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BACKGROUND: Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) systolic dysfunction. However, the diastolic function (DF) manifestations of TTC have not been widely investigated. We performed a bicentric study with retrospective analysis of DF in patients with TTC, during onset and at follow-up.

METHODS: Twenty-eight patients with TTC (64 ± 10 years, F 24) were included. All underwent echocardiograms acutely and at the recovery phase (average three months later). Diastolic and systolic function parameters were recorded, including E-wave velocity (E), A-wave velocity, E/A ratio, relaxation (e') and contractility (S') based on tissue Doppler velocities of the mitral annuli, ejection fraction (EF), left atrial (LA) size and DF stages.

RESULTS: Recovery, including the mean difference with 95% confidence interval, was associated with tending improvement (i.e. uncorrected significance) in E [13 cm s(-1) (-24, -2·3), P = 0·02] and in E/A ratio [0·2 (-0·41, -0·02), P = 0·04], as well as significant improvement (after multiple comparison correction) in mean e' [2·0 cm s(-1) (-3·3, -1·2), P<0·001] and in A-wave duration [29 ms (-46·7, -12·7), P = 0·002]. LA area tended to decrease during recovery [-2 cm² (0·33, 2·4), P = 0·01]. Improvement in DF stages was significant between the phases (21% versus 58% defined as normal DF, P = 0·016). Improvement in LVEF correlated with improvement in mean e' (r = 0·52, P = 0·02).

CONCLUSIONS: TTC is associated with an acute impairment of conventional DF variables, which improves during recovery. DF recovery seems to occur in parallel with systolic recovery in patients with TTC.

BACKGROUND: Describing the systolic function of the right ventricle (RV) is a difficult task due to the complex shape and orientation of the RV. The purpose of this study was to investigate the extent to which the volumes encompassed by the pulmonary and tricuspid valve displacements contribute to the total right ventricle stroke volume (RVSV).

METHODS: Twelve healthy volunteers were examined using cardiac magnetic resonance (CMR). Two series of time-resolved axially rotated MR images were acquired that encompassed the tricuspid valve and the pulmonary valve, respectively. The volume related to each valve movement, the tricuspid plane displacement (TPD) and the pulmonary plane displacement (PPD), was determined by delineation in diastole and systole. These volumes, RVSVTPD and RVSVPPD , were compared to the stroke volume to determine the contributions to the total stroke volume from the TPD and the PPD. The remaining volume of the total RVSV was referred to as RVSVOther . An initial in vitro study was carried out to validate the accuracy of volume measurements using axially rotated images.

RESULTS: In vitro measurements indicated that the method for volumetric measurements using axially rotated images was a very accurate one, with a mean difference of 0·04 ± 0·10 ml. The in vivo measurements of RVSVTPD , RVSVPPD and RVSVOther were 45 ± 10%, 13 ± 2% and 42 ± 11%, respectively.

CONCLUSIONS: Right ventricle stroke volume is determined by different individual volume changes as follows: RVSVTPD together with RVSVOther contributes to almost the entire RVSV in nearly equal proportions, while RVSVPPD contributes only a small amount and is approximately 30% of either RVSVTPD or RVSVOther.

Objectives: Takotsubo cardiomyopathy (TTC) is a condition of transient left ventricular (LV) dysfunction. The effects on LV mass (LVM) and geometry have not been studied enough in TTC. Retrospectively, we analyzed our TTC cohort both by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), for comparative purposes.

Design: Thirteen women undergoing TTE and MRI, at onset and three months later, were included. LVM was estimated by MRI, and two TTE-methods. Segmental wall thickness (SWT) was measured, whilst radial strain was assessed by TTE. Data analysis included Wilcoxon's test (between phases), Mann Whitney U- and McNemar's tests (between and within groups). Bland-Altman analyzes were used for intertechnique coherence, whilst interactions regarding TTE were tested using Spearman's coefficient.

Results: LVM decreased during recovery (p<0.05), by MRI and one of the TTE-methods; truncated ellipsoid formula (TEF), which also showed relatively better coherence compared to MRI. SWT decreased in two of three sites, by both modalities, but with ambiguous coherence therebetween. The TEF-data interacted partially with a demonstrated increase in radial strain.

Conclusions: TTC associates with acute increase in LVM, which appears to be an apical effect, tending to follow the changes in concentric wall motion. MRI and TTE show adequate coherence; primarily for the TEF-method regarding LVM.

