2 Rest 4.2* 1.0 0.98 0.96 0.95 0.94 Hyper 4.4 f 1.0 0.98 0.97 0.95 0.93 %Che 4.0 f 1.0 0.87 0.78 0.60 0.57 Gti-1 4.6k 1.0 1 0.99 1 0.97 1 0.97 1 0.96 %Chgl 8.0* 1.0 ) 0.89 1 0.81 1 0.66 1 0.58 The standard deviation from the mean was 5% for observer 1 and 7% for observer 2. The equivalent deviation between observers was 8% for manual and 10% for automated measurement. Conclusion: BAR measurements appear concordant between observers but both manual and automated methods show deviation from the mean.