Assessment of intracardiac flow dynamics for the evaluation of patients with different ventricular geometry

Abstract Background Over the last decades growing evidence have demonstrated the promising role of intracardiac flow dynamic analysis in evaluating cardiac performance. Diastolic forces contribute to the formation of vortices, complex structures capable of kinetic energy storage and responsible of a smoother transition of blood from left ventricular (LV) inlet to outlet. Change in shape and location of these structures has been related with cardiovascular disease and prognosis. Purpose To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods We enrolled 72 consecutive patients (age 66±11 years, 49 male, 68%) with LV concentric hypertrophy (CH, n=15), eccentric hypertrophy (EH, n=13), concentric remodeling (CR, n=15) and normal LV geometry (CTRL, n=29). Each patient underwent a complete echocardiographic examination and a non-invasive intracardiac fluid dynamic analysis by Color Vector Flow Mapping. A 3-chamber apical view with a frame rate between 22 and 25 Hz has been acquired and subsequently analyzed offline by a semi-automatic software obtaining the following parameters: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean VD was higher in CR, CH and EH compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). Moreover, CH showed higher VL (p=0.006) and larger VA (p=0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (p=0.21 and p=0.07 for VA and VL respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Higher values of VD were found in CR, CH and EG. Quantitative intra dynamic fluid assessment was feasible and reliable in the whole population and could provide additional information to the standard echocardiographic examination. FUNDunding Acknowledgement Type of funding sources: None.

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751 Quantitative changes in intracardiac vortices between patients with different ventricular geometry

European Heart Journal Supplements ◽

10.1093/eurheartj/suab132.050 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Antonio Strangio ◽

Jolanda Sabatino ◽

Isabella Leo ◽

Marco Maglione ◽

Fabio Troilo ◽

...

Keyword(s):

Fluid Dynamic ◽

Statistical Significance ◽

Dynamic Assessment ◽

Flow Mapping ◽

Ventricular Geometry ◽

Concentric Hypertrophy ◽

Echocardiographic Examination ◽

Color Vector ◽

Eccentric Hypertrophy ◽

Quantitative Changes

Abstract Aims Over the past decades growing evidence have demonstrated the promising role of intracardiac fluid-dynamics in evaluating cardiac performance. To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods and results We enrolled 50 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodelling, and normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler). The following parameters were obtained: vortex area (VA); vortex length (VL); and vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Mean VD was higher in CR, CH, and EH compared to CTRL (P = 0.013, P = 0.001, and P = 0.022, respectively). Moreover, CH showed higher VL (P = 0.006) and larger VA (P = 0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (P = 0.21 and P = 0.07 for VA and VL, respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusions This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Quantitative fluid-dynamic assessment was feasible and reliable in the whole population.

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Assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0128 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Strangio ◽

J Sabatino ◽

I Leo ◽

M Maglione ◽

F Troilo ◽

...

Keyword(s):

Aortic Stenosis ◽

Left Ventricular ◽

Flow Dynamics ◽

Vortical Flow ◽

Paravalvular Leak ◽

Vortex Center ◽

Aortic Valve Area ◽

Longitudinal Length ◽

Significant Difference ◽

Intracardiac Flow

Abstract Background Assessment of intracardiac flows and turbulence has acquired rising significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have shown that alterations in intracardiac fluid dynamics can be helpful to identify abnormalities in cardiac function. Purpose This study investigates the additional information provided by the quantitative assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods Sixty-one patients with severe AS (33 females) and 38 healthy sex- and BSA-matched controls (CTRL) (15 females) were prospectively included and underwent echocardiographic assessment of intracardiac flow dynamics. Echocardiographic measurements were performed on apical three chamber views. The HyperDoppler software adapted to the echo-scanner without contrast injection was used to assess intracardiac vortex properties. The following parameters were obtained: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Inter-rater variability was measured using intraclass correlation coefficients (ICCs) between two independent operators. Results Patients with severe AS (mean gradient: 47,5±13,9 mmHg; aortic valve area: 0.7±0.2 cm2; ejection fraction: 53±7%) had increased LV wall thickness (p<0.001) and mass index (p<0.001) compared with controls. Greater indexed left atrial volume (p<0.001), E/e' (p<0.001) and trans-tricuspid gradient (p<0.001) were also observed in the AS group. The assessment of VA, VL and VD was feasible in the whole population. Their calculation was reliable, as ICCs were very good for VA (0.878, p=0.033), VL (0.960, p=0.004) and VD (0,905, p=0.021). Mean VA was significantly larger in patients with severe aortic stenosis compared with CTRL (p=0.033). VL and VD (p=0.026 and p>0.001, respectively) were significantly higher in AS patients compared with CTRL. Among those who underwent TAVR, we observed a significant difference in the delta values of VA and VL pre-postTAVR in patients with and without significant paravalvular leak (p<0.05). Conclusions The newly defined VA, VL and VD, quantitative indices of vortical flow, were significantly increased in the LV cavity of patients with severe AS compared to normal subjects. These indices, whose measurement was feasible and reliable, might provide complementary information to standard echocardiography, useful for the further diagnostic and prognostic characterization of the heterogeneous population of patients with severe AS. FUNDunding Acknowledgement Type of funding sources: None.