Objectives: In patients with aortic stenosis the valve area is usually obtained by transthoracic echocardiography (TTE) and the continuity equation. The method is time consuming and another way to obtain the area is to trace the valves (planimetry).In the present study the both methods are compared.

Methods: 34 consecutive patients with known aortic stenosis were included and examined by TTE. The aortic valve area was obtained using planimetry in the short axis view and by using the continuity equation.

Results: There was no significant difference between the two methods (p=0.16) and the correlation was rather good (r=0.60; p<0.01). The agreement was better in the lower ranges of areas (<1.1 cm2) than in the higher ranges (>1.1 cm2).

Conclusions: The agreement between the both methods is rather good in the lower ranges of areas (<1.1 cm2), but worse in the higher ranges of areas (>1.1 cm2). The difference between the areas in the lower ranges can be up to 0.3 cm2, a difference that can be the difference between thoracic surgery or not. It is therefore best to still use the continuity equation during TTE.

Objectives: To study the correlation of the aortic-, mitral-, and tricuspid annuli and their amplitudes and velocities with the left ventricular stroke volume (LVSV) in young healthy subjects at rest using echocardiography.

Methods: Twenty four healthy subjects with mean age 24 years were examined with echocardiography. The systolic, early and late diastolic velocities of the aortic-, mitral- and tricuspid annuli were measured with pulsed wave tissue Doppler and quantitative two-dimensional color Doppler tissue imaging as well as their amplitudes.

Results: There was only one significant correlation found between the measured parameters and LVSV, a finding that can be statistically random. All other correlations were not significant.

Conclusion: In young healthy individuals at rest the correlation between the amplitudes and velocities of the aortic-, mitral- and tricuspid annuli and LVSV is weak.

Objectives: The velocities at the mitral (MA) and tricuspid (TA) annuli have earlier been studied by using both colour coded tissue Doppler imaging (TVI) and pulsed wave tissue Doppler imaging (PW DTI) but the velocities at the aortic annulus (AA) and the both other annuli have only been examined using TVI and not PW DTI in one study before. Therefore the aim of the present study was to compare the systolic (s´)-, early (e´)- and late (a´) diastolic velocities at the three different annuli with both methods.

Design: 24 healthy subjects were examined by echocardiography and the velocities at the annuli were measured using PW DTI and TVI.

Results: For all the velocities there was a statistically significant difference (p<0.001) between the two methods, the velocities obtained by PW DTI being higher. However some heterogeneity of the mean velocity differences between methods were noted by annuli and site, but PW DTI always showing highest mean levels. There were also statistically significant velocity differences between different sites and annuli. There was a good-very good intra- and inter observer reproducibility of measuring the velocities at the aortic annulus.

Conclusion: The velocities were significantly higher using PW DTI than using TVI at the different annuli, probably mainly due to the way the respective method is measuring the velocities. In addition there was shown some heterogeneity of the mean velocity differences and statistically significant velocity differences between different sites and annuli.The both methods need different reference values and could not be used interchangeably. The findings could be of importance in special cases where the interaction between the three different annuli and sites is of importance, but including the velocities at all the three different sites in a clinical routine echocardiographic examination will often not be necessary.

Aims

Cigarettes and Swedish snuff influence the cardiovascular system in many ways. Cigarette and snuff usage have been linked with an acute impairment in several diastolic cardiac parameters during intake. The aim of this study is to investigate whether long-term usage of Swedish snuff or cigarettes also causes a more permanent impairment of systolic and/or diastolic cardiac parameters in the left ventricle in otherwise healthy middle-aged snuffers and smokers.

Methods and results

Eighty-seven age-matched volunteers were included and examined with echocardiography. The volunteers were divided into three subgroups; one group with non-tobacco users, one group with long-term smokers and finally one group with long-term snuffers. The smokers and snuffers were instructed not to use these products for at least 5h before the examination. The systolic and diastolic cardiac parameters were collected at one time. Most of the systolic parameters measured were unaltered between the tobacco subgroups and non-tobacco users, and therefore, no alteration of significance was found in systolic parameters. Also, almost all of the diastolic parameters measured were not significantly impaired in the tobacco subgroups compared with non-tobacco users. However, the deceleration time (DT) was slightly prolonged (P<0 center dot 05) and thus statistically significant in the tobacco subgroups. This finding is somewhat difficult to interpret but may be seen as random.

Conclusions

This study reveals that most systolic- and diastolic cardiac parameters are not chronically significantly altered in middle-aged long-term tobacco users compared with age-matched non-tobacco users.

Aims: Cigarettes and Swedish snuff contain nicotine, which influence the cardiovascular system. Cigarette smoke has been shown to give an acute impairment in diastolic heart parameters. The systolic and diastolic heart function in snuff users is not thoroughly enough investigated. The aim of this study was to investigate if Swedish snuff will give an acute decrease in systolic and diastolic heart parameters in the left and right ventricles in healthy Swedish snuffers.

Methods and results: Thirty healthy volunteers were examined with echocardiography. The study involved recordings from four different times: before snuff intake, 5 and 30 min after intake and finally 30 min after snuff withdrawal. The systolic and diastolic heart parameters were collected with conventional echocardiographic methods. In addition, the heart frequency and blood pressure response were measured. The pulse and blood pressure response were significantly altered (P<0Æ01) during the test. Left ventricular ejection fraction and the amplitudes of mitral and tricuspid annulus motion did not alter significantly. The main finding in the study was the significant decrease (P<0Æ05) in several diastolic heart parameters for both the left and right ventricles.

Conclusions: This study shows that snuff intake causes a significant decrease in E ⁄ A ratio and a delay in ventricular relaxation and therefore a decrease in diastolic heart function in the left and right ventricles. The mechanism behind these alterations is probably very complex, but a combination of nicotine effects and loading conditions is probably the main factor.

Short-axis (SA) magnetic resonance (MR) images are commonly planned parallel to the left atrioventricular valve. This orientation leads to oblique slices of the right ventricle (RV) with subsequent difficulties in separating the RV from the right atrium in the SA images. The insertion points of the tricuspid valve (TV) in the myocardium can be clearly identified in the right ventricle long axis (RVLA) and four-chamber (4CH) views. The purpose of this study was to develop a method that transfers the position of the tricuspid plane, as seen in the RVLA and 4CH views, to the SA images to facilitate the separation of the RV from the atrium. This methodology, termed Dissociating the Right Atrium from the Ventricle Volume (DRAW), was applied in 20 patients for calculations of right ventricular stroke volume (RVSV). The RVSV using DRAW (RVSVDRAW) was compared to left ventricular stroke volumes (LVSV) obtained from flow measurements in the ascending aorta. The RVSV was also determined using the conventional method (RVSVCONV) where the stack of images from the SA views are summarized, and a visual decision is made of the most basal slice to be included in the RV. The mean difference between RVSVDRAW and LVSV was 0.1 +/- 12.7 ml, while the mean difference between RVSVCONV and LVSV was 0.33 +/- 14.3 ml. Both the intra- and interobserver variability were small using the DRAW methodology, 0.6 +/- 3.5 and 1.7 +/- 2.7 ml, respectively. In conclusion, the DRAW method can be used to facilitate the separation of the RV and the atrium.

Background: Magnetic resonance (MR) imaging and echocardiography both allow assessment of aortic valve stenosis. In MR the aortic valve area (AvA) is measured using planimetry while in transthoracic echocardiography (TTE) AvA is usually calculated by applying the continuity equation.

Purpose: To compare the measured stenotic aortic valve areas using five different MR-acquisition alternatives with the corresponding area values calculated by TTE.

Material and Methods: The aortic valve was imaged in 14 patients, with diagnosed aortic valve stenosis, using balanced steady state free precession (bSSFP) gradient echo (GE) and phase contrast imaging (PC). Three adjacent slices were planned to encompass the aortic valve and the aortic valve area was measured using planimetry. The two sets of complex valued images generated by the PC sequence formed three kinds of images that could be used for aortic valve area measurements: the magnitude image (PC/Mag), the modulus (PCA/M), and phase difference (PCA/P) between the two complex images, respectively. The valve area from TTE was calculated using the continuity equation. A cut-off of <1.0 cm(2) was used as a criteria for severe stenosis.

Results: The mean area differences between the different MR acquisitions and TTE method were -0.05 ± 0.37 cm(2) (GE), -0.18 ± 0.46 cm(2) (bSSFP), 0.27 ± 0.43 cm(2) (PC/Mag), 0.15 ± 0.32 cm(2) (PCA/P), and 0.26 ± 0.27 cm(2) (PCA/M). The valve area was significantly overestimated using PCA/M that, in turn, implied a significant underestimation of the aortic valve stenosis severity compared to the assessments using TTE.

Conclusion: The smallest area valve difference between TTE and an MR-acquisition alternative is obtained with gradient echo images. The use of PCA/M leads to significant differences in planimetry measurements of the aortic valve orifice and the gradation of the stenosis severity compared to TTE.