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Arterial Compliance and Hypertensive Left Ventricular Geometry

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84260-x ◽

1998 ◽

Vol 31 (2) ◽

pp. 128A-129A

Author(s):

G de Simone

Keyword(s):

Arterial Compliance ◽

Left Ventricular ◽

Left Ventricular Geometry ◽

Ventricular Geometry

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A Case of Neonatal Heart Failure Caused by Left Ventricular Diverticulum: Successful ECMO Support Application

The Heart Surgery Forum ◽

10.1532/hsf.1530 ◽

2016 ◽

Vol 19 (4) ◽

pp. 189

Author(s):

Ugur Gocen ◽

Atakan Atalay ◽

Orhan Kemal Salih

Keyword(s):

Heart Failure ◽

Left Ventricular ◽

Ecmo Support ◽

Cardiac Anomaly ◽

Low Cardiac Output Syndrome ◽

Ventricular Diverticulum ◽

Endoventricular Circular Patch Plasty ◽

Echocardiographic Examination ◽

Left Ventricular Diverticulum ◽

Patch Plasty

Congenital left ventricular diverticulum is a rare cardiac anomaly. During the newborn period, symptomatic patients are diagnosed with heart failure findings. We present a 23-day-old male newborn with congenital left ventricular diverticulum diagnosed during fetal echocardiographic examination. After the birth, the patient had heart failure symptoms and his echocardiographic examination showed low cardiac ejection fraction. Diverticulum was operated with endoventricular circular patch plasty (DOR) technique, and after, cardiopulmonary bypass venoarterial extracorporeal membrane oxygenation (ECMO) support was performed because of low cardiac output syndrome. On postoperative day 17, he was discharged with no problem.

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The Carpentier-Edwards Classic and Physio Mitral Annuloplasty Rings: A Randomized Trial

The Heart Surgery Forum ◽

10.1532/hsf.419 ◽

2006 ◽

Vol 8 (5) ◽

pp. 389 ◽

Cited By ~ 9

Author(s):

Ghada M. M. Shahin ◽

Geert J. M. G. van der Heijden ◽

Michiel L. Bots ◽

Maarten-Jan Cramer ◽

Wybren Jaarsma ◽

...

Keyword(s):

Left Ventricular Function ◽

Ventricular Function ◽

Absolute Risk ◽

Statistical Significance ◽

Nyha Class ◽

Left Ventricular ◽

Mitral Annuloplasty ◽

Risk Of Death ◽

Late Failure

Objective: To evaluate clinical and echocardiographic outcomes for the semi-flexible Carpentier-Edwards Physio and the rigid Classic mitral annuloplasty ring. Methods: Ninety-six patients were randomized for either a Classic (n = 53) or a Physio (n = 43) ring from October 1995 through July 1997. Mean follow-up was 5.1 years (range .1-6.6). We included standard patient characteristics at baseline and during follow-up. Analyses were adjusted for age and gender, and for factors that differed across groups at baseline. In 2002, echocardiography was performed in 74% of the survivors. Results: We found a 16% difference in mortality: 14% in the Physio group (n = 6) and 30% in the Classic group (n = 16) (adjusted P = .41). Life table analysis shows that the absolute risk of death after 30 months is lower in the Physio group. Intra-operative repair failure occurred in 3 patients (6%) of the Classic group, and in 4 (9%) of the Physio group, resulting in mitral valve replacement. Late failure occurred in 1 patient (2%) in the Classic group, and in 4 (9%) in the Physio group. At follow-up, left ventricular function did not differ across groups (ejection fraction 45% and 48% (adjusted P = .65)). The combined NYHA class III-IV had improved for the Classic group in 42% and for the Physio group in 34%. Conclusion: Although the 16% difference in mortality did not reach statistical significance, it is considered clinically important. No differences in morbidity, valve function, and left ventricular function were found. Further research to explain the difference in mortality is required.

